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Schölin L, Tucker Z, Chopra A, Borschmann R, McKay C. Detention of children and adolescents under mental health legislation: a scoping review of prevalence, risk factors, and legal frameworks. BMC Pediatr 2024; 24:12. [PMID: 38178014 PMCID: PMC10765764 DOI: 10.1186/s12887-023-04464-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/05/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND For individuals with severe mental illness, involuntary assessment and/or treatment (hereafter detention) can be a necessary intervention to support recovery and may even be lifesaving. Despite this, little is known about how often these interventions are used for children and adolescents. METHODS This global scoping review set out to: (1) map the current evidence around mental health detentions of children and adolescents (< 18 years); (2) identify the clinical, sociodemographic, and behavioural factors associated with detention; and (3) document the views of professionals and young people on the implementation of mental health legislation. RESULTS After searching databases of peer-reviewed literature and citation chaining, 42 articles from 15 jurisdictions were included. About one fifth of psychiatric admissions in national register data were detentions, however trends were only available for a few high-income Western countries. The circumstances justifying detention and the criteria authorising detention varied between studies, with a mix of clinical factors and observed behaviours reported as the reason(s) warranting/precipitating a detention. Particular groups were more likely to experience detention, such as children and adolescents from minority ethnic communities and those with a documented history of abuse. There was a notable absence of qualitative research exploring the views of professionals or children and adolescents on detention. CONCLUSION Further research is needed to explore the impact of detention on those aged < 18 years, including national register-based studies and qualitative studies. This is particularly relevant in nations currently undergoing legislative reform.
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Affiliation(s)
- Lisa Schölin
- Centre for Pesticide Suicide Prevention, University of Edinburgh, Edinburgh, UK.
| | - Zack Tucker
- Masters student at University of Edinburgh, Edinburgh, UK
| | - Arun Chopra
- Mental Welfare Commission for Scotland, Edinburgh, UK
| | - Rohan Borschmann
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, OX3 7JX, UK
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Colin McKay
- Centre for Mental Health and Capacity Law, Edinburgh Napier University, Edinburgh, UK
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Melvin CL, Barnoux M, Alexander R, Roy A, Devapriam J, Blair R, Tromans S, Shepstone L, Langdon PE. A systematic review of in-patient psychiatric care for people with intellectual disabilities and/or autism: effectiveness, patient safety and experience. BJPsych Open 2022; 8:e187. [PMID: 36268640 PMCID: PMC9634562 DOI: 10.1192/bjo.2022.571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND An increasing number of children, adolescents and adults with intellectual disabilities and/or autism are being admitted to general psychiatric wards and cared for by general psychiatrists. AIMS The aim of this systematic review was to consider the likely effectiveness of in-patient treatment for this population, and compare and contrast differing models of in-patient care. METHOD A systematic search was completed to identify papers where authors had reported data about the effectiveness of in-patient admissions with reference to one of three domains: treatment effect (e.g. length of stay, clinical outcome, readmission), patient safety (e.g. restrictive practices) and patient experience (e.g. patient or family satisfaction). Where possible, outcomes associated with admission were considered further within the context of differing models of in-patient care (e.g. specialist in-patient services versus general mental health in-patient services). RESULTS A total of 106 studies were included and there was evidence that improvements in mental health, social functioning, behaviour and forensic risk were associated with in-patient admission. There were two main models of in-patient psychiatric care described within the literature: admission to a specialist intellectual disability or general mental health in-patient service. Patients admitted to specialist intellectual disability in-patient services had greater complexity, but there were additional benefits, including fewer out-of-area discharges and lower seclusion rates. CONCLUSIONS There was evidence that admission to in-patient services was associated with improvements in mental health for this population. There was some evidence indicating better outcomes for those admitted to specialist services.
