The Staffing of Inpatient Child and Adolescent Mental Health Services.

BACKGROUND: There is a need for more accurate information regarding the staffing of Child and Adolescent Psychiatric inpatient units. This is both to facilitate clinical governance and to allow planning and focused further development of these services. METHOD: Postal surveys were sent to all units in England and Wales. RESULTS: Seventy-three percent (n = 1060) of the 1460 staff employed by the units were nurses; 43% of nurses were unqualified. On average there was one consultant psychiatrist for every 25 patients. Only 12% of nurses working on a 'census' day held a specialist qualification in nursing children. The use of agency and bank staff was higher in independent sector units than in NHS units (37% vs 10% of all nurses who worked a shift on the census day). CONCLUSIONS: Some child and adolescent inpatient units are not staffed by a multi-disciplinary team. There is evidence of problems of recruitment and retention of nurses.

Distribution and characteristics of in-patient child and adolescent mental health services in England and Wales.

BACKGROUND: Little is known about the current state of provision of child and adolescent mental health service in-patient units in the UK. AIMS: To describe the full number, distribution and key characteristics of child and adolescent psychiatric in-patient units in England and Wales. METHOD: Following identification of units, data were collected by a postal general survey with telephone follow-up. RESULTS: Eighty units were identified; these provided 900 beds, of which 244 (27%) were managed by the independent sector. Units are unevenly distributed, with a concentration of beds in London and the south-east of England. The independent sector, which manages a high proportion of specialist services and eating disorder units in particular, accentuates this uneven distribution. Nearly two-thirds of units reported that they would not accept emergency admissions. CONCLUSIONS: A national approach is needed to the planning and commissioning of this specialist service.

Variations in the costs of child and adolescent psychiatric in-patient units.

BACKGROUND: Child and adolescent in-patient care is a highly specialised service, ideally requiring planning at a national level, but there are no routine data collections specifically for these services. AIMS: To estimate unit costs for child and adolescent psychiatric in-patient units and to analyse the variations in costs between units. METHOD: Data collection alongside a national survey with cost estimations guided by principles drawn from economic theory. Bivariate and multivariate analyses are employed to identify cost influences. RESULTS: Fifty-eight units could provide sufficient data to allow calculation of the cost per in-patient day; mean= pound 197 (s.d.=71.6; 1999-2000 prices). The management sector, type of provision, number of rooms, capacity and location explained nearly half of the cost variation. CONCLUSIONS: Child and adolescent psychiatric in-patient units are an expensive resource, with personnel absorbing two-thirds of the total costs. Costs per in-patient day vary fourfold and the exploration of cost variations can inform commissioning strategies.

Characteristics of the Detained and Informal Child and Adolescent Psychiatric In-Patient Populations.

BACKGROUND: This project surveyed the use of the Children Act and the Mental Health Act in in-patient child and adolescent mental health services in England and Wales. METHODS: Data were collected as a day census from child and adolescent psychiatric inpatient units, questionnaire forms completed by consultant psychiatrists or key-workers. Returns were received from 71 of the 80 units. RESULTS: One hundred and twenty-seven of the 663 patients had been admitted formally, the great majority under a section of the Mental Health Act. Compared with those admitted informally, those admitted formally were older, contained a higher proportion of males and had 'adult-type diagnoses', mainly schizophrenia, mood disorders and personality disorder. The clinical and psychosocial characteristics of formal and informal patients were consistent with these differences. CONCLUSIONS: This study provides a timely and useful snapshot of the use of the Acts in this population.