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ObjectiveTo examine the impact of the COVID-19 pandemic on adolescent psychiatric inpatient admissions by comparing sociodemographic, diagnostic, and clinical characteristics before and during the pandemic.MethodsA Melbourne adolescent psychiatric inpatient unit admitted 963 adolescents during March-December 2019 (pre-pandemic) and March-December 2020 (pandemic). Comparisons of demographics, diagnoses, symptom severity and functioning (HoNOSCA, SDQ), and admission characteristics including restraint and seclusion were analysed.ResultsAdmission volume increased by 17% while overall symptom severity remained stable. Personality and Autism Spectrum Disorder diagnoses increased, as did use of physical restraint and symptoms of hyperactivity, psychosis, and somatic complaints. Substance misuse decreased significantly. Most demographic variables were unchanged, except for a decline in Indigenous admissions. Effect sizes were small.ConclusionWhile concerns about increased mental health problems have been expressed during the pandemic period, adolescent admissions did not show increased symptom severity or functioning difficulties. The increased admission rate was accompanied by increases in only two diagnostic groups; possibly overlapping in heightened internal distress amid pervasive social disruption. That one vulnerable group - indigenous young people - had lower admission rates, may talk to stronger community supports or to further marginalisation from the health care system, during the pandemic.