Background
Young
people with complex or severe mental health needs sometimes require care and
treatment in inpatient settings. There are risks for young people in this care
context, and this study addressed the question: ‘What is known about the
identification, assessment and management of risk in young people (aged 11–18)
with complex mental health needs entering, using and exiting inpatient child
and adolescent mental health services in the UK?’
Methods
In
phase 1 a scoping search of two electronic databases (MEDLINE and PsychINFO)
was undertaken. Items included were themed and presented to members of a
stakeholder advisory group, who were asked to help prioritise the focus for
phase 2. In phase 2, 17 electronic databases (EconLit; ASSIA; BNI; Cochrane
Library; CINAHL; ERIC; EMBASE; HMIC; MEDLINE; PsycINFO; Scopus; Social Care
Online; Social Services Abstracts; Sociological Abstracts; OpenGrey; TRiP; and
Web of Science) were searched. Websites were explored and a call for evidence
was circulated to locate items related to the risks to young people in mental
health hospitals relating to ‘dislocation’ and ‘contagion’. All types of
evidence including research, policies and service and practice responses
relating to outcomes, views and experiences, costs and cost-effectiveness were
considered. Materials identified were narratively synthesised.
Results
In
phase 1, 4539 citations were found and 124 items included. Most were concerned
with clinical risks. In phase 2, 15,662 citations were found, and 40 addressing
the risks of ‘dislocation’ and ‘contagion’ were included supplemented by 20
policy and guidance documents. The quality of studies varied. Materials were
synthesised using the categories: Dislocation: Normal Life; Dislocation:
Identity; Dislocation: Friends; Dislocation: Stigma; Dislocation: Education;
Dislocation: Families; and Contagion. No studies included an economic analysis.
Although we found evidence of consideration of risk to young people in these
areas we found little evidence to improve practice and services.
Conclusions
The
importance to stakeholders of the risks of ‘dislocation’ and ‘contagion’
contrasted with the limited quantity and quality of evidence to inform policy,
services and practice. The risks of dislocation and contagion are important,
but new research is needed to inform how staff might identify, assess and
manage them.
Below: Phase 1 themes
By: Deborah Edwards1, Nicola Evans1, Elizabeth Gillen2, Mirella Longo3, Steven Pryjmachuk4,Gemma Trainor5 and Ben Hannigan1*
1School of Healthcare Sciences, College of
Biomedical and Life Sciences, Cardiff University, Cardiff, UK
2Information Services, Cardiff University,
Cardiff, UK
3College of Human and Health Sciences,
Swansea University, Swansea, UK
4School of Nursing, Midwifery and Social
Work, University of Manchester, Manchester, UK
5Greater Manchester West Mental Health NHS
Foundation Trust, Manchester, UK
