Inpatient treatment in child and adolescent psychiatry – a prospective study of health gain and costs

Background: Inpatient treatment is a complex intervention for the most serious mental health disorders

in child and adolescent psychiatry. This is the first large-scale study into its effectiveness and costs.

Previous studies have been criticised for methodological weaknesses. Methods: A prospective cohort

study, including economic evaluation, conducted in 8 UK units (total n ¼ 150) with one year follow-up

after discharge. Patients acted as their own controls. Outcome measurement was the clinician-rated

Childhood Global Assessment Scale (CGAS); researcher-rated health needs assessment; parent- and

teacher-rated symptomatology. Results: We found a significant (p < .001) and clinically meaningful

12-point improvement in CGAS following mean 16.6 week admission (effect size .92); this improvement

was sustained at 1 year follow-up. Comparatively, during the mean 16.4 week pre-admission period

there was a 3.7-point improvement (effect size .27). Health needs assessment showed similar gain

(p < .001, effect size 1.25), as did teacher- and parent-rated symptoms. Improvement was found across

all diagnoses. Longer stays, positive therapeutic alliance and better premorbid family functioning

independently predicted better outcome. Mean cost of admission was £24,100; pre-admission and postdischarge

support costs were similar. Conclusions: Inpatient treatment is associated with substantive

sustained health gain across a range of diagnoses. Lack of intensive outpatient-treatment alternatives

limits any unqualified inference about causal effects, but the rigour of measurement here gives the

strongest indication to date of the positive impact of admission for complex mental health problems in

young people. Keywords: Child, adolescent, psychiatry, inpatient, outcomes, costs.