A child in need of hospital admission for psychiatric treatment had to spend seven days on a trolley in the A&E unit of a Dublin hospital recently, a consultant psychiatrist said yesterday.
Dr Margo Wrigley said the incident highlighted the shortage of child and adolescent inpatient psychiatric beds, with just 20 for the whole State.
She warned that the situation would get worse from the beginning of next month when there would be a legal requirement to detain certain children but for whom there would be no beds.
The consultant at the Mater hospital said many reports had in recent years recommended the provision of more beds for this age group, but they had not been acted on.
Asked where children and adolescents would end up now if more and more of them were committed by the courts under part II of the 2001 Mental Health Act which comes into force on November 1st, she said: "we just don't know", but it was likely the numbers being admitted to adult psychiatric hospitals would "mushroom out of control". She said such placements were totally inappropriate.
Children in need of psychiatric help also ended up "periodically" on trolleys in A&E units.
"Any time any of our colleagues want to admit a child it's a huge issue for them because there are only 20 beds in the country."
She said the State had had five years to prepare for the implementation of the Act, and more beds should have been provided by now.
There were also other elements of the Act for which the HSE was unprepared. It had not set up a panel of psychiatrists to provide independent second opinions in situations where a doctor felt a patient should be detained against his or her will. "Again, with just 21 days to go, there is no such panel in existence."
Furthermore, the Act stipulates that escorts be provided for persons needing admission but who have no transport. However, the HSE had only recently tendered for an escort service. This was unlikely to be in place on November 1st.
She said the aim of the Act was to provide proper safeguards and care for patients, and psychiatrists did not want its implementation postponed.
Finbarr Fitzpatrick, secretary general of the Irish Hospital Consultants' Association, said a national director with the HSE, Aidan Browne, had written to the Department of Health in July admitting it would not be possible to address all issues "in the timeframe to the commencement of the Act". Mr Fitzpatrick went on to warn that there was a distinct possibility that patients or their next of kin could take an action against the HSE if its care was compromised as a result of provisions of the Act not being complied with.
"There is a very strict legal code and timeframe within which things have to be happen under the Act.
"You can't put somebody on a waiting list or send them to the National Treatment Purchase Fund." However, the HSE in a statement claimed it was fully committed to implementing the necessary supports that would allow for full compliance with all sections of the Act.
It said capital funding for four new child and adolescent psychiatric units had also been allocated, and the HSE had begun establishing a national panel of consultant psychiatrists to provide second opinions.