When hospital harms more than helps: Iatrogenic processes in adolescent inpatient settings

Abstract

More adolescents than ever are being hospitalised in mental health units. As with all forms of clinical intervention, psychiatric inpatient admission poses its own risks of harm resulting from treatment (iatrogenesis), of which there is minimal literature. In this article we explore the factors that contribute to iatrogenic processes in the adolescent inpatient environment. Of note, the socialization of unsafe behaviours in these environments can contribute to poorer treatment outcomes as well as the harmful effects of experiencing, or witnessing, coercive and traumatising clinical practices. Inpatient admissions also have a systemic impact on family and community ecosystems that can detrimentally influence young people while they are in hospital and even after returning to the community. Recommendations for minimizing and preventing iatrogenic harm for adolescents in inpatient environments are outlined, as well as the patient characteristics that might make young people more vulnerable to these deleterious processes.

Plain language summary

When Hospital Harms More Than Helps: How Mental Health Hospital Admissions can Sometimes be Harmful for Teenagers: Hospital admission is considered a last resort treatment for teenagers suffering from mental health conditions. Teenagers admitted to hospital are usually those with the most severe and complex mental health disorders, and at risk of hurting themselves or others. Whilst admission to psychiatric units is generally helpful, they can also sometimes lead to a worse outcome for both teenagers and their families. In this article, we explore the various ways that hospital can be more harmful than helpful for teens undergoing mental health crises. These include the impact of experiencing, or witnessing, traumatic and coercive treatments while in hospital (such as physical restraint or sedation) as well as the risk of negative influence from peers. We also outline how hospital admission can have various impacts on parents and families – making it hard for teenagers to return home at the end of their admission. Based on our review of the literature and our experiences working in adolescent inpatient units, we provide some recommendations for how to minimize the potentially harmful impact of hospital admissions, such as by arranging planned and time-limited stays, maximising time spent outside of hospital, and involving parent-caregivers as much as possible.