Adolescent Mental Health Inpatient Units Research Articles

“If you’re struggling, you don’t really care” – what affects the physical health of young people on child and adolescent mental health inpatient units? A qualitative study with service users and staff

BackgroundPhysical health inequalities of people with serious mental illness (SMI) have been labelled an international scandal; due to the 15–20-year reduction in life expectancy associated with poor physical health. This occurs at an early stage and evidence shows young people with and at risk for SMI are a particularly vulnerable group requiring intervention and support. However, most work has been conducted with adults and little is known about what affects physical health for young people, specifically those receiving inpatient care.MethodsWe conducted semi-structured qualitative interviews with 7 service users and 6 staff members (85% female, age 14–42) on a generic mental health inpatient unit for children and adolescents. Interviews aimed to identify how young people viewed theirphysical health and factors affecting physical health and lifestyle and identify any support needed to improve physical health. Thematic analysis was conducted. .ResultsThematic analysis revealed the main factors affecting physical health and lifestyle for young people. Three main themes were individual factors (subthemes were mental health symptoms, knowledge, attitudes and beliefs), environmental factors (subthemes were opportunities in a restricted environment and food provision), and the influence of others (subthemes were peers, staff, family members). These factors often overlapped and could promote a healthy lifestyle or combine to increase the risk of poor physical health. Young people discussed their preferences for physical health initiatives and what would help them to live a healthier lifestyle.ConclusionsPromoting physical health on inpatient units for young people is an important, yet neglected area of mental health research. We have identified a range of complex factors which have an impact on their physical health, and there is a pervasive need to address the barriers that young people experience to living a healthy lifestyle. There is an increasingly strong evidence base suggesting the benefits of physical health interventions to improve outcomes, and future work should identify ways to implement such interventions considering the barriers discussed in this article. Further collaborative research is needed with young people, clinical teams, caregivers, and commissioners to ensure improvements are made to clinical care provision and optimisation of the inpatient environment.

“If you’re struggling, you don’t really care” – what affects the physical health of young people on child and adolescent mental health inpatient units? A qualitative study with service users and staff

BackgroundPhysical health inequalities of people with serious mental illness (SMI) have been labelled an international scandal; due to the 15–20-year reduction in life expectancy associated with poor physical health. This occurs at an early stage and evidence shows young people with and at risk for SMI are a particularly vulnerable group requiring intervention and support. However, most work has been conducted with adults and little is known about what affects physical health for young people, specifically those receiving inpatient care.MethodsWe conducted semi-structured qualitative interviews with 7 service users and 6 staff members (85% female, age 14–42) on a generic mental health inpatient unit for children and adolescents. Interviews aimed to identify how young people viewed theirphysical health and factors affecting physical health and lifestyle and identify any support needed to improve physical health. Thematic analysis was conducted. .ResultsThematic analysis revealed the main factors affecting physical health and lifestyle for young people. Three main themes were individual factors (subthemes were mental health symptoms, knowledge, attitudes and beliefs), environmental factors (subthemes were opportunities in a restricted environment and food provision), and the influence of others (subthemes were peers, staff, family members). These factors often overlapped and could promote a healthy lifestyle or combine to increase the risk of poor physical health. Young people discussed their preferences for physical health initiatives and what would help them to live a healthier lifestyle.ConclusionsPromoting physical health on inpatient units for young people is an important, yet neglected area of mental health research. We have identified a range of complex factors which have an impact on their physical health, and there is a pervasive need to address the barriers that young people experience to living a healthy lifestyle. There is an increasingly strong evidence base suggesting the benefits of physical health interventions to improve outcomes, and future work should identify ways to implement such interventions considering the barriers discussed in this article. Further collaborative research is needed with young people, clinical teams, caregivers, and commissioners to ensure improvements are made to clinical care provision and optimisation of the inpatient environment.

An Audit on Telephone Referrals to Beechcroft, a Step 5 Regional Child and Adolescent Mental Health Inpatient Unit

An Audit on Telephone Referrals to Beechcroft, a Step 5 Regional Child and Adolescent Mental Health Inpatient Unit

Impact of a debrief tool in acute child and adolescent mental health inpatient units: a centre’s experience

This manuscript presents the pioneering use of a post-event staff debriefing tool, TALK, in Acute Child and Adolescent Mental Health Units (CAMHU). While unsuccessful in reducing the rate and severity...

Long-term outcome of intensive home treatment for children and adolescents with mental health problems - 4 years after a randomized controlled clinical trial.

