The lives of hundreds of thousands of Irish children are being blighted by under-staffing and skills shortages in the State's child and adolescent mental health services, writes Mimi Tatlow
A hidden population of young people in Ireland is suffering. At any one time, one in five children and young people are struggling with the impact on their lives of a mental, emotional or behavioural disorder. Yet, incredibly, of these cases, an estimated 80 per cent will remain undetected, undiagnosed and untreated.
Up to 160,000 children simply will not get the help they need. For those who do get help, many will have endured a lengthy wait, losing out on crucial developmental and educational years, sometimes until their condition has become severe or even life-threatening.
The problems these children are facing encompass a broad range - from major illnesses such as depression, anxiety and eating disorders to conditions such as ADHD, recurrent abdominal pains, learning disabilities and specific learning disorders such as dyslexia or dyspraxia.
Self-harming behaviours are also common. By the time they reach their mid-teens, 10 per cent of children have deliberately harmed themselves in some way. Just as with physical childhood illnesses, most of these are either curable or at least treatable, but the longer they remain untreated, the worse things get.
A 2005 report by the Irish College of Psychiatrists states - as just one example - that the Clare/Limerick/Tipperary North area's multi-disciplinary child and adolescent out-patient team is able to see some 300 children and teens with depression each year. Yet research tells us that there will be about 1,500 cases in any year in that area. On those figures, 1,200 of these children and teens will be left untreated.
Meanwhile, clinical psychologists are reporting much higher depression rates among teens in some areas of the country, such as Cavan, suggesting that the figures reported by the Irish College of Psychiatrists, high as they are, may themselves be an underestimate.
For anyone who is inclined to be sceptical about figures, listen to the voices of young people themselves. In 2004, nearly 3,000 students aged between 15 and 17 were interviewed about their wellbeing and mental health for the National Suicide Research Foundation. Over one-quarter of them reported that they were grappling with a serious problem such as anxiety, depression or deliberate self-harming.
Again, fewer than one in five had received any professional help.
Our spending on mental health fell proportionately between 1997 and 2003 - from 11 per cent to 6.8 per cent of the health budget. Child and adolescent psychiatric services account for just 5-10 per cent of that impoverished pot, while they are needed to bring help to nearly 23 per cent of the population.
The end effect is a shocking catalogue of under-staffing, skills shortages and inadequacies in services which is blighting the lives of hundreds of thousands of children. For example, multi-disciplinary out-patient child and adolescent mental health teams - who often do an excellent job under adverse conditions - are inherently limited because of chronic under-staffing. Over one-third of those teams struggle to serve double the recommended catchment populations. The result is waiting lists for assessments which can be as long as two years - a completely unacceptable length of time for anyone, but worse for a child.
Most teams suffer from a lack of crucial skills - they simply do not have the right mix of team members to provide a high-quality, holistic assessment and treatment service to children. For example, 83 per cent of teams do not have sufficient clinical psychologists; psychotherapists and family therapists are missing from nearly 90 per cent of these teams; over 50 per cent have no speech and language therapist and nearly 60 per cent have no occupational therapist. The effect is that, even after a wait of months or years for an assessment, parents may discover that the staffing lottery means no appropriate help is available.
At the acute end of the scale, matters are even worse. For our population, we should have 156 in-patient psychiatric beds for children up to 15. There are only 20. (Finland, with a similar population, has 290). For 16/17-year-olds, there should be 80 in-patient beds, but there are none.
Finally, for the worst crisis of all, a suicide attempt, emergency services are woefully inadequate. Many young people arriving at A&E after deliberately harming themselves are not even offered a psychiatric assessment, even though research shows that this would significantly reduce the risk of a repeat episode of deliberate self-harm. A significant proportion is not offered any follow-up either, and in many cases A&E notes lack crucial details, suggesting an unacceptably lax approach to this vulnerable group.
Unidentified mental illness is a feature of up to 90 per cent of completed suicides while untreated mental illness is the greatest block to young people being able to work and become self-sufficient.
What needs to be done? While tackling the unacceptable staffing levels of child and adolescent mental health services is an obvious priority, other equally important approaches would reduce the burden on services themselves. Young people told the National Suicide Research Foundation that they want counsellors in their schools to help them manage issues such as loneliness, abuse and bereavement. They also want bullying to be dealt with - this is a major risk factor and can have life-long consequences.
Professor Mona O'Moore of TCD has shown that whole-school anti-bullying policies reduce bullying by 50 per cent, yet the political will to introduce these measures appears to be absent.
Finally, young people tell researchers that they want emotional awareness as a classroom topic. They also want an erosion of the taboo surrounding mental health issues and a raising of awareness of mental health issues for themselves and for society. We would be well advised to listen to them.
Mimi Tatlow is a psychology researcher working in the area of children and presenter of The Other Side of Childhood, a series beginning on RTÉ Radio 1 this evening at 7 o'clock