Waiting lists for Child and Adolescent Mental Health Services on the rise

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With public outrage over long waiting lists, Child and Adolescent Mental Health Services (CAMHS) and chaos in emergency departments need to be prioritised.

However, this importance is not reflected in the number of clinical staff or expenditure put towards mental health services. In 2007, there was a total of €990 million spent on mental health services compared to €917.8 million in 2018. That is a decrease of 7 percent in 11 years.

Following a Freedom of Information request, it was found that in July 2017, there was a total of 2,419 children and young adults on the waiting list for CAMHS. As of May this year, there are 2,639 children and teens on the waiting list, which shows an increase of 9 percent in ten months.

In 2017, 218 of those on the list were waiting over a year compared to 319 people as of May 2018, which represents a 46.33 percent increase.

The HSE management data report for March 2018, revealed that there were 18,489 CAMH referrals, including re-referrals received by the Mental Health Commission (MHC).

A total of 10,304 of those were seen by mental health services, and 226 of them were admitted to CAMHS acute inpatient units.

The MHC recently published a report which highlights the issues in mental health services, such as the gaps in service provision and the waiting lists. CAMHS is meant to be a service for young people with acute mental stress. The limited choices medical practitioners have when referring a child to mental health services places more stress on an already overstrained service.

According to a report, published in the Irish Medical Journal, paediatric services have an increased rate of mental health issues. The report revealed hidden costs in paediatric psychiatry consultation-liaison services (PCPLS).

The majority of work done by PCPLS involves children with acute or deteriorating psychiatric disorders that co-exist with other physical health conditions, and most of which are previously known to CAMHS.

In Ireland, there aren’t many options when dealing with PCLS cases in paediatric hospitals. Therefore, almost all of the 61 cases (80 percent) in 2016, as revealed in the report, were discharged to CAMHS.

The MHC explained in their 2017 annual report that there were 82 admissions of children to 21 adult units in 2017 compared to 68 in 2016. This is a result of bed shortages in dedicated children’s units across the country.

CAMHS can’t admit patients to out-of-hours care, which means that children seeking help are forced to seek medical attention in adult care services.

In the absence of CAMHS, due to their out-of-hours services, PCPLS are directed to children who show up to the emergency room with psychosomatic illnesses.

The MHC report showed that eating disorders were notably the highest mental health issue represented and account for a substantial share of expenditure. The report claims that the annual cost of bed days and one-to-one nursing care for these patients does not feature on any of the HSE CAMHS data records and comes out of hospital funds which means it’s not properly documented.

Dr Fiona McNicholas, an author of the report, told The City that “there used to be much better detailed data records in previous CAMHS reports. Given there is a large volume of work coming in, and the cost is both in hospital stay, special and manpower, it needs to be added to mental health HSE data, but it is not.”

Dr McNicholas added: “There is no ring-fenced budget for mental health provision within the paediatric hospitals. Going forward in planning the National Paediatric Hospital, this increasing volume of acute psychiatry that comes to the emergency department (ED) needs to be recognised by the HSE Mental Health Division. It needs to be measured, costed and resourced, so that the children and families in acute psychiatric crisis attending ED feel welcomed and are given a good mental health assessment without a sense that they are taking away specialist consultant liaison time from the children with combined medical and psychiatry issues.”

 

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