Roe J, Holland J, Burn AM, Hopkin E, Wild L, Fisher M, Nazir S, Ford T, Dubicka B, James A, Tuomainen H, Fung N, Horton K, Wagner AP, Morriss R, and Sayal K
Background: There are significant clinical, policy and societal concerns about the impact on young people (YP), from admission to psychiatric wards far from home. However, research evidence is scarce., Aims: To investigate the impact of at-distance admissions to general adolescent units, from the perspectives of YP, parents/carers and healthcare professionals (HCPs) including service commissioners, to inform clinical practice, service development and policy., Method: Semistructured interviews with purposive samples of YP aged 13-17 years (n=28) and parents/carers (n=19) across five large regions in England, and a national sample of HCPs (n=51), were analysed using a framework approach., Results: There was considerable agreement between YP, parents/carers and HCPs on the challenges of at-distance admissions. YP and parents/carers had limited or no involvement in decision-making processes around admission and highlighted a lack of available information about individual units. Being far from home posed challenges with maintaining home contact and practical/financial challenges for families visiting. HCPs struggled with ensuring continuity of care, particularly around maintaining access to local clinical teams and educational support. However, some YP perceived separation from their local environment as beneficial because it removed them from unhelpful environments. At-distance admissions provided respite for some families struggling to support their child., Conclusions: At-distance admissions lead to additional distress, uncertainty, compromised continuity of care and educational, financial and other practical difficulties, some of which could be better mitigated. For a minority, there are some benefits from such admissions., Clinical Implications: Standardised online information, accessible prior to admission, is needed for all Child and Adolescent Mental Health Services units. Additional practical and financial burden placed on families needs greater recognition and consideration of potential sources of support. Policy changes should incorporate findings that at-distance or adult ward admissions may be preferable in certain circumstances., Competing Interests: Competing interests: All authors declare research funding support from the NIHR Applied Research Collaboration for the submitted work. TF has offered Research Consultation to Place2Be and is the Vice Chair for the Association of Child and Adolescent Mental Health. BD has received a research grant from the NIHR HTA, payment for expert testimony for a legal report on the impact of climate change on mental health, is chair of a steering committee, is Editor-in-Chief of the Journal of Child and Adolescent Mental Health, is on the board of the Association of Child and Adolescent Mental Health, has been the Chair of the Child and Adolescent Faculty of the Royal College of Psychiatrists. RM has received grants or contracts from the NIHR, Wellcome Trust, EU Horizon, UKRI, Electromedical Products Inc, P1Vital Ltd and Magstim PLC and has participated on an advisory board for Novartis. KS has received grant funding from the NIHR., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. Published by BMJ.)