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Affiliation(s)
| | | | - Regi Alexander
- Broadland Clinic and Community Forensic Learning Disability Team, Hertfordshire Partnership University NHS Foundation Trust, UK; and School of Life and Medical Sciences, University of Hertfordshire, UK
| | - Ashok Roy
- Centre for Educational Development, Appraisal and Research, University of Warwick, UK; Centre for Mental Health and Wellbeing Research, University of Warwick, UK; and Brooklands Hospital, Coventry and Warwickshire Partnership NHS Trust, UK
| | - John Devapriam
- Trust Headquarters, Herefordshire and Worcestershire Health and Care NHS Trust, UK
| | - Robert Blair
- School of Computing Sciences, University of East Anglia, UK
| | - Samuel Tromans
- Adult Learning Disabilities Service, Leicestershire Partnership NHS Trust, UK; and Department of Health Sciences, University of Leicester, UK
| | - Lee Shepstone
- Norwich Medical School, University of East Anglia, UK
| | - Peter E Langdon
- Centre for Educational Development, Appraisal and Research, University of Warwick, UK; Centre for Mental Health and Wellbeing Research, University of Warwick, UK; Brooklands Hospital, Coventry and Warwickshire Partnership NHS Trust, UK; and Research and Development, Herefordshire and Worcestershire Health and Care NHS Trust, UK
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Walker S, Barnett P, Srinivasan R, Abrol E, Johnson S. Clinical and social factors associated with involuntary psychiatric hospitalisation in children and adolescents: a systematic review, meta-analysis, and narrative synthesis. THE LANCET. CHILD & ADOLESCENT HEALTH 2021; 5:501-512. [PMID: 33930330 PMCID: PMC8205858 DOI: 10.1016/s2352-4642(21)00089-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Disparities in involuntary psychiatric hospitalisation between population subgroups have been identified in adults, but little is known about the factors associated with involuntary hospitalisation in children or adolescents. We did a systematic review, meta-analysis, and narrative synthesis to investigate the social and clinical factors associated with involuntary psychiatric hospitalisation among children and adolescents. METHODS We searched MEDLINE, PsycINFO, Embase, and the Cochrane Central Register of Controlled Trials for studies of any type up to July 22, 2020, that compared the characteristics of voluntary and involuntary psychiatric inpatients (mean age of sample ≤18 years). We synthesised results using random effects meta-analysis on unadjusted data and by narrative synthesis. Heterogeneity between studies was calculated using I2. This study is registered on PROSPERO, CRD42020099892. FINDINGS 23 studies from 11 countries were included in the systematic review and narrative synthesis, of which 19 studies (n=31 212) were included in the meta-analysis. On meta-analysis, involuntary rather than voluntary hospitalisation of minors was associated with a diagnosis of psychosis (eight studies; odds ratio 3·63, 95% CI 2·43-5·44, p<0·0001), substance misuse (five studies; 1·87, 1·05-3·30, p=0·032), or intellectual disability (four studies; 3·33, 1·33-8·34, p=0·010), as well as presenting with a perceived risk of harm to self (eight studies; 2·05, 1·15-3·64, p=0·015) or to others (five studies; 2·37, 1·39-4·03, p=0·0015). Involuntary hospitalisation was also found to be associated with being aged 12 years or older (three studies; 3·57, 1·46-8·73, p=0·0052) and being from a Black rather than a White ethnic group (three studies; 2·72, 1·88-3·95, p<0·0001). There was substantial between-study heterogeneity for most factors included in the meta-analysis (I2 from 51·3% to 92·3%). Narrative synthesis found that more severe illness and poorer global functioning was associated with involuntary hospitalisation. INTERPRETATION Over-representation of involuntary psychiatric hospitalisation in certain groups might begin in childhood, potentially establishing a cycle of inequality that continues into adulthood. Further research into the systemic factors underlying these health-care inequalities and the barriers to accessing less coercive psychiatric treatment is urgently required, with specific consideration of racial and ethnic factors. FUNDING UK National Institute for Health Research and Wellcome Trust.
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Affiliation(s)
- Susan Walker
- Division of Psychiatry, University College London, London, UK; Great Ormond Street Institute of Child Health, University College London, London, UK.
| | - Phoebe Barnett
- Department of Clinical Educational and Health Psychology, Centre for Outcomes Research and Effectiveness, University College London, London, UK; National Institute of Health Research Mental Health Policy Research Unit, University College London, London, UK
| | | | - Esha Abrol
- Division of Psychiatry, University College London, London, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK; National Institute of Health Research Mental Health Policy Research Unit, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
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Cairó MR, Urben S, Terren M, De Rocquigny H, Courossé S, Bisio C, Caspani V, Legoux C, Petraglia G, Guignet B, Plessen KJ, Holzer L. Evolution of Clinical Outcome During Adolescents’ Psychiatric Inpatient Care: A Prospective Multiple Informant Study. ADOLESCENT PSYCHIATRY 2021. [DOI: 10.2174/2210676610999200623114116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Examining the effectiveness and adequacy of adolescents’ psychiatric
inpatient treatment through multiple perspectives is crucial to provide the best care.
