Across the UK, more young people than ever before are struggling with their mental health, representing a global public health concern (read more in Shuwen’s blog). Research suggests that admissions of young people with mental health difficulties to acute medical wards are rising sharply, reflecting wider pressures on Child and Adolescent Mental Health Services (CAMHS; Vázquez-Vázquez et al., 2024) and gaps in community care.
Acute medical wards are inpatient hospital wards that provide care for patients with serious health problems requiring immediate assessment, treatment or close monitoring. There are growing concerns about acute medical wards being used to manage mental health crises, as evidence suggests that these environments may be ill-suited to provide safe or therapeutic psychological care (Clisu et al., 2022; Health Services Safety Investigations Body (HSSIB), 2024; Otis et al., 2023). Medical wards may lack purpose-built facilities, specialist staffing and therapeutic activities that are core components of inpatient mental health care (HSSIB, 2024; Ward et al., 2025). Staff working on acute medical wards have reported feeling underprepared to provide mental healthcare (HSSIB, 2024; Kirwan et al., 2025).
To learn more about these increased admission rates, Ward et al. (2025) conducted a cohort study to explore the patterns of young people admitted to acute medical wards in England for mental health concerns between 2012 and 2022. This blog unpacks the findings.
Acute medical wards are not designed to support young people experiencing mental health difficulties.
Methods
Ward et al. (2025) conducted a robust national cohort study using linked Hospital Episode Statistics (HES) data covering 97% of hospital activity in England. The study analysed all emergency admissions for 5-18-year-olds between 2012 and 2022.
Mental health–related admissions to acute medical wards were identified using standardised medical codes (ICD-10) mapped to the Global Burden of Disease hierarchy. Mixed-effects logistic and survival models examined associations with prolonged and repeat admissions, adjusting for sociodemographic and clinical factors. Young people with lived experience were involved in informing the grant application, study design and in interpretating the study’s results.
Results
342,511 emergency admissions to acute medical wards among children and young people aged 5-18 years in England in 2021/22 were identified. Of these, 39,925 (11.7%) were for mental health concerns. Across the full study period (2012/13 to 2021/22), mental-health-related admissions rose from 24,198 to 39,925 (65% increase) compared with all-cause admissions, which rose from 311,067 to 342,511 (10% increase).
Demographic patterns
Mental health admissions to acute medical wards were concentrated among older female adolescents; in 2021/22, 95.2% occurred in those aged 11–18 years, and 79.0% were females. Females aged 11–15 years experienced the steepest increase, from 9,091 to 19,349 admissions over the decade (112.8% increase). By 2021/22, mental health concerns accounted for 28.3% of all admissions to acute medical wards for females aged 11-15 years old.
Interestingly, mental health admissions to acute medical ward for males declined after 2018/19, though remained far above 2012/13 levels.
Geographical variation was also substantial: in 2021/22, admission rates ranged from 171.3 to 718.7 per 100,000 across Integrated Care Boards (ICBs), representing a four-fold difference. All ICBs saw increases over the decade, with the largest relative rise identified in NHS Frimley, in the Southeast of England (from 212.7 to 525.5 per 100,000; +147% increase).
Clinical presentation
- Self-harm accounted for 21,337 mental health admissions (53.4%) in 2021/22 and was the largest single category.
- Eating disorders showed the most dramatic growth, increasing from 478 to 2,938 admissions from 2012-2022 (515% increase), including a 638% increase among females aged 11–15 years.
- Anxiety-related admissions more than doubled in most age/sex groups, while admissions for substance misuse declined in older adolescents.
Length of stay
In 2021/22, 7.8% of mental health admissions exceeded one week (versus 3.5% of all-cause admissions), although length of stay varied sharply by diagnosis. Multivariable modelling showed markedly elevated odds of long stays for young people admitted to acute medical wards with eating disorders, older age groups, those from less deprived areas, young black people and those with chronic medical conditions.
