Hospital admission in adolescents with acute psychiatric disorder: how long should it be?

To determine the length of stay in hospital for youth with acute psychiatric illness, and the treatment outcome.

Diagnostic and Statistical Manual of Mental Disorders (4th edn; DSM-IV) psychiatric diagnosis, clinical outcome and the length of stay were systematically gathered for admissions over an 18 month period at the Christchurch Youth Inpatient Unit (YIU). Clinical outcome data were collected at admission, 3 weeks after admission and at discharge, using the Health of the Nation Outcome Scale for Children and Adolescents (HoNOSCA). The length of stay was determined retrospectively. Discharge was decided on clinical grounds.

During the 18 months of the investigation, 72 subjects were admitted for the treatment of acute mental illness. The most common diagnostic category was mood disorder (n=39, 54%), followed by anxiety or adjustment disorder (n=18, 25%), and major psychosis (n=15, 21%). The mean length of admission for the whole population was 27.3 days, 23.7 days for mood disorders, 18.9 days for anxiety disorders and 46.9 days for the major psychosis diagnostic groups. According to HoNOSCA clinician ratings, the major portion of the improvement occurred during the first 3 weeks of admission.

For the majority of youth with acute psychiatric illness, a relatively short stay in hospital is feasible, because most health gains tend to occur early during an admission.