Child and adolescent in-patient units – room for expansion

We read with interest the concerns expressed in a recent article by Cotgrove et al (Psychiatric Bulletin, December 2007, 31, 457–459). The Ashfield Unit is an adolescent unit able to accept emergency admissions that opened in 2003 in recognition of a lack of emergency provision leading to delayed admissions and inappropriate use of paediatric or adult psychiatric wards. Our experience since opening has been in contrast to the concerns expressed by Cotgrove et al. We have not had inappropriate admissions and there have been no difficulties with recruitment and retention of staff.

What has been unexpected is the high level of violence, aggression and risk to others in some young people. This may be similar to the experience in adult psychiatry in recent years, with only the most disturbed patients being referred for admission into in-patient psychiatric units. There has been a higher than expected need for intensive nursing care in a low-stimulus environment – a third of our young people presenting with psychosis required the use of the intensive nursing area at some point in their admission (Cullen et al, 2006).

Although O’Herlihy et al in their paper (2007) demonstrate a dramatic increase in forensic provision, we would recommend an increase in provision of a spectrum of psychiatric intensive care units for adolescents alongside general and acute adolescent in-patient units, which could be used flexibly to allow the young person to be rehabilitated back onto an open ward as soon as possible.