In-patient mental health services for young people--changing to meet new needs?

There is currently considerable interest in consulting with young people and involving them in the development and delivery of mental health services--both at the local and national level. This is a welcome development since, as various studies have highlighted, young people can offer both valuable insights into the services they receive and suggestions for what they want from services. In 2003, YoungMinds, a national charity that works to promote children's mental health, completed a two-year, in-depth qualitative study focused on a sample of in-patient units drawn from across England and Wales. Such units, found at Tier 4 (the most severe or complex problems) within Child and Adolescent Mental Health Services (CAMHS) provide highly specialist care and treatment to some of the most seriously ill and vulnerable children and young people. A key aim of the study was to give a 'voice' to these young people in order to help in-patient services develop their provision in ways that are possibly more 'young-person friendly'. Alongside this, information from staff working both within in-patient units and the community was gathered, to provide an important contrasting perspective and to build up understanding of the current pressures and challenges that face service providers in this area. In total, data was gathered from 107 young people, 35 parents and 169 staff. Information from a number of other services was also compiled to provide case study illustrations of some new models of in-patient care now emerging. Multi-centre Research Ethics Committee approval was gained for the study, with considerable attention being paid to the design of clear 'young person' friendly information sheets, consent forms and questionnaires. Much attention was also paid to explaining how information would be used and confidentiality respected. The study findings reveal a picture of considerable change--of improvements but also continuing service gaps. Most importantly, there was a high level of consistency amongst young people as to the areas of greatest concern and many highly realistic, practical suggestions and requests for how in-patient provision for young people should be improved. This article outlines some of the issues raised by young people and in particular highlights the importance of information sharing and of in-patient units being properly staffed. The need for inter-agency links and coordination between in-patient and community based mental health services is also emphasised.