‘Children are falling in between mental health and disability services’, says psychiatrist

Low funding levels, despite improvements in recent Government budgets, resulting in a critical shortage of specialist in-patient beds for children is another issue that needs to be addressed. Picture: Gareth Fuller/PA

A greater focus on children’s mental health is urgently needed, as it has become acceptable to turn children away from services, a leading child psychiatrist has warned.

Children are falling between mental health and disability services without getting solutions, according to Dr Kieran Moore, specialist consultant paediatric psychiatrist who worked in Child and Adolescent Mental Health Services (Camhs) for 16 years.

“The services are not working for children,” he said. “That is the most difficult thing, that they are suffering and go for help and everyone says: ‘Not for me, not for me’.

“Why do we, as a society, still accept that for somebody with mental illnesses it’s OK to treat them like that, but if there was one child with asthma treated like that, it would be all over the papers?”

The crisis in children’s services has been “barely mentioned in the buildup to the election,” said Dr Moore, an associate professor of psychiatry in UCD who now works in children’s hospitals. In his experience, parents can end up going from one service to another, with more and more referral letters, without finding answers.

“We see it every day in our practice,” he said.

GPs are at their wits’ end getting multiple refusals of the same child. Emergency department staff in general have little or no training in psychiatry and the ED is absolutely the wrong place for a child to come.

A busy ED has “multiple sensory overloads, infection, crowding, no dedicated rooms to talk properly and confidentially, and no rooms that would be deemed safe for children who might have behavioural difficulties or are aggressive,” he said.

Children living with autism face particular challenges, he pointed out. Their care can fall between Camhs and the Children’s Disability Network Teams (CDNT).

“This classic example is autism, which Camhs doesn’t primarily treat for some reason, and CDNT clinicians who are tasked with assessing and treating autism won’t assess the child generally if there is a question of another condition such as ADHD or depression,” he said.

“It almost never happens that a person with autism doesn’t have other difficulties — comorbidity. Autism simply doesn’t exist as a standalone entity, in reality. The result is that children and their parents cannot get any treatment, in many cases.”

He contrasted this with a hypothetical situation where a child with asthma goes to a hospital. “If the patient has other conditions, such as diabetes or depression, the doctors in the hospital wouldn’t say: ‘We only deal with patients who have asthma’.

They wouldn’t say, as an example, ‘if you have diabetes you need to get that treated first before we treat the fact that you’re finding it difficult to breathe’. Yet that is what happens in the HSE Camhs, disability, autism, CDNT, and the primary care psychology services.

Low funding levels, despite improvements in recent Government budgets, resulting in a critical shortage of specialist in-patient beds for children is another issue he wants politicians to address.

“There were 486 patients under 18 admitted to paediatric psychiatric/ Camhs units [last year], but we have no figures on the hundreds of patients admitted, treated, and discharged from acute hospitals,” he said.

For example, he said Children’s Health Ireland sites admit hundreds of children in Dublin alone.

“There are children, as we speak, admitted into paediatric wards,” he added.

He says that solutions can be found, however. “I still love when you meet a child and his or her parents and you have the ability to help,” he said. “We have beds here, and I’m not speaking for CHI in this interview, but there are at least beds, even if they are the wrong beds.”