Admissions Far Away from Home or to Adult Wards - Mapping and understanding the impact of current practices for accessing inpatient care for adolescents with mental health difficulties: multi-methods study – Health Economic component
The overall project, led by the ARC East Midlands, intends to map and understand the impact of current practices for accessing inpatient care for adolescents with mental health difficulties. The ARC East of England leads the project’s health economic component, which seeks to explore the economic impact on the NHS and social services, young people and their parents and carers of such admissions.
The overall project focuses on young people, aged 13-17 years, who require admission to hospital for psychiatric care. Many types of serious mental ill-health start during the teenage years. In the long term, young people with severe mental health problems are at risk of having poor mental and physical health as well as difficulties with holding down a job, social involvement and activities, and making and maintaining friendships and relationships. These poor outcomes may be more likely if their early experience of support from services is poor and disjointed. This research aims to understand and improve the experience of care for young people with such severe mental health problems that they need to be admitted to inpatient mental health services.
National policy specifies that young people requiring such admissions should be cared for in units appropriate to their age-group. Unfortunately, there are few units that serve children with poor mental health, so places are limited and many young people are either admitted to adult wards or units located far away from their home. This means separation from family and friends, or receiving care that is not specifically tailored for their age. At an already difficult time, such admissions may worsen the distress that young people and their families experience. Negative experiences may lead to rejection of help from services after discharge. At present, we know little about the young people who are admitted far away from home or to adult wards, what they and their families feel about this and the impact it has, or how many are affected.
The overall project has 3 parts:
1. To find out how many young people in the UK are admitted far away from home (that is to an adolescent unit further than 50 miles from their home or to a different NHS region) or to adult wards. Over a 12 month period, we will ask doctors (psychiatrists working with young people aged under 18) to complete questionnaires about how many young people are admitted to different types of inpatient care, how long they spent there, and how they got on.
2. To explore the views and experiences of young people, their parents, doctors, other health professionals and NHS commissioners (who decide how funding for services should be allocated for different groups of patients). Across 4 different areas in England, this will involve in-depth interviews with young people, their parents/carers and health professionals. It will reflect participants who have experienced different types of admission - to a distant adolescent unit, a unit near home, or an adult ward.
3. To find out how much the different types of admission cost, taking into account the wider impact for patients and families including out-of-pocket expenses, as well as to the NHS. This is important for future planning of services that are efficient and good value for money, helping them to support as many children as possible.
The ARC East of England will focus on this third part.
The project formally started in April 2020. As of October 2020, we are preparing an application for ethical approval, so that data collection can begin.
As part of this process, the study’s ARC EoE HEP contingent have been preparing questionnaires for collecting demographics and health economic information from young people and parents/carers. These questionnaires have been reviewed by young people and parent/carer PPIE. We have also determined a list of data to be sought from the young people’s patient records (where permission is given for this).
Potential or actual impact
Overall, the study will provide an understanding, at a national level, of how many young people experience different types of inpatient care, what they and their families feel about this and how this could be improved. It will establish the cost of different kinds of inpatient admissions, to families as well as to the NHS. The study will help us to assess the impacts of admission far away from home or to adult wards and make recommendations on how best to improve access to local inpatient services. We will also learn more about how community services might be used differently to reduce the need for admission.
Obtaining ethical permission and progresses with data collection. Subsequently, analysis of the collected data.
- Preparing an application for ethical approval.
- Additional involvement outside of Health Economics.
A systematic review of the impact of child and adolescent inpatient psychiatric admissions out of area or to adult wards
This review supports the main ‘Far Away From Home’ study. The aim is to understand the extent to which the impacts of acute, psychiatric, inpatient admissions far away from home or to an adult ward, in children and adolescents, has been reported in the literature.
For more information on the review please visit the PROSPERO register
The review will provide an understanding of the experiences of young people across different types of inpatient care as reported in the literature to-date. This will provide a broader understanding of the relevant literature and subsequently support the health economics portion of the main study.
Additionally, the HEP theme are contributing to this project as a means to support the development of HEP PhD candidate, Alice Wreford.
Who is involved?
Health economics lead: Adam Wagner, ARC EoE HEP, firstname.lastname@example.org
Overall FAFH project lead: Prof Kapil Sayal, ARC East Midlands/ University of Nottingham
Researchers and institutions
Supporting health economics:
Alice Wreford, ARC EoE HEP/UEA
Dr Anees Pari
Consultant in Public Health Medicine
PHE lead, Specialised commissioning for Mental Health Programme of Care
Overall project team:
Dr James Roe
Operational lead researcher /Qualitative lead & Oversight of Surveillance study
ARC East Midlands/ University of Nottingham
Prof Richard Morriss
Professor of Psychiatry, University of Nottingham
Consultant in Child & Adolescent Psychiatry,
Nottinghamshire Healthcare NHS Foundation Trust
Statistics lead, University of Nottingham
Professor of Child & Adolescent Psychiatry, ARC East of England
Consultant in Child & Adolescent
Psychiatry, ARC Oxford and Thames Valley
Consultant in Child & Adolescent
Psychiatry, ARC Greater Manchester
Academic Clinical Fellow in Child & Adolescent Psychiatry, Nottinghamshire Healthcare NHS Foundation Trust
Qualitative researcher, ARC EoE
Health economic related queries: Adam Wagner, email@example.com
Overall FAFH project queries: Project manager, Dr James Roe James.Roe@nottingham.ac.uk