'Far Away from Home': adolescent inpatient admissions far from home, out of area or to adult wards: a national surveillance study.

Background: The increasing prevalence and acuity of mental disorders among children and adolescents have placed pressure on services, including inpatient care, and resulted in young people being admitted at-distance or to adult wards. Little empirical research has investigated such admissions.
Objective: To determine the incidence, clinical characteristics and 6-month outcomes of patients aged 13-17 years old admitted at-distance (>50 miles from home or out of region) to general adolescent psychiatric wards or to adult psychiatric wards.
Methods: Surveillance over 13 months (February 2021-February 2022) using the Child and Adolescent Psychiatry Surveillance System including baseline and 6-month follow-up questionnaires.
Findings: Data were collected about 290 admissions (follow-up rate 99% (288 of 290); sample were 73% female, mean age 15.8 years). The estimated adjusted yearly incidence of at-distance admission was 13.7-16.9 per 100 000 young people 13-17 years old. 38% were admitted >100 miles from home and 8% >200 miles. The most common diagnoses at referral were depression (34%) and autism spectrum disorder (20%); other common referral concerns included suicide risk (80%), emotional dysregulation (53%) and psychotic symptoms (22%). Over two-fifths (41%) waited ≥1 week for a bed, with 55% waiting in general hospital settings. At 6-month follow-up, 20% were still in hospital, the majority in at-distance placements.
Conclusions: At-distance and adult ward admissions for patients aged <18 remain an ongoing challenge for healthcare provision and have an impact on acute hospital resource use.
Clinical Implications: Long waits in non-specialist settings increase pressure across the healthcare system, highlighting the need to improve local service provision and commissioning to reflect identified clinical needs.
Competing Interests: Competing interests: All authors declare research funding support from the NIHR Applied Research Collaboration for the submitted work. BD has received a research grant from the NIHR HTA, payment for expert testimony for a legal report on impact of climate change on mental health, 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, and has been the chair of the Child and Adolescent Faculty of the Royal College of Psychiatrists. TF has offered research consultation to Place2Be and is the vice chair for the Association of Child and Adolescent Mental Health. RM has received grants or contracts from: the NIHR, Wellcome Trust, EU Horizon, UKRI, Electromedical Products, P1Vital, Magstim, and had participated in an advisory board for Novartis. KS has received grant funding from the NIHR.
(© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)