Children admitted to adult psychiatric units despite new rules to cease practice

Children with mental health problems are still being admitted to adult units of psychiatric hospitals, despite rules introduced to end the practice more than two years ago.

In a new inspection report, the State's mental health watchdog – the Mental Health Commission – found that in the southeast children had been admitted to the adult unit of the department of psychiatry at Waterford Regional Hospital.

The practice is understood to be continuing in other parts of the State, despite an increase in the number of specialist inpatient beds for children and adolescents over recent years.

The Inspector for Mental Health Services has previously described the practice as “inexcusable and counter-therapeutic”.

In December 2011, the official code of practice relating to admission of children under the Mental Health Act 2001 came into effect. It states that apart from exceptional circumstances, “no child is to be admitted to the adult unit of a psychiatric hospital”.

The latest inspection report states that mental health services in the Wexford/Waterford catchment area were delivered by three teams across the region.

After-hours
However, there was no on-call service available, which meant children who attended after-hours were either seen by teams who specialise in treating adults or older people.

It found access to inpatient beds for children in the region was “extremely difficult” and it was reported there was no access to an emergency bed at all for one child in crisis.

Where children were admitted into adult beds, the report said, the child and adolescent teams provided joint inpatient care.

In response to a query from The Irish Times , the Mental Health Commission expressed concern that children continued to be admitted to adult units of psychiatric hospitals, despite rules aimed at ending the practice.

Official figures for last year have not yet been compiled, but in 2012 the commission was notified of just over 100 admissions of children into adult inpatient units, which corresponds to one quarter of all child admissions.

Criteria
John Saunders, chairman of the commission, said he was concerned at the scale of the admissions, even though the number of specialist child and adolescent facilities had increased significantly over recent years.

He called on health authorities to ensure proper admission criteria were being used, emphasising that these admissions should only be a measure of last resort. Mr Saunders also called on the HSE to ensure proper community-based care services for young people were in place, rather than focusing on increasing inpatient units.

Other issues flagged in recent inspection reports show concern over the continued use of out-of-date buildings for some psychiatric patients.

In St Joseph’s Hospital in Limerick, for example, inspectors found that while the building was clean and nicely decorated, the structure of the ward was not suitable for residents. No time frame had been agreed for the closure of the hospital.

At Sligo/Leitrim Mental Health In-Patient Unit, inspectors said there was a shortage of psychology, nursing and medical staff. A special care unit had been due to close at the end of 2011 with the majority of the residents moving to more appropriate facilities.