Objectives To evaluate the service provided by an Acute Children’s Hospital for patients admitted with mental health issues during the first wave of Covid-19.
Methods Data was collated on patients admitted with mental health-related complaints between 1st March 2020 and 31st May 2020. This included ‘intoxication’; ‘overdose’; ‘psychosis’; ‘self-harm’; ‘suicidal ideation/attempt’; ‘CAMHS’, ‘disordered/reduced eating/anorexia’; ‘mental health’; ‘anxiety’; ‘unwell’. Only patients admitted via Children’s Accident & Emergency Department were included. Current inpatients, and those attending with injuries were excluded.
The following parameters were evaluated: presenting complaint; age; length of hospital stay; time medically fit for discharge (MFFD); time to see mental health professional (MHP); time MFFD to discharge; nursing ratio; number of readmissions; episodes of restraint; absconsions; and safeguarding referrals during admission.
Results 72 mental health-related admissions were identified. The mean age at presentation was 14.8years, with modal age 16years(33%). 10%(n=7) of these were admitted for disordered eating, while 90% were admitted for a range of mental health diagnoses. The modal presenting complaint was overdose(n=20), of which paracetamol(70%, n=19) was the most common substance.
The average length of stay was 59hours. 62%(n=42) patients were MFFD at time of admission, whilst a further 16%(n=11) were MFFD within 6 hours of admission. The mean time to see a MHP was 21hours with a modal time of within 24hours(42%, n=22), which correlates with the modal time from MFFD to time of discharge(n=24 within 24hours).
During the period of analysis, 10 patients(14%) were readmitted, of which 80% were readmitted twice, and 60% within 48hours of discharge. 18%(n=13) patients required 1:1 or 2:1 care, and a further 4 patients(6%) required hourly observations. Of those requiring 1:1 care, a resident parent/carer provided this in 18% of cases and RMN staff in 36% cases, whilst nursing staff made up 45% of the support. When 2:1 support was required, this always required a member of the nursing team to be re-allocated.
14%(n=10) of patients required physical restraint, which always involved the security team, and involved police in a third of cases, whilst chemical restraint by sedation was required in 10%(n=7). During admission to the ward as a ‘place of safety’, 3% patients attempted strangulation, and 3% took an overdose during their stay. 14%(n=10) patients absconded or attempted to abscond from the ward and 15%(n=11) patients triggered a safeguarding referral as a result of admission.
Conclusions This study highlights the resource burden of mental health(MH) inpatients – burden on nurse staffing, use of security team for physical restraint and use of chemical restraint. It also highlights how frequently restraint is used in order to keep CYP safe, and encourages robust trust policies regarding Deprivation of Liberties. Risk of strangulation and further overdose during inpatient stays demonstrates the difficulties with non-mental health trained nursing staff caring for patients with complex MH needs.
With a readmission rate of 14%(60% within 48hours), there is a necessity to improve short term follow-up for CYP discharged with MH issues, and consideration of a separate unit for MFFD patients awaiting MHP review(62%).
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