title: What do we know about the risks for young people moving into, through and out of inpatient mental health care? Findings from an evidence synthesis.
abstract: BACKGROUND
  Young people with complex or severe mental health needs sometimes require care and treatment in inpatient settings. There are risks for young people in this care context, and this study addressed the question: 'What is known about the identification, assessment and management of risk in young people (aged 11-18) with complex mental health needs entering, using and exiting inpatient child and adolescent mental health services in the UK?'
  
  
  METHODS
  In phase 1 a scoping search of two electronic databases (MEDLINE and PsychINFO) was undertaken. Items included were themed and presented to members of a stakeholder advisory group, who were asked to help prioritise the focus for phase 2. In phase 2, 17 electronic databases (EconLit; ASSIA; BNI; Cochrane Library; CINAHL; ERIC; EMBASE; HMIC; MEDLINE; PsycINFO; Scopus; Social Care Online; Social Services Abstracts; Sociological Abstracts; OpenGrey; TRiP; and Web of Science) were searched. Websites were explored and a call for evidence was circulated to locate items related to the risks to young people in mental health hospitals relating to 'dislocation' and 'contagion'. All types of evidence including research, policies and service and practice responses relating to outcomes, views and experiences, costs and cost-effectiveness were considered. Materials identified were narratively synthesised.
  
  
  RESULTS
  In phase 1, 4539 citations were found and 124 items included. Most were concerned with clinical risks. In phase 2, 15,662 citations were found, and 40 addressing the risks of 'dislocation' and 'contagion' were included supplemented by 20 policy and guidance documents. The quality of studies varied. Materials were synthesised using the categories: Dislocation: Normal Life; Dislocation: Identity; Dislocation: Friends; Dislocation: Stigma; Dislocation: Education; Dislocation: Families; and Contagion. No studies included an economic analysis. Although we found evidence of consideration of risk to young people in these areas we found little evidence to improve practice and services.
  
  
  CONCLUSIONS
  The importance to stakeholders of the risks of 'dislocation' and 'contagion' contrasted with the limited quantity and quality of evidence to inform policy, services and practice. The risks of dislocation and contagion are important, but new research is needed to inform how staff might identify, assess and manage them.
authors.affiliation: School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK.
authors.forename: Deborah
authors.initials: D
authors.lastname: Edwards
authors.affiliation: School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK.
authors.forename: Nicola
authors.initials: N
authors.lastname: Evans
authors.affiliation: Information Services, Cardiff University, Cardiff, UK.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Gillen
authors.affiliation: College of Human and Health Sciences, Swansea University, Swansea, UK.
authors.forename: Mirella
authors.initials: M
authors.lastname: Longo
authors.affiliation: School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK.
authors.forename: Steven
authors.initials: S
authors.lastname: Pryjmachuk
authors.affiliation: Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK.
authors.forename: Gemma
authors.initials: G
authors.lastname: Trainor
authors.affiliation: School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK.
authors.forename: Ben
authors.initials: B
authors.lastname: Hannigan
keywords: Child and adolescent mental health services; Contagion; Education; Families; Friends; Identity; Inpatient; Normal life; Risk; Stigma