March 26, 2008

Children waiting months for psychiatric assessment

CARL O'BRIEN, Social Affairs Correspondent

THOUSANDS OF children with mental health problems are waiting months or years for vital psychiatric assessments as a result of severe staff and bed shortages, according to an internal Health Service Executive (HSE) report.

The executive commissioned a report last year into waiting lists for child and adolescent psychiatric services which found major gaps in community mental health teams and a serious lack of beds for emergency cases.

The report, obtained by The Irish Times, shows that the number of children waiting for vital assessments has grown to 3,608.

The majority have been waiting more than a year (30 per cent), followed between six months and a year (22 per cent) and between three and six months (18 per cent).

Groups such as the Irish Psychiatric Association have warned that delays in treatment for children with severe mental health difficulties leave young people at a much higher risk of becoming chronically unwell.

The situation is most serious among "emergency cases", or children who have severe psychiatric disorders such as schizophrenia, depression and mania. The lack of beds is "resulting in enormous difficulty accessing beds in crisis situations".

The report notes: "Such children are frequently admitted to paediatric hospitals where their mental health needs are often not well met as the environment can be unsuitable and the nursing and medical staff lack the specialist knowledge in treating such children and adolescents. "

It says these children are admitted to adult psychiatric wards that "cannot provide an appropriate environment for the assessment and treatment of adolescents."

A total of 272 adolescents were admitted to adult units in 2005.

A detailed breakdown of waiting lists for treatment in 2007 shows they were longest in Carlow/ Kilkenny (278 cases), with most children waiting more than a year for treatment. Long waiting lists were also recorded in Swords, Co Dublin (230), the Lucena service for under-12s in Dún Laoghaire (217), Co Kerry (196), Co Donegal (180) and east Co Limerick (173).

The report also highlights major gaps in the child and adolescent services in areas such as the beds, skilled staff and community supports. There are just 14 in- patient beds in the country for children with severe problems, compared to a recommended level of 118 beds set out in the Government's blueprint for mental health services, A Vision for Change.

In the area of staffing, it notes there are 45 community mental health teams in the State compared to a recommended level of 85. Even among the existing teams, it notes they are operating well under capacity. They had just 67 per cent of their recommended staffing complement, with 418 staff instead of a recommended 611. Similar staffing gaps are evident in other existing services such as in-patient beds, which are at 77 per cent of their recommended staffing levels.

When mental health staff were asked why waiting lists were so long in some parts of the country, among the reasons given were large population catchment areas, the number of urgent cases with limited scope for treatment of intervention, difficulties filling consultant posts and under-development mental health teams.

Staff were also critical of the environment in which they operate, with 55 per cent saying their working conditions were unsuitable.

Of this figure, 11 per cent said conditions were "totally unsuitable".

The HSE says it is in the process of developing this sector and estimates that the number of in- patient beds will increase from 12 to 30 shortly. Construction is also due to begin soon on two new 20-bed units for children and adolescents in Cork and Galway.

© 2008 The Irish Times