UK Edition
As many as seven in 10 children in some hospitals were admitted for mental health problems, amid a rise in admissions for eating disorders and depression across the country, according to a study.
A survey of paediatricians across England found that the vast majority had seen an increase in the number of children in hospital due to mental health disorders, compared to a year earlier, before the three national lockdowns.
The research, backed by The Royal College of Paediatrics and Child Health (RCPCH), will add to concerns about the impact of the Covid-19 pandemic and the resulting restrictions on the mental health of children.
Writing for The Telegraph, in an article published below, Dr Lee Hudson, chief of mental health at Great Ormond Street Hospital, and the study’s lead author, said: “So many children and young people have effectively been collateral damage in this pandemic and evidence suggests that it is the most vulnerable, socioeconomically, who have had the worst hit to their mental health.”
Dr Karen Street, a consultant paediatrician and child mental health officer at the RCPCH, and a co-author, said: “It is absolutely what paediatricians across the country are seeing.”
While there was a “significant drop” in the number of children arriving at hospitals with physical ailments during the three national lockdowns, “what we did see was more and more children and teenagers presenting with acute mental health problems”, Dr Street said.
Last week, The Telegraph revealed forecasts from the Centre for Mental Health, involving NHS economists, which stated that an extra 1.5 million children and young people would require mental health support “as a direct impact of the pandemic” during the next three to five years. Separately, it emerged that the number of children taking antidepressants has soared to an all-time high.
The study found that “a majority of respondents felt that access to inpatient mental health support was inadequate, poor or non-existent,” suggesting that hospitals were not adequately set up to care for the increase in young mental health patients.
The study cites a 2019 survey which found that just 6 per cent of general paediatric inpatient beds in the UK were occupied by children and young people – generally defined as under 18s, or in some cases under 25s – with a mental health disorder.
But of 36 paediatricians who responded to the new survey, 15 (42 per cent) said that up to a quarter of children and young people admitted to the paediatric ward at their hospital between January and March 2021 were there because of a mental health disorder, while 14 (39 per cent) said the proportion was between a quarter and a half of patients. Two paediatricians (6 per cent) said that more than three quarters of beds were taken up by children with a mental health disorder.
Dr Street added that paediatricians had observed a “significant rise in young people with eating disorders who had become really physically unwell, but also an increasing number of children and young people presenting in crisis, either from trying to self-harm or because they were feeling suicidal or struggling to cope.
“There’s lots of work going on now to try to understand it better. But we can’t really underestimate the impact on young people of everything that has happened over the last 18 months. It is a combination of their lives changing, losing contact with friends, losing normal activities, being worried about education, not being able to access education at home, difficult home circumstances with families losing jobs and income and sadly losing older relatives. A combination of all these factors have put additional stress on young people.”
Dr Hudson added: “For the first time in generations, our young people have been asked to sacrifice much, and at large scale, to protect the rest of society. As we move forwards and rebuild, we owe it to them to do our utmost to do right by them, especially when they present in crisis.”
These are children who are so unwell they cannot go home
The mental health of children and young people was already deteriorating before the pandemic but it is clear that for many, it has significantly worsened, writes Lee Hudson. Data from the NHS’s own digital study showed that proportions of children with a likely disorder increased from 10 per cent in 2017 to 16 per cent in July 2020.
Our survey, which asked paediatricians across England about admissions to general children’s wards for mental health problems, speaks not only to increases in numbers, but also to just how unwell these children and young people are. These admissions happen when they are too unwell to go home – for example because the risk they pose to themself is so high, or because they are so severely malnourished from an eating disorder.
I should sound a note of caution – those surveyed are from a network of paediatricians already linked to eating disorder teams, and were asked to provide estimates – but our findings are in keeping with what many paediatricians are saying across the country.
Such admissions need a high level of clinical support and are very challenging for children and the teams treating them – for example, extra nurses needed to protect and support patients and sometimes the need to feed them through a tube because they are unable to eat. Some are admitted by applying the law (via the Mental Health Act) and may need to be restrained, so the frequent reports of the lack of mental health professional back-up is concerning.
It isn’t difficult to imagine how the pandemic has had such an impact on children’s mental health – particularly if they are in families which are under strain, or if they are separated from friends and broader family. But increased admissions are also a sign of a system under intense strain, too. The severity and sheer numbers of children, combined with a lack of inpatient mental health beds, means that children’s wards are often the only place of safety left for these children.
It seems unlikely that this is a problem that will go away soon, and teams who work on children’s wards have always provided this kind of support but to a lesser degree.
Now is the time to rethink and plan how children and young people who need a mental health crisis admission are managed. The NHS and the Government have put more resource into mental health, but this feels like a corner of the jigsaw that has been missed. It requires better integrated care, and services that fit around children and young people, not the other way around.
I’m struck by how so many children and young people have effectively been collateral damage in this pandemic and evidence suggests that it is the most vulnerable, socioeconomically, who have had the worst hit to their mental health. For the first time in generations, our young people have been asked to sacrifice much, and at large scale, to protect the rest of society. As we move forwards and rebuild, we owe it to them to do our utmost to do right by them, especially when they present in crisis.
Lee Hudson is clinical associate professor at the Great Ormond Street UCL Institute of Child Health and chief of mental health at Great Ormond Street Hospital