The IACAPAP Special Interest Group (SIG) on Inpatient Child and Adolescent Psychiatry: A Call for Collective Action

Inpatient child and adolescent psychiatry occupies a unique space in our field – a paradox. Often it is the least discussed, most resource-intensive, and yet the service of last resort for our most vulnerable young people. As child psychiatrists and child mental health clinicians who have worked across emergency, outpatient, and inpatient settings, many of us have seen firsthand how inpatient units can be both a sanctuary for stabilization and a mirror reflecting system failures. Yet despite its centrality in our continuum of care, inpatient child and adolescent psychiatry often lacks a dedicated global forum for exchange, innovation, and research collaboration.

At IACAPAP, we have an opportunity to change this. The formation of a Special Interest Group (SIG) on Inpatient Child and Adolescent Psychiatry would address a critical gap, bringing together clinicians, researchers, policymakers, and lived experience experts to advance this essential component of care.

Inpatient units around the world face shared challenges: 

1. Managing severe psychiatric crises within constrained lengths of stay
2. Attempting to provide trauma-informed care while ensuring safety in restrictive environments
3. Supporting families while addressing system-level barriers to discharge
4. Preventing iatrogenic harm (and risk of re-traumatization) through use of psychotropic medications and seclusion/restrain
5. Addressing the intersection of neurodevelopmental disorders, medical comorbidities, and acute psychiatric care
6. Navigating staff burnout and moral distress within high-acuity environments 

While there are regional forums and occasional workshops on inpatient care, there is no sustained international platform for shared learning, quality improvement, and research collaboration in inpatient child psychiatry. Given the variability in service models across high-, middle-, and low-resource settings, variability in legal and societal expectations of care, there is an urgent need to collect, synthesize, and adapt best practices that are contextually relevant. This forum is designed to achieve that. 

Moreover, the COVID-19 pandemic has exposed the fragility of inpatient systems worldwide, with increased acuity, prolonged lengths of stay due to community service bottlenecks, and staff attrition. It is critical that we learn from these challenges to build resilient, humane, and effective inpatient systems for the future. 

The proposed IACAPAP SIG on Inpatient Child and Adolescent Psychiatry would aim to: 

1. Establish a Global Community of Practice:
   • Facilitate regular virtual meetings and discussions to share innovations, challenges, and system-level solutions. 
   • Create mentorship opportunities for clinicians and researchers seeking to develop inpatient expertise. 
2. Advance Research and Quality Improvement: 
   • Identify shared research priorities, such as effective models for aggression management, family involvement in care, and reducing restrictive interventions. 
   • Foster multi-site collaborative research, including low-cost, pragmatic studies that can improve care in diverse contexts. 
   • Develop repositories for protocols, guidelines, and outcome measures specific to inpatient care. 
3. Promote Best Practices and Knowledge Translation: 
   • Curate and disseminate evidence-based practices in psychopharmacology, therapeutic milieu interventions, and trauma-informed approaches. 
   • Share strategies for interdisciplinary collaboration with nursing, social work, education, and lived experience advisors.
   • Highlight case studies demonstrating innovative inpatient models, including virtual inpatient care and step-up/step-down units. 
4. Advocate for Policy and System Change: 
   • Support advocacy efforts to address the systemic under-resourcing of child mental health inpatient services globally. 
   • Facilitate discussions on equitable access to inpatient care and the prevention of unnecessary hospitalizations through community partnerships. 
5. Center the Voices of Youth and Families: 
   • Embed the perspectives of young people and families with lived experience of inpatient care in shaping SIG activities.
   • Develop resources and position statements on promoting dignity, rights, and culturally sensitive care within inpatient settings. 

We believe that inpatient child and adolescent psychiatry deserves focused attention within IACAPAP. A SIG would create a sustained, structured space to explore innovations, address shared challenges, and advance research that directly impacts our most vulnerable patients.

If you work within or have a research interest in inpatient child and adolescent psychiatry, we invite you to join this initiative. Whether you are in a high-resource or low-resource setting, whether you are a trainee or a senior clinician, your voice and experience are needed. Together, we can build a vibrant, inclusive community dedicated to improving inpatient care globally.

Please reach out to indicate your interest, suggest focus areas, or share your vision for what this SIG could achieve. Let us build a global dialogue that ensures inpatient child and adolescent psychiatry receives the collective attention, rigor, and compassion it deserves.

Hughes, E. K., et al. (2020). Inpatient mental health care for adolescents: A systematic review of international service models. Child and Adolescent Mental Health, 25(4), 239–248. 

Cortese, S., et al. (2023). Child and adolescent mental health services across Europe: The need for harmonization. European Child & Adolescent Psychiatry. 

Walter, G., et al. (2016). Inpatient care in child and adolescent psychiatry—An international perspective. Australas Psychiatry, 24(1), 6–10. 

Kohrt, B. A., et al. (2018). Global child mental health services: Challenges and solutions. Child and Adolescent Psychiatric Clinics of North America, 27(1), 15–31. 

IACAPAP e-Textbook of Child and Adolescent Mental Health (www.iacapap.org) 

Stewart, S. L., & Hamza, C. A. (2017). The effectiveness of inpatient psychiatric treatment for children and adolescents: A review. Journal of Child and Family Studies, 26(3), 760–773.