Alternatives to mental health admissions for children and adolescents experiencing mental health crises: A systematic review of the literature

Background: Many children and young people (CYP) presenting with mental health crises are admitted to hospital due to concerns around illness severity and risk. Whilst inpatient admissions have an important role for such children, there are a number of burdens associated with them, and safe avoidance of admissions is favourable. We systematically reviewed the literature for studies of interventions reported as alternatives to a hospital admission in CYP presenting with mental health crises, in any inpatient setting. Methods: Three databases (PsychInfo, PubMed and Web of Science) were searched for peer-reviewed papers in October 2020, with an updated search in May 2021. Results: We identified 19 papers of interventions delivered in the emergency department, the home, outside of home but outside of clinics and in hospital clinics. The quality of most included studies was low, with less than half being randomised controlled trials and only half of these at low risk of bias. The best quality studies and greatest evidence for efficacy came from in-home interventions, in particular multisystemic therapy, which improved psychological outcomes, and though a large number of CYP still ended up being admitted, there appeared to be decreased length of stay. Conclusions: Overall, we could not recommend a particular intervention as an alternative to inpatient admission; however, our review describes benefits across a range of types of interventions that might be considered in multi-modal treatments. We also provide recommendations for future research, in particular the evaluation of new interventions as they emerge.

The Long-Term Impact of Multisystemic Therapy: An Experiential Study of the Adolescent-Young Adult Life Transition

This qualitative study examines the possible long-term impact of multisystemic therapy (MST) as young people experience the transition from adolescence to young adulthood. MST is an intensive intervention aimed at reducing antisocial behavior among young people. Interviews were conducted with 32 young people aged 16 to 22 years at their 48-month follow-up as part of the Systemic Therapy for At-Risk Teens (START) evaluation trial in the United Kingdom. Sixteen participants had received MST while 16 received management as usual (MAU). Interviews addressed participants’ current life experiences and were analyzed with interpretative phenomenological analysis (IPA). The inductive qualitative analysis data were transformed into numerical data. Interview extracts were coded as either forward-looking and hopeful (“mature”) or static and frustrated (“stuck”). Among males, significantly more mature outcomes were found among participants who had received MST compared with MAU. No differences were seen between the female groups. A detailed qualitative commentary shows how the constructs, mature and stuck, are manifest across the four domains. The findings suggest that working with an MST therapist during adolescence helped young men cultivate more mature, forward-looking viewpoints and life activities 4 years later when transitioning into adulthood. Findings are discussed in relation to relevant theory and practical applications.

Alternatives to mental health admissions for children and adolescents experiencing mental health crises: a systematic review of the literature

Background: Increasingly more children and young people (CYP) present in mental health crises, many being hospitalised due to concerns around illness severity and lack of community services. To release the burden of admission, we systematically reviewed the literature on the effects of proposed alternatives to CYP in crises. Methods: Three databases (PsychInfo, PubMed and Web of Science) were searched for peer-reviewed papers in October 2020, with an updated search in May 2021. Results: We identified 19 papers of interventions delivered in the emergency department, the home, outside of home but outside of clinics and in hospital clinics. The best evidence came from in-home interventions, in particular multisystemic therapy (MST), which proved to be promising alternatives by improving psychological outcomes and decreasing length of inpatient stay. The quality of included studies was low, with less than half being randomised controlled trials and only half of these at low risk of bias. Conclusions: We could not recommend a particular intervention as an alternative to inpatient admission, however our review describes benefits across a range of types of inteventions that might be considered in multi-modal treatments. We also provide recommendations for future research, in particular the evaluation of new interventions as they emerge.

Identification of Multisystemic Therapy (MST) Subgroups with Distinct Trajectories on Ultimate Outcomes in Norway

The effect of Multisystemic Therapy (MST) treatment for serious behavior problems among adolescents has been established through multiple studies. However, variations across individuals should also be examined to better understand how MST works or for whom. In this study, we explored and identified subgroups of youth with serious problems in Norway regarding their responses to MST in terms of ultimate MST outcomes (e.g., living at home, abstaining from violence) over time. We further explored whether immigrant background, in addition to gender and age of the youth at intake, predicted belonging to the subgroups. Data came from 1674 adolescents (MeanAge = 14.55, SDAge = 1.58; 60.7% boys) and their families referred to MST treatment by the municipal Child Welfare Services for serious and persistent antisocial behavior. The outcomes were assessed at five time-points from intake to 18-months after discharge for youth and families who completed the treatment. Latent class growth analyses revealed heterogeneous trajectories regarding youths’ responses to MST. Results indicated a high and sustained degree of improvement across the ultimate outcomes for the vast majority of the youths. However, there was still variation in the groups, with improvement and deterioration trajectories for various outcomes. Most of these trajectories were predicted by gender and youth’s age at intake, but not by immigrant status. Not every youth-at-risk responds similarly to MST, and more studies examining heterogeneity will help us to identify factors to be targeted to better tailor the MST interventions for youth with serious problems.