Objectives:
The aims of the current study were to examine the consistencies and discrepancies
between patients and clinicians and to understand how each group considered
the timing of improvement of symptoms and psychosocial difficulties of adolescents
during a psychiatric inpatient stay.
Methods:
The Health of the Nation Outcome Scales for Children and Adolescents
(HoNOSCA, assessing symptoms and psychosocial difficulties) was rated on a weekly
basis by patients and clinicians during a psychiatric inpatient stay. Data were collected
from 297 patients, 58.2% females.
Results:
Both clinicians and patients reported a significant decrease of the HoNOSCA
scores from admission to discharge, revealing that inpatient treatment is perceived as
helping the adolescents to alleviate their symptoms and psychosocial difficulties. However,
the item-by-item analyses indicated that patients and clinicians reported difficulties
in different symptoms and psychosocial domains. Moreover, the week-by-week
analyses revealed discrepancies in the perception of the time-course of clinical outcome-
changes between clinicians and patients, as well as between males and females,
and between voluntarily and involuntarily admitted patients.
Conclusions:
By integrating perspectives of patients and clinicians and their respective
timelines, as well as by taking into account the mode of admission and the patient’s
gender, this study provides a deeper understanding of the evolution of clinical outcome
during adolescents’ hospitalizations, which allows to adapt their treatment and therewith,
to help patients more efficiently.
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Affiliation(s)
- Marta Ruiz Cairó
- Division of Child and Adolescent Psychiatry, University Hospital of Lausanne, Lausanne, Switzerland
| | - Sébastien Urben
- Division of Child and Adolescent Psychiatry, University Hospital of Lausanne, Lausanne, Switzerland
| | - Morgane Terren
- Division of Child and Adolescent Psychiatry, University Hospital of Lausanne, Lausanne, Switzerland
| | - Hélène De Rocquigny
- Division of Child and Adolescent Psychiatry, University Hospital of Lausanne, Lausanne, Switzerland
| | - Swen Courossé
- Division of Child and Adolescent Psychiatry, University Hospital of Lausanne, Lausanne, Switzerland
| | - Cecilia Bisio
- Child and Adolescent Psychiatric Service, Hospital of Valais, Sierre, Switzerland
| | - Vivien Caspani
- Child and Adolescent Psychiatric Service, Hospital of Valais, Sierre, Switzerland
| | - Céline Legoux
- Child and Adolescent Psychiatric Service, Hospital of Valais, Sierre, Switzerland
| | - Géraldine Petraglia
- Child and Adolescent Psychiatric Service, Hospital of Valais, Sierre, Switzerland
| | - Boris Guignet
- Child and Adolescent Psychiatric Service, Hospital of Valais, Sierre, Switzerland
| | - Kerstin Jessica Plessen
- Division of Child and Adolescent Psychiatry, University Hospital of Lausanne, Lausanne, Switzerland
| | - Laurent Holzer
- Division of Child and Adolescent Psychiatry, University Hospital of Lausanne, Lausanne, Switzerland
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Haessler F, Paeckert J, Reis O. [The Care of Intellectually Disabled Children and Adolescents with Psychiatric Disorders in Hospitals for Child and Adolescent Psychiatry and Psychotherapy in Germany]. DAS GESUNDHEITSWESEN 2019; 82:132-140. [PMID: 30802922 DOI: 10.1055/a-0832-2066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE This study explores the care situation of children and adolescents with intellectual disabilities (ID) suffering from mental problems in Germany in 2014. It complements the study of Hennicke, which was conducted a decade ago. METHOD All clinics and departments of child and adolescent psychiatry in Germany (n=138) were contacted via mail or personally and requested to fill out a questionnaire. We received data from one-third (n=46) of all hospitals contacted. RESULTS Eight hospitals (17%) offered specialized services for this client base as either inpatient or outpatient treatment. Three hospitals (7%) provided both. Average proportions of children with ID treated were 6.6% for inpatient, 7.9% for day hospital, and 3% for outpatient services. More than half of responding institutions (54%) judged inpatient services as being defective. Slightly less (43%) reported their outpatient services as being defective or inadequate. For the treatment of mental disorders in young patients with ID, different treatments were used, according to the degree of the ID and applying the standard of child and adolescent psychiatry. Some interventions were used independently of the degree of ID, such as practical exercises, interventions in the patient environment (parents, family). Other interventions, such as psychotherapy were used to a lesser degree when the degree of ID increased. Youth with mild ID received twice as much psychotherapeutic interventions compared to children and adolescents with severe ID. The latter received more psychopharmacotherapy instead. Youth with severe ID received twice as much (67%) psychotropic medication compared to children and adolescents with mild ID. CONCLUSION The defective care situation of the highly vulnerable children and adolescents with ID did not change much between 2004 and 2014. The amount of specialized care services increased only marginally. Non-pharmacological treatments were used to a larger extent, compared to psychotropic medication, independent of the degree of ID.
