Abstract
Background
There are challenges in providing high quality care for children and young people (CYP) who are admitted to acute medical wards due to mental health concerns. Although there is concern these admissions are increasing, national data describing these patterns are lacking. The aim of this study is to describe trends in these admissions in England over a 10 year period, and identify factors associated with repeat admission and length of stay.
Methods
We undertook a cohort study using data on all admissions to medical wards in England amongst CYP aged 5 to 18 from April 1st 2012 to March 31st 2022. We classified admissions due to mental health concerns using the Global Burden of Disease Study cause hierarchy. We describe national trends in mental health admissions over time by sex, age, ethnicity, index of multiple deprivation (IMD) quintile, and examined geographic variation across Integrated Care Boards (ICB). We examined associations between sociodemographic and clinical factors and odds of the admission lasting more than one week, and hazard ratios of repeat admissions, using mixed effects models.
Findings
We identified 342,511 admissions for any cause in CYP aged 5 to 18 in 2021/22 in England, of which 39,925 (11.7%) were due to mental health concerns. 21,337 (53.4%) of mental health admissions were due to self-harm. Between 2012/13 and 2021/22, annual mental health admissions increased from 24,198 to 39,925 (65.0% increase), compared with all cause admissions which increased from 311,067 to 342,511 (10.1% increase). Increases were particularly steep in females aged 11 to 15, rising from 9,091 to 19,349 (112.8% increase), and for eating disorders, rising from 478 to 2,938 (514.6% increase) . In 2021/22, 3,130 (7.8%) of mental health admissions lasted longer than one week, compared with 12,044 (3.5%) of all-cause admissions. Of 239,541 CYP who had a mental health admission between 2012/13 and 2021/22, 32,107 (13.4%) had a repeat admission within 6 months. Odds of long stay admission, and hazard ratios for being readmitted, were significantly higher for CYP who were aged 11 to 15, female, from less deprived areas, and those with eating disorders.
Interpretation
We found large increases in the number of CYP admitted to acute medical wards due to mental health concerns over a ten-year period, not all accounted for by the COVID-19 pandemic. Further work is needed to understand factors driving these trends, and how to improve care for CYP with mental health concerns admitted to medical wards.