Objectives Children and young people (CYP) presenting with a mental health (MH) crisis are frequently admitted to general acute paediatric wards as a place of safety. A recent systematic review of interventions to avoid inpatient admissions for CYP presenting in MH crisis1 showed that evidence is poor and limited. Meaning that CYP are likely to continue to need to be admitted in crisis, with paediatric wards a common allocation whilst waiting for assessment given the lack of direct access to specialist mental health wards for most children. Anecdotal reports from within the paediatric community internationally confirm that numbers of such admissions have increased, as has acuity. Teams are increasingly caring for CYP under the Mental Health Act, using restrictive practices sometimes without mental health liaison support. Moreover, no data have been published on the outcomes for CYP, patient experience, or whether such admissions may be avoidable or better managed in other settings. Therefore, we aim to conduct a rapid review of the literature since 1990 on the impact of mental health on paediatric admissions. This rapid systematic review will also inform the Mental Health Admissions to Paediatric Wards Study (MAPS), NIHR-funded mixed methods study, the relevant evidence about the factors that influence decisions to admit CYP to paediatric wards for primary MH problems.
Methods We will undertake a rapid review of the literature following PRISMA guidelines. We will search across four databases (PubMed, Embase, PsycINFO and Web of Science) and an additional search of Google Scholar to identify unpublished data or additional studies. Search strategies will be tailored for each database but in summary, searches will consist of search terms combining three overall domains: (admissions) AND (paediatric or children’s wards) AND (mental health diagnosis/problem). We will include observational and qualitative studies, randomized and non-randomized controlled trials and reports published by professional bodies that report trends in the number of admissions, risk factors for adverse care for CYP and families during admissions, views/experiences of CYP, families and health professionals during admissions to paediatric wards and interventions that aim to improve the care of CYP and families during admissions. The results of the search will be imported into Covidence, an online software tool for systematic reviews. Duplicate records will be removed using Covidence.
Results Screening and extraction of the data are still in progress and results will be available at the conference.
Conclusions This rapid review is essential to synthesise the evidence available not only about the trends of admissions but also about the reasons for admissions, the contributing factors to the admissions, the clinical needs of CYP when admitted, and the views/experiences of CYP, families and health professionals to understand the context of care.
Clisu D, Layther I, Dover D, Viner RM, Read T, Cheesman D, Hodges S, Hudson LD. Alternatives to mental health admissions for children and adolescents experiencing mental health crises: a systematic review of the literature. 2021. Clin Child Psychol Psychiatry. (in press).
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