Admission rates to child and adolescent mental health inpatient units in Germany are substantial (58.831 admissions in 2019). Historically, different treatment pathways have not been available. The evidence suggests that home treatment could be an alternative. The objective of this study was to assess the long-term stability of treatment gains among children and adolescents treated for serious mental health problems with home treatment (HT) as compared with inpatient treatment-as-usual (TAU). Hundred patients were enrolled and randomized into an intervention (HT n=54) and control group (TAU n=46). Follow-up data were available after 8.4months (n=78) (T3) and after 4.3years (n=51) (T4). The primary outcome measured was overall level of functioning, for which the Children's Global Assessment Scale (CGAS) was used. Secondary outcomes included severity of patient impairment and parental competency in dealing with their child's symptoms, measured using the Health of the Nation Outcome Scales (HoNOSCA). A qualitative interview with parents was performed at T3 and T4. Treatment effects remained stable for both groups at T3 and T4 (p<.001). After 4.3years 70% of the parents in the intervention group stated satisfaction with the treatment received, while only 36.8% of the parents within the control group rated themselves as satisfied. 43.7% of parents in the home treatment group reported that the most helpful aspect of this pathway was the prompt and intensive professional help and advice they received as primary caregivers at home. Home treatment may be considered a viable alternative to inpatient care.

Nurses' responses to adolescent distress in an acute child and adolescent mental health inpatient unit: A qualitative interpretive descriptive study.

To describe observed nursing responses and interventions to adolescent inpatients experiencing distress. Thorne's interpretive descriptive approach guided data collection and analysis of nonparticipant observations of a purposive sample of adolescents, and nurses. Three major themes are presented: engagement: responses and interventions for working with distress; adolescent reactions and nurses' clinical decision making to manage distress; and outcomes: escalation or resolution of distress. The TAR3 conceptual model developed from this study can guide nurses' responses to distressed adolescents and promote safety, enhance positive outcomes, and reduce the use of coercive interventions.

Physical health interventions on adolescent mental health inpatient units: A systematic review and call to action.

Physical health inequalities experienced by people with mental health conditions are labelled an international scandal; due to the 15 to 30-year gap in life expectancy, driven mostly by physical health conditions. Lifestyle interventions are recommended to prevent the onset of poor physical health in people with mental illness. Yet, there is less high-quality evidence for adolescents, particularly those in inpatient settings. We aimed to assess existing literature reporting physical health or lifestyle interventions conducted on adolescent mental health inpatient units. An electronic search of MEDLINE, PsycINFO, Embase, the Cochrane Central Register of Controlled Trials and AMED was conducted on 13th June 2019. Eligible studies included peer-reviewed English language research articles of physical health interventions delivered within child and adolescent mental health inpatient services. A narrative synthesis was conducted on the data. Only three studies were identified implementing health interventions for adolescent inpatients. The interventions consisted of two physical health interventions aiming to increase activity levels within routine care (one gym-based, one sports led) and a yoga intervention. Outcome measurements varied and benefits were observed in relation to overall health (HONOSCA), physical health (waist, hip and chest circumference) and behaviour. Although preliminary results suggest lifestyle interventions may be feasible and beneficial for this group, more work is needed to fully understand the best way to implement these interventions within adolescent clinical settings. Adolescent inpatients are an important target for such interventions, affording the opportunity to prevent the onset of physical comorbidities.

Understanding the nature of mental health nursing within CAMHS PICU: 2. Staff experience and support needs

In the UK and other western countries, child and adolescent care is increasingly understood as a distinct speciality. Internationally, inpatient units are the most widely used element of acute adolescent mental health services. Child and adolescent mental health inpatient nursing has been identified as unique, and yet there is a dearth of research investigating the role of nursing in adolescent mental health inpatient units and its impact. This is the second of a two papers presenting findings from a first of its kind, qualitative study investigating into the nature of mental health nursing within a child and adolescent mental health service psychiatric intensive care unit (CAMHS PICU). A qualitative conceptual analysis design was used. Findings relating to understanding of staff experience of their work and their support needs are presented. Results indicate there is significant emotional labour generated from the detailed and intense relationally-focused work with young people; responsible for both a sense of value and job satisfaction, and corrosion of staff capacity to sustain these interventions over the longer term. The central role of projective identification and the specific support requirements that emerge from these intrapersonal dynamics are explored. A conceptual model of CAMHS PICU nursing is proposed, synthesised from findings in the two parts of this series.

