Number of children admitted to psychiatric hospitals rises by one-fifth

The number of children admitted to psychiatric hospitals increased by about a fifth last year compared to 2018, the majority of them girls, a report published on Thursday finds.

The children stayed an average of 2½ months, with the youngest child admitted aged 11.

The annual report for the Mental Health Commission (MHC) also reported 168 suicides among people who were engaged with mental health services last year, as well as repeated overcrowding, understaffing, and non-compliance with rules on the use of seclusion and electroconvulsive therapy (ECT) .

The 13-member MHC is an independent body, appointed by the Minister for Health under the 2001 Mental Health Act, to oversee, regulate and inspect mental health services.

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Last year, 497 children were admitted to mental health beds, compared with 408 in 2018 and 439 in 2017. Of these 54 children were admitted to 15 adult units, the youngest of these aged 15.

Unacceptable

There were 443 children admitted to child/adolescent beds, staying for an average of 50 days. Some 65 per cent were girls.

The report noted there are six Child and Adolescent Mental Health Service (CAHMS) units in just three counties (Dublin, Cork and Galway), and only two of them take out-of-hours admissions.

“Children and young people in crisis are left with the unacceptable ‘choice’ between an emergency department, general hospital, children’s hospital or an adult in-patient unit,” said the report.

It added: “Children and young people should not be admitted to adult units except in exceptional circumstances. The reason for the majority of admissions to adult units are due to an immediate risk to the young person or others, or due to the lack of a bed in a CAMHS unit.”

There were 563 deaths of people using mental health services last year, of which 168 were reported as “suspected suicide”. This compares with 184 suspected suicides out of 533 people engaging with mental health services in 2018.

Overcrowding, or “over capacity” was reported on 208 occasions, in 13 centres, the report said.

Just five centres reported 194 of these instances. These were the department of psychiatry at University Hospital Waterford; the Sliabh Mis mental health admission in University Hospital Kerry; the adult mental health unit in Mayo University Hospital; department of psychiatry in St Luke's' Hospital, Kilkenny, and, the department of psychiatry in Roscommon University Hospital.

In all there were 65 inspections of the 65 approved mental health centres last year, of which five were announced and 60 unannounced. The overall compliance rate with all regulations and indicators was 78 per cent – down from 79 per cent in 2018 - with a 33 per cent “excellent” record.

The highest compliance rates were in centres where the inspections were announced. These were St Edmondsbury Hospital in Lucan, Dublin, with a compliance rate of 100 per cent; St Patrick's Hospital, Dublin (100 per cent); Willow Grove adolescent unit in St Patrick's Hospital (97 per cent) and Tearmann Ward in St Camillus' Hospital, Limerick (96 per cent).

Compliance rates

Lowest compliance rates were in the acute psychiatric unit, Tallaght Hospital (57 per cent) ; St Finbarr's Hospital, Cork, (64 per cent) and the Elm Mount Unit at St Vincent's University Hospital, Dublin (66 per cent).

The commission took 40 enforcement actions against 31 approved centres in response to critical risks in relation to issues including premises, understaffing and the privacy and dignity of residents. It secured it first prosecution under the Mental Health Act 2001, “on foot of findings that patients were deprived of basic dignity and human rights by being secluded in a dirty, malodorous, badly-lit and badly-ventilated room”.

Last year saw a decrease to 21 per cent in compliance with the rules on seclusion “from an already low level of compliance” of 55 per cent in 2018. Compliance with rules on the use of ECT fell from 58 per cent in 2018 to 45 per cent last year, while compliance on staffing rates fell from 9 per cent in 2018 to just 8 per cent.

Some €3.5 million was spent of the Decision Support Service last year, which was established in 2015 to replace the outdated wards of court system. It has yet to begin working.