Title: MAPS: Mental Health Admissions to Paediatric Wards Study
Funder: Department of Health and Social Care

Abstract: Some children and young people (CYP) become so unwell because of their mental health that they need an admission to hospital. Often this is firstly to a general children’s ward at their local hospital. Children’s wards and the health professionals working on them have always had this role, but recently (especially since the pandemic) the numbers of CYP needing to be admitted has increased. CYP also seem to be more unwell when they are admitted too – for example needing to be admitted under the mental health act or needing feeding tubes to provide fluids and nutrition. _x000D_ _x000D_ Children’s wards weren’t designed for this and sometimes the health care professionals working on them haven’t had enough training in looking after unwell CYP with mental health problems. Staff from children’s wards across the country are reporting that they are finding supporting CYP admitted with mental health problems really challenging. _x000D_ _x000D_ Even though this not a new problem there is very little research into CYP with mental health problems admitted to general paediatric wards. We don’t know the exact size of the problem, or what factors affect how well CYP do on wards. There is no research looking at the experiences of young people and their families when admitted to general children’s wards because of their mental health. This is important information at the moment as services are struggling to cope and the NHS needs to understand what needs to change to develop and improve care. _x000D_ _x000D_ We have designed a study to research this in detail. There are 4 parts. The first part will look at the information all hospitals in England provide to the NHS about admissions so we can investigate overall numbers and patterns for who gets admitted and if this differs across the country. In the second part, we will study 15 children’s wards across England to learn about admissions of CYP because of mental health in detail. We will first involve professionals, and CYP and families with experience of mental health admissions to help decide on what to study and measure at those wards. In the third part, we will interview CYP who were admitted because of their mental health from 5 of the 15 hospitals, as well as families and health professionals who looked after them. We will get information on their experiences of being admitted. The fourth part will happen at the end, bringing together what we have learnt. We will do this with a group of CYP, families, professionals and other stakeholders (such as representatives from national patient groups and professional groups) to come up with ways of communicating the information, and what recommendations to make. _x000D_ _x000D_ This research will be led by a team of children’s doctors, a psychiatrist, and nursing experts who are also researchers. We also have a young person who is part of the team who has experience of involving young people in research. We are also teaming up with national health bodies and royal colleges that are able to influence planning and care using our results. We will have a group of patients, families and professionals to advise throughout the study too who will meet frequently throughout the research._x000D_ _x000D_ We believe that this research is important and needed. It will look in detail at a really serious health care problem at the moment for how CYP are treated and have access and care for their mental health. It will impact positively by providing the information needed to develop the way care is provided for CYP and families.

Lay abstract: Children and young people (CYP) presenting with a mental health (MH) crisis are frequently admitted to general acute paediatric wards as a place of safety. Prior to the pandemic, a survey in England showed that 6% of general paediatric inpatient beds were occupied by CYP due to MH crisis, and there have been longstanding concerns about quality of care to support these patients in this setting. Since the pandemic there is evidence that both numbers of paediatric admissions and severity of CYP in MH crisis have increased, and paediatric teams are experiencing challenges delivering safe care. There is a general paucity of published data on CYP with MH crisis admissions to general paediatric wards including total numbers, factors associated with admissions, outcomes for CYP admitted and the impact of admissions on CYP, parents and professionals caring for them._x000D_ _x000D_ Aims and objectives _x000D_ _x000D_ We aim to generate a Theory of Change (ToC) model to positively impact upon quality of care for CYP presenting in a MH crisis to acute paediatric services who are admitted. To reach this aim, our objectives are to investigate: 1) national trends in admissions; 2) characteristics of admissions in terms of sociodemographic factors, diagnoses and reasons admitted 3) factors influencing decisions to admit CYP to paediatric wards for primary MH problems; 4) views and experiences of CYP, families and health professionals during admissions to paediatric wards. _x000D_ _x000D_ Research methods_x000D_ _x000D_ We will conduct a mixed methods study combining qualitative and quantitative data collection and analysis to inform a Theory Of Change (ToC) framework, this alongside a stakeholder group (consisting of patients, families, key professionals from health and social care, professional groupings such as royal colleges and commissioners). To achieve this, we will undertake several work packages (WP) over 30 months (Apr 2022-Mar 2024). WP1 will analyse national service level data (health episode statistics) of MH admissions to paediatric wards. WP2a we will undertake a rapid review, and will bring together the research team and stakeholder group, using a modified Delphi process, to develop our data collection instrument for WP2b. WP2b will be a prospective reporting system of MH crisis admissions from 15 paediatric wards in England over 6 months (planned sample size 720 cases). WP3 will be a qualitative study of the experiences of CYP admitted in MH crisis at 5 paediatric wards, as well as their families and staff members caring for them (planned sample size 36 CYP, 15 families and 36 professionals across a range of disciplines). Findings from the WPs will be brought together in WP4 (at 18 months) with the stakeholder group, so a final ToC can be developed with outputs agreed to achieve impact._x000D_ _x000D_ Outputs, dissemination_x000D_ _x000D_ We will publish papers from our findings for WP1, 2B and 3 to provide much needed additions to the published literature. We will also publish the overall synthesis of data in WP4 and the final ToC to improve care of CYP with MH crisis admitted to general acute paediatric settings. As co-producers of the ToC, we will work with our stakeholder group and collaborators to ensure wide dissemination of findings to effect change. Potential impacts will be upon service development, new models of care, training and workforce planning.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: MENTAL HEALTH