A quantitative investigation of inequalities in out-of-area admissions in child and adolescent mental health services

Abstract

BackgroundUnderstanding inequalities in mental health care is vital for the development of more equitable services. This study investigates inequalities in out-of-area admissions to general adolescent units, a controversial but necessary part of Child and Adolescent Mental Health care in England.MethodsAnonymised data on 279 out-of-area (at-distance or out-of-region) admissions to general adolescent units in England between February 2021-2022 were analysed for an association between demographics (age, sex, ethnicity) or clinical characteristics (diagnosis and risks) and admission characteristics (7+ day wait for a bed, distance from home, admission out-of-region, compulsory admission and length of stay >6 months).ResultsNo association was found between demographic characteristics and admission characteristics. Personality disorder was the only diagnosis associated with admission greater distance from home. Young people with personality disorder or neurodevelopmental disorder were more likely to be admitted compulsorily (OR = 8.89 and OR = 1.93 respectively). Those with suicide risk were more likely to be admitted non-compulsorily (OR = 2.06) but more likely to be admitted out-of-region (OR = 2.25).DiscussionWithin these data, the clinical presentation of the young person influenced their out-of-area admission characteristics. Young people with a diagnosis of personality disorder may be particularly likely to experience more negative aspects of out-of-area admission.

Keywords: Inequality; child and adolescent mental health; mental health inpatient care; personality disorder; stigma.