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Child and adolescent in-patient units – room for expansion

Published online by Cambridge University Press:  02 January 2018

Nicole Karen Fung
Affiliation:
Ashfield Unit, Parkview Clinic, 60 Queensbridge Road, Moseley, Birmingham B13 8QE, email: nkf@doctors.org.uk
Linda Cullen
Affiliation:
Ashfield Unit
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Abstract

Type
The columns
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
Copyright © Royal College of Psychiatrists, 2008

We read with interest the concerns expressed in a recent article by Cotgrove et al (Psychiatric Bulletin, December 2007, 31, 457–459). The Ashfield Unit is an adolescent unit able to accept emergency admissions that opened in 2003 in recognition of a lack of emergency provision leading to delayed admissions and inappropriate use of paediatric or adult psychiatric wards. Our experience since opening has been in contrast to the concerns expressed by Cotgrove et al. We have not had inappropriate admissions and there have been no difficulties with recruitment and retention of staff.

What has been unexpected is the high level of violence, aggression and risk to others in some young people. This may be similar to the experience in adult psychiatry in recent years, with only the most disturbed patients being referred for admission into in-patient psychiatric units. There has been a higher than expected need for intensive nursing care in a low-stimulus environment – a third of our young people presenting with psychosis required the use of the intensive nursing area at some point in their admission (Reference Cullen, Thomas and SmithCullen et al, 2006).

Although O’Herlihy et al in their paper (Reference O'Herlihy, Lelliott and Bannister2007) demonstrate a dramatic increase in forensic provision, we would recommend an increase in provision of a spectrum of psychiatric intensive care units for adolescents alongside general and acute adolescent in-patient units, which could be used flexibly to allow the young person to be rehabilitated back onto an open ward as soon as possible.

References

Cullen, L., Thomas, B. & Smith, P. (2006) A novel acute admission and assessment service for teenagers with first episode psychosis. Schizophrenia Research, 86 (suppl 1), S168.Google Scholar
O'Herlihy, A., Lelliott, P, Bannister, D., et al (2007) Provision of child and adolescent mental health in-patient services in England between 1999 and 2006. Psychiatric Bulletin, 31, 454456.Google Scholar
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