CHILDREN AS young as 13 without mental health illnesses are being admitted to adult mental health units because of a lack of adequate social work services in the community, a new report claims.
This practice is particularly acute outside Dublin where there is no proper out-of-hours social work provision to deal with high risk cases, which can involve juvenile drug and alcohol abuse.
In some cases children end up being admitted to adult mental health units because no places are available in child psychiatric units.
A report published yesterday by the Mental Health Commission says a lack of “crisis solutions” inevitably causes the burden of dealing with these young people to fall on mental health services.
“There would appear to be a lack of engagement of community care social work services and other partner agencies in offering support to children and families . . . Children and young people may therefore be receiving a mental health service inappropriately when their needs are in fact social,” the report concludes.
It strongly criticises the placement of children with social needs in psychiatric wards because it “unfairly labels young people and may potentially lead to stigmatization and discrimination”. The report identifies a particular problem in Limerick where emergency services are not backed up with either appropriate beds or intensive community support.
“There would appear to be a low tolerance of risk and a high tolerance of admission in Limerick,based on long-standing practice and a perception of isolation,” the report says. It was commissioned due to concerns about the high numbers of children in Limerick admitted to adult mental health units.
The report, by Scottish expert Dr Sally Bonnar, says there is likely to be considerable pressure from parents for admissions, which in other countries would be considered “social admissions” rather than mental health admissions. It recommends consideration be given to withdrawing these types of out-of-hours emergency services when there is no clear support from other agencies.
The report also criticises the admission of children with mental health problems to paediatric units, a practice that is routine in Limerick. It also found children as young as 13 years are still being admitted to adult mental health units despite the introduction of a code of practice to stop it.
The code drawn up by the State regulator, the Mental Health Commission, stipulates that children under 17 years should not be placed in adult facilities. From December 1st, 2011, it will be extended to teenagers under 18.
The report concludes the deadlines set in the code to prevent the admission of young people under 18 years into adult units are ambitious and unlikely to be met without significant shifts in the operation of inpatient units.
The report found 91 children were admitted to adult psychiatric units in the first six months of 2010, 11 of who were 15 years or younger, 28 who were 16 years and 52 who were 17 years. Eight young people under 16 years were admitted to an adult ward in Limerick during this same period.
The report says there is a lack of capacity in community child and adolescent mental health services to provide comprehensive community treatment and care. The numbers working in the service are less than half of that promised by the Government.
It also says there is still a lack of clarity on Government promises to reach a target of providing 108 beds in children’s mental health units, especially in the current financial climate. This 108-bed target is “generous” compared to equivalent standards in Scotland, England and Wales, where the emphasis is on community care close to patients’ homes.
The report says the 108-bed target should be reviewed in light of the relative poverty of community service provision.
Hugh Kane, chief executive of the Mental Health Commission, said the report identified the particular issues in Limerick and confirmed that the code of practice should remain in place.
CLEAR PROTOCOLS: MAIN RECOMMENDATIONS
* Define the “exceptional circumstances” clause that allows under 18s to be admitted to adult units
* Local services should develop clear protocols covering the admission of children to adult units
* Adult wards should state how the educational, recreational and developmental needs of children are to be met
* Inpatient units should formally share admission criteria, referral forms and discharge procedures;
* Consider withdrawing mental health services out-of-hours cover when there is no clear support from other agencies and no appropriate beds available
* The formal use of paediatric beds to care for children with mental illness is risky and should not be routine