What nonpharmacological therapeutic interventions are provided to adolescents admitted to general mental health inpatient units? A descriptive review.

Limited research exists regarding the therapeutic operations of adolescent mental health inpatient units, particularly in terms of nonpharmacological therapeutic interventions. This review collates what is known about reported nonpharmacological therapeutic interventions for young people admitted to general or non-disorder-specific adolescent mental health inpatient settings. A descriptive review of this nature was not located in the literature. The aim was to identify what is currently known about reported nonpharmacological therapeutic interventions. The purpose was to consider gaps and contribute to further work being undertaken in describing an exemplary inpatient model of care for adolescents. Sources included CINAHL, MEDLINE, ERIC, EMBASE, and PsycINFO. Studies included were those published in English, between the years 2000 and 2018. Exclusions included residential, community, outpatient, forensic settings, and studies detailing pharmacological interventions. Ten studies were identified. This descriptive review provides an objective foundation to inform an exemplary inpatient model of care currently being investigated. There is a critical need to understand these interventions to identify key components of an inpatient model of care. Such knowledge will provide guidance for future services seeking to create an exemplary model of care. Furthermore, these results can influence current practice by improving quality and delivery of inpatient care.

Understanding experiences of the self-harm of others: A qualitative exploration of the views of young people with complex mental health needs.

As adolescent self-harm is a growing public health concern, more research is needed to identify potential risk factors. Studies have highlighted that exposure to the self-harm of others may be a risk factor associated with engagement in self-harm. However, research investigating young people's experiences of the self-harm of others has been limited. This qualitative study aimed to explore young people's experiences of the self-harm of others and interviewed a total of eight young people (five females and three males; aged between 13 and 18 years) resident at one of two adolescent mental health inpatient units in the North of England. The interviews were analysed using Interpretative Phenomenological Analysis and four themes were identified: 'Pre-admission exposure to self-harm', 'Exposure on the inside: An unpleasant environment', 'Helper vs helped' and 'Separation from the attention seekers: competing for authenticity'. Prevention efforts to reduce the social transmission and stigma surrounding self-harm among young people are discussed.

Evaluating effectiveness in adolescent mental health inpatient units: A systematic review.

Adolescent mental health research is a developing area. Inpatient units are the most widely used acute element of adolescent mental health services internationally. Little is known about inpatient units, particularly when it comes to measuring improvement for adolescents. Clinical outcome measurement in the broad context has gathered momentum in recent years, driven by the need to assess services. The measurement of outcomes for adolescents who access inpatient care is critical, as they are particularly vulnerable and are often considered the most difficult to treat. Following the PRISMA guidelines, the aim of this review was to assess whether adolescent inpatient units are effective and understand how outcomes are measured. CINAHL, MEDLINE with Full Text, ERIC, PsycINFO, and Cochrane databases were systematically searched. Studies were included if the inpatient units were generic and adolescents were between the mean age of 12-25years. Furthermore, studies published in English within the last ten years were included. Exclusions were outpatient and disorder-specific inpatient settings. A total of 16 studies were identified. Each study demonstrated effectiveness on at least one outcome measure in terms of symptom stabilization. However, several outcome measures were used and therefore inpatient units lack consistency in how they measure improvement. Inpatient units are effective for the majority of young people as they result in symptom stabilization. Whilst symptom stabilization can be achieved, future research examining the mechanism of change is needed.

Referral to an Acute Child and Adolescent Inpatient Unit: The Experiences and Views of Community Mental Health Referrers.

Admission to an acute mental health inpatient unit is a significant event for a young person. The interface between inpatient and community teams negotiating the admission and later discharge can be fraught. To understand how to improve the transition between inpatient and community care, we interviewed 48 community clinicians about their experiences of engaging with an acute child and adolescent mental health inpatient unit. Through thematic analysis, we identified management of risk was a central issue. Participants wanted more time in hospital, and more communication and collaboration. They expressed appreciation, but some gave intense descriptions of dissatisfaction. The analysis suggests avenues to improve communication and experience, recognizing the (felt) power differential between inpatient and referring community clinicians. Managing the power dynamics requires inpatient clinicians to use active inquiry to bring forward community clinicians' views and be mindful of the risk of community clinicians experiencing communication as criticism.

Does Space Matter? An Exploratory Study for a Child-Adolescent Mental Health Inpatient Unit.

