A clinical study of child mental health inpatient care

Abstract

Objectives To explore whether admissions to a child mental health inpatient unit in a tertiary care paediatric hospital were justified and estimate whether inpatient unit provided a beneficial service to patients and their families.Method A retrospective analysis of 191 consecutive admissions to unit over 15 months. Relevant information was obtained from clinical case notes recorded and maintained during hospital stay. Additional data was obtained from standardized assessment schedules used for validation of diagnoses and neuropsychological assessment carried out during admission.Results Ages ranged from 2-12 years. Most patients were referred by paediatricians. Medically unexplained somatic symptoms and disruptive behaviour were the most prevalent presenting features. Multidisciplinary approach to care and objectively supported assessment and intervention strategies were beneficial in over 80% of patients. Average duration of hospitalisation was 6.4 days. None dropped out of treatment. There was a 12% readmission rate and an 18.4% unsatisfactory rating for outcome.

Psychiatric Illness in the Paediatric Population Presenting to a Psychiatry Clinic in a Tertiary Care Centre

“…16,17 It has been argued that the cross-cultural variation in rates of the disorder is related to the possibility that Indian culture discourages direct expression of emotional distress, and physical symptoms are a common way of expressing psychological distress. 18,19 We did not find specific child psychiatric illnesses such as Specific Learning Disability (SLD), Attention Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorders, Mental Retardation as noted in the Pakistan study 10 and other inpatient and Child Guidance Clinic Based studies. 14,19 The reason may be that our sample pool is from a recently developing psychiatric unit dealing mainly with general psychiatric outpatients only.…”

“…18,19 We did not find specific child psychiatric illnesses such as Specific Learning Disability (SLD), Attention Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorders, Mental Retardation as noted in the Pakistan study 10 and other inpatient and Child Guidance Clinic Based studies. 14,19 The reason may be that our sample pool is from a recently developing psychiatric unit dealing mainly with general psychiatric outpatients only.…”

“…Similar findings were seen in various other studies. 14,19 This can be explained by the fact that most of the paediatric population visits other specialists, mainly paediatricians rather than directly coming to the psychiatric care as reported in the study done at BPKIHS. 8 On evaluating the presence of other physical illnesses, the maximum number (30%) was seen in seizure disorder, while the lowest number of physical findings were seen in patients with dissociative disorder attaining statistical significance (p-value<0.001).…”

Primary care access and feasibility of Spatial Accessibility Index (SAI) in assessing primary care in rural Sri Lanka

“…Though the quality of service delivery at private hospitals was widely discussed in Sri Lankan health system-related studies (15,26) attribution of private allopathic PCD was overlooked due to lack of accurate databases (27). Although state healthcare staff was distributed proportionate to the patient capacity of the healthcare facilities, dismissal of spatial accessibility of the facilities has led to a disproportionate division of the healthcare workforce in the country.…”

“…Primary Medical Care Units (PMCU), Divisional Hospitals (DH), Outpatient Departments (OPD) of Base Hospitals (BH) and OPD of the Teaching Hospital (TH) serve as the main state sector primary care facilities (PCF) providing curative services in Anuradhapura (14). The private sector for curative care comprises private hospitals with OPD services and private sector allopathic practitioners, often referred to as general practitioners or GP, who are state medical officers practicing outside regular working hours (15). Preventive PHC services are provided through a state services consisting of a team led by the Medical Officer of Health (MOH).…”