Doctors’ fear over mental health care for children

The chronic shortage of child mental health services in the South East resulted in suicidal children being hospitalised – some for several days – over a four-year period, while they waited to be seen by a specialist psychiatrist.

A concerned staff member at the Child and Adolescent Mental Health Services (CAMHS) reported the practice to the Ombudsman in 2016, according to an internal review of the service in the South East.

The lack of consistent consultant cover had been going on for four years and “up to 60 children had been affected”, according to the internal review of one of the most chronically under-resourced child and adolescent services in the country.

It was prepared for the Health Service Executive’s mental health service’s division, in response to the shortage of psychiatric beds for children and adolescents. The review was among documents released to the Sunday Independent under the Freedom of Information Act that raise concerns about the CAMHS service in the South East, where three psychiatrists resigned during the summer.

They reflect broader concerns about a system beset by staff shortages and long waiting lists across most parts of the county, with 2,615 currently on a waiting list and 356 waiting more than a year.

The undated review highlights the lack of psychiatric day beds or in-patient beds for children and teenagers in a catchment area covering South Tipperary, Waterford, Wexford and Carlow and Kilkenny. Children travel long distances and wait for months for beds in other regions.

The report proposed referring patients to private specialist psychiatrists with direct access to private beds until the HSE is in a position to provide public beds. It highlighted an “urgent clinical requirement” for an out-of-hours child and adolescent service, in keeping with international standards.

It noted an out-of-hours service in Waterford/Wexford was provided by a locum psychiatrist who was not on the specialist register for dealing with children. In South Tipperary, Carlow and Kilkenny, another out-of-hours service was provided by an adult or old age psychiatry consultant. This needed to be addressed “as a matter of priority”.

A second document highlighted how consultants in adult psychiatry who had traditionally provided out-of-hours care for children in Waterford and Wexford had withdrawn their cover two years ago. They believed the Medical Protection Society would not cover them in the event of complaints to the Medical Council because children were not their speciality.

The report suggested adult psychiatry consultants in other areas who found themselves treating children out of hours could follow suit and called for a national strategy.

Dr Kieran Moore, who resigned as a CAMHS psychiatrist in July, repeatedly raised concerns.

He warned management that treating children in adult psychiatric hospitals “clearly interferes with their human rights and I couldn’t ethically, morally or contractually have anything to do with such practice”.

In another, Dr Moore wrote that “the risk of serious morbidity and potential mortality continues to be high due to the lack of resources”; describing the local paediatric psychiatry service as an “absolute hell hole”.

Dr Moore was one of seven consultants who boycotted a CAMHS consultants forum in May this year. “As medical practitioners, we cannot engage in unsafe medical systems set up by the employer,” they wrote in a joint letter.

The HSE said it was working on “filling any vacancies” in the South East via a national recruitment campaign.

“The HSE’s South East Community Healthcare services wish to assure the public that it is there to care and provide support, has dedicated teams of professionals in place and that the welfare of service users and their families is paramount,” it said.

Author: Maeve Sheehan
Source: Sunday Independent