The benefits of an adolescent psychiatric day service: the Harrow experience – a pilot study

Abstract

PurposeThe purpose of this study is to describe the characteristics of severely psychiatrically impaired adolescents requiring day hospital management and the effectiveness of the service using standardised outcome measures.Design/methodology/approachThe data was collected on adolescents aged 13‐17 years in two London boroughs, attending the day service over a period of one year. Outcome measures were HoNOSCA, CGAS, SDQ and qualitative data from feedback forms from adolescents and parents.FindingsThe adolescents (n=22) had varied disorders, but mainly depression, (n=9) and psychosis (n=4). HoNOSCA score on admission was mean 18.14 (SD 3.78) but by discharge it had reduced to mean 15.39 (SD 7.31) (p=0.07), and CGAS reduced from initial mean score of 43.83 (SD 9.90) to 53.17 (SD 12.04) (p=0.003). Attendance for 19 (86 per cent) adolescents was for less than six months. Following discharge 14 (64 per cent) returned to education or employment. Adolescents and their carers reported high levels of satisfaction. The findings indicate substantial improvement and satisfaction with the service. The size of the improvement in outcome scores and the consistency across the HoNOSCA and CGAS associated with high service satisfaction also suggest that the data is reliable.Research limitations/implicationsThe small size of the sample and loss of data made it difficult to extrapolate from the results to other groups of impaired adolescents. There was no control group in the study and therefore it was not possible to demonstrate whether the improvement was due to spontaneous changes over time, Tier 3 CAMHS input or the attendance at the day service. It is difficult to demonstrate what proportion of adolescents who were admitted to the day service would have required a Tier 4 in patient admission had the service not been available. A larger study using a more robust design involving randomisation to the day‐service or in‐patient service would provide important comparative data regarding the service benefits.Originality/valueCurrently there is little provision for severely psychiatrically impaired adolescents who require a day treatment programme. Day patient programmes appear to offer a useful and accessible treatment method. The service is much cheaper than an in‐patient service, and may also reduce the demands for or duration of inpatient admission. Unfortunately the service did not obtain continuation funding in view of NHS funding cuts, rather than dissatisfaction by local commissioners, and so needed to close. The data presented here can hopefully be used to support the case for child and adolescent psychiatric day programmes.