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Inpatient services for young people

What type of inpatient care is best for young people?

This study is evaluating the effectiveness and cost of different models of inpatient care for young people with mental health problems. The early results show that an increasing proportion of this scarce resource is provided by the independent sector.


Detailed information

Title: Costs, Outcomes and Satisfaction for In-patient Child and Adolescent Psychiatric Services (COSI-CAPS)

Funded by NHS Service Delivery and Organisation National Research & Development Programme (SDO)

Ethical approval reference: MREC 04/6/23



Read the COSI CAPS Report




Different types of in-patient psychiatric care are provided for young people including NHS, independent, specialised, general and adult psychiatric wards (NICAPS, 2001). In-patient CAMHS are highly specialised and effective (Green et al, 2001) but costly services, which require central planning to ensure that they are available to all who need them. To facilitate this availability, we need to find out whether the different types of services for young people are contributing to their varying clinical and social outcomes. It is hoped that the findings to emerge from this study will influence the development of these specialist services.


Research question:

Do services differ in terms of their a) cost, b) clinical and social outcomes and c) the experience and satisfaction for the care received?




COSI-CAPS: Main findings and conclusions


1. In the absence of alternatives of proven effectiveness, there is a continuing role for CAMHS inpatient units in England

Young people admitted to inpatient units have more severe problems than those treated by existing community services, improve substantially during their inpatient stay and are generally satisfied with their care. However, these findings must be considered in the context of very limited research about the effectiveness, safety and cost of alternatives to inpatient care for young people in England. It is possible that some of the young people admitted to these units could have been cared for as well by intensive community services. For other young people such community services could shorten the duration of the hospital stay.


2. With the current configuration of services, the independent sector is an indispensable element of tier 4 CAMHS

It provides the commonest place for emergency admissions and produces outcomes that appear to be as good as those achieved by the NHS.


3. With respect to eating disorders, specialist units tend to admit young people with more severe problems than general adolescent units

At discharge, the severity of problems is the similar for both groups.


4. Clinical outcome is affected by treatment climate and specifically by ward atmosphere


5. Patients and parents place great value on the attitudes and interpersonal and communication skills of staff

These attributes might be actively considered at job interviews, discussed during supervision and might be assessed by eliciting feedback from young people and parents perhaps as part of a 360-degree assessment that might form one component of staff appraisal.


6. The use of agency nurses to cover shifts adversely affects young people’s experience of care

The last review cycle of the Quality Network for Inpatient CAMHS (QNIC) highlighted the problems faced by units with recruitment and recommended that unavoidable long-term absences should be covered by bank as opposed to agency staff.


7. The level of satisfaction experienced by patients and parents is influenced by the quality of information that units provide about the young person’s problem and treatment, and about the unit itself


8. Young people with an eating disorder have mixed feelings about whether it was better to be admitted to a specialist unit or to a general unit

With regard to the former, staff in specialist units should be aware that there can be counter-therapeutic interactions between young people with an eating disorder who live together.


9. It is feasible to collect information about clinical status and outcomes routinely for admissions to CAMHS units

The team that led the COSI-CAP study have worked with colleagues managing the Quality Network for Inpatient CAMHS (QNIC) to build on this by offering units the opportunity to continue with data collection as part of a system for allowing inpatient staff to monitor outcomes and compare casemix and outcomes with other units (see QNIC-ROM)



Health Services Research, Royal College of Psychiatrists, 4th Floor Standon House, 21 Mansell Street, London E1 8AA    





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