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Psychiatric Care

27 children and adolescents stayed in adult psychiatric units in 2021 despite CAMHS capacity

A HSE spokesperson said that in exceptional circumstances this may be in the best interest of the adolescent at that time.

CLOSE TO 30 children receiving mental health care were accommodated in adult psychiatric units in 2021, according to information released recently in response to a Parliamentary Question from TD Mark Ward. 

In a statement today Ward, Sinn Féin’s spokesperson on mental health, said he had received information that 27 children spent a total of 87 days in adult psychiatric facilities last year, despite there being free CAMHS bed capacity at the time of their admissions.

He called the findings “extremely worrying”, and said that the reason given to him by the HSE was that “some areas do not offer an emergency out-of-hours service.”

These areas include Kerry, Cork, Tipperary, Carlow, Kilkenny, Waterford, Wexford, Cavan, Monaghan, Louth and Meath.

“It is scandalous that 11 out of 26 counties in this state do not offer an emergency out-of-hours service for children suffering from mental distress. This is yet another abject failure on the provision of children’s mental health care,” Ward said. 

One child, who was admitted in December 2021, spent 13 days in an adult facility and two other children spent a week.

“The child was from CHO area 9. Information I have been shown states that there were six vacant beds in St Vincent’s, which covers CHO 9, at the time of the child’s admission,” said Ward.

“So why was this child kept for 13 days in an adult facility when there were vacant beds in an acute children’s mental health facility?

“Even if the child was deemed to be at immediate and serious risk, was this for the whole 13 days of admission?”

In the information provided by the HSE to Ward, the reasons given for these admissions include a lack of beds in CAMHS units or an immediate and serious risk to self and others.  

“One of the children spent seven days in an adult facility in February 2022. The only reason given by the HSE was that there were no beds in CAMHS units,” said Ward, adding that he had received other information that there were five beds vacant in their catchment area in CHO 9 time of admission.

Last week the HSE confirmed that several beds in CAMHS would be closed until September, taking the number of beds from 22 to 13 at the Linn Dara Child and Adolescent Mental Health Unit in Cherry Orchard.

In a statement to The Journal, a HSE spokesperson said: “The capacity issue is not related to any funding difficulties, but is due to challenges in hiring and retaining nursing staff at levels necessary to operate Linn Dara at full capacity while maintaining necessary standards of care”.

HSE response

A spokesperson for the HSE told The Journal that the body is “committed to age-appropriate placement and to the minimisation of the number of admissions of children to adult units.”

They added that the HSE acknowledges that “in exceptional circumstances, it will continue to be necessary, where there is a clear clinical imperative, to admit a small number of children to adult units, for the shortest time possible.”

The spokesperson said that children are admitted to adult units after efforts to place them in a CAMHS in-patient unit are unsuccessful due to capacity or clinical needs.

There is a range of factors that can influence the clinical decision to admit a child to an adult acute inpatient unit, including crisis admission where no adolescent bed is immediately available.

Distance to the nearest CAMHs in-patient unit can also be a factor when immediate clinical assessment and treatment may be the requirement, the spokesperson said. 

“In some cases, the presenting clinical needs of the young person, (who may be nearly 18 years old) may be more appropriately assessed and treated in an adult unit.”

All admissions of young people under the age of 18 years are notified to the Mental Health Commission in accordance with regulations. All such admissions are also notified to a National Mental Health Office, they added. 

“Whilst the percentage of admissions to Adult units has decreased over the years there will continue to be emergency situations where admission is indicated (as per Mental Health Commission Guidelines) and the only available option may be to an adult mental health service.”

The spokesperson said that this may be in the best interest of the adolescent at that time, and that “the goal in such circumstances is to reduce the length of such admissions either by discharge to Community CAMHS or transfer to CAMHS, CAMHS in-patient unit or another appropriate service.”

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