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Abstract
Aims The increasing prevalence of mental health problems is a well-recognised phenomenon in the paediatric population. While there are reviews of presentations to accident and emergency and to in-patient psychiatric hospitals, there are few studies of child mental health admissions to a general paediatric ward. The aim of this study was to investigate the prevalence of mental health conditions on a general medical paediatric ward and care pathways once admitted.
Method A retrospective case note study was performed of all cases admitted to a general paediatric ward between March 2011 and March 2014 in a district general hospital that required psychiatric review. Time of presentation, reason for presentation and admission, waiting time for psychiatric review, outcome of review and length of stay were all recorded, as well as the mental health background of those who presented.
Results 201 cases were identified, the youngest was 9 years old the median age was 15 years. Mental health admissions have increased from 38 between March 2011 and February 2012 to 93 from March 2013 to February 2014. The most common reason for presentation (58%) was overdose, followed by suicidal ideation (15%) and self-harm (11%), (Figure 1). Sixty percent of these admissions occur out of hours. 76% of children who present are already known to the Child And Adolescent Mental Health Service (CAMH). Of children admitted to the ward 49% required CAMH review only. Of these reviews, 16% occurred the same day as admission, 51% the following day and 6% waited more than a day for review. The most common outcome of review was discharge with CAMH follow up as an outpatient (73%)
Conclusion Mental health admissions to the general paediatric ward increased in our population, reflecting the national trend. Most of these admissions occurred out of hours when there is no specialist child mental health cover. As a consequence of this most children did not see a physician with expertise in mental health on the day of admission. Most admissions were discharged with ongoing mental health follow up adding to the burden placed on CAMH.