Abstract
Adolescence has long been described as a period of ‘storm and stress’ (Hall, 1904) meaning that it is a challenging period for young people. Meanwhile, reports suggest children and young people’s mental health (MH) appears to have declined over the past two decades (McGorry et al., 2024). In England, 1 in 5 children and young people (CYP) aged 8-25 are thought to have a MH disorder (NHS-England-Digital, 2023). Despite increased investment, community services are often unable to meet demand (Evans et al., 2023). In 2024, 8% of CYP in England had an active referral to Child and Adolescent Mental Health Services (CAMHS), with 26% to 40% cases closed before treatment. Wait times can range from 4 weeks to 2 years (Children's-Commissioner-for-England, 2025) and unsuccessful referrals, sometimes for following the wrong process or not meeting referral criteria, are distressing for CYP and their families (Abel et al., 2025). One consequence is increased presentations in emergency departments (ED). Mental Health admissions account for 11.7% of admissions to paediatric wards in England, representing an increase of 65% over the last 10 years (Ward et al., 2025) suggesting that MH admissions of CYP are now core business in paediatric wards across England. Furthermore, admissions are longer, there are more readmissions and presenting MH features have increased in complexity over the years (Ward et al., 2025). At the end of September 2024 there were 352,682 CYP under 18 waiting for a first contact with NHS-funded MH services, with 1 in 10 of those CYP waiting for more than two years (at least 798 days) (https://digital.nhs.uk/data-and-information/publications/statistical/mental-health-servicesmonthly-statistics). There is a mismatch between demand for specialist MH services and what is available, leading to services consistently failing to meet the needs of this vulnerable population and healthcare professionals (HCPs) facing challenges to deliver optimal care in acute care settings (Cadorna et al., 2024; Vázquez-Vázquez et al., 2024).
Paediatric wards in many countries, including the United Kingdom (UK), are primarily designed for physical health care, rather than specialist MH care and therapeutic engagement (HSSIB, 2024). Responsibility for risk often lies with frontline staff (HSIB, 2023) with insufficient training or resources to meet the needs of this patient group (HSIB, 2023; Williams & Walker, 2022). Problems can escalate resulting in restrictive practices, including restraint and sedation (Fuller, Sheridan, Hudson, et al., 2024; Holden & Jackson, 2025).
Improving MH services for CYP requires insights from CYP, their parents/carers and the staff who support them (NHS-England, 2022). Systematic reviews of hospitalisation of CYP with MH concerns (Kirwan et al., 2025; Vázquez-Vázquez et al., 2024) have largely involved healthcare staff who suggest the need to overcome barriers to care through more education around MH, with clearer protocols and policies. A few studies involving CYP have emphasised the importance of compassionate care, but here experiences are limited to particular settings, for example emergency departments (Eds) (Lategan et al., 2023; Worsley et al., 2019) or patient populations, for example those with anorexia nervosa (Ramjan & Gill, 2012). Some of these studies have also involved families (Lategan et al., 2023), as have studies on restraint and nasogastric tube feeding (Fuller, Sheridan, Tan, et al., 2024; Fuller et al., 2025). None have encompassed the range of experiences of CYP with MH disorders admitted to paediatric wards, giving voice to their families/carers and triangulated the perspectives of CYP, families and staff across multiple sites.
Our aim was to inform care by exploring experiences of admission to a paediatric ward for MH, including the reasons for admission and care and treatment received, of a diverse group of CYP, their families and the healthcare staff caring for them.