‘Admissions to paediatric medical wards with a primary mental health diagnosis: a systematic review of the literature’

ABSTRACT Objective To systematically review the literature describing children and young people (CYP) admissions to paediatric general wards because of primary mental health reasons, particularly in MH crisis. Design PubMed, Embase, PsychINFO, Web of Science and Google Scholar were searched. We addressed five search questions to inform: trends and/or the number of admissions, the risk factors for adverse care, the experiences of CYP, families/carers and health care professionals (HCPs) and the evidence of interventions aimed at improving the care during admissions. Two reviewers independently assessed the relevance of abstracts identified, extracted data and undertook quality assessment. This review was registered with Prospero (CRD42022350655). Results Thirty-two studies met the inclusion criteria. Eighteen addressed trends and or numbers/proportions of admissions, 12 provided data about the views/experiences of HCPs, two provided data about CYPs’ experiences and four explored improving care. We were unable to identify studies examining risk factors for harm during admissions, but studies did report the length of stay in general paediatric/adult settings while waiting for specialised care, which could be considered a risk factor while caring for this group. Conclusions MH admissions to children’s wards are a long-standing issue and are increasing. CYP will continue to need to be admitted in crisis, with paediatric wards a common allocation whilst waiting for assessment. For services to be delivered effectively and for CYPs and their families/carers to feel supported and HCPs to feel confident, we need to facilitate more integrated physical and MH pathways of care. What is already known on this topic? - There is evidence that both the number of paediatric admissions and the severity of MH crisis in CYP have increased. Children’s wards are not designed to treat CYP with MH problems and HCPs haven’t had enough training. - There is no published systematic review on this topic. What this study adds? - This is the first systematic review on CYP admissions to paediatric wards with a primary MH indication. - Evidence suggested increased numbers of admissions to paediatric wards over time. HCPs reported concerns about skill sets to manage CYP with MH presentations and questioned the appropriateness of the acute ward for this care. - There is limited evidence on CYP experiences during admissions and on studies to improve care. We found no evidence of specific risk factors for adverse care for CYP and families/carers during admissions and no studies on families/carers’ experiences.