Psychiatric services for young people in need require drastic overhaul

Between January and September 2013, three teenagers aged 14 were admitted to adult mental health units. So were two teenagers aged 15, 27 teenagers aged 16, and 36 aged 17. So 68 children were admitted in all, according to the last child and adolescent mental health services (CAMHS) report.

Adult psychiatric units have improved greatly in recent years, but they are no place for a child.

Imagine the impact on a 14-year-old of being confined in a psychiatric unit with very unwell adults. At the very least, she or he would be uneasy, and at worst, afraid and traumatised.

Suitable facility
The decision to admit a child to an adult unit is never taken lightly, and the stays tend to be short, eight days on average. However, the only reason that the decision is ever taken is because no more suitable facility is available.

Things are improving. In 2008, there were three 12-year-olds who spent time in adult units, and the total number of admissions of children under 18 was 263.

However, 68 children in adult units is still absolutely unacceptable. But what about a 19-year-old, or 20-year-old in a bed in a ward next to a man aged 75? Until recently, the cut-off point for treatment as an adolescent was often 16, but even 18 is still very arbitrary. It should be a priority to move to services that cater for 15- to 25-year-olds, as is the case elsewhere, for example, in Australia.

Last October, research published by the Royal College of Surgeons in Ireland highlighted that young Irish people appear to have higher rates of mental health difficulties than their peers in the UK and US.

It is important to maintain perspective. Most young people enjoy good mental health, and there are helpful treatments and therapies for those who do not.

However, the Psychiatric Epidemiology Research across the Lifespan (PERL) Group Report found that one in five young Irish adults aged 19-24 and one in 6 young people aged 11-13 were experiencing a mental disorder at the time they took part in the research.

The PERL report shows that young people who experience mental ill-health during adolescence have higher rates of mental disorders and substance misuse during their young adult years, and are three times more likely to be unemployed.

It is imperative that we prioritise identifying and helping young people at risk. However, CAMHS have been underfunded and under-resourced for a very long time. The patently false idea that mental health problems are primarily a concern for older people still lingers.

One of the key recommendations of A Vision for Change in 2006 was multidisciplinary CAMHS teams. By September 2013, no area had more than 55 per cent of the staffing level in place recommended by A Vision for Change , and in Waterford/Wexford, it was under a third of the recommended level.

There is a sense of frustration among some mental health professionals to whom I have spoken, that the current State priority seems to be the “softer” end of mental health. They cite the emphasis on a “whole school” approach to mental health, and on creating Youth cafes where young people can hang out but also receive mental health support.

Both of these initiatives are important, and should continue. However, given that the new whole school guidelines on mental health were published at a time of savage cuts to guidance counselling, how credible is State support?

Also, these approaches are not appropriate for young people with the most serious problems, who are also the most stigmatised. Whatever progress has been made in accepting the reality of anxiety and depression, it is very different if a young person admits to hearing voices.

In fact, one senior professional said to me that when approaches that work for people with less serious problems are offered to people with grave mental health issues, it is the equivalent of offering cold symptom relief medication to someone with cancer. All it achieves is to make them feel worse.

She also pointed out that if you ask the general population of young people what they need in terms of mental health, you get very different answers to what you will hear from service users with more serious problems.

Intensive professional help
There seems to be almost a view that if the general population of young people receive support such as training in coping skills to develop resilience, that no serious mental health problems will develop.

This is very naive. A certain percentage of young people will always be at risk of serious mental ill-health, and will need specialised and intensive professional help, and outcomes are generally good if they do receive that help.

However, stigma remains a problem. Time and time again, parents have told me, half-ashamed, and half-angry, that it would be much easier if their child had been diagnosed with a serious physical illness, because there would be so much more sympathy and support from friends and family.

Until we see significant cultural shifts, which must include proper funding for CAMHS, unfortunately that situation will continue.