19th September
2005
A
Better Future Now
Saol níos fearr amárach an ráthaíocht
inniu
Position statement on psychiatric
services for children and adolescents in Ireland.
Mr. Dan Neville TD, President, Irish Association of Suicidology, today launched
‘A Better Future Now’, a position
statement on psychiatric services for children and adolescents
in Ireland, in Dublin.
The Faculty of Child and Adolescent Psychiatry of the Irish
College of Psychiatrists prepared the document.
Children
under 18 years comprise 25% of the population i.e. 1 million. There is an equivalent amount of mental health disorders
in the child as in the adult population. Mental health disorders
in childhood frequently have life long implications.
Overall
1 in 5 children have a mental or behavioural disorder at any one
time. 1 in 10 i.e.100,000 will have a moderate to severe disorder.
Disorders include depression, anxiety, attention deficit hyperactivity
disorder, behavioural disorders, eating disorders, autistic spectrum
disorders and psychotic disorders.
These disorders
cause significant distress for the child and impact on their ability
to fulfil normal everyday living including family life, class
work, friendships and leisure activities. They also cause distress
for the other family members. Vulnerable children and families
are more prone to mental health problems. Treatment services for
these problems are underdeveloped, which reflects the low priority
and stigma attached to mental health. From 1997 to 2003 spending on mental health services fell from 11% to
just 6.8% of the health budget (amounting to €622.8 million
in 2003). Child and adolescent psychiatric services account for
only 5–10% of spending on mental health services, while
serving 22.68% of the population (around €53 per child under
16 years of age).
The Child and Adolescent Psychiatric Services currently
provides treatment for children up to 16 years of age. However treatment in the adult setting is considered
inappropriate for the 16 to 17 year age group and this report
includes the needs of this age group in its model for service
development.
To work effectively, a range of disciplines, skills and
perspectives are required, so that children and adolescents are
offered a care and treatment package geared to their individual
needs. A multidisciplinary composition is therefore required,
to incorporate the skills necessary for the clinical management
of the varied and complex clinical problems presented.
Most
of the assessment, treatment and care of children with mental
health needs is provided by specialist multidisciplinary outpatient
teams. There are currently only 40 such specialist outpatient
multidisciplinary teams (the recommended number is 59).
The majority
of these teams are also significantly below the recommended multidisciplinary
staffing complement, and see severe and urgent cases predominately. This restricts the scope for treatment
and intervention which in turn leads to significant unmet need
and long waiting lists. There are only a total of 20 inpatient
beds for the assessment and treatment of children less than 16yrs
(recommended number 144).
This
serious deficit of beds results in enormous difficulty accessing
a bed, particularly in a crisis situation. Such children are frequently
admitted to paediatric wards or adult psychiatric wards and on
occasion sent out of the country for treatment.
Other specialist services are required for particular
groups such as adolescent day hospitals, autism spectrum disorder services,
eating disorder services, intellectual disability services, alcohol
and substance misuse and forensic services. These services are
available only to a limited degree or in the case of eating disorders
and forensic services totally absent.
There
are currently 55 whole-time equivalent (WTE) consultant child
and adolescent psychiatry posts in the Republic of Ireland, a
ratio of 1:16,150 of the population under 16 years of age. In
Finland this ratio is 1:6000 (of the population aged 0–19
years).
A comprehensive service for young people up to the age
of 18 years would require a total of 150 consultant child and
adolescent psychiatry posts and multidisciplinary teams. To achieve
this would require an extra annual expenditure of approximately
€80 million and a capital investment of approximately €150
million.
Untreated or under treated mental health problems are
not only a human tragedy for the young people involved and their
families, they are also responsible for considerable financial
cost to the nation. This cost falls on education, social services,
the juvenile justice system and on other parts of the health services.
The Subgroup
that prepared the document were:
• Dr Brendan
Doody, Chairman, Consultant Child and Adolescent Psychiatrist
• Dr Amanda
Burke, Consultant Child and Adolescent Psychiatrist
• Dr Brenda
Dowling, Consultant Child and Adolescent Psychiatrist
• Dr Finbarr
O’Leary, Consultant Child and Adolescent Psychiatrist
• Dr Philip
Tyndall, Consultant Child and Adolescent Psychiatrist
• Dr Sarah
Buckley, Senior Registrar in Child and Adolescent Psychiatry
