LAUSR

Aim A growing number of UK and international studies show a substantial rise in affective disorders in young people. In fact, a recent BMJ article described an ‘Adolescent Mental Health Crisis’. This increase had been noted in our district general hospital but had not yet been quantified. To better understand the needs of these patients and to improve our management, a ‘Working Group for Paediatric Mental Health Patients’ was set up locally. One of the early tasks was to undertake an audit of patients admitted with mental health issues, with particular focus on their admission clerking and risk assessment. Methods An audit of admissions between February and April 2018. Patients presenting with the following were included: Suicidal ideation, Deliberate self-harm (DSH), Overdose, Eating disorder, Depression and Behavioural issues. Excluded: Accidental overdose. Data on admission and ongoing management were collected. Our results were benchmarked against standard 3 of the RCPCH ‘Facing the Future’ audit – every child to be seen within 14 hours by a consultant. There was a paucity of standards for risk assessment in paediatric mental health patients. Results 41 admissions included (10 admissions for the same 4 patients). Average age: 13.8 years (range 7–15 years). 90% were female. 52% were attending hospital for the first time with mental health concerns. Mean length of stay 2.3 nights (range 1–17 nights). Main reason for admission: DSH and overdose. 73% required medical investigation. Key issues identified 60% not asked about suicidal ideation. No patient had their capacity commented on. 90% had no documentation about the need for an RMN/adequate risk assessment. 54% did not see a consultant within 14 hours of admission and 12.5% of patients were not seen by a consultant during admission. Only 49% were seen by CAMHS within 24 hours. Conclusion We need to improve our management of patients with mental health issues. In particular, improvement is needed in the admission clerking, risk assessment and in ensuring all patients are seen by a consultant within 14 hours. Following on from this audit, an admission proforma and risk assessment tool has been developed. A re-audit is planned for 3 months’ time.