The ‘underbelly’ of children’s mental health services

• Published date: 24 August 2021
• Author: Sheila Wayman
• Publication title: Irish Times (Dublin, Ireland)

Attendances at EDs for mental health issues jumped by 58 per cent (514 to 810) over the second half of 2020, compared with the same period the previous year, according to figures supplied by Children's Health Ireland (CHI), which oversees acute paediatric hospital services.

Admissions for children and adolescents with eating disorders have also escalated, with a 66 per cent increase in admissions to CHI hospitals in the first three months of this year, compared with the same period last year.

Yet, officially, mental health services don't operate in these hospitals. While some of these children need medical treatment for a physical consequence of their mental condition, the rest are in the "wrong" place and going under the radar.

None of these hospitals are "approved centres" for inpatient mental health care, under the watchful eye of the Mental Health Commission. Nor are they part of the Health Service Executive's Child and Adolescent Mental Health Services (Camhs), which are delivered both in the community and through specialist inpatient units.

But families are going to EDs in desperation because there is nowhere else to go with their distressed children. Camhs doesn't operate out of hours; "emergency slots" during the day are very limited or non-existent; and waiting lists are long.

Suicidal ideation, self-harm thoughts and self-harming acts, as well as anxiety and behavioural issues, are the most common issues being seen in EDs. It is a trend in keeping with what other paediatric hospitals internationally are reporting, according to the CHI, in looking at the impact of the pandemic on children and children's services.

A sharp drop in all attendances at CHI emergency departments during the first months of the 2020 lockdown preceded the surge in the second half of the year. However, while overall ED attendance in the Dublin paediatric hospitals during the 12 months to the end of February 2021 was 34.3 per cent below the prior year, those presenting with mental health issues were 8.9 per cent up, according to a study led by University College Dublin and published in the Irish Medical Journal.

Red flags

Even before Covid-19, the children's hospitals here were raising red flags over the risks they take in admitting youngsters with mental health conditions to general paediatric wards. There are dangers not only to those patients themselves who, in CHI's words, "are receiving less than optimum care in an unacceptable clinical environment", but also to staff, who have been stressed and injured, and there are knock-on effects for other patients too. "The impact of treating these children - who require care for their mental health illness but not other medical care - in a suboptimal environment results in poorhier outcomes for children and adolescents with mental health issues and also...