Making the case for the family model in in-patient child and adolescent mental healthcare.

Lesley Cousins,Joanne Holmes

doi:10.1192/bjb.2021.8

Abstract

Within paediatrics, young children experiencing physical and emotional distress are admitted to hospital with their parents as a matter of course, recognising the trauma associated with parting children from their carers. Much of this practice is underpinned by our understanding of attachment theory, which also sits as a fundamental tenet of child psychiatry. Yet the culture in psychiatric in-patient hospitals remains to admit young children without their parents, often to units that are geographically distant from the family home. We argue that the practice of admitting lone children to psychiatric in-patient units is likely to be traumatising as well as less effective. We believe this culture requires challenge and change.

Highlights

Enter a paediatric ward today and the sight of a parent accompanying their sick child would be commonplace
For children of primary school age, and especially those requiring extended treatment over weeks or months, if a parent or carer were not present for much of the admission there would be concerns raised about the adequacy of the care they were receiving from the family
We in child and adolescent mental health (CAMH) in-patient services continue to admit lone children, often to facilities that are a considerable distance from the family home

Summary

AGAINST THE STREAM

Making the case for the family model in in-patient child and adolescent mental healthcare. Admitting the parent and child together allows clinicians to assess attachment patterns directly and to establish to what extent disruption in relational security is driving and/or maintaining the child’s mental disorder It is not uncommon for a parent’s own emotional difficulties to affect their attachment relationship and we know that a parent’s mental health represents the most important correlate for all domains of the child’s potential mental health difficulties.[8] Many parents of children in in-patient CAMH services have significant backgrounds of trauma and it is common to see the effects of intergenerational trauma displayed in a child’s behaviour or for a traumatic response to be triggered in the parent by this behaviour. Argue that the family’s financial needs could be more actively addressed societally and appropriate reimbursement made available

Clinical implications and future plans

CULTURAL REFLECTIONS Dosani Narrative medicine in psychiatric practice

Sabina Dosani