Taoiseach Brian Cowen says a new purpose-built facility in Cork will cater for future child psychiatric admissions in the southeast from early December. However, the head of Ireland’s leading independent children’s charity has painted a “dismal picture” of the State’s neglect of psychologically-vulnerable youngsters, despite the best efforts of frontline staff.

Two boys and a girl aged 17, and a 14-year-old girl were admitted to the Waterford Adult Mental Health services unit last Sunday and Monday, despite the fact that since July 2009 no-one under-16 is supposed to be placed in an adult psychiatric setting. Indeed, the minimum age limit is to be raised to 17 from December 1st and to 18 in late 2011.

The HSE said it was “exceptional and uncommon” for adolescents to have been admitted to the 44-bed Waterford unit. However, it’s been revealed that 200 young people were taken into adult psychiatric units last year – seven of them on an involuntary basis.

The Psychiatric Nurses Association says teenagers have been turning up at hospital emergency departments all over the country with mental-health complaints. Consultants are admitting them to general children’s wards in some cases rather than turning them away. They receive one-to-one psychiatric care in the paediatric wards, but the situation is “far from ideal,” said PNA chairman Liam MacNamara. “If a child receives the proper treatment, they may never have a problem again,” he added.

The HSE has vehemently denied claims that just one nurse was left in charge of the WRH unit during this week’s crisis admissions, insisting it “was fully staffed”. Also, “claims that a teen was cared for by a security guard are completely untrue,” it said. “In fact, additional nurses were provided to ‘special’ the teenager with one-to-one care.” It’s understood the four teenagers were kept in separate rooms away from adults, with their own en-suite facilities.

‘Not ideal’

The Executive added that “the vast majority” of young people receive the mental health care they need from professionals in their own community, with support from their family (and friends). A small number of young people will require inpatient psychiatric care, based on a medical assessment, and only after all other treatment options have been considered.

Whilst “admitting under-17s to an adult unit is not ideal, the Mental Health Commission guidelines do allow for such admission in exceptional circumstances” in the best interests of the individual concerned. “When this does happen, every effort is made to provide a single room, and one-on-one nursing care for the young person. Each admission is under the care of a Consultant Psychiatrist with advice and support provided by community based Child & Adolescent Psychiatrists.”

The HSE South has an eight-bed Child and Adolescent Psychiatric Inpatient Unit at St Stephen’s Hospital in Cork. An interim facility with 27 staff, it provides specialist inpatient treatment to children and teenagers up to age 18 for counties Kerry, Cork, Waterford, Carlow, Kilkenny, South Tipperary and Wexford.

Eight beds for seven counties is clearly insufficient to say the least, and a new 20-bed Unit, with 30 additional frontline mental health staff, is to be opened Bessboro, Blackrock, Cork by December 1st. The national mental health policy ‘A Vision for Change’ (2006) recommended the provision of four inpatient units for young people in Cork, Galway and two in Dublin.

Cork-based Consultant Psychiatrist Dr Siobhán Barry said putting vulnerable underage persons in adult environments is “unhelpful and inappropriate.” She acknowledged that a special unit for young people in Waterford had been planned as far back as 1984, but never materialised.

Fergus Finlay, CEO of Barnardos, concurred that underage admissions are “totally inappropriate as both the facilities and staff can be ill-equipped to cope with teenagers’ illnesses and this can subsequently have a negative affect on the patient’s recovery.

“Unfortunately, this is not a new problem,” he said, “as already 100 children and adolescents have been admitted to adult psychiatric units so far this year on top of 200 in 2009. Children needing inpatient services must be admitted to age-appropriate settings in order to ensure access to age appropriate treatment in order to prevent their condition escalating.”

Raised in Oireachtas

In the Dáil on Wednesday Brian Cowen was questioned by Fine Gael leader Enda Kenny about how a situation could arise in the southeast where “vulnerable young people with serious problems” were treated in an adult ward – something that was “completely contrary to the Mental Health Commission guidelines.” He also repeated the refuted allegation that “because of staff cutbacks, at one stage just one nurse was attempting to take care of more than 30 patients” in the ward at WRH.

Asked if legislation will be introduced later this year “to outlaw this practice which is very dangerous in many cases”, Mr Cowen said he did “not know if specific legislation is involved, but I accept it is inappropriate to admit young people to units providing care and treatment to adults. However, recognising the absence of an alternative, such admissions are sometimes necessary for the safety and treatment of a child,” he maintained.

The Taoiseach added that “during 2009 the bed capacity for children and adolescents almost doubled, bringing the total number of inpatient beds to 30. That capacity will be further increased to 52 following the commissioning of two new units in Cork and Galway later this year.” The new 20-bed unit in Cork “will provide for the inpatient needs of the Waterford area in the future,” he said.

Waterford FG Senator Paudie Coffey told the Seanad that what happened in Waterford last weekend was “wholly inappropriate” and “in complete contravention of the policies adopted by the Department of Health and Children and the HSE.

“A great deal is said about ‘A Vision for Change’ and the mental health services. How have we arrived at a situation in 2010 where a 14-year-old is held at an adult psychiatric facility? […It’s] an indictment of the health service,” he slammed, saying “Agencies such as Barnardos and the Psychiatric Nurses Association are very frustrated because their members are doing their best on the front line but are not in a position to provide the services required by the most vulnerable in society. This is a direct result of the litany of waste that bedevils the HSE.”

Lives blighted

However, the Executive defended the provision of community support through its dedicated Child and Adolescent Mental Health Teams as “the preferred option.” These teams include consultant psychiatrists, mental health clinical nurse specialists, speech and language therapists, occupational therapists, play therapists and social workers.

There are currently 55 Teams nationally, 13 in the HSE South area, including three covering Waterford/Wexford (2). But Fergus Finlay says the development of these Teams is slow, with the majority of the 55 in place at present (out of a recommended total of 78) still not having the required complement of professionals.

“The ongoing waiting lists children experience for assessment and treatment with these services presents a true but dismal picture of the state of mental health care for children in Ireland,” he asserted. Indeed, as of last December, 2608 children and adolescents were waiting to be seen by a Team, 623 had been waiting for 6-12 months, and 562 for more than a year.

“Time matters to children,” the Barnardos chief stressed. “Difficulties quickly identified and dealt with pose fewer long term problems than those left to fester because children can’t get the support they need.”

That the budget for mental health services has decreased in recent years raises “societal questions of how many young lives need to be blighted by our inadequate mental health system before we finally prioritise these vitally important services.”