The external advisory panel for the Landscape study comprises a range of professionals, service users, providers and commissioners in the field of children and young people’s mental health services across the UK. The panel informs multiple aspects of the research design and conduct. One aspect is on research prioritisation. This blog post gives a summary of the panel’s discussion and insight on areas for research in mental health inpatient and intensive care for young people. This information is shared to benefit the wider research community.
The panel met in March 2025. At this meeting, the external advisory panel reflected on challenges and evidence gaps, and what data needs to be generated to answer key questions. The panel recognised the significant systemic and operational challenges in intensive and inpatient psychiatric service provision for children and young people’s mental health
The panel expressed concerns about a perceived national approach for inpatient services for children and adolescents that is reactive rather than needs-driven and suggested a need for an approach that is more child and adolescent friendly. This means equipping the workforce with further training on child development, attachment, trauma informed training to better support the health needs of patients who have experienced adverse childhood experiences. The panel highlighted the usefulness of experts with lived experience in giving feedback on what has worked and what has not worked for them in practice.
The panel highlighted inconsistencies among providers due to varied commissioning strategies and differing care models, especially from independent providers. Local variations in how service specifications are interpreted and implemented across units was also highlighted as service specification can influence type of patient treated. These inconsistencies alongside increasing emergency admissions lead to reflection on appropriate thresholds for inpatient versus community care. In discussing admission pathways, the panel noted complexities such as young people’s transfers between Psychiatric Intensive Care Units (PICU) and Low Secure Units (LSU) based on clinical needs and environmental considerations, and the impact of restricted access to local inpatient beds (i.e. near to where the young person lives). The panel queried whether young people are being treated in settings wit a higher level of security and restriction than needed,due to not enough alternative provision to inpatient settings such as intensive day services, day hospitals, residential settings.
Another key discussion point was on care for ethnically diverse populations and for young people with neurodiversity and high-risk self-harm behaviours. The panel reflected on disparities in care for ethnically diverse populations, noting insufficient accommodation of cultural and faith considerations. For young people with neurodiversity and high-risk self-harm behaviours, the panel expressed concerns regarding increasing admissions of young people who present challenges in standard acute wards. The panel suggested a need for clearer definitions and alternative approaches to General Adolescent Units (GAUs), particularly regarding neurodiversity and learning disabilities.
The panel expressed concerns about the psychological impact of restrictive practices and rapid tranquilisation, which are designed to be used as a last resort for short periods to ensure young people safety at times of mental health crisis, on both patients and staff. Theyexpressed concerns about high staff turnover and compromised staffing levels. Lastly, the challenges related to late admissions and limited transitional safeguarding mechanisms for adolescents reaching adulthood were also highlighted. The panel suggested that the 12-18 and 18-+ framework may create unhelpful transition scenarios.
The External advisory panel for The Landscape Study provides an important contribution in the design and conduct of the project throughout the project’s life course. The summary provided here is the research team’s interpretation and understanding of the panel’s discussion.
Written by Dr Isabel Adeyemi