Lockdown during the pandemic has had significant impacts on public mental health. Previous studies suggest an increase in self-harm and suicide in children and adolescents. There has been little research on the roles of stringent lockdown.

To investigate the mediating and predictive roles of lockdown policy stringency measures in self-harm and emergency psychiatric presentations.

This was a retrospective cohort study. We analysed data of 2073 psychiatric emergency presentations of children and adolescents from 23 hospital catchment areas in ten countries, in March to April 2019 and 2020.

Lockdown measure stringency mediated the reduction in psychiatric emergency presentations (incidence rate ratio of the natural indirect effect [IRRNIE] = 0.41, 95% CI [0.35, 0.48]) and self-harm presentations (IRRNIE = 0.49, 95% CI [0.39, 0.60]) in 2020 compared with 2019. Self-harm presentations among male and looked after children were likely to increase in parallel with lockdown stringency. Self-harm presentations precipitated by social isolation increased with stringency, whereas school pressure and rows with a friend became less likely precipitants. Children from more deprived neighbourhoods were less likely to present to emergency departments when lockdown became more stringent,

Lockdown may produce differential effects among children and adolescents who self-harm. Development in community or remote mental health services is crucial to offset potential barriers to access to emergency psychiatric care, especially for the most deprived youths. Governments should aim to reduce unnecessary fear of help-seeking and keep lockdown as short as possible. Underlying mediation mechanisms of stringent measures and potential psychosocial inequalities warrant further research.

Specialised inpatient mental health services for children and young people are commissioned and managed by NHS England (NHSE) and provided by NHS as well as independent sector. The access to beds has been managed nationally with young people admitted far from home. There were capacity issues identified in London. To address these concerns, NHSE invited organisations to work in partnership to co-design and establish new models of care. This is one of the first of such projects, set up to manage the budget for children and young people's beds on behalf of NHSE and change the way of managing and monitoring admissions.

Our aims:

To reduce length of inpatient stay

To enable admission of young people as close to home as possible

To improve resource efficiency, capacity and capability of managing young people in crisis in the community.

A number of changes were introduced, including engagement of community and inpatient clinical staff, repatriation to units closer to home and introduction of CRAFT meetings (early review meetings in inpatient units to enable timely and effective discharge planning and support back to local services). The implementation has been closely monitored by the project manager and clinical group, which included representatives from all organisations involved.

After four years, young people are admitted to hospitals closer to home and the length of inpatient stay has decreased by 18%. The number of admissions has decreased by 28%. Out of area occupied beds days have been decreased by 66%.

Significant recurrent budget savings have been achieved. Over the past three years, these savings have been reinvested in developing crisis community support and more specialist community services within CNWL and West London Trust.

There have been considerable benefits of multiple organisations working in partnership to improve patients care. The success of the project has created further opportunities for the development of services which provide safe and effective alternatives to admission (such as crisis services, home treatment teams and specialized community services). In summary, this collaborative model has improved the quality of care and experience for young people and reduced the need for psychiatric admission.

• • To provide emergency psychiatric assessment throughout the COVID-19 pandemic.

• • To maintain patient and staff safety by minimising exposure to infection risk by reducing A&E contact.

• • To alleviate pressures on the A&E department by enabling CAMHS patients be seen in an alternative setting.

• • To provide a more appropriate environment for the assessment of young people in acute distress.

• • Service live 8th April 2020 to 8th June 2020.

• • Exclusion criteria: 1) confirmed/suspected overdose; 2) self-harm with injuries requiring medical attention; 3) acute psychotic episode; 4) drug/alcohol intoxication; 5) high risk of absconding (ASD/LD/LAC), 6) severe agitation/aggression; 7) eating disorders requiring medical intervention; 8) section 136 of the MHA; 9) break down of a social care placement; 10)medically unexplained symptoms.

Data reviewed of all young people who were referred to A&E during March–April 2020. Each case was assessed as to whether they were then seen within the EAS Service.

These cases were reviewed demographically looking at ethnicity, gender, while also reviewing the reason for referral.

• • A total of 90 cases referred to Urgent Care Team

• • Nineteen (21%) met criteria for assessment at EAS

• • 80% of presentations between 12am and 9am.

• • Commonest reasons for referral : low mood with suicidal ideation (42%), anxiety (26%)

  • → 50% service users not previously known to CAMHS

• • Majority of service users were female

• • Mean age 15 years

• • All but one of the young people assessed at the EAS, were discharged home with community follow-up

• • Average total no. monthly referrals to CAMHS Urgent Care Team (UCT) fell from approx. 90 to 45.

• • Only a small proportion of referrals (21%) could be safely seen by the EAS, suggesting that the majority of young people required a joint assessment by A&E and CAMHS Urgent Care Team.

• • When need arises, very rapid reconfiguration and implementation of CAMHS emergency services is achievable.

• • EAS diverted a small number of young people from exposure to COVID-19 in A & E.

• • The service was set up speedily without evaluation of parent/carer/young people views or evaluation of cost-effectiveness.

• • If similar services are to be set up permanently, the balance between safety and the risk of division between mental & physical health services and potential to increase stigmatisation of mental illness should be considered.

• • Adaptation to future outbreaks should be informed by this initiative.

There is strong evidence that the rates of psychiatric admission for psychosis in the UK are elevated for the Black adult population compared with the White population. Black adults also have a higher rate of involuntary psychiatric admissions. There have been no studies in this country investigating links between ethnic background and psychiatric admission in the adolescent population.

To investigate whether Black compared with White adolescents from London are over represented in psychiatric in-patient settings and whether they are more likely to be detained under the Mental Health Act 1983.

Cross-sectional survey of London adolescents aged 13–17 years, who were in-patients in psychiatric units.

Adolescents from the Black group (Black African, Black Caribbean, Black British) were over represented among those admitted with a diagnosis of a psychotic disorder when compared with adolescents from the White group (White British/White Irish, White Other): odds ratio=3.7,95% C12.0–6.7. They were also more likely to be detained on admission and more likely to be born outside the UK and have refugee background.

The possible impact of various background factors influencing admission is discussed.

Antipsychotic medication, an effective treatment modality in the management of psychiatric/behaviour disorders in people with learning disability, is often criticised because of poor clinical practice. Rational and judicious use, subject to evidence-based guidelines and systematic monitoring, is mandatory. A five-year clinical audit programme on the quality of prescribing for this clientele was undertaken.

Significant quality improvement with minimal resource consumption was demonstrated.

Clinical audit facilitates high-quality prescribing: pragmatic and economic, it can easily be integrated into routine clinical practice.