Tsunami of young people seeking mental health care but too few beds, say consultants

There is now a tsunami of distressed young people presenting in crisis to paediatric hospitals and to paediatric emergency departments in particular, hospital consultants have maintained.

However, the Irish Hospital Consultants Association (IHCA) said on Tuesday that at present it was not possible to provide appropriate urgent inpatient care to children and adolescents due to a severe lack of beds for this group of patients.

The IHCA also said the number of adult psychiatry beds available for acute admissions had been reduced to the point where there were “frequently no beds available at night in many of our community healthcare organisations (CHOs), and no co-ordinated national system to manage that availability”.

It said this represented “an ongoing patient safety issue” and that “at least 300 additional adult psychiatric inpatient beds were required to meet recommended levels.

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The association said only three-quarters of the available child and adolescent mental health service (CAMHS) beds were open at any one time.

It said in a pre-budget submission on mental health that in October 2020, there were 72 operational beds for the CAMHS service, out of a total of 98 CAMHS beds.

“There are CAMHS inpatient units in only three counties nationally, and these generally do not take out-of-hours admissions. Waits of up to six weeks for admission can occur.”

“This lack of a co-ordinated national system to resolve crisis situations when they arise presents a significant patient care and safety issue. Children and young people in crisis are left with the unacceptable ‘choice’ between an emergency department, general hospital, children’s hospital, or an adult inpatient unit,” the association said.

The chairwoman of the IHCA's psychiatry committee, Prof Anne Doherty, said overall mental health services in Ireland were experiencing a major shortfall in relation to beds and a major shortfall in relation to staff recruitment and retention.

Prof Doherty said as the population increased the mental health budget was not keeping pace. She said there were insufficient consultants, that the pandemic was placing increased strain on services and that a realistic mental health budget was needed.

The IHCA submission said that at 5.4 per cent of the overall health budget, funding for mental health in 2021 was proportionately the lowest level of spending since 2012. It said the mental health budget in Ireland was approximately half that of most northern European countries

She said there were also a lot of disparities within the various community CHOs across the country.

The IHCA submission said: "For example, CHO 7 (Kildare, West Wicklow, Dublin South), with a population 697,644, was allocated a mental health budget of €94.56 million in 2019 and had a wholetime equivalent (WTE) complement of 835 in mental health in Dec 2018. With just 1 per cent less of a population (690,575), CHO 4 (Cork/Kerry) was allocated €116.68 million (+23 per cent) for mental health services in 2019 and employed 1,483 WTEs – a 78 per cent difference in staffing. There is a 25 per cent difference in funding mental health services in CHO 7 compared with CHO 4 on a population basis.

The IHCA argued that the significant increase in paediatric mental health problems “warrants increased funding as part of the response to Covid-19”.

Dr Elizabeth Barrett, consultant child and adolescent liaison psychiatrist, said during the first Covid-19 lockdown there had been a drop in presentations and when restrictions eased there was a massive surge.

“Overall at times we have been seeing twice the number of patients that we normally see in a month. Across the Children’s Health Ireland (group) there has been about a 9 per cent increase overall.”

“We are seeing a lot of very distressed and anxious adolescents. We are seeing lots and lots of self-harm teenagers presenting. That is not surprising. We had been seeing that increasing over the last ten years but certainly there was an escalation during Covid. We have seen a huge increase in the number of eating disorders.”

The IHCA submission said one hospital had reported a 66 per cent increase in medically unwell young people with eating disorders needing admission.

It said there were currently just three eating disorder public beds for adults in the country – at St Vincent’s University Hospital – and that these were only available to those living in CHO 6 (Wicklow, Dún Laoghaire, Dublin South East.