At any given point of time, it is estimated that one in every 4–5 people under the age of 18 suffers from a psychiatric disorder (Costello, Mustillo, Erkanli, Keeler, & Angold, 2003; Jaffee, Harrington, Cohen, & Moffitt, 2005). Although most children and adolescents with behavioral problems can be managed at their natural environment, a significant minority of this population need to be admitted to inpatient facilities (Blader, 2004, 2011; Case, Olfson, Marcus, & Siegel, 2007; Glick, Sharfstein, & Schwartz, 2011). Residential facilities for children and adolescents, mainly applying discipline to delinquent youth and general care for mentally retarded orphans, have existed in the US since the nineteenth century (Jemerin & Philips, 1988). More therapeutically oriented facilities have not been established till 1930s and 1940s (Association, 1957; Harper, 1987; Jemerin & Philips, 1988; Lewis, 1985). In other parts of the world, Child and adolescent inpatient services have developed from the theoretical concept of “therapeutic milieu” that aims to shape the behavior of youth at early stage of personality development (Kennard, 1983).
In the second half of the twentieth century, the availability of child psychiatric inpatient services increased rapidly in the US and Europe, with several changes in trends of admission, quality of care and targeted population (Worrall-Davies, 2015). An increasing number of admissions, shorter length of stay, with multiple changes in diagnostic patterns of youth in need for admission was reported in several studies. For example, a comprehensive study of overall psychiatric admissions in the US between 1996 and 2007 showed much more increase (180%) in children, and adolescents (141%), as compared to adults (108%) (Blader, 2011). In 2014, approximately 606,000 adolescents received inpatient or residential specialty mental health services in the US (Rachel N. Lipari, 2016). The number of psychiatric inpatient beds dedicated to adolescents in England and Wales increased from 900 beds in 1999 to 1128 beds by 2006, with increase in adolescent only unit and general units (i.e. units which admit both children and adolescents) but 30% decrease in units dedicated only to children under 14 years of age (O'Herlihy et al., 2018). Inpatient admission rates for children and adolescents also increased by 38.1% in Germany between 2000 and 2007 with a sharp increase of cases for depressive disorders (219.6%) and hyperkinetic disorders (111.3%) (Holtmann et al., 2010). A recent study from Spain also reported an increase of youth under 18 years old admitted to psychiatric units from 27,7 per 100000 inhabitant in 2005 to 49.8 per 100000 inhabitant in 2015 (Llanes-Alvarez et al., 2019). In a study carried out in a French public hospital, 2.0% of the children and adolescents cared for in the emergency department were admitted to the psychiatric emergency department (Boyer et al., 2013).
A retrospective meta-analysis of 34 studies (Pfeiffer & Strzelecki, 1990), in addition to a prospective one-year follow up study (Green et al., 2007) all highlighted meaningful clinical improvement with child and adolescent psychiatric inpatient treatment across all diagnostic categories. Two long-term follow up studies (Fuchs et al., 2016; Healy & Fitzgerald, 2000) reported that most of children and adolescents admitted to inpatient psychiatric units still met the criteria of psychiatric disorders during their adulthood but only 26% of these patient were readmitted to psychiatric inpatient units as adults. Despite the widespread use of inpatient services for children and adolescents with mental health problems in developed countries, the costs and benefits of such practice and the call for alternative approaches to deal with their problems in less restrictive settings have been the focus of a long, ongoing debate among experts (Boge, Schepker, & Fegert, 2019; Branik, 2001; Edwards et al., 2015; Glick et al., 2011; Mattejat, Hirt, Wilken, Schmidt, & Remschmidt, 2001). In a randomized controlled study in two German centers for child and adolescent mental health, authors concluded that residential treatment can be replaced by home treatment with no significant differences in therapeutic outcome in at least 15% of those patients treated in inpatient setting (Mattejat et al., 2001). In 2008, a systematic review (Shepperd et al., 2009) identified eight worldwide commonly used alternative models to inpatient care for youth with complex mental health needs, such as multisystemic therapy, day hospitals, intensive specialist outpatient service. However, a more recent review reported high levels of parental burden and complex emotional reactions associated with engagement with such alternative interventions (Vusio, Thompson, Birchwood, & Clarke, 2019).
A review of potential risks that affects children and adolescents using inpatient child and adolescent mental health services in the UK concluded that dislocation from normal life, together with stigmatization, are the main potential risks caused by hospitalization of youth with severe psychiatric problems. However, the same review reported little evidence supports the existence of better options to care for this population other than inpatient setting (Edwards et al., 2015). In another study, a sample of adolescents interviewed within 7 days of discharge from their first psychiatric hospitalization, the participants reported "a little" stigma towards their admission (Moses, 2011). Having an assisted transition from an inpatient psychiatric service to school and open community was found to facilitate the re-integration of discharged youth into their natural environment and decreased rates of re-admission (Weiss et al., 2015)
Few studies explored the characteristics of children and adolescents admitted to psychiatric inpatient units outside the US and Europe (Bharath, Srinath, Seshadri, & Girimji, 1997; Jacob, Seshadri, Girimaji, Srinath, & Sagar, 2013). An early study from India (Bharath et al., 1997), the most common diagnoses among admitted children were hysterical neurosis (30.8%), psychoses (25.2%), conduct disorder (10.5%) and hyperkinetic syndrome (9.8%) with average duration of stay was 4–12 weeks. Egypt population was recently estimated to exceed 100 million people, with approximately 43% of this number aged less than 19 years ((CAPMAS), 2018). However, there is absence of studies reporting the case of admission of children and adolescents into specialized psychiatric inpatient services in Egypt and the Arab region. The first specialized university-affiliated psychiatric inpatient unit for both children and adolescents was started in Tanta psychiatry and neurology center in 2013 to serve a wide catchment area of about 13 million people. The unit included 10 beds for both children and adolescents while 7 more beds were later added in 2017 to serve adolescents only. In a previous report (Seleem, Amer, Romeh, & Hamoda, 2019), our team described the demographic and clinical characteristics of children seeking psychiatric advice in our outpatient service. The current study aims to identify the demographic and clinical correlates of admission into our psychiatric inpatient unit for children and adolescents.