Slow progress on child and adolescent mental health services

• a consultant psychiatrist
• a junior doctor
• 2 psychiatric nurses
• 2 clinical psychologists
• 2 social workers
• 1 occupational therapist
• 1 speech and language therapist
• 1 child care worker
• 2 administrative staff

The HSE has just published its first audit of mental health services for children and adolescents. The audit was carried out last November and this found 49 functioning teams with staffing varying between 2.5 and 14 team members, just one or two teams have their full complement but even these were providing services for twice or three times the recommended numbers. Since then, six more teams are in place.

So the headline figure of 54 teams is far from the reality of what services are like on the ground. They are under staffed (many of them just two people) and under huge pressure. They end up having to deal with the most acute cases – the emergencies – but are unable to do the multi disciplinary working that is envisaged in A Vision for Change.

These teams are meant to be providing a range of mental health care and supports for all young people under 18. They are responsible for assessments of children with disabilities under 5 years of age for all psychiatric and mental health, care for 0-18 years olds ranging from diagnosis and treatment of ADHD and autism in young children to working with teenagers who are deliberately self harming, or suffering from depression or easting disorders. Plus since 2006, they are responsible for 16-18 years olds.

Services are improving but are going from a very low or non existent base in some parts of the country and they are still just a fragment of what they need to be. About one third of the service as outlined in A Vision for Change is there and there are huge variations in different parts of the country with Dublin and East faring best and the South doing the worst.

There have been improvements in appointment of child and adolescent psychiatrists but mush less progress in psychiatric nurses and therapists. For example a year ago, 30 teams had no OTs, 23 teams no speech and language therapists, 10 teams no clinical psychologists, 30 no childcare workers. This means if a child is presenting who needs the care of a speech and language therapist or a OT, this work is carried by the psychiatrist, which means that the child is not getting the actual treatment or care required and its not the best use of the psychiatrists time.

I spoke to a good few psychiatrists in the last few days and all would acknowledge that money is being invested in this area but not enough and not fast enough. Ask any parent of a child with a disability and they will tell you they have to fight for every bit of care their child gets. Also, the more serious the situation the more likely you are to get a response. If it is a real crisis then you will be seen as soon as possible.

According to the HSE, if a child or adolescent’s situation is deemed urgent then they will be seen as a priority. And only routine cases are on waiting lists. That depends on definition of an emergency and what a parent believes may be different to a professional assessment.

When the audit was done just a year ago, at the end of November 2008

• 3,117 children were waiting to be seen
• of these 29 per cent waiting longer than a year
• Another 21 per cent waiting more than 6 months
• 16% seen in 3-6 months
• 19% seen in 1-3 months
• 15% seen in 4 weeks

But again figures are getting better (except for the west) a decline of 14 per cent from 2007 – reflecting increased staffing on teams.

We have a very poor record across child mental health services however we have been particularly bad in providing acute psychiatric beds for children and young people?

Ireland has been breaking all sorts of international human rights and children’s rights conventions by putting child and adolescents in adult psychiatric units – which is totally inappropriate.

It is an area which has been monitored by the Mental Health Commission and reported on in their annual reports. In their report published in May 2009, it states

• 406 admissions to inpatient units last year
• 263(65 per cent) of them were children admitted to adult units
• 26 of them were under 16 years

In MHC annual report, they say “This practice is in-excusable, counter-therapeutic and almost purely custodial in that clinical supervision is provided by teams unqualified in child and adolescent psychiatry. While plans are in place for new beds, the delivery is slow”

There been some but not much progress since. In 2006, there were 12 inpatient child and adolescent beds. Now there are 22 – 6 in Warrenstown, 6 in St Vincent’s in Fairview and 10 new temporary beds in St Annes in Galway. Minister Maloney opened a new temporary unit in Cork in April but no bed has yet been occupied there. HSE assure me it will open this week or next. The plan is to have 56 beds by end of 2010 but progress has been very slow. As Brid Clake who is had of the Mental Health commission aid on publication of their last report “children with mental health problems need timely access to adequate services, in order to attain their full potential, and these should be provided as matter of urgency”.

Perhaps more urgency is required.