Child and Adolescent Mental Health Services: inpatient report

A4.9 Admissions to the National Child Psychiatry Inpatient Unit

Numbers of admissions were too small to this service to give a meaningful breakdown of patient characteristics.

The National Child Psychiatry Inpatient Unit was identified as managing well some young people with significant levels of learning disability and/or autism spectrum disorder. Descriptions were given of admissions of highly complex patients where there was excellent assessment and treatment, with detailed handover, practical instruction and guidance to families and local services. These proved helpful even a long time after discharge. Follow-up over extended periods via conference calls and occasional out-patient appointments was valued. A clinician from a remote rural area felt their service was well supported, with advice from the unit prior to admission, a quick response and prioritisation for admission due to difficulties for local services managing in their geographical setting.

For <5 children with severe learning disability (who also had autism spectrum disorder), only day patient attendance was possible, as they were unable to be safely managed alongside other children. A separate part of the ward usually used for other purposes was used to provide a quiet, individualised environment. This took a long time to arrange in one case due to concern about whether the ward could manage the patient's complexity in that environment. These children ideally required a specialist LD CAMH inpatient unit and despite helpful and detailed multidisciplinary assessment it was not possible for full assessment and treatment in the National Child Psychiatry Inpatient Unit. One went on to receive this in an English LD CAMH unit. However, other parents objected to distant cross-border admissions for their children, which therefore did not go ahead.

Chronological age rather than development stage cut offs were viewed by some clinicians as unhelpful. There were young teenagers with learning disability and/or autism spectrum disorder who some clinicians felt would fit better with the National Child Psychiatry Inpatient Unit model than that of the YPUs. Their social skills and developmental needs would suit better the younger age group. A clinician illustrated this concern based on experience with a young teenager at an YPU who had misinterpreted and copied other people's behaviours, presenting quite a challenge to the unit.

A4.9.1 Parental concerns/relationships with services

Some difficulties were highlighted in supporting families from remote parts of Scotland with admissions and one admission was cut short as the family could not maintain the travelling to visit. Another family found negotiations difficult around the expectation for the whole family to visit regularly for family therapy sessions. Families struggled with the expense of travelling to and staying in Glasgow. Expenses were paid by their Health Board for the time the hospital stated was required. However, families may choose to visit more frequently or stay on longer to make a trip worthwhile and to spend more time with their child. At least one family ran up a lot of debt due to the admission. For those attending as day-patients, this could be time-consuming for the family, impacting on time available for other children.

A4.9.2 Staff expertise and experience

Good outcomes for children were put down to staffing skills, greater experience of neurodevelopmental disorders and availability of one to one care, which was viewed by some clinicians as more personalised and individual compared to what is offered in the YPUs. Being on the site of a highly specialist childrens' hospital allowed crucial access to and liaison with a range of pediatric medical specialties. This was valuable for a patient group with frequent complex medical co-morbidities.