Psychiatric units - HSE, state are failing children

THE Health Service Executive (HSE) is often perceived, and justifiably so, as more concerned with its PR image than patient care, especially regarding promises to improve aspects of the health service.

Nowhere is this more evident than the continuing failure, despite a litany of promises, to stop the unacceptable practice of placing troubled teenagers in adult psychiatric units. A Mental Health Commission report due out this week is expected to find the HSE in breach of the code of practice that allows for the placing of children in adult facilities only under “exceptional circumstances”.

The state continues to pay private residential childcare companies €14,000 a week to look after individual children while beds remain empty at HSE-run homes. Contractors are paid nearly €10,000 more per week to care for a child than it would cost in HSE facilities.

This despite the fact that inspection reports of HSE-run homes for troubled children show they have spare bed space and are almost never occupied to capacity. The HSE should explain to the aggrieved taxpayer why it pays such exorbitant costs. Meanwhile, the domino effect of unfulfilled promises is illustrated in today’s challenging letter from 17-year-old Peter (not his real name) to Minister of State for Disability and Mental Health, John Moloney.

Peter argues cogently that children are being admitted to acute adult psychiatric facilities because there is nowhere else to put them. He claims it is not safe for young people to be incarcerated in such units, alleges they are often left unattended by nurses, questions the capability of psychiatrists dealing with adults to treat children, and asks how the HSE can possibly deal with 3,600 children in need of in-patient and out-patient care when there are only 30 existing beds in Galway, Dublin and Cork, with 70 more promised in 2011.

This revealing document shows young people in great mental distress continue to be subjected to Victorian practices described by professionals in the field of child and adolescent psychiatry as “inexcusable, counter-therapeutic, and almost purely custodial”. So far this year, 120 children and adolescents under the age of 18 have been admitted to adult units. Shockingly, they include 13 children under the age of 16. Similarly, out of 212 young people admitted to adult units last year, nine were 15-year-olds and four were aged only 13 or 14.

Behind the cold statistics are the troubled lives of young people trying to survive in a world pervaded by drugs, violence, dysfunctional families and suicide, a grim picture that ought to be de-stigmatised.

In his final plea to Minister Moloney, Peter expresses a forlorn hope that the Government will implement its 2006 strategy A Vision for Change — “without too much of a delay, and also construct psychiatric units to specifically cater for adolescents and children’s needs as soon as possible”.

In the vital realm of child psychiatry, the HSE’s performance makes a mockery of repeated pledges that troubled teenagers will not be incarcerated with adult psychiatric patients. Peter’s letter is a damning indictment of the failure of the HSE and this Government to deliver the kind of service where troubled teenagers will be treated humanely.