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.