Health services: The State's largest children's hospital has asked the Eastern Regional Health Authority (ERHA) to investigate the possibility of sending children in need of acute psychiatric care abroad for treatment because of the dearth of facilities for treating them here. Eithne Donnellan, Health Correspondent, reports
Our Lady's Hospital for Sick Children in Crumlin has made the request following serious concern among staff that the hospital is having to admit such children without being properly resourced to do so. The admission of these children to the hospital has been described as unsafe in internal hospital correspondence obtained by The Irish Times under the Freedom of Information Act.
"Admitting these patients in the present environment is felt by the hospital executive to be both unsafe and unfair to the acute psychiatric patients as well as other patients and staff, exposing both patients and staff to unacceptable risks," the hospital's then acting chief executive and now its general manager, Ms Moira McQuaid, wrote in a letter to the hospital's head of consultant child and adolescent psychiatry, Prof Fiona McNicholas last October.
"Until such time as the hospital receives the funding to deliver an appropriate level of service, the executive does not feel the hospital can accept the care of these patients," she added.
Her letter, copied to the Minister for Health, Mr Martin, also said it was imperative that appropriate resources were put in place "in a suitable environment as soon as possible in an effort to correct the deficiencies that characterise this service at the present time".
Replying to it, Prof McNicholas said she agreed the admission of children with psychiatric illness to the hospital in the absence of resources "are both unsafe and unethical to both the children and families involved as well as other children in the hospital and the staff involved".
She said that while consultant child psychiatrists in the hospital had "no direct access to beds" there were children arriving in the hospital following overdoses who needed admission for medical stabilisation and it was then her department became involved.
"For some of these cases following a very brief admission, the bulk of the ongoing treatment can be organised on an outpatient basis with the appropriate local child psychiatry services. In other cases, however, and these are typically the most high risk cases, they will need a further period of assessment on a child psychiatry ward. Sadly in Dublin there are no emergency child psychiatry beds available and this has led to many of these children being detained in the hospital for extended periods of time inappropriately and often without the correct legal framework to do so.
"On other occasions, it has become apparent that some children who have been admitted are not in fact in need of emergency psychiatric assessment but are in the care of social services, and are in need of secure accommodation. In the absence of available emergency secure places provided by social services, this has led to their ongoing inappropriate detention in the paediatric hospital," she wrote.
"It has reached crisis situation in the Department of Psychiatry. The clinical nurse specialist who took up post in February has now resigned and I am in receipt of a letter from one of my consultant colleagues also outlining her concerns with regard to the feasibility of continuing to provide a liaison psychiatry service in the absence of resources. These concerns are shared by all the consultants in the department."
Ms McQuaid then wrote to the ERHA in December asking that consideration be given to transferring the patients abroad for appropriate treatment.
Asked yesterday if it had decided to send the children abroad, the ERHA in a statement said