Last week, the Irish Examiner reported that the Child and Adolescent Mental Health (CAMH) ED service was unavailable on Monday, but since then, the problem has escalated.
On Friday, the HSE took the step of writing to GPs in the city advising that they have had to “postpone out-of-hours on-call to the EDs until staffing levels improve”.
The staffing shortages will have a knock-on effect on daytime psychiatric assessment of children and young people presenting at Cork University Hospital and the Mercy University Hospital EDs because resources will have to be redeployed from the community to respond.
The HSE has warned this is likely to cause delays. The delays will be worse for those presenting out-of-hours as they wait for the community team to respond.
Dr John Sheehan, a GP in Cork City said he, “like every other GP” has had young people come to his surgery who were suicidal and where there was no option but to refer them to the ED.
“I’m talking about extremely vulnerable 14-year-olds, 15-year-olds who can’t be hanging around in a crisis waiting to be seen.”
He said sending them to an ED without CAMHs back-up would be “completely overwhelming”.
“This is a very worrying development and I will be raising it at the next regional health forum,” said Dr Sheehan, who is also a Fianna Fáil Cork City Councillor.
The letter to GPs, seen by this newspaper, says in recent weeks it has been “increasingly difficult” to maintain the ED service while also providing an out-of-hours on-call service to Eist Linn, the CAMHs inpatient service.
The upshot was the “the difficult decision” to prioritise cover to Eist Linn, while temporarily pulling the ED service, according to Sinead Glennon, head of mental health in Cork and Kerry.
A separate document from Ms Glennon details how the service has been impacted by junior doctor sick leave and the recent resignation of the locum at Eist Linn.
The letter to GPs urges doctors to contact the community CAMHs team in the first instance in the case of patients who require urgent CAMHs review.
Ms Glennon said the local team has “some limited capacity to see very urgent cases within a short period of time, or to advise you on care pathway options, in the hope that this may avoid the need for ED attendance”.
However, she acknowledged ED referral would be unavoidable in circumstances such as “a social situation breakdown or the threat of immediate harm”.
The problem of chronic staff shortages was also impacting other CAMHS services around the country, Ms Glennon said.