Doctors ‘firefighting without adequate training’ to deal with surge in children facing mental health problems

Doctors and healthcare workers are “firefighting without adequate training” to deal with a surge in children facing mental health problems, according to paediatric staff.

An editorial co-signed by health professionals in Dublin and Limerick published in the latest edition of the Irish Medical Journal (IMJ) calls for improved funding to address “a mental health epidemic in our paediatric population” which they say is partly driven by a rise in eating disorder cases.

“Paediatricians, GPs and other health professionals are firefighting without adequate training or support – because there are no other options,” the authors said, of current services.

“At roughly 5.1 per cent of the Irish health budget, Ireland’s investment in mental health services is grossly inadequate, approximately half that of most northern European countries. Even with clear evidence of increasing [mental health] demands during the pandemic, minimal extra funding was provided.”

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It was signed on behalf of the departments of paediatrics at Limerick University and University Hospital Limerick; the liaison psychiatry unit at Dublin’s Temple Street Hospital and the child and adolescent psychiatry department at University College Dublin’s School of Medicine.

Its publication on Thursday comes just days after the Ombudsman for Children, Dr Niall Muldoon, criticised the State for a “profound violation of children’s rights” in the areas of mental health and disability care.

In a letter to the recently appointed chief executive of the Health Service Executive (HSE), Dr Muldoon said the service had “seriously failed in its duty to uphold the rights of children, to the best possible healthcare”.

That view is echoed in the IMJ’s editorial, which sets out various shortcomings and proposes five key areas of investment that could deliver change.

“The prevalence and debilitating nature of mental health difficulties among our children and adolescents cannot be ignored, with approximately 20 per cent of the total childhood population affected.”

Noting a surge in demand for services since Covid, the authors said mental health cases had been rising even before the pandemic. Referrals to the Child and Adolescent Mental Health Services (Camhs) increased by 24 per cent between 2012 and 2018.

Six months into the pandemic, Camhs referrals increased by 50 per cent compared with previous years, and paediatric hospital admissions also grew, with average stays of four days.

Staff at Temple Street Children’s Hospital noted a “disconcerting” two-thirds increase in eating disorder cases between 2019 and 2020, reflecting a global trend.

“While post-pandemic data continue to emerge, Camhs demand has not abated. The WHO [World Health Organisation] reports depression and anxiety have increased by 25 per cent post-pandemic,” the article said.

“This global data confirms our fears: the genie’s bottle is lying shattered on the ground, and we are now dealing with a mental health epidemic in our paediatric population.”

A Royal College of Paediatrics and Child Health position paper in 2020 recommended all paediatric trainees should be equipped to manage common mental health issues and that some, such as neurologists, should receive more extensive training. It cites a 2019 study that showed while 84 per cent of trainees had been involved in a mental health case, just 8 per cent felt able to manage.

The editorial calls for this to be addressed and for the incorporation of mental health services into paediatric services.

It highlights a need to develop infrastructure such as community “crisis hubs” and emergency psychiatry care from within emergency departments, to keep children out of acute hospital settings.

There is a need, it says, to implement national programmes dealing with paediatric self-harm, suicidal thoughts and non-suicidal self-harm.

Liaison psychiatric teams to help with patients who have both physical and mental illness are also required, according to the authors. The “A Vision for Change” report recommended 13 such hospital-based teams but only four exist. With population growth taken into account, the number should now be 15, the article noted. It also looks for a long-term analysis of mental health trends.

In response, the HSE said it acknowledged “inconsistencies in our services” but that it was working to address various issues.

It said there were “continuous improvement plans and [we] are genuinely sorry for anyone who has had a bad experience of the Camhs service”.

A service improvement programme includes several measures including the establishment of a new lead national office for child and youth mental health and the appointment of both a national lead and a national clinical lead.