*This was an ARC East Midlands led project

 

What were we trying to do?
This research 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 needed to be admitted to inpatient mental health services. 

 

 

Why was it important?
National policy specifies that young people requiring such admissions should be cared for in units appropriate to their age-group. Unfortunately, at the time of the study, there were few units that served children with poor mental health, so places were limited and many young people were either admitted to adult wards or units located far away from their home. This meant separation from family and friends, or receiving care that was not specifically tailored for their age. At an already difficult time, such admissions could worsen the distress that young people and their families experience. Negative experiences could lead to rejection of help from services after discharge. We knew little about the young people who were admitted far away from home or to adult wards, what they and their families felt about this and the impact it had, or how many were affected. 

 

The study provided an understanding, at a national level, of how many young people experienced different types of inpatient care, what they and their families felt 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 made 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.

 

 

How did we do it?
The project had 3 parts:

• To find out how many young people in the UK were 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 were admitted to different types of inpatient care, how long they spent there, and how they got on.

 

• 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. Participants who had experienced different types of admission - to a distant adolescent unit, a unit near home, or an adult ward - were included.

 

• 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.

 

Across all parts of the study we captured and explored the impact of COVID-19 on young people and their families, clinicians and service provision.

 

 

Who did we work with?
Young people with severe mental health difficulties, their families, mental health professionals, and NHS service commissioners (who allocate NHS funding), in the East Midlands and nationally. 

 

ARC East Midlands were leading this project and collaborated with ARCs based in Greater Manchester, East of England, Oxford and Thames Valley and West Midlands regions.

 

 

Findings

• Data was collected about the admissions of 290 young people (aged 13-17 years old), 73% of the sample was female. 
• At referral, the most common diagnoses were depression (34%) and autism spectrum disorder (20%) with other common referral concerns including suicide risk (80%), emotional dysregulation (34%) and psychotic symptoms (20%). 
• The estimated yearly incidence of at-distance admissions was 13.7-16.9 per 100,000 young people. 
• 38% were admitted more than 100 miles from home and 8% over 200 miles from home. 
• 41% waited more than a week for a hospital bed in a Child and Adolescent Mental Health Service (CAMHS) setting, with 55% waiting in general hospital settings. 
• At 6-month follow-up, 20% were still in hospital, the majority in at-distance placements. 
• Young people aged 13-17 who were admitted at-distance stayed, on average, 15 days longer in hospital than the overall average, with a delay to their discharge in a third of cases. 

 

Animations

A trio of videos have been produced explaining more about the Admissions Far Away From Home study. 

 

This animation presents a summary of the research study and its findings: 

 

 

This animation summarises the experiences of some of the young people who were admitted to hospital because of their mental health:

 

 

The Far Away From Home ARC East Midlands webinar took place on 21 March 2024. During the webinar, researchers shared the findings and learning from the cross-ARC collaboration:

 

 

 

Downloadable resources

 

• Publications
  • Holland J, Roe J, Guo B, Dasilva-Ellimah M, Burn A-M, Dubicka B, Ford T, Wagner AP, Nazir S, James A, Morriss R, Sayal K, CAPSS Scientific Committee. ‘Far Away from Home’: adolescent inpatient admissions far from home, out of area or to adult wards: a national surveillance study. BMJ Mental Health 2023;26;e300843
• News stories
  • Webinar to reveal ‘alarming’ number of young people in mental health wards far from home

 

 

More information

 

 

Programme Manager
Gill Rizzello
gill.rizzello@manchester.ac.uk