A specialist inpatient unit for children with complex, and often life-threatening, mental illnesses will be operating at half capacity for at least the next five months because of a staffing crisis.
The Psychiatric Nurses Association (PNA) has condemned the closure of 11 of the 23 beds at the Linn Dara Child and Adolescent Mental Health Unit in West Dublin.
It said the HSE has confirmed to it that the beds will remain closed until September at least because of nursing shortages.
Linn Dara, based on the grounds of Cherry Orchard Hospital in Ballyfermot, is the busiest inpatient unit in the Child and Adolescent Mental Health Service (CAMHS) in the country.
It deals with children with severe mental illnesses, including eating disorders, schizophrenia, and depression.
It is one of the few units providing nasogastric feeding to children with severe eating disorders and may do so by restraint, on foot of court orders, in order to save the child’s life.
PNA general secretary Peter Hughes said it was inexplicable how the HSE had allowed the beds at Linn Dara to close in the light of the “ongoing and worsening crisis” in the provision of CAMHS services nationally.
“This reduction in beds will further exacerbate an already unacceptable waiting list for CAMHS and will ultimately lead to an increase in the inappropriate admission of children and adolescents to adult mental health units," he said.
“In fact, for the next four months there will only be 56 operational beds in CAMHS in the entire country, which is just over 50% of the 100 beds recommended in mental health strategy Vision for Change (2006).”
He called on Health Minister Stephen Donnelly to ensure that resources were put in place so that these beds were re-opened as a matter of urgency.
“Linn Dara plays a vitally important role in the provision of child and adolescent mental health services in the greater Dublin region," Mr Hughes said.
“A similar decision to close beds in this unit was made in 2017 and was met by widespread shock and opposition.
He asked what it would take for the HSE to realise the extent of the CAMHS crisis. “The HSE says the reason for this decision is nursing shortages,” Mr Hughes said.
“The nursing complement for the in-patient unit is 51, however, at present, there are only 24 nurses employed for the unit — a shortage of 27 nurses.”
Mr Hughes said one of the effects of the receding of Covid-19 was the opening of international borders for recent nursing graduates to emigrate once again.
This was causing a recruitment and retention crisis, particularly in CAMHS, he said.
“The situation at Linn Dara is one more graphic illustrations of the crisis in the recruitment and retention of psychiatric nurses which is the direct result of poor HSE planning and HSE must now come forward to target solutions and incentives to encourage the recruitment and retention of nurses to adequately staff CAMHS services," he said.
Sinn Féin spokesperson on mental health Mark Ward called on the Government to “intervene immediately”.
He said: “Linn Dara inpatient units provide services for children and adolescents with severe or complex mental illness requiring a combination of intense interventions and supervision that cannot be provided by community and outpatient services.”
People Before Profit health spokesperson Gino Kenny said: “We already had a crisis in child mental health services with over 50 children inappropriately placed in adult facilities over the last years.
“It’s really hard to take lectures form Government about their concern for children’s mental health during Covid when they have failed miserably to come near providing the levels of inpatient beds called for by the Vision for Change plan.
"That means we should have at least 100 beds available for CAMHS patients nationally. If this cut happens, we will have just 56 operational beds in the entire country.”
According to HSE figures, there were four inpatient CAMHS units operating in 2019, with Linn Dara then providing 24 beds (including two high observation beds), covering not only Dublin, Kildare, and Wicklow but also Laois, Offaly, Longford, and Westmeath.
The other units are Merlin Park in Galway (20 beds), Eist Linn in Cork (16), and St Joseph's in North Dublin (12).
The HSE figures show the number of admissions to inpatient CAMHS units grew from 187 in 2013 to 312 in 2016, before dropping to 226 in 2017 and increasing to 308 in 2019.
Linn Dara accounted for 138 of those 308 admissions.
Last February, the clinical director of Linn Dara, Professor Brendan Doody, told the Oireachtas Health Committee that the recommended provision of inpatient beds for child and adolescent services in A Vision for Change, published in 2006, was 100 beds and there were 70 in place at the start of this year.
“We have 70% of the recommended level,” he said. “The population has significantly increased since 2006."
“In a sense, we had that coupled with a growing population and increasing rates of referral of young people to CAMHS.
"In addition, post-Covid, there has been a significant increase in referrals to community services, inpatient services, and a large increase in, for example, young people presenting with eating disorders.”