Adolescent admissions to adult psychiatric units: patterns and implications for service provision.

OBJECTIVE

The aim of this study was to investigate patterns of child and adolescent admissions to an acute adult psychiatric unit in a rural city. Correlates of admissions were then considered in terms of service reform for this vulnerable, under-resourced group.

METHOD

The study reviewed consecutive clinical records of children and adolescents who were admitted to an acute general psychiatric inpatient unit over a 6 year period (N = 332).

RESULTS

Patients generally experienced numerous pre-admission psychosocial stressors; there were many abuse histories and/or juvenile justice involvement. The principal diagnosis was varied and comorbidity was common. Maori patients were over-represented. The majority of admissions occurred out of working hours and more than half came from rural areas. There was high usage of the Mental Health Act on admission. Common causes of admission were self-harm and suicidal behaviour. The majority of the admitted adolescents required follow up by child and adolescent mental health services after discharge.

CONCLUSION

We identified several reform possibilities, including up-skilling emergency and adult mental health staff in child and adolescent mental health, exploration of alternatives to admissions and specialist service coverage.