Purpose of the research
The mental health of children and young people is a major public health issue both in the UK and internationally. In 2024, the Royal College of Psychiatry reported that in 2023 there was a 50% increase in emergency referrals of young people needing to be seen within 24 hours (RCPsych 2024). Following emergency referrals, children and young people may be treated within inpatient (hospital), crisis and/or intensive home-based mental health care. These are sometimes referred to as Tier 4 Child and Adolescent mental health services (T4 CAMHS), Children and young people’s inpatient mental health services (CYPIMHS) or more recently enhanced specialist support services (CYP MH enhanced specialist support services).
NHS England’s children and young people mental health inpatient task force has acknowledged that inpatient provision is not currently of high enough quality and are engaged in a programme of transformation (CYP IMHS Task group; NHS England 2020). The task group charter highlighted an ambition to reduce inappropriate admissions and provide evidence-based outcomes-led intervention for young people. Following consultation with carers, young people, providers and commissioners, they have now set out principles for improving practice, such as developing flexible intensive therapeutic environments available in the localities in which young people live, and that can provide integrated specialist care for the needs of young people. This Is a change from previous working practices where children and young people would have been located in separate general adolescent inpatient units (GAU), eating disorder services (EDS), psychiatric intensive care units (PICU), low secure services (LSU), and services for CYP with underlying learning disability and neurodiversity.
The problem is the historic lack of research priority and interest given to specialist inpatient and intensive mental health interventions for young people means that there is little research evidence upon which to start building a plan for realising these principles in practice. From a research perspective little is known about the barriers and enablers to operationalising them. In terms of children and young people’s experiences of receiving care in inpatient and other intensive mental health services, the limited research to date shows the need for further exploration. Studies highlight a complex picture in which inpatient units seem to provide an important stabilising environment for some young people, without clarity about exactly how this is achieved, whilst also posing significant risks for other young people and moral distress for the staff that work in them (Matthews & Williamson 2016; Hayes et al. 2017).
The Landscape study
The Landscape study is examining the current provision for children and young people’s inpatient mental health care in England and Wales. The research study is addressing a gap in our collective understanding of care quality and outcomes for children and young people receiving intensive therapeutic mental health care in CYPIMHS or alternatives.
The research aims to identify gaps in the current evidence base; to establish a comprehensive understanding of how care provision for children and young people experiencing acute and complex mental health needs is currently organised, implemented, and used in the UK; and to identify barriers and enablers to effective child-led intensive mental health care provision.