Readmissions
Of 239,541 individuals admitted for mental health concerns to acute medical wards during the decade, 32,107 (13.4%) were readmitted within six months. Eating disorders carried the highest risk of readmission. Adjusted hazard ratios (aHR) showed the relative rates at which young people were readmitted to hospital across different diagnoses; this was highest for eating disorders, (aHR = 4.98), followed by depression (aHR = 3.91) and self-harm (aHR = 2.97).
Mental health admissions to acute medical wards have risen by 65% in the decade since 2012. This is in comparison to the 10% increase in all-cause admissions.
Conclusions
This study by Ward and colleagues (2025) demonstrates a substantial and disproportionate rise in mental-health-related admissions to acute medical wards among young people in England from 2012–22, particularly among adolescent girls and those presenting with eating disorders.
Admissions are lasting longer, and repeat admissions are common, indicating increasing clinical complexity and unmet mental health needs in the community.
Geographical variation and sociodemographic differences suggest inequities in access to care.
Overall, the findings highlight escalating demand, strained health services, and the need for integrated, adequately resourced models of care.
There has been a disproportionate rise in mental health-related admissions to acute medical wards in England over the past decade, especially for young girls and those with eating disorders.
Strengths and limitations
This study makes a substantial and timely contribution to the evidence base on youth mental health admissions to acute medical settings. Its greatest strength lies in the scale and completeness of its national dataset, using ten years of Hospital Episode Statistics to capture nearly all emergency admissions for children and young people in England. Such population-level coverage significantly reduces sampling bias and enables genuine trend estimation rather than inference from local service snapshots. The authors’ use of mixed-effects modelling and linkage to mortality data further enhances methodological robustness, allowing for more nuanced insights into readmission risk and length of stay.
The study also incorporates attention to sociodemographic details, offering one of the clearest national pictures to date of which groups are most affected by rising mental health admissions to acute medical wards. Importantly, the research team engaged meaningfully with young people and families in study design, strengthening the study’s ecological validity and ethical grounding.
Nevertheless, some limitations deserve attention:
- Coding constraints within these hospital episode statistics inevitably risk underestimating mental health–related admissions, particularly when psychological distress presents through medical pathways (e.g., toxicity, somatic symptoms).
- Differential coding practices between hospitals may introduce misclassification bias, acknowledged by the authors but not adjusted for, and could contribute to the wide geographical variation observed.
- Ward et al. acknowledge that they were unable to determine whether mental health related admissions for young people were made to acute paediatric or adult medical wards. Approximately half of children’s ward in England only admit young people up to the age of 16, therefore those aged 16-18 may be admitted to adult medical wards. This limits the interpretation of care contexts—an important nuance given the different staffing models and therapeutic environments.
- Potential confounding variables remain, especially around local CAMHS capacity, service thresholds, and sociodemographic influences that cannot be fully captured through area-based measures of deprivation alone. Still, the authors are transparent about these constraints and situate their findings appropriately.
Ward et al. (2025) provides a robust, decade-long national analysis of youth mental health admissions to medical wards, highlighting patterns and readmission risks while acknowledging limitations of administrative data and contextual confounders.
Implications for practice
This study offers compelling evidence that acute medical wards in England are increasingly operating as mental health services, regardless of whether they were designed for this role. The rapid and disproportionate rise in admissions—particularly among girls aged 11–15 and young people with eating disorders—means that these wards are now routinely managing complex mental health presentations. These trends carry important implications for clinical practice, policy development and future research.
For clinical practice, paediatric medical wards should now assume that mental health care is a core component of their workload. Many paediatric staff report limited confidence managing self-harm, agitation, or complex eating disorders (Kirwan et al., 2025; Vázquez -Vázquez et al., 2024). The prolonged length of stay for eating disorders and high readmission rates across diagnoses highlight gaps in community capacity and the need for integrated ward-based mental health expertise. Embedding liaison psychiatry teams, expanding staff training in risk assessment and trauma-informed care, and redesigning ward environments to ensure psychological and physical safety should be priorities.
