Do we need specialist adolescent units in hospitals?

If you were an adolescent aged 12-19 and you needed to be admitted to hospital would you want to be admitted to a paediatric unit with young children, an adult ward, or a separate unit just for adolescents? And if the last was your choice, what arguments would you put forward to justify it? A paper in this week's issue puts forward several.

One argument for separate adolescent wards is that professionals skilled in the care of young people create a “therapeutic environment” that might be especially beneficial. However, this is difficult to prove and no one has undertaken a controlled study to identify such an impact. Most obviously it could be argued that properly organised adolescent units provide for the specific developmental needs of those in the second decade of life—schooling, recreation, socialising—as well as for their increased needs for privacy. Additionally, such facilities have the potential for enhanced medical services at the interface between medical, psychiatric, and substance misuse treatments. Further, for young adults with chronic diseases, who may be developmentally less mature than their peers, the adolescent unit provides a more ideal hospital environment than those provided by either child or adult wards.

Yet are these arguments enough to justify separate hospital facilities specifically set aside for adolescents? Are the teenage years so unique? Or is the age group 12-19 years so heterogeneous—socially, physiologically, and emotionally—as to make such facilities inefficient, ineffective, and ill conceived? Are the issues that lead to the admission of adolescent males (predominantly trauma) and adolescent females (predominantly obstetric) sufficiently different to warrant substantially different clinical and emotional support systems?

Russell Viner, the foremost British expert on hospital adolescent medicine, cogently argues that there are enough adolescents being admitted to district general hospitals as inpatients or for day case treatment to warrant a dedicated adolescent hospital ward in most of these hospitals (p 957).¹ Others would concur. In their survey of hospitals in England and Wales, Suresh et al report that 26% of the 225 hospitals surveyed had made some accommodation for their adolescent patients.² Most had a separate bay for adolescents within a paediatric ward, but 16 hospitals (nine district and seven university hospitals) had separate units. Exactly what lead to the establishment of units where they exist is unclear, but the authors suggest that it was probably available funding coupled with interested clinicians.

The call for separate units for adolescents in hospitals in the United Kingdom is not new. In 1959 the Platt report acknowledged that “the requirements of adolescents differed from those of adults and children and ideally adolescents need their own accommodation.”³ What is new is that Viner has worked out that enough adolescents are admitted to British hospitals to warrant making such accommodation available.

In the United States during the 1970s and 1980s there was a tremendous push to establish inpatient adolescent units. By the mid-1990s the Society for Adolescent Medicine, the leading US professional organisation for adolescent health, estimated that there were 40-60 such units in the United States. As in Britain, some of these units are simply sections within other wards. The Society for Adolescent Medicine continues, however, to advocate “the continuation and establishment of adolescent medicine inpatient units in both paediatric and general hospitals as an optimal approach to the delivery of developmentally appropriate health care to hospitalised adolescent.”³ If Viner is correct this ideal can and should be realised in many district hospitals in the United Kingdom.

But even where the numbers do not justify a separate ward for adolescents, a multidisciplinary approach from health professionals with interest and expertise in adolescent health is still feasible in every hospital. As the Society for Adolescent Medicine suggests, this will be achieved through establishing guidelines for the managing teenagers in hospital, so that those with greatest expertise can be involved with young people's care.⁴ But to truly realise a vision where all young people can receive the comprehensive services they need to become healthy adults we need to ensure that all health professionals in both primary and secondary care have the training they need to provide optimal care for this age group.

Papers p 957