Investigating inequalities in admissions of young people out-of-area or to adult psychiatric wards: a qualitative study.

backgroundHigh occupancy rates and uneven bed distribution throughout England mean some young people are admitted to Child and Adolescent Mental Health Service beds out-of-area or to adult psychiatric wards in Adult Mental Health Services. No previous research has investigated how the characteristics of young people, families, or services may influence the impact of these types of admissions.

methodData were collected as part of the "Far Away from Home" research program. Semi-structured interviews were carried out with 13-17-year-olds (n = 30), parents/carers (n = 21) and healthcare professionals (n = 68) who had experience of out-of-area, local or adult psychiatric ward admissions. Thematic analysis of transcripts identified characteristics which positively or negatively moderated the impact of these admissions.

resultsYoung people in the care of the state (looked-after children) and those from more disadvantaged families with fewer financial resources, low social capital, health problems and disability were found to be more negatively affected by out-of-area admissions. In adult ward admissions, less mature young people were found to be more negatively affected. Service characteristics which lessened these negative effects were identified, such as: flexible visiting times, transport, financial reimbursement or accommodation for visiting parents. For families with complex dynamics being admitted locally was sometimes felt to be negative.

conclusionsThe impacts of admissions to out-of-area or adult wards are not equal in all circumstances. Potential inequalities should be considered before and during admission and throughout discharge processes, with steps taken to support disadvantaged groups.