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

Abstract

Background

Understanding 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.

Methods

Anonymised 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).

Results

No 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).

Discussion

Within 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.

Plain Language Summary

Due to the number and uneven spread of specialist mental health beds throughout the country, young people may be admitted far-away from where they live (more than 50 miles from their home address or out of their local region). Previous research has shown inequalities in the care received by young people based on their demographics and diagnoses. This study looks at whether there is evidence of this unequal treatment based on demographics, diagnoses, and risks within a sample of young people admitted far-away from home. Statistical tests were used to look for whether there was evidence that the demographics (age, sex and ethnicity) or presentation (diagnoses or risks) of a young person were associated with negative aspects of an admission (having to wait for a week or more for a bed, longer distance from home, being admitted out-of-region, spending more than 6 months in hospital and having to be admitted against their will). The researchers found no links between demographics and negative aspects of the admission in this data. However, they found that young people with a diagnosis of a personality disorder were sent on average further away than those who did not have this diagnosis, they were also more likely to be admitted against their will. Young people with a neurodevelopmental disorder (autism spectrum disorder, attention-deficit hyperactive disorder or Tourette’s syndrome) were also more likely to be admitted against their will. Young people judged to be at high risk of suicide were more likely to be sent out-of-region and less likely to be admitted against their will. These findings do not show evidence of unequal treatment based upon demographics but potential inequalities due to diagnosis and risks. The reason for these differences may represent stigma against young people with certain diagnoses such as personality disorder.