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Affiliation(s)
- Frank Haessler
- Tagesklinik Kinder-und Jugendpsychiatrie, GGP Gruppe, Rostock
| | - Julia Paeckert
- Klinik für Innere Medizin II, Sana Klinikum Lichtenberg, Berlin
| | - Olaf Reis
- Klinik für Psychiatrie, Neurologie, Psychosomatik und Psychotherapie im Kindes- und Jugendalter, Universitatsmedizin Rostock, Rostock
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Hayes C, Simmons M, Simons C, Hopwood M. Evaluating effectiveness in adolescent mental health inpatient units: A systematic review. Int J Ment Health Nurs 2018; 27:498-513. [PMID: 29194885 DOI: 10.1111/inm.12418] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/17/2017] [Indexed: 11/28/2022]
Abstract
Adolescent mental health research is a developing area. Inpatient units are the most widely used acute element of adolescent mental health services internationally. Little is known about inpatient units, particularly when it comes to measuring improvement for adolescents. Clinical outcome measurement in the broad context has gathered momentum in recent years, driven by the need to assess services. The measurement of outcomes for adolescents who access inpatient care is critical, as they are particularly vulnerable and are often considered the most difficult to treat. Following the PRISMA guidelines, the aim of this review was to assess whether adolescent inpatient units are effective and understand how outcomes are measured. CINAHL, MEDLINE with Full Text, ERIC, PsycINFO, and Cochrane databases were systematically searched. Studies were included if the inpatient units were generic and adolescents were between the mean age of 12-25 years. Furthermore, studies published in English within the last ten years were included. Exclusions were outpatient and disorder-specific inpatient settings. A total of 16 studies were identified. Each study demonstrated effectiveness on at least one outcome measure in terms of symptom stabilization. However, several outcome measures were used and therefore inpatient units lack consistency in how they measure improvement. Inpatient units are effective for the majority of young people as they result in symptom stabilization. Whilst symptom stabilization can be achieved, future research examining the mechanism of change is needed.
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Affiliation(s)
- Claire Hayes
- University of Melbourne, Department of Psychiatry, Melbourne, VIC, Australia.,Albert Road Clinic, Melbourne, VIC, Australia
| | - Magenta Simmons
- University of Melbourne, Centre for Youth Mental Health, Melbourne, VIC, Australia.,Orygen Youth Health Research Centre, Melbourne, VIC, Australia
| | - Christine Simons
- University of Melbourne, Department of Psychiatry, Melbourne, VIC, Australia.,Albert Road Clinic, Melbourne, VIC, Australia
| | - Malcolm Hopwood
- University of Melbourne, Department of Psychiatry, Melbourne, VIC, Australia.,Albert Road Clinic, Melbourne, VIC, Australia
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Clegg J, Bigby C. Debates about dedifferentiation: twenty-first century thinking about people with intellectual disabilities as distinct members of the disability group. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/23297018.2017.1309987] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Jennifer Clegg
- Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
- Living with Disability Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Christine Bigby
- Living with Disability Research Centre, La Trobe University, Melbourne, Victoria, Australia
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