Sir, – The article “Children’s hospitals seeing ‘astronomical’ number of young people self-harming” (News, January 2nd) which cites Prof Mary Cannon and Dr Michele Hill is timely and welcome.
As a group of paediatric liaison psychiatrists working within Children’s Health Ireland, we have seen the exponential increase in children and adolescents presenting with psychiatric crisis and illness over the past two decades.
Referrals to community Child and Adolescent Mental Health Services (Camhs) in Ireland had increased by 26 per cent prior to the pandemic, with referrals to hospitals for self-harm nationally increased by 22 per cent between 2007 and 2016, most pronounced in those aged 10 to 14 year olds. In one emergency department which analysed the presentations and published in the Irish Medical Journal in 2017, the rates of self-harm and suicidal crises rose from 69 in 2006 to 430 in 2017, an increase of 526 per cent. This increase has continued, with a peak of up to 10-fold in presentations during and following the Covid-19 pandemic, as recognised in a major international study of the serious impact of the pandemic on the mental health of our youngest citizens.
These rates have remained consistent since lockdowns have ended. We have also seen a worrying increase in eating disorders. Increasingly children and adolescents are admitted to paediatric wards as there are insufficient Camhs inpatient beds to meet the needs of this “silent epidemic”. These increases in emergency and crisis presentations have not been met with HSE investment in Camhs or acute hospital paediatric liaison services. Planning for such emergency psychiatric care has been omitted from relevant mental health policy and planning documents and these figures are not counted in any HSE reports and therefore this very vulnerable group remain hidden and in our view neglected.
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Prof Cannon and Dr Hill rightly highlight the need for increased resources within our Child and Adolescent Mental Health services to permit capacity to cater for emergency presentations safely and effectively. There is also urgent need to develop out of hours services for all youth, to facilitate rapid assessment, appropriate therapy and treatment in the most appropriate setting. As currently structured, our extremely busy emergency departments (EDs) are not the most appropriate setting for the majority of such presentations, unless there is an acute medical need necessitating combined medical and psychiatric care. EDs could provide immediate access and form part of a wider “out of hours” emergency response only if dedicated mental health funding is provided. In addition, there is a need to develop paediatric liaison psychiatry services nationally, as many centres do not have adequate access to these specialist psychiatric services, which provide essential psychiatric treatment for children and young people with medical illnesses, in whom the rates of mental health difficulties and illness are indeed higher than the general population. These services have been necessarily curtailed due to the increasing need for emergency psychiatry provision.
While there is an increase in prevalence of psychiatric illness in older adolescents and the need to develop services to facilitate transition and appropriate care for young people, there is also an urgent need to address the psychiatric needs of children and younger adolescents across childhood, from infancy to adolescence. We know from research that adequate early recognition and treatment at all ages is protective of future mental health. In addition to responsive care, there is a need for research into preventive and early interventions which can mediate the impact of factors known to increase risk. This needs, as the article suggests, a waking up of the Government to the crisis and true commitment to mental health funding. – Yours, etc,
Dr AOIFE TWOHIG,
Dr ELIZABETH BARRETT,
Prof FIONA McNICHOLAS,
Dr KIERAN MOORE,
Dr MARTIN O’SULLIVAN,
Consultant Paediatric
Liaison Psychiatrists,
Children’s Health Ireland
at Temple Street,
Dublin 1.