The aim of this study is to explore design elements and spaces as a contributing influence to behavior and well-being for patients, staff, and families in a child-adolescent mental health unit. The University of Minnesota Masonic Children's Hospital Child-Adolescent Mental Health Inpatient Unit embarked on a renovation project to relocate the hospital's child and adolescent mental health units. Evidence-based strategies were employed for the design of the new unit to enhance the experience for patients, staff, and families and to support changes in operational and procedural strategies. A mixed-methods approach was utilized to explore the influence of several design strategies intended to induce calm feelings for patients, staff, and families. A comprehensive literature review informed the design process and study design. Methods include patient image surveys (PIS; n = 188), online staff surveys (n = 48), and face-to-face staff interviews (n = 25). Several design elements and spaces were identified through the image survey as influential in eliciting feelings of calm among patients. Additionally, staff were also influenced by the new unit design, generating feelings of calm, safety, and pride in the work environment. Results suggest that design features in which patients have choice and control offer greater perceptions of calm during their stay in the unit. Staff were positively influenced by the colors and artwork throughout the unit as well as the upgraded security and safety features. Findings also show the space has a positive influence on families, demonstrated by its welcoming character and features that help to facilitate better interaction with patients.

Cost-effectiveness of intensive home treatment enhanced by inpatient treatment elements in child and adolescent psychiatry in Germany: A randomised trial

BackgroundAdmission rate to child and adolescent mental health inpatient units in Germany is high (54 467 admissions in 2013), resources for providing necessary beds are scarce. Alternative pathways to care are needed. Objective of this study was to assess the cost-effectiveness of inpatient treatment versus Hot-BITs-treatment (Hometreatment brings inpatient-treatment outside), a new supported discharge service offering an early discharge followed by 12 weeks of intensive support. MethodsOf 164 consecutively recruited children and adolescents, living within families and being in need of inpatient mental health care, 100 patients consented to participate and were randomised via a computer-list into intervention (n=54) and control groups (n=46). Follow-up data were available for 76 patients. Primary outcome was cost-effectiveness. Effectiveness was gathered by therapist-ratings on the Children's Global Assessment Scale (CGAS) at baseline (T1), treatment completion (T2) and an 8-month-follow-up (T3). Cost of service use (health care costs and non–health care costs) was calculated on an intention-to-treat basis at T2 and T3. ResultsSignificant treatment effects were observed for both groups between T1/T2 and T1/T3 (P<0.001). The Hot-BITs treatment, however, was associated with significantly lower costs at T2 (difference: −6900.47€, P=0.013) and T3 (difference: −8584.10€, P=0.007). Bootstrap cost-effectiveness ratio indicated that Hot-BITs was less costly and tended to be more effective at T2 and T3. ConclusionsHot-BITs may be a feasible cost-effective alternative to long inpatient stays in child and adolescent psychiatry. Further rigorous evaluations of the model are required. (Registration number: ISRCTN02672532, part 1, Current Controlled Trials Ltd, URL: http://www.controlled-trials.com).

Patients' and their parents' satisfaction levels about the treatment in a child and adolescent mental health inpatient unit

The aim of this study is to demonstrate the feedback and the satisfaction levels of the adolescents and their parents who received treatment in the newly opened inpatient unit. The results of the questionnaire evaluating the quality of the mental health service provided by the inpatient unit were examined retrospectively. The participants were the adolescents and their parents who received treatment and were discharged between January 2006 and May 2007. They were asked to give feedback on their observations and perceptions about the treatment they received, starting from the admission assessment until the time they were discharged. The satisfaction level of young people and their families regarding the service they received during their stay in the unit were determined to be high. The results of the questionnaires completed by adolescents and parents showed that the availability and the helpfulness of the staff, the admission process was given the highest satisfaction scores. Information about the adolescents' and their parents' experience of the treatment they received is essential and valuable in terms of promoting the quality of service and better treatment outcomes of an inpatient unit.

"It's Like Mental Torture": Participation and Mental Health Services

AbstractThis article discusses findings from an ethnographic research study looking at the ways in which children's participation rights are incorporated within an adolescent mental health inpatient unit. The practitioners working within this setting have reinterpreted the concept of 'participation' to suit a coercive agenda associated with the authoritarian medical model of treatment used within child psychiatry. Indeed, the use of the term 'participation' has become a tool to enforce children's compliance with adult (and practitioner) determined treatment plans. For the most part, the barriers to according children's participation rights within this setting relate to the institution's and practitioners' protectionist stance vis-à-vis children who are deemed informally to be both vulnerable and incompetent.