Project HEP04

Far Away From Home (FAFH)

The project, led by the ARC East Midlands, mapped the impact of current practices for accessing inpatient care for adolescents with mental health difficulties. The ARC East of England led the project’s health economic component, which aimed to explore the economic impact on the NHS and social services, young people and their parents and carers of such admissions.


The overall project focused on young people, aged 13-17 years, who required 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 aimed 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. 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.

Project Aims

The overall project had 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 asked 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 involved in-depth interviews with young people, their parents/carers and health professionals. It reflected participants who 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 was 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 focused on this the third part.

Project Activity

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 Health Economics and Prioritisation (HEP) contingent had prepared questionnaires for collecting demographics and health economic information from young people and parents/carers. These questionnaires were reviewed by young people and parent/carer PPIE. We also determined a list of data to be sought from the young people’s patient records (we where permission is given for this).

Anticipated Impact

The review provided an understanding of the experiences of young people across different types of inpatient care as reported in the literature to-date. This provided a broader understanding of the relevant literature and subsequently support the health economics portion of the main study. Additionally, the HEP theme contributed to this project as a means to support the development of HEP PhD candidate, Alice Wreford.  

This study provided 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 established the cost of different kinds of inpatient admissions, to families as well as to the NHS. The study helped 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 also learnt more about how community services might be used differently to reduce the need for admission.

Who was involved?

Co-Principal Investigator: Professor Kapil Sayal, University of Nottingham

Researchers and Institutions:

  • Health Economics Lead: Dr. Adam Wagner, ARC East of England Health Economics and Prioritisation (HEP) theme, University of East Anglia
  • Alice Wreford, ARC East of England Health Economics and Prioritisation (HEP) theme / University of East Anglia
  • Dr Anees PariPublic Health Medicine
  • Dr James RoeARC East Midlands / University of Nottingham
  • Professor Richard Morriss, University of Nottingham
  • Saeed Nazir, Nottinghamshire Healthcare NHS Foundation Trust
  • Boliang Guo, University of Nottingham
  • Tamsin Ford, ARC East of England
  • Tony James, ARC Oxford and Thames Valley
  • Bernadka Dubicka, ARC Greater Manchester
  • Josephine Holland, Nottinghamshire Healthcare NHS Foundation Trust
  • Anne-Marie Burn, ARC East of England

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