24th January 2003

We write on behalf of the Child & Adolescent Section of the Irish College of Psychiatrists. Our members - all practising Child & Adolescent Psychiatrists in this country - are seriously concerned about the lack of provision of inpatient beds for the treatment of children and adolescents with serious psychiatric disorders.

Psychiatrists regularly find themselves in the situation where seriously ill children requiring inpatient treatment are unable to access such treatment. There are only two inpatient units at present in the country, in the Eastern Regional Health Authority and Western Health Board areas, which confine their services to their own health boards. As you may be aware, the children’s inpatient units at the Lucena Clinic, Orwell Road, Dublin 6W and the adolescent unit at St John of God’s Hospital, Stillorgan, Co. Dublin previously provided national services. These units were closed in 1997 and 1999 respectively, and have not been replaced. Outside of the Eastern Regional Health Authority and Western Health Board areas, Consultant Child Psychiatrists occasionally access beds in private hospitals in Dublin. This is usually on a goodwill basis with colleagues in the private hospitals - not through any formal contractual arrangements. Also, it is an informal service that is only available for adolescents, with no service available for children under 13 years old. In many cases, children requiring hospitalisation must be treated at home. These children are often seriously psychotic, depressed and suicidal or anorexic. Many of these children may be at risk of suicide, and they may also be on high doses of medication, which need medical and nursing supervision. These situations obviously pose very serious risk.

As you are aware, the Working Group on Child & Adolescent Psychiatric Services, Department of Health & Children, reported in February 2001, recommending the development of 5 inpatient units around the country – two in the ERHA, one in Cork, one in Limerick and one in Galway. It also recommended that Boards outside of the catchment areas for these proposed units should enter into contractual arrangements with the Health Boards which do have units, in order to gain access to beds.

At this stage, now two years later, our members request the following information:-

1. Is there a project team planning a unit in your Health Board? If so, what stage of development is this project at?
2. If your Health Board will not have a unit of its own, have any negotiations taken place between your Health Board and other Health Boards to access beds for children in your area?

1. A formal arrangement with a centre outside of the Board’s own area
2. The availability of intensive home nursing
3. The availability of day hospital placements
4. Access to beds in an adult psychiatric facility, with special nursing made available for children who may be admitted (while this is not a desirable solution, it may be the only course of action available to access inpatient beds, and should represent a last-resort action).

We would be grateful if you would advise us by return of the situation in your Health Board, in order that we may further this matter in our representations to the Department of Health and Children and the Mental Health Commission, and in the interests of safe and equitable child and adolescent psychiatric services throughout the country.

With kind regards in anticipation of your reply,

Yours sincerely,