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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.
Methods
This is 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 1 January and 31 March 2021. The project was registered as an audit at Great Ormond Street Hospital.
Results
Thirty-six paediatricians responded (58%). Thirty-two (89%) reported an increase in CYP admitted with a primary mental health disorder compared with the same period in 2020. The median estimated admissions over 3 months was 40 (range 4–130; n=21); the median estimated number of CYP admitted under the Mental Health Act was 2 (range 0–45; n=33); the median estimated CYP needing restraint was 2 (range 0–15; n=33); and the median estimated CYP needing a nasogastric tube was 2 (range 0–30; n=33). Responses according to region of the respondents and the Likert responses for questions regarding diagnoses, proportions and service specifics are summarised in table 1.
Summary of survey responses for regions and Likert options showing the question, possible responses with the number of responses per option and percentage of the total responses for each question
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 the total admissions. This suggests a higher proportion than reported prepandemic.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 CYP2 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.
Although the pandemic appears to be associated with a surge in mental health crisis, such admissions have always existed with challenges. While 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 are fitting around services under strain, not always equipped to meet their needs, rather than as it should be the other way around.
Ethics statements
Patient consent for publication
References
Footnotes
Twitter @eatyourpeas, @damian_roland, @gabriellealphon
Contributors LDH and SC conceived the survey and designed it with KNS. LDH collected the data and prepared the first draft.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.