Good news for young mental health patients

 

MIND MOVES:New unit offers a welcome alternative in care, writes TONY BATES

IT WAS heartening to read last week about the opening of the new HSE inpatient facility for young people in crisis in Merlin Park, Galway. With the planned opening of a similar unit in Cork in 2011 and the recent opening of a specialised adolescent unit in St Patrick’s Hospital, we are in a better position than ever to offer young people a welcome alternative to being admitted to adult psychiatric facilities.

Everyone concerned in driving these new innovations is to be congratulated. But as laudable as they may be, it is worth considering similar facilities that have been established in other countries for many years, in terms of their unique advantages and their limitations.

One example of best practice that has become a gold standard in terms of adolescent inpatient care is the Orygen service in Melbourne, Australia. I visited this service some years ago and was very impressed at the range of interventions it offered young people.

Like the new facility in Merlin Park, Orygen offers young people an environment that is developmentally sensitive and therapeutic. Young people themselves play a role in creating an ethos that is “homely”, through advising on decor and structural details. Their policy is to admit a young person for a brief period – on average nine to 10 days – to manage risk and construct a long-term recovery plan.

The Orygen team has no illusions that meaningful psychotherapy can be provided within this timeframe. Assessment, family meetings and care planning are the goals of admission. A case manager is identified for each young person to ensure continuity of care after discharge.

Ideally, the same team who cares for the young person in hospital follows through with them after discharge, but this is not always feasible. To address this potential discontinuity in care, Orygen has a mobile home-care team who work with young people after admission in the community, helping them to address unresolved issues that could lead to relapse.

One of the unique strengths of Orygen that could be adopted within our own emerging child and adolescent units is the emphasis it places on youth participation.

Through a programme called “Platform”, young people who have successfully resolved their difficulties, are recruited, trained and paid to offer mentoring for their peers, working closely with nurses within the ward routine.

Prof Patrick McGorry, founder and clinical director of Orygen, pointed out that no matter how pleasant a hospital environment might be, it is never the ideal solution for a young person. In so far as possible, he believed, intervention with a young person should happen in the community. Reaching out through home-care community mental health teams and providing youth-friendly spaces in the community where young people could access a variety of mental health supports was always preferable, in his view.

McGorry also emphasised that inpatient services needed clearly defined “step-down” options, which allowed the young person to progress beyond hospital through a series of therapeutic steps back into their communities.

Without these options, admissions could be prolonged, and the danger was that young people could over-identify with their diagnosis and fail to see a life beyond that of being a “patient”.

Best thinking on adolescent inpatient services say that they work when they are integrated within a broader system of care that includes early intervention – to prevent a young person becoming so troubled that hospitalisation is necessary – and an aftercare plan to re-engage them with their families, their educational or vocational goals, and life in their community.

Let us remember that in the past, institutionalisation was caused not only by the poor quality of the environment we offered, but through taking people away from their communities for long periods and failing to support them in rebuilding their identity outside of those settings.

Tony Bates is founder director of Headstrong – The National Centre for Youth Mental Health (headstrong.ie)