Access to emergency assessments for adolescent populations

Sir: The article by Corrigall and Mitchell (Psychiatric Bulletin, October 2002, 26, 388-392) provides a valuable contribution to the debate on emergency provision for adolescents with severe mental health difficulties. The authors describe a service offering emergency access 24 hours a day and 7 days a week. In 1995, “Pine Lodge” Young People's Centre in Chester set up just such a service (Cotgrove, 1997). In our experience, at times, an emergency admission adds nothing to the resolution of a young person's difficulties, but can result in a lost opportunity to enhance motivation through careful pre-admission objective setting and care planning. For this reason we perform our own assessment with a different emphasis which is not simply a duplication of the referrer's.

Alongside emergency admissions, we have continued to take planned admissions of young people with a wide range of complex disorders. However, treating youngsters with different needs within one unit is not without some cost to the therapeutic milieu and ward atmosphere.

It is vital that adolescent populations have access to emergency assessments and for some, immediate admission. However, I suggest that a range of inpatient services are required to meet the needs of adolescents with the most severe and complex disorders. Close working relationships between units, possibly to the extent of common assessment and admission pathways, can avoid fragmentation. Ideally, the service described by Corrigall and Mitchell should be seen as one in a network of services rather than an alternative to other specialist provision.