Admission to acute medical wards for mental health concerns among children and young people in England from 2012 to 2022: a cohort study

Abstract

Background

There are challenges in providing high quality care for children and young people who are admitted to acute medical wards for mental health concerns. Although there is concern that these admissions are increasing, national data describing these patterns are scarce. We aimed to describe trends in these admissions in England over a 10-year period, and to identify factors associated with repeat admission and length of stay.

Methods

In this cohort study we used data on all admissions to medical wards in England among children and young people aged 5–18 years from April 1, 2012, to March 31, 2022. We classified admissions for mental health concerns using the Global Burden of Disease Study cause hierarchy. We described national trends in admissions for mental health concerns over time by sex, age, ethnicity, and index of multiple deprivation quintile. We examined associations between sociodemographic and clinical factors and odds of the admission lasting more than 1 week, as well as hazard ratios of repeat admissions, using mixed-effects models.

Findings

We identified 342 511 admissions for any cause in children and young people aged 5–18 years in 2021–22 in England, of which 39 925 (11·7%) were for mental health concerns. 21 337 (53·4%) admissions for mental health concerns were due to self-harm. Between 2012–13 and 2021–22, annual admissions for mental health concerns increased from 24 198 to 39 925 (65·0% increase), whereas all-cause admissions increased from 311 067 to 342 511 (10·1% increase). Increases were particularly steep in females aged 11–15 years, rising from 9091 to 19 349 (112·8% increase), and for eating disorders, rising from 478 to 2938 (514·6% increase). In 2021–22, 3130 (7·8%) admissions for mental health concerns lasted longer than 1 week, compared with 12 044 (3·5%) all-cause admissions. Of 239 541 children and young people who were admitted for mental health concerns between 2012–13 and 2021–22, 32 107 (13·4%) had a repeat admission within 6 months. The odds of long-stay admission and hazard ratios for being readmitted were significantly higher for children and young people aged 11–15 years, those who were female, those from less deprived areas, and those with eating disorders than among other groups.

Interpretation

We found large increases in the number of children and young people admitted to acute medical wards for mental health concerns over a 10-year period. Further work is needed to understand factors driving these trends and how to improve care for children and young people with mental health concerns admitted to medical wards.

Funding

National Institute for Health and Care Research