Chapman, S

Dubicka, B

Gibson, F

Hudson, LD

Mathews, G

Nicholls, D

Roland, D

Street, KN

Viner, RM

English

Introduction:

A 2019 survey reported that 6% of the general paediatric inpatient beds in the UK were occupied by children and young people (CYP) with a primary mental health disorder.1 Data suggest a significant impact of COVID-19 on the mental health of CYP,2 3 with anecdotal reports of increased CYP with mental health problems in acute paediatric care, although the impact on inpatient care has not been studied. We surveyed a network of paediatricians with an interest in eating disorders about their experiences of inpatient admissions for mental health reasons in the first quarter of 2021

Hudson, Lee D

Chapman, Simon

Street, Karen Nicola

Nicholls, Dasha

Roland, Damian

Dubicka, Bernadka

Gibson, Faith

Mathews, Gabrielle

Viner, Russell M

UCL Discovery

Increased admissions to paediatric wards with a primary mental health diagnosis – results of a survey of a network of eating disorder paediatricians in England.  Lee D Hudson,1,8 Simon Chapman,2 Karen Street,3 Dasha Nicholls,4 Damian Roland,5 Bernadka Dubicka,6 Faith Gibson,1,7,8 Gabrielle Mathews,4 Russell Viner.1   1. GOS UCL Institute of Child Health 2. King’s College Hospital London 3. Royal College of Paediatrics and Child Health 4. Imperial College London 5. Leicester Hospital and University  6. Royal College of Psychiatrists 7. University of Surrey 8. Great Ormond Street Hospital for Children NHS Foundation Trust  Introduction  A 2019 survey reported that 6% of general paediatric inpatient beds in the UK were occupied by Children and Young People (CYP) with a primary mental health disorder.1  Data suggests a significant impact of COVID on the mental health of CYP,2-3 with anecdotal reports of increased CYP with mental health problems in acute paediatric care, although impact on inpatient care has not been studied. We surveyed a network of paediatricians with an interest in eating disorders about their experiences of inpatient admissions for mental health reasons in the first quarter of 2021.   Methods  An anonymous online survey, circulated in April 2021, to an established network of 62 paediatricians from 62 paediatric units in England. We asked for estimates of numbers, proportions and clinical care required for patients admitted with primary mental health diagnosis between January 1st and March 31st 2021. The project was registered as an audit at Great Ormond Street Hospital.  Results  36 paediatricians responded (58%). 32(89%) reported an increase in CYP admitted with a primary mental health disorder compared to the same period in 2020. Median estimated admissions over 3 months was 40 (range 4-130; n = 21); median estimated number of CYP admitted under the mental health act was 2 (range 0-45; n =33); median estimated CYP needing restraint was 2 (range 0-15; n=33); median estimated needing an NG tube was 2 (range 0-30; n = 33). Responses for regions of respondents, and Likert responses for questions regarding diagnoses, proportions and service specifics are summarised in Table 1.   Discussion  Respondents estimated increased numbers of admissions for mental health problems in the first quarter of 2021, compared with 2020, with more than half of paediatricians reporting that mental health admissions made up more than a quarter of total admissions. This suggests a higher proportion than reported pre-pandemic.1 Reasons for increased admissions could include increased presentations in crisis, severity of presentations and also restricted access to inpatient mental health units. Of particular concern, a majority of respondents felt that access to inpatient mental health support was inadequate, poor or non-existent.  We acknowledge a relatively low response rate (58%) and limited network coverage (40% of all general paediatric units in England).  Paediatricians were also asked for perceptions and estimates, not exact figures, and a network working with eating disorders might be expected to see more mental health admissions. That said, these data support other quantitative evidence of increasing mental health concerns in CYP,2 and highlight the importance of ensuring paediatric wards are adequately resourced and prepared for such numbers of admissions. In free text responses, paediatricians also reported a lack of mental health support and insufficient skills and training, for example restraint practices.  Though the pandemic appears to be associated with a surge in mental health crisis, such admissions have always existed with challenges. Whilst there has also been extra investment into child and adolescent mental health, this feels like a missed corner of the jigsaw. There is a clear need for greater provision of liaison mental health support; but the situation calls for more integrated, physical and mental health models and pathways of care. This needs resource and training but also changes in mindsets over responsibilities, workforce components and infrastructure.  It also needs research to understand the more granular needs, including on variation from centre to centre. At present it feels like CYP people are fitting around services under strain, not always equipped to meet their needs, rather than as it should be, the other way around.    Table One: Summary of survey responses for regions and Likert options showing question (note questions asked for estimates of children and young people admitted to the respondant’s paediatric ward between between January 1st and March 31st 2021), possible responses with number of responses per option and percentage of total responses for each question.  Question Response Number (% of total responses) Region of England  East of England 2 (6%) Midlands 2 (6%) North of England 18 (50%) SE England & London 6 (17%) SW England 8 (21%) Total responses 36 What proportion of children and young people were admitted because of a primarily mental health diagnosis? None 2 (6%) 1-25% 15(42%) 26-50% 14 (39%) 51-75% 3 (7%) 76-100% 2 (6%) Total responses 36 Of those admitted because of a primarily mental health diagnosis, what proportion had an eating disorder? None 2 (6%) 1-25% 21 (62%) 26-50% 7 (21%) 51-75% 4 (11%) 76-100% 0 (0%) Total responses 34 Of those admitted because of a primarily mental health diagnosis, what proportion had a diagnosis of depression/anxiety or self harm? None 2  (6%) 1-25% 6 (18%) 26-50% 6 (18%) 51-75% 15 (45%)  76-100% 4 (13%) Total responses  33 Of those admitted because of a primarily mental health diagnosis, what proportion needed involvement of social services or safeguarding during the admission?  None 2 (6%) 1-25% 12 (36%) 26-50% 6 (18%) 51-75% 9 (27%) 76-100% 4 (13%) Total responses 33 Who would usually make and lead the decision for restraint being needed for these admissions?  A full MDT decision of all of the above 12 (37%) A member of a supporting mental health team 2 (6%) Joint nursing and medical team 6 (18%) Joint paediatric mental health and mental health team 9 (30%) Member of the nursing team 1 (3%) Member of the paediatric medical team 2 (6%) Total responses 32 Who would usually make and lead the decision for a naso-gastric tube being needed for these admissions? A full MDT decision of all of the above 11 (34%) A joint paediatric medical and mental health team decision 11 (34%) A joint paediatric medical and nursing decision 1 (3%) A member of the paediatric medical team 9 (29%) Total responses 32 How many times has your trust/ward employed registered mental health nurses to care for children and young people? Never 8 (26%) rarely 7 (22%) sometimes 5 (15%) often 7 (22%) very often 5 (15%) Total responses 32 How many times has child or young person has had to wait in an emergency department for more than 12 hours Never 8 (27%) rarely 12 (40%) sometimes 8 (27%) often 0 (0%) because they couldn't be admitted to a ward? very often 2 (6%) Total responses 30 How would you rate the level of inpatient access to mental health professional leadership for support and guidance? No access 1 (4%) Poor access or infrequent 4 (13%) Sometimes but not adequate 14 (47%) Good and adequate 8 (28%) Excellent 3 (10%) Total responses 30  References 1. Royal College of Paediatrics and Child Health. A snapshot of general paediatric services and workforce in the UK. 2020. https://www.rcpch.ac.uk/sites/default/files/2020-09/a_snapshot_of_general_paediatric_services_and_workforce_in_the_uk_1.4.pdf (last accessed 21st June 2021). 2. NHS Digital. Mental Health of Children and Young People in England, 2020: Wave 1 follow up to the 2017 survey. 2020. https://digital.nhs.uk/data-and-information/publications/statistical/mental-health-of-children-and-young-people-in-england/2020-wave-1-follow-up#summary (last accessed 21st June 2021). 3. Ford T. Mental health of children and young people during the pandemic. BMJ 2021;372:n614.  

Increased admissions to paediatric wards with a primary mental health diagnosis: results of a survey of a network of eating disorder paediatricians in England

https://discovery.ucl.ac.uk/10136617/1/Hudson_Archives%20MH%20admissions%20letter%20final%20resubmission%20clean%20cut%20down.pdf

Increased admissions to paediatric wards with a primary mental health diagnosis: results of a survey of a network of eating disorder paediatricians in England

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