For policy, the study reinforces that CAMHS is under significant strain. Rising admission rates are not simply a hospital issue; they reflect a whole-system issue in early intervention, community treatment, and crisis response. Policy frameworks must support earlier, more flexible care closer to home. Investment should prioritise crisis resolution teams, 7-day CAMHS provision, and community eating disorder services, reducing both the likelihood and duration of admission. The four-fold geographic variation observed suggests inequities in local service configuration, national standards may be needed to ensure equitable access.
For future research, the findings highlight several questions:
- Why are girls aged 11–15 disproportionately affected?
- How do service structures shape admission thresholds?
- What is the lived experience of young people and families navigating medical wards during mental health crises?
Mixed-methods research—combining clinical data, patient narratives, and system-level metrics— could deepen understanding and support the development of preventative interventions.
The results of this study resonate strongly with my own clinical work with young people experiencing mental health crises and eating disorders, who were often cared for on acute medical wards. Families reported that, although acute medical ward staff worked hard to provide appropriate care, they also recognised the limitations of the setting and expressed a wish for young people to be supported by specialist mental health teams better suited to addressing their psychological needs.
I hope that these findings contribute to a call to improve service provision for young people, focussing on early intervention and prevention.
With rising admissions rates, staff on acute medical wards need to be equipped with the skills and resources to support young people in psychological distress.
Statement of interests
Beth Cumber – None.
Edited by
Dr Nina Higson-Sweeney.
Links
Primary paper
Joseph L. Ward, Adriana Vázquez-Vázquez, Kirsty Phillips, Kate Settle, Hanifa Pilvar, Francesca Cornaglia, Faith Gibson, Dasha Nicholls, Damian Roland, Gabrielle Mathews, Helen Roberts, Russell M. Viner, & Lee D. Hudson (2025). Admission to acute medical wards for mental health concerns among children and young people in England from 2012 to 2022: a cohort study. The Lancet Child & Adolescent Health, 9(2), 112-120. https://doi.org/10.1016/S2352-4642(24)00333-X
Other references
Clisu, D. A., Layther, I., Dover, D., Viner, R. M., Read, T., Cheesman, D., … & Hudson, L. D. (2022). Alternatives to mental health admissions for children and adolescents experiencing mental health crises: a systematic review of the literature. Clinical Child Psychology and Psychiatry, 27(1), 35-60. https://doi.org/10.1177/13591045211044743
Health Services Safety Investigations Body (2024). Keeping children and young people with mental health needs safe: the design of the paediatric ward – interim report. Health Services Safety Investigations Body. Available at: https://www.hssib.org.uk/patient-safety-investigations/keeping-children-and-young-people-with-mental-health-needs-safe-the-design-of-the-paediatric-ward/interim-report/ (Accessed: [14/12/2025]).
Kirwan, L., Apriyanti, E., Sheaf, G., DeVries, J., & Coyne, I. (2025). Experiences of Care for Adolescents With Mental Health Difficulties in Acute Paediatric Services: A Systematic Review. Journal of Clinical Nursing. https://doi.org/10.1111/jocn.17861
Otis, M., Barber, S., Amet, M., & Nicholls, D. (2023). Models of integrated care for young people experiencing medical emergencies related to mental illness: a realist systematic review. European Child & Adolescent Psychiatry, 32(12), 2439-2452. https://doi.org/10.1007/s00787-022-02085-5
Su, S. (2025). Global insights into youth mental health prevalence: challenges and future directions. The Mental Elf.
Vázquez-Vázquez, A., Smith, A., Gibson, F., Roberts, H., Mathews, G., Ward, J.L., Viner, R.M., Nicholls, D., Cornaglia, F., Roland, D., & Phillips, K. (2024). Admissions to paediatric medical wards with a primary mental health diagnosis: a systematic review of the literature. Archives of Disease in Childhood, 109(9), 707-716. https://doi.org/10.1136/archdischild-2023-326593
