Far too many children are being let down by a mental health system that “did nothing but patch over huge gaping holes” in the service since the last closure of inpatient beds five years ago, the Children’s Ombudsman has said.
Dr Niall Muldoon said consistent calls from him and others for recruitment and retention plans for staff have “fallen on deaf ears”. The ombudsman was responding to widespread alarm at the closure of almost half of the beds at the country’s biggest child and adolescent inpatient psychiatric unit, at Linn Dara, in west Dublin.
The closure – the consequence of a psychiatric nurses' staffing shortage – has raised concerns for the necessary inpatient treatment of severely ill children, with the Psychiatric Nurses Association (PNA) warning of staffing shortages in the three other inpatient children’s units.
Last Monday, Minister of State for Mental Health Mary Butler confirmed PNA disclosures that 11 of the 24 beds at the CAMHS inpatient unit at Linn Dara were closing until September, at the earliest, because of a staffing crisis.
This is set to bring the total number of inpatient beds from 68 down to 57, with 16 in Merlin Park in Galway, 16 in Eist Linn in Cork, 12 in St Vincents in north Dublin, with 13 remaining in Linn Dara.
Commenting, Dr Niall Muldoon, Ombudsman for Children, said: “The impact of not getting into an inpatient bed, for a child or adolescent, can be devastating, and can mean that the longed-for respite from pain and opportunity to focus on recovery has been lost.
He said he and others have consistently called for plans around the recruitment and retention of staff to be published, but, said that, so far, “this has fallen on deaf ears”.
He said they have also not been able to find out from the Government or the Department of Health exactly how much money is spent on children’s mental health every year.
“We are inundated with the numbers of vacant posts but never do we see the plan to fill these positions, or to create a new system that might not rely so heavily on a single profession.”
He said that earlier this week, Ms Butler spoke about six consultant psychiatrist posts being empty on a long-term basis and also about how there are ongoing difficulties in recruiting for specific geographical areas such as Kerry, Donegal and Wexford.
“We know that the horrific South Kerry CAMHS scenario originated with the loss of a full-time consultant psychiatrist in 2016, but who was charged with filling this and all the other posts?
Sinn Féin mental health spokesperson, Mark Ward, has expressed serious concern as to where children in need of specialist inpatient care will now go. In replies to parliamentary questions this week, the HSE gave him figures showing that 27 children were admitted to adult psychiatric wards in 2021.
The figures further show that 10 of these cases were because there was “no bed in CAMHS units” – at a time when there were supposed to be 68 operational beds.
Mr Ward said: “In 2021, even though there were spaces in the four CAMS units, children were still being admitted to adult psychiatric units – where are they going to go now?” The figures show that only Linn Dara was near or at full capacity in recent years, with the other three units showing spare capacity.
The figures for March of this year show:
- Merlin Park 8-10 beds in use (out of 17);
- Eist Linn 11-12 beds in use (out of 16);
- St Vincent's 9-10 beds in use (out of 12);
- Linn Dara: 21-24 beds in use (out of 24)
The HSE said operational capacity depended on staffing, Covid impact and complex and challenging cases. The PNA told thethis week there were staffing shortages in the Galway, Cork and north Dublin units.
The HSE said that neither Eist Linn nor St Vincent's provide an emergency out-of-hours service, with only Linn Dara and Merlin Park providing that.
“It is scandalous that 11 out of 26 countries in this state do not offer an emergency out-of-hours service for children suffering from mental distress," said Mr Ward.
"These areas include Kerry, Cork, Tipperary, Carlow, Kilkenny, Waterford, Wexford, Cavan, Monaghan, Louth and Meath.”
In a letter to Mr Ward, Jim Ryan, Assistant National Director – Head of Operations National Mental Health Service - said “enhanced inpatient CAMHS capacity has seen a reduction in child admissions to adult units", down from 84 in 2018, to 50 in 2019, to 27 in 2020 and 27 in 2021.
He said recent figures suggest no such cases up to the end of March this year.