Child and Adolescent Mental Health Services: inpatient report

A4.11 Admissions to pediatric wards

Numbers of admissions were too small to these wards to give a meaningful breakdown of patient characteristics.

Children and young people with mental health/behavioural problems admitted to pediatric wards (where LD CAMH inpatient units were required) needed to be nursed separately in side rooms. Families of the majority stayed with their child or young person 24 hours a day to provide care and this was stressful for them. One patient had use of a family suite, usually used for critically ill babies. Their family and care staff moved in too. Some families accepted admission to a pediatric ward as their only option, where things were unmanageable at home and suitable school and/or respite facilities unavailable.

A patient with autism spectrum disorder but no learning disability was already familiar with pediatric ward and team. The family were fully supportive and the patient happy to go in. No beds were available in the YPU, but it would not have been easy for him there anyway due to his autism and other difficulties. The patient also struggled with the noise, change and busy environment on the pediatric ward, despite having his own cubicle.

Parents of a young person with severe learning disability hated the admission, feeling that the pediatric ward staff took "nothing to do with him". To reduce the patient's distress levels, the carers had to go out to push him in his wheelchair around the grounds, including in the evenings.

Nursing and medical staff lacked confidence and skills to deal with young people with acute behavioural disturbance and mental health problems. They were anxious about how to manage aggression. Pediatricians sometimes had to use psychotropic medication, outside their area of expertise and without support from psychiatrists, in an attempt to manage situations. These situations could be very time consuming for Pediatricians, having to review the patient on the ward several times a day.

Community CAMHS, LD CAMHS or pediatric liaison psychiatry teams tried to support these admissions. A psychiatrist noted how generous their local pediatric ward was in allowing admission for mental health reasons, but that it needed to be heavily supported by CAMH staff visiting daily. Sometimes bank staff with mental health experience were brought in from elsewhere to support.