Inappropriate admission of young people with mental disorder to adult psychiatric wards and paediatric wards: cross sectional study of six m
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《英国医生杂志》
1 Royal College of Psychiatrists' Research Unit, 6th Floor, 83 Victoria Street, London SW1H 0HW, 2 Health Services Research Department, Institute of Psychiatry, King's College London, De Crespigny Park, London, 3 Phoenix Centre, Fulbourn Hospital, Cambridge, 4 Department of Psychological Medicine, Great Ormond Street Hospital for Children, London
Correspondence to: A Worrall aworrall@cru.rcpsych.ac.uk
Introduction
We chose nine health authorities representative of England and Wales in terms of location, population size, deprivation, and provision of child and adolescent psychiatric wards (see table on bmj.com). These health authorities served 1.13 million people aged under 18, representing 9% of the population of England and Wales (1999 projections of 1991 census).
We identified all adult psychiatric wards and paediatric wards. Consultant general psychiatrists and paediatricians completed a questionnaire for each eligible patient (patients aged under 18 on general psychiatric wards and patients on paediatric wards for treatment of mental illness not solely for medical treatment of self harm) admitted between 1 July and 31 December 1999.
All 31 adult psychiatric wards replied, yielding 43 eligible admissions (23 male). Five were aged 15, and the remainder were 16 or 17. Sixteen of the 21 paediatric wards replied, with 11 eligible admissions (three male, one aged 3 and the others 8-16). The table presents estimates of the numbers and rates of admissions.
Estimates of numbers and rates of admissions of young people with mental disorder to general adult psychiatric wards and paediatric wards in England and Wales
The consultants rated whether each eligible admission was appropriate and, if not, why the patient had not been admitted to a more appropriate unit. Twenty six (60%) adult psychiatric admissions and six (55%) paediatric admissions were deemed "inappropriate." The main reasons for these admissions were non-provision of an appropriate facility (n = 25) or the appropriate facility being full or refusing the patient (n = 12).
Comment
Scott D, McGilloway S, Donnelly M. Young people's experience of adult in-patient psychiatric care: a Northern Ireland case study. Mental Health and Learning Disabilities Care 2001;4: 305-8.
O'Herlihy A, Worrall A, Banerjee S, Jaffa T, Hill P, Mears A, et al. National in-patient child and adolescent psychiatry study (NICAPS). Report submitted to the Department of Health, 2001. www.rcpsych.ac.uk/cru/complete/nicaps.htm (accessed 18 Mar 2004).
Barker S. Environmentally unfriendly: patients' views of conditions on psychiatric wards. London: MIND, 2000.
MILMIS Project Group. Monitoring inner London mental illness services. Psychiatr Bull R Coll Psychiatr 1995;19: 276-80.
Worrall A, O'Herlihy A. Psychiatrists' views of in-patient child and adolescent mental health services: a survey of members of the child and adolescent faculty of the Royal College of Psychiatrists. Psychiatr Bull R Coll Psychiatr 2001;25: 219-22.(Adrian Worrall, senior re)
Correspondence to: A Worrall aworrall@cru.rcpsych.ac.uk
Introduction
We chose nine health authorities representative of England and Wales in terms of location, population size, deprivation, and provision of child and adolescent psychiatric wards (see table on bmj.com). These health authorities served 1.13 million people aged under 18, representing 9% of the population of England and Wales (1999 projections of 1991 census).
We identified all adult psychiatric wards and paediatric wards. Consultant general psychiatrists and paediatricians completed a questionnaire for each eligible patient (patients aged under 18 on general psychiatric wards and patients on paediatric wards for treatment of mental illness not solely for medical treatment of self harm) admitted between 1 July and 31 December 1999.
All 31 adult psychiatric wards replied, yielding 43 eligible admissions (23 male). Five were aged 15, and the remainder were 16 or 17. Sixteen of the 21 paediatric wards replied, with 11 eligible admissions (three male, one aged 3 and the others 8-16). The table presents estimates of the numbers and rates of admissions.
Estimates of numbers and rates of admissions of young people with mental disorder to general adult psychiatric wards and paediatric wards in England and Wales
The consultants rated whether each eligible admission was appropriate and, if not, why the patient had not been admitted to a more appropriate unit. Twenty six (60%) adult psychiatric admissions and six (55%) paediatric admissions were deemed "inappropriate." The main reasons for these admissions were non-provision of an appropriate facility (n = 25) or the appropriate facility being full or refusing the patient (n = 12).
Comment
Scott D, McGilloway S, Donnelly M. Young people's experience of adult in-patient psychiatric care: a Northern Ireland case study. Mental Health and Learning Disabilities Care 2001;4: 305-8.
O'Herlihy A, Worrall A, Banerjee S, Jaffa T, Hill P, Mears A, et al. National in-patient child and adolescent psychiatry study (NICAPS). Report submitted to the Department of Health, 2001. www.rcpsych.ac.uk/cru/complete/nicaps.htm (accessed 18 Mar 2004).
Barker S. Environmentally unfriendly: patients' views of conditions on psychiatric wards. London: MIND, 2000.
MILMIS Project Group. Monitoring inner London mental illness services. Psychiatr Bull R Coll Psychiatr 1995;19: 276-80.
Worrall A, O'Herlihy A. Psychiatrists' views of in-patient child and adolescent mental health services: a survey of members of the child and adolescent faculty of the Royal College of Psychiatrists. Psychiatr Bull R Coll Psychiatr 2001;25: 219-22.(Adrian Worrall, senior re)