Abstract
ObjectivesSince the pandemic, the number and severity of CYP admissions in a mental health crisis have increased and paediatric teams describe delivery of safe care more challenging.1 As part of a wider project,2 this study seeks to understand the experience of CYP who are admitted to a general paediatric ward during a mental health crisis, their accompanying carers, and the experiences of ward staff.MethodsCYP were recruited initially from seven paediatric wards across England. CYP, parents/carers and HCPs participated through volunteer sampling, after being identified and approached by local research teams. Semi-structured interviews for CYP and parents/carers explored experiences prior to admission, on the ward, discharge process and recommendations to improve care. HCPs were asked about their experiences, capability and capacity to care for CYP on an individual, ward and Trust level. Anonymised interview transcripts were analysed using Framework analysis.3 ResultsData analysis is concurrent with recruitment. Participants include CYPs admitted for self-harm, overdose and/or restricted eating, the most common causes for admission.4 Additionally, CYP reported being neurodivergent, not currently attending school, and/or having had previous admissions to the same ward. Consideration of needs, not just physical but mental health was a challenge consistently reported – ‘they just see it from a medical point of view,’ CYP; ‘I felt like those people didn’t understand mental health issues as well as they could,’ CYP. The ward environments felt safe, most staff were perceived as friendly and competent, and play activities were a welcome distraction – ‘I can’t fault them,’ Father; ‘almost relaxing,’ CYP. There was a consistent narrative centred on communication and coordination, impacting on the overall experience. Some CYPs were unclear on what rules applied on the ward – ‘I didn’t really know what I was actually allowed to make decisions about,’ CYP. Coordination between the ward, CAHMS and other services was sometimes lacking, affecting discharge processes and creating uncertainty in families – ‘it felt a little bit like a hot potato situation,’ Mother – ‘a lot of the time they (CAHMS) won’t see the patient if they’re not deemed as medically fit, even though NICE guidance kind of says that they can still see patients,’ Nurse.ConclusionCYP and their families felt the care they received while on paediatric wards could be improved, especially the understanding of mental health issues by staff and the integration between the services involved in their care.ReferencesHudson LD, Chapman S, Street KN, et al. Increased admissions to paediatric wards with a primary mental health diagnosis: results of a survey of a network of eating disorder paediatricians in England. Arch Dis Child. 2021.Hudson LD, del Pilar Vázquez-Vázquez A, Gibson F, et al. Mental Health Admissions to Paediatric Wards Study (MAPS): protocol of a prospective study of mental health admissions to paediatric wards in England using surveillance and qualitative methods. BMJ Paediatrics Open 2024.Gale NK, Heath G, Cameron E, et al. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol 2013.Ward JL, del Pilar Vazquez Vazquez A, Phillips K, Settle K, Pilvar H, Cornaglia F, Gibson F, Nicholls D, Roland D, Mathews G, Roberts H, Viner R, Hudson LD. Admissions to Acute Medical Wards Due to Mental Health Problems Amongst Children and Young People in England, 2012 to 2022 Preprints, The Lancet 2024.