Abstract
Clinical guidelines recommend intensive community care service treatment (ICCS) to reduce adolescent psychiatric inpatient care. We have previously reported that the addition of ICCS led to a substantial decrease in hospital use and improved school re-integration. The aim of this study is to undertake a randomised controlled trial (RCT) comparing an inpatient admission followed by an early discharge supported by ICCS with usual inpatient admission (treatment as usual; TAU). In this paper, we report the impact of ICCS on self-harm and other clinical and educational outcomes. 106 patients aged 12–18 admitted for psychiatric inpatient care were randomised (1:1) to either ICCS or TAU. Six months after randomisation, we compared the two treatment arms on the number and severity of self-harm episodes, the functional impairment, severity of psychiatric symptoms, clinical improvement, reading and mathematical ability, weight, height and the use of psychological therapy and medication. At six-month follow-up, there were no differences between the two groups on most measures. Patients receiving ICCS were significantly less likely to report multiple episodes (five or more) of self-harm (OR = 0.18, 95% CI: 0.05–0.64). Patients admitted to private inpatient units spent on average 118.4 (95% CI: 28.2–208.6) fewer days in hospitals if they were in the ICCS group compared to TAU. The addition of ICCS to TAU may lower the risk of multiple self-harm and may reduce the duration of inpatient stay, especially in those patients admitted for private care. Early discharge with ICCS appears to be a viable alternative to standard inpatient treatment.
Highlights
Despite a considerable increase in the number of alternatives to inpatient admission, the absolute number of young people admitted for psychiatric inpatient care in England has remained relatively stable in the past three years
We have previously reported that intensive community care service treatment (ICCS) was associated with shorter duration of inpatient admissions, better school integration and a reduction in multiple self-harm episodes [19, 22]
287 patients were referred for inpatient admission during the study recruitment period. 123 patients were eligible for the study. 15 (12%) refused to participate. 108 patients were randomly assigned to a treatment group and 82 patients (77%) were assessed at 6-month follow-up
Summary
Despite a considerable increase in the number of alternatives to inpatient admission, the absolute number of young people admitted for psychiatric inpatient care in England has remained relatively stable in the past three years. There had been a twofold increase in the number of admissions in the preceding 15 years [26].All admissions to NHS units are state-funded and free for patients. Most admissions to private units in the UK are state-funded. They occur when there are no available suitable beds in the NHS system. Most young people admitted for inpatient care report a history of at least one episode of self-harm [25]. The period following an inpatient admission is the period of greatest
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
