Child and Adolescent Mental Health Services: inpatient report

4.4 Presenting behaviours and admission characteristics

Presenting behaviours and admission characteristics- summary

Presenting behaviours:

• 65% had self-injury (100% where severe/profound learning disability)
• 67% had aggression (100% where severe/profound learning disability)
• 51% had destructiveness (80% where severe/profound learning disability)
• 28% had sexualized behaviour (42% where mild learning disability)

41% had police involvement at some stage (52% where mild learning disability)

Steady admission numbers reported from 2012 – 2014. Less for 2010 and 2011.

Reasons for admission:

• Most common across all levels of learning disability were:
  • Mental health assessment and stabilisation (58-67%)
  • Risk management (excluding suicidality/deliberate self harm) 50% of those with no learning disability, 70-80% of those with all levels of learning disability
• Suicidality/deliberate self harm: 37% of those with no learning disability, very low rates in all levels of learning disability
• Medication management: 16% of those with no or mild learning disability, 29% for moderate learning disability and 35% for severe/profound learning disability
• Home/care placement breakdown was a common reason for admission only for those with moderate learning disability (23%)

53% of patients noted to have been detained under the Mental Health Act for all or part of an admission

Staff: patient ratio - limited information given, but >15% needed more than 2 nurses per patient

A4.4.1 Presenting behaviours

% of patients of varying levels of learning disability reported as having specified behaviours are given in the table below.

Level of learning disability / Behaviour	None	Mild	Moderate	Severe/ profound	All patients
Self-injury	79	46	59	100	65
Aggression	56	68	70	100	67
Destructiveness	37	48	58	80	51
Sexualised	19	42	24	20	28

A4.4.2 Police involvement at any stage

A total of 37 patients out of 90 in the study were known to have had police involvement at some stage. There were various reasons for police involvement, including support for behavioural disturbance, taking to a place of safety, as well as arrests.

Police involvement was particularly high for those with mild learning disability. For the different levels of learning disability, police involvement was as follows:

• No learning disability – 41%
• Mild learning disability 52%
• Moderate learning disability – 40%
• Severe/profound learning disability – 20%

A4.4.3 Year of admission

Although 5 patients were admitted before the study period, they were included as they remained inpatients into 2010 or beyond. Figures exclude those who stayed at home or who were admitted to a non-hospital unit.

A4.4.4 Reasons for admission

There was frequently more than one reason for any one admission

For all admissions:

Comparison for those with different degrees of learning disability:

• Mental health assessment and stabilisation was a very common reason for admission across patients with all levels of learning disability and none, ranging from 58-67%.
• Medication management was a reason for admission in 16% of those with no or mild learning disability, 29% for moderate learning disability and 35% for severe/profound learning disability.
• Home/care placement breakdown was a common reason for admission only for those with moderate learning disability (23%) .
• Risk management was a common reason for admission across all groups, but varied as follows: no learning disability 51%, mild learning disability 80%, moderate learning disability 71%, severe/profound learning disability 82%.

• Suicidality/self harm was a reason for admission in 37% of those with no learning disability and 4% for those with each degree of learning disability. This was separated from other risk management for the purposes of these results as the nature differed from self-injury seen in those with more severe levels of learning disability. The latter was included under risk management.

A need for behavioural assessment and implementation of behaviour management strategies was rarely given as a reason for admission. However, these were common interventions, particularly within learning disability and learning disability child and adolescent mental health inpatient units.

A4.4.5 Detention under the Mental Health Act

53% of patients were detained under the Mental Health Act for all or part of an admission.

A4.4.6 Staff: patient ratio required during admission

For all admissions where this information was available:

• Standard ward level 16%
• 1:1 23%
• 2:1 14%
• 3:1 (<5)
• 4:1 (<5)