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The lead consultants of all adolescent in-patient psychiatric units in England and Wales were surveyed in 2000 and again in 2005, to determine whether they could admit young people in an emergency.
In 2000, 51 of 64, and in 2005, 70 of 79 units responded. Although the number of units with dedicated ‘emergency admission beds’ had increased from 6 to 16, 34% of the total could never admit as an emergency in 2005 and 44% could never admit out of hours. The consultants estimated that, in 2005, they turned away 72% of referrals for emergency admission. Although 87% of consultants agreed that there should be emergency access to specialist adolescent psychiatric beds, concern was expressed that services are not configured to accept emergency admissions.
This problem is unlikely to be resolved by requiring units to accept both emergency and planned admissions. These groups have very different needs. Coherent and unified commissioning is needed to achieve equity of access to emergency beds, along with separate planned admission units and a range of alternative emergency services.
In 1999, child and adolescent mental health (CAMH) in-patient provision was unevenly distributed across England. A repeat of a1999 bed count survey was conducted in 2006 to determine whether change had occurred in response to government policy.
Total bed numbers in England were found to have increased by 284; 69% of the increase is due to the independent sector, whose market share has risen from 25% in 1999 to 36% in 2006. Regions with the highest number of beds in 1999 have increased bed numbers more than areas with the lowest number of beds in1999 (8.3 v. 3.6 beds per million population). In units that admit only children under the age of 14, there has been a 30% reduction in beds available (123 to 86).
Inequity in provision of CAMH inpatient services has increased despite government policy to the contrary. We speculate that this might be partly due to fragmented and local commissioning, and the effects of market forces operating as a result of increasing privatisation.
Little is known about the current state of provision of child and adolescent mental health service in-patient units in the UK.
To describe the full number, distribution and key characteristics of child and adolescent psychiatric in-patient units in England and Wales.
Following identification of units, data were collected by a postal general survey with telephone follow-up.
Eighty units were identified; these provided 900 beds, of which 244 (27%) were managed by the independent sector. Units are unevenly distributed, with a concentration of beds in London and the south-east of England. The independent sector, which manages a high proportion of specialist services and eating disorder units in particular, accentuates this uneven distribution. Nearly two-thirds of units reported that they would not accept emergency admissions.
A national approach is needed to the planning and commissioning of this specialist service.
Child and adolescent inpatient care is a highly specialised service, ideally requiring planning at a national level, but there are no routine data collections specifically for these services.
To estimate unit costs for child and adolescent psychiatric in-patient units and to analyse the variations in costs between units.
Data collection alongside a national survey with cost estimations guided by principles drawn from economic theory. Bivariate and multivariate analyses are employed to identify cost influences.
Fifty-eight units could provide sufficient data to allow calculation of the cost per in-patient day; mean=$197 (s.d.=71.6; 1999–2000 prices). The management sector, type of provision, number of rooms, capacity and location explained nearly half of the cost variation.
Child and adolescent psychiatric in-patient units are an expensive resource, with personnel absorbing two-thirds of the total costs. Costs per in-patient day vary fourfold and the exploration of cost variations can inform commissioning strategies.
To obtain a prioritised list of psychiatrists' concerns relating to in-patient child and adolescent mental health services. Four-hundred and fifty-four members of the child and adolescent faculty of the Royal College of Psychiatrists were asked to list their main concerns.
Two-hundred and seventy-four members responded. The most reported themes included lack of emergency beds; lack of services for severe or high-risk cases; lack of beds in general; poor liaison with patients' local services; lack of specialist services; and poor geographic distribution of services.
The range of themes identified from this survey have served to focus the National In-patient Child and Adolescent Psychiatry Study (NICAPS) and several design changes have been made to NICAPS as a result.
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