This is a plain English summary of an original research article. The views expressed are those of the author(s) and reviewer(s) at the time of publication.
Researchers interviewed young people, parents and carers, and healthcare professionals with relevant experience. They found that young people admitted to psychiatric units a long way from home could face difficulties keeping in touch with home, organising home leave and returning to school. Rarely, distant admissions could be beneficial: a young person could find distance empowering, and it could give their families respite.
The team hopes its insights will form the basis of national policy to provide more support to young people admitted far from home, and their families.
The issue: many young people are admitted to psychiatric units far from home
Young people (aged 17 and below) with severe and/or complex mental health difficulties (depression, psychosis, eating disorders and/or suicide risk, for example) might need to be admitted to a child and adolescent mental health unit if treatment in the community is not adequate or safe.
However, the availability of beds in these units varies across the UK. This means that finding a bed, particularly when it is needed quickly, can be challenging. As a result, many young people are admitted to units far from their home. In 2017, most (61%) clinical commissioning groups had admitted at least one young person to a mental health unit outside their area; 1 in 3 had sent young people at least 100 miles away from home.
Researchers explored the impact of at-distance admissions (50 miles or more from home, or outside of their NHS commissioning region) on young people, their parents or carers, and healthcare professionals.
What is the impact of at-distance psychiatric admissions for young people?
Researchers interviewed 28 young people aged 13 to 17 years, and 19 parents or carers, with experience of a psychiatric admission within the previous year in England. Most participants were female (77%), and White British (66%). Admissions were both at-distance (more than 50 miles away from home), or more local but outside of their NHS commissioning region.
The team also interviewed 51 healthcare professionals in England who had cared for a young person admitted to a psychiatric unit. Interviews were by video, phone or face to face between 2021 and 2022.
They drew out themes from the interviews covering the admission, care at a distance, and discharge.
The admission
Young people and parents or carers felt informed but not involved in the decision to admit to a distant unit. They felt they lacked influence and had limited alternatives; some felt pressure to accept the bed offered. Healthcare professionals were upset by the lack of beds, and the uncertainty.
Some young people were desperate and took the first bed available. Parents and carers could feel relieved to have their child somewhere safe. One parent said: ‘…we were actually relieved because we thought it’s better that she’s in the care of professionals who could deal with this rather than us who you know, could easily make a mistake and make things worse.’
Some young people had only a day or two’s notice about a bed becoming available and were afraid of being far from home. They welcomed easily accessible information (a digital book about the unit, or a welcome pack). One young person said: ‘I got to see like what the environment sort of looked like and how things would work with like your care team and MDT [multidisciplinary team]...’
Care at a distance
Challenges in keeping in touch, especially when mobile phone use was restricted, could lead to feelings of isolation. Parents’ and carers’ health was sometimes impacted. One parent said: ‘There were times when actually I felt suicidal myself, because I thought there’s no help, like I felt so lonely and frustrated… Trying to constantly phone …and hearing nothing back, was just soul destroying.’
A lack of regular visits worsened feelings of sadness. Parents or carers could struggle because of the time and cost of travel and accommodation; healthcare professionals called for more support. One psychiatrist said: ‘… They just couldn’t afford to go and see her. We tried all sorts of different funding streams to see if we could get some money through social care, we even tried charities...it was just awful. There’s just not that support there for the families.’
On occasion, less contact with family could be positive. It could give the young person a break from a complex social situation, reduce their concerns about being recognised, and/or be empowering. It could also give the family respite.
Discharge
Arranging home leave was more difficult from a distance. One young person said: ‘…If my home leaves were going bad, like almost every time, then like it would have been a nightmare having to bring me back at the time.’ The prospect of being discharged without periods of home leave first could be daunting for young people.
Discharge planning could be limited. Schools tended not to provide additional support for young people admitted far away from home which meant they missed a lot of education and could find reintegration difficult. But some young people remained in touch with their school or care coordinator, and were more able to work remotely.
Similarly, young people had limited contact with their local child and adolescent mental health services (CAMHS) team when admitted far away. This reduced continuity of care; re-establishing links could be difficult.
Why is this important?
Clinical urgency can lead to at-distance admissions. The interviews highlight the impact of at-distance admissions on young people, parents or carers, and healthcare professionals. They provide insights into how to make these admissions less difficult. Good practice, such as providing clear information, could reduce some of the negative impacts.
Most of the young people were interviewed while still in hospital, and could not reflect on the whole process, especially returning home.
What’s next?
The study suggests that at-distance psychiatric admissions could be improved for young people and their families with:
- co-produced, easily accessible information to reassure young people and their families before admission; this is helpful whether the admission is local or distant
- better communication between services to understand which young people might benefit most from an at-distance admission, and who might need to be transferred closer to home prior to discharge to ease the transition out of hospital.
The researchers are developing a Far Away From Home checklist, which is a list of considerations for healthcare professionals admitting a young person at-distance. They hope it will improve the experience of admission for the young person and their family, and reduce barriers to discharge.
A national policy is needed to support the families of young people who have been admitted far from home, the researchers say. They would like it to incorporate the Far Away From Home checklist, along with a standardised template of information (developed with young people and parents) that inpatient units would make publicly available. At-distance admissions need to be costed to include additional funding for families’ travel, accommodation and childcare costs, they say.
How can I act on this new knowledge?
You may be interested to read
This is a summary of: Roe J, and others. Experiences and impact of psychiatric inpatient admissions far away from home: a qualitative study with young people, parents/carers and healthcare professionals. BMJ Mental Health 2024; 27: 1 – 9.
The findings are summarised in this animation and were discussed at a webinar in March 2024.
An NIHR article about supporting discharge.
Information about mental health in children and young people can be found on the Young Minds charity website.
An NIHR Evidence Collection about mental healthcare for children and young people: Experience of children and young people cared for in mental health, learning disability and autism inpatient settings.
Funding: This study was funded jointly by several NIHR Applied Research Collaborations (ARCs): East Midlands, East of England, West Midlands, Oxford and Thames Valley, Greater Manchester.
Conflicts of Interest: No relevant conflicts were declared. Full disclosures are available on the original paper.
Disclaimer: Summaries on NIHR Evidence are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that the views expressed are those of the author(s) and reviewer(s) at the time of publication. They do not necessarily reflect the views of the NHS, the NIHR or the Department of Health and Social Care.
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