Child mental health services creaking

VERY real fears about the impact of the current financial crisis; gaps in services; a lack of cooperation between agencies; and a lack of crisis solutions — these are the challenges facing our child and adolescent mental health services, according to a new report commissioned by the Mental Health Commission.

Although carried out to look at the specific issue of why young people are admitted to adult units, its author, Dr Sally Bonnar, a Scottish consultant child and adolescent psychiatrist, provides a unique insight to the provision and running of the services.

Although the report finds serious difficulties around extending services from the age of 16 to 18 by the end of next year, Dr Bonnar recommends timelines for reducing admissions of patients under the age of 18 years to adult units should not be changed.

The Sottish consultant singles out Limerick as a place where young people are admitted to in-patient beds more easily than in other parts of the country.

This comes from historical practice but carries “significant risks” and is out of step with the rest of the country.

According to Dr Bonnar, staff in Limerick have conscientiously attempted to put in place appropriate protocols for the admission of young people locally. Nevertheless, having visited the wards, particularly the adult ward, she found these are not appropriate settings for the care of acutely ill adolescents. This, she says, is what happens when emergency services are not backed up with either appropriate beds or intensive community support.

The Scottish child specialist maintains that the provision of social work services for young people and their families is “patchy” and there is no out-of- hours provision, outside Dublin, for children and young people.

“Consequently, much of the work that in other jurisdictions would be undertaken by social services inevitably falls to Child and Adolescent Mental Health Services (CAMHS),” she writes.

And this is particularly acute where services are trying to provide that out-of-hours cover — as is the case in Limerick.

Under the Government’s blue- print for mental health service reform, more than 100 inpatient beds are planned for the sector.

According to Dr Bonnar, however, the planned provision of 108 inpatient beds for a population of 4.45 million people is generous by today’s standards where the emphasis is on community care. It compares to 48 planned beds for adolescents and nine child beds in Scotland for a population of just over 5 million people.

Another important point Dr Bonnar raises is the lack of the service user’s voice in the debate.

“Involvement of users and carers in planning would seem to be at an early stage,” she says.

“Experience from Scotland suggests that the user and carer voice is very influential with planners and politicians and can positively influence clinical decision making. While it is clear that parents have a major say in how their young people are looked after, it is less clear how the wishes and opinions of children and young people themselves are heard.”

Dr Bonnar writes of “a lack of engagement of community care social work services and other partner agencies in offering support to children and families in crisis”, not only out of hours — but ‘in hours’ too.

Often mental health services are left to fill in the gaps, with children and young people receiving a mental health service inappropriately when their needs are social.