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Inpatient services
Simon G Gowers1, Laura Rowlands
1University of Liverpool, Section of Adolescent Psychiatry, Academic Unit, Chester, UK. simon.gowers@cwpnt.nhs.uk
Insights
Child and adolescent mental health inpatient services are crucial for severe disorders. However, research on their effectiveness compared to community care is limited, with benefits remaining uncertain.
Area of Science:
- Child and Adolescent Psychiatry
- Mental Health Services Research
Background:
- Inpatient services represent the most specialized child and adolescent mental health provision.
- These services cater to the most severe mental health disorders in this age group.
Purpose of the Study:
- To review the function and effectiveness of child and adolescent mental health inpatient services.
- To consider recent UK mapping and audit initiatives and global changes in admission policies.
Main Methods:
- Review of existing literature, focusing on descriptive and uncontrolled outcome studies.
- Analysis of trends in service configuration, auditing against standards, and emerging controlled trials.
Main Results:
- A focus on describing service configurations and auditing against standards is evident.
- International trend shows admission of more severe, comorbid, and aggressive patient groups.
- Limited quality research exists on clinical outcomes, but comparative trials are emerging.
Conclusions:
- Descriptive and uncontrolled outcome studies dominate the literature.
- While many benefit, the specific advantages of inpatient admission over intensive community management are not yet certain.
Purpose Of Review:
Inpatient services constitute the most highly specialized child and adolescent mental health provision and cater for the most severe disorders in this age group. In view of a number of mapping and audit initiatives in the UK in recent years and changing influences on admission policies worldwide, it is timely to review their function and effectiveness.
Recent Findings:
Recent attention has focused on describing service configurations and auditing against standards. National surveys of cost, referral processes and patient satisfaction are in progress in the UK. There seems to be an international trend toward a more severe, comorbid and aggressive patient group being admitted to inpatient services. There is a shortage of quality research into clinical outcomes of inpatient treatment, but controlled trials comparing hospital treatment with intensive community management are emerging.
Summary:
Inpatient descriptive studies and uncontrolled outcome studies predominate in the literature. Although many children and adolescents benefit from admission to mental health inpatient facilities, the specific advantages of admission over intensive community management are uncertain.
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