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Evaluating Short-Stay Admissions and Referral to Pediatric Liaison Psychiatry: A Mixed-Methods Study in a Tertiary
Background:
Children and adolescents increasingly present to pediatric emergency departments with acute mental health difficulties, yet short-stay pediatric liaison psychiatry admissions remain poorly characterized.
Objective:
To characterize the demographic, clinical, and service features of short-stay pediatric liaison psychiatry admissions (≤24 h) in a tertiary pediatric hospital; compare them with longer admissions (>24 h); and explore multidisciplinary clinicians' perspectives on their management.
Methods:
A mixed-methods study was conducted comprising a retrospective review of all pediatric liaison psychiatry admissions between January 2024 and August 2025, alongside qualitative interviews and focus groups with frontline pediatric liaison psychiatry, emergency department, and social work clinicians (n = 16).
Results:
Of 529 admissions, 213 (40.3%) were short-stay. These admissions were predominantly emergency-driven (67.1%), commonly assessed in the emergency department (65.7%), and frequently occurred out of hours (51.2%). Compared with longer admissions, short-stay patients were significantly more likely to present with self-harm or suicidality (65.3% vs 29.4%, P < 0.001), behavioral and externalizing difficulties (17.8% vs 10.1%, P < 0.001), aggression during admission (22.5% vs 10.4%, P < 0.001), and to be new referrals (85.9% vs 73.4%, P < 0.001). Although nearly 70% were not previously known to Child and Adolescent Mental Health Services, almost three-quarters were discharged with specialist mental health follow-up. Qualitative findings positioned the emergency department as the default site of youth mental health crisis care and an informal gateway to specialist services, highlighting environmental and safety mismatches.
Conclusions:
Short-stay admissions represent high-acuity youth mental health crises rather than low-impact encounters, underscoring the need for investment in multidisciplinary crisis pathways, workforce capacity, and alternative models of care.
