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14 January 2004
Irish College
of Psychiatrists Response to the Second Report of the Working
Party on Child and Adolesecent Psychiatry (2003)
The Irish College of Psychiatrists has recently submitted
its response to the above report to a range of intersted parties,
including the Minister for Health and Children, Department Officials
and Health Board Executives. Details of this response are outlined
below.
- "The Irish College of Psychiatrists broadly
welcomes this Report and agrees with the recommendations that
Mental Health Services should be developed to meet the specific
needs of the adolescent population. It is our view that a service
for adolescence is preferable to a narrow age defined service
between the ages of 16 and 18 years".
- "The current position is that psychiatric
care for sixteen to eighteen years is provided under the 1945
Mental Health Act by General Adult Psychiatrists. This is an
unsatisfactory arrangement because of the particular needs of
this group. This is acknowledged by the introduction in the
Children’s Act and in the Mental Treatment Act defining
childhood as ending at eighteen. This acknowledges that this
age group has specific needs that would not be best met in the
milieu of general adult psychiatry. General adult teams do not
have the training to deal with the particular demands of this
age group, in terms of conduct disorder, or development difficulties
for example. Given the recent changes in legislation with the
Children’s Act and the Mental Treatment Act, general adult
psychiatrists would not have the training or expertise in dealing
with the legal requirements involved in the delivery of care
to this age group. Legal advice is also being sought which advises
General Adult Psychiatrists not to stray from the principal
of treating patients outside their area of expertise".
- "The Irish College welcome the recommendation
that priority should be given in 2004 to the development of
Child and Adolescent Psychiatric Services in each Health Board
area. The full multi-disciplinary service must be in place,
as outlined in the report in order to provide comprehensive
services. The Irish College in its position paper recommended
that a Consultant led team provide services for the 14-18 year
age group, serving an area with a total population of 100,000.
One team cannot be expected to provide a safe comprehensive
service to an entire Health Board area, which has an average
population of 400,000"
- "The First Report of the Working Group
on Child and Adolescent Psychiatric Services outlined the number
of Consultant led multi-disciplinary teams for the provision
of community services for the 0-16 age group. This recommended
one consultant led multi-disciplinary team per 66,000 unit of
total population. It also set out the recommended compliment
of this multi-disciplinary team (total number –15)"
- "The 2002 census reported a total
population of 3.92 million. This translates into 59 consultant
led community teams to provide services for the 0-16 age group.
There are currently less than 40 such teams in place, with the
majority of these teams below the recommended complement, some
to a serious degree"
- "With regard to in-patient admissions
of the 16-18 yr. age group, there were a total of 201 admissions
of this age group to psychiatric hospitals in 2001. The First
Report of the Working Group on Child and Adolescent Psychiatric
Services made specific recommendations with regard to the provision
of inpatient services for children and adolescents in the 0-16
yr. age group. A total of 7 units {2 located within the Eastern
Regional Health Authority Area and 5 Regional units} were planned
providing a total of 144 beds. At present there are just 2 functioning
In-patient Child & Adolescent Psychiatry Units nationally,
providing a total bed compliment of approximately 20. Priority
must be given to the establishment of these units and modification
with a view to providing inpatient services for the 0-18 yr.
age group. Units may be designed in a modular fashion catering
separately for the Child 0-14 years and Adolescent 14-18 year
age groups or developed on separate sites"
- "The First Report of the Working
Group on Child & Adolescent Psychiatry recommended a total
of 144 in-patient beds. The Irish College recommends the provision
of an extra 80 in-patient beds to meet the needs of the 16-18
year old population. The new total compliment being 224 (144
+ 80)"
- "In the interim where specialist
adolescent in-patient units are not available, a newly appointed
Adolescent Consultant should enter into an arrangement with
the relevant Adult Psychiatric Services within that consultant’s
catchment area for the admission of adolescents aged 16-18 years
for in-patient care"
- "The Irish College of Psychiatrists
is concerned that this Report fails to recognise the need for
specialist services such as Forensic Child and Adolescent Psychiatry
or Child and Adolescent Psychiatry for those with Intellectual
Disability. We are of the view that the development of such
specialist services is of considerable importance and goes unrecognised
as a service need for adolescents. Within the Forensic Psychiatry
service there have been a number of requests for assessment
of this age group by the Children’s Court. There is at
least one case in the last 6 months in which the Court recommended
that a severely disturbed adolescent be taken from custody in
St Patrick’s Institution and placed in a secure child
psychiatric unit in the UK. The consensus among the Irish College
is that failing to develop such specialist services within the
Republic of Ireland propagates the continued dependency on out
of State placements. Such placements are extremely expensive
on the Health Board and are a drain on resources, which could
otherwise be used to develop our own National Specialist Service"
- "The Irish College agrees that it
is vitally important that a data base be established for the
16-17 year olds referred to and attending outpatient and other
services such as to facilitate service planning"
- "The Irish College strongly agrees
with the recommendations that all Mental Health Services Child,
Adolescent and Adult to be managed under the one management
structure with in the Health Board. This would encourage
across ages initiatives such as early intervention services
for people with first onset psychosis".
Summary
"The Irish College of Psychiatrists welcomes the Second Report
of the Working Group on Child and Adolescent Psychiatric Services
and yet are concerned that it emphasises the need for an interim
solution without taking a more longer term strategic view on services
that are required specifically for an adolescent population.
The Irish College of Psychiatrists considers that it is of paramount
importance that the necessary funding is put in place, such as to
make the hoped for level of service provision a reality. We are
concerned that no money has been allocated and ringfenced for this
service in the budget for 2004"
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