Aspects of separate psychiatric care for adolescents: A review of adolescent inpatient care and propositions for future efforts

Abstract

Background: Adolescence, the transitional phase between child- and adulthood, represents a sensitive period. Vulnerability to mental illness is thus increased at a young age. Chronicity and impairments must be prevented through targeted interventions. In addition, the developmental processes taking place at this age, e.g. identity development, ought to be taken into account simultaneously. Adolescents seem to be too old for child and adolescent psychiatry and too young for adult psychiatry. The need for a distinct treatment program for this age group is already discussed in the literature. However, so far it presents to be difficult to summarize which characteristics such an offer must contain. Methods: In the present review, we selected and evaluated relevant literature regarding our research questions. We performed a thorough web- and data-based search (databases PubMed, PsycInfo and Google Scholar) of peer-reviewed journals on a variety of relevant key terms. Based on the studies, we provide an overview of the various aspects that appear to be of importance. In addition, keywords were developed in order to subsequently establish guiding categories for practical implementation. Results: 30 peer-reviewed articles were identified that matched the agreed-on screening criteria. The following important categories could be formed: Therapeutic characteristics of an adolescent ward, Structural framework on the ward, Psychosocial support, Family involvement, Inclusion of outpatient facilities, Multidisciplinary team, Professional training opportunities, Structure in care system, Further research and Environmental context. We ordered the categories according to their relevance. Discussion: By forming the categories, it was possible to create an overview of the most frequently mentioned relevant aspects for transitional psychiatry in the literature. Despite the fact, that adolescence psychiatry is increasingly coming into focus, research is scarce. Specifically, there is a lack of explicit practice approaches and models. Therefore, we suggest that further studies should be conducted to review and produce reliable manuals that support the elements we have distinguished in this review. The established categories can be further used as a basis for an implementation into practice. However, empirical verification is pending, which is a limitation of this work. Conclusions: A deeper understanding of relevant treatment characteristics for the transitional age group may not only enable a tailored treatment approach but may also facilitate the implementation of separate psychiatric wards for adolescents. This literature review identified several aspects that appear to be of importance in the psychiatric treatment of adolescent patients. Considering the alarming increase in psychiatric disorders worldwide, new treatment programs targeted at the transitional age group should be developed to reduce the manifestation and preservation of mental disorders.