Alternatives to mental health admissions for children and adolescents experiencing mental health crises: A systematic review of the literature

Alternatives to mental health admissions for children and adolescents experiencing mental health crises: A systematic review of the literature

Background: Many children and young people (CYP) presenting with mental health crises are admitted to hospital due to concerns around illness severity and risk. Whilst inpatient admissions have an important role for such children, there are a number of burdens associated with them, and safe avoidanc...

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Published in:Clinical Child Psychology and Psychiatry Vol. 27; no. 1; pp. 35 - 60
Main Authors: Clisu, Denisa A, Layther, Imogen, Dover, Deborah, Viner, Russell M, Read, Tina, Cheesman, David, Hodges, Sally, Hudson, Lee D
Format: Book Review Journal Article
Language:English
Published: London, England SAGE Publications 01-01-2022
SAGE PUBLICATIONS, INC
Subjects:
Adolescent
Alternatives
Avoidance behavior
Child
Child & adolescent psychiatry
Children
Clinical outcomes
Clinics
Crises
Efficacy
Emergency Service, Hospital
Emergency services
Hospitalization
Humans
Inpatient care
Intervention
Length of stay
Literature reviews
Mental Health
Multisystemic therapy
Patient admissions
Psychotherapy
Special Issue: Covid-19
Systematic review
Youth
adolescent
inpatient admissions
crisis
Child
mental health
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Summary:Background: Many children and young people (CYP) presenting with mental health crises are admitted to hospital due to concerns around illness severity and risk. Whilst inpatient admissions have an important role for such children, there are a number of burdens associated with them, and safe avoidance of admissions is favourable. We systematically reviewed the literature for studies of interventions reported as alternatives to a hospital admission in CYP presenting with mental health crises, in any inpatient setting. Methods: Three databases (PsychInfo, PubMed and Web of Science) were searched for peer-reviewed papers in October 2020, with an updated search in May 2021. Results: We identified 19 papers of interventions delivered in the emergency department, the home, outside of home but outside of clinics and in hospital clinics. The quality of most included studies was low, with less than half being randomised controlled trials and only half of these at low risk of bias. The best quality studies and greatest evidence for efficacy came from in-home interventions, in particular multisystemic therapy, which improved psychological outcomes, and though a large number of CYP still ended up being admitted, there appeared to be decreased length of stay. Conclusions: Overall, we could not recommend a particular intervention as an alternative to inpatient admission; however, our review describes benefits across a range of types of interventions that might be considered in multi-modal treatments. We also provide recommendations for future research, in particular the evaluation of new interventions as they emerge.
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ISSN:1359-1045
1461-7021
DOI:10.1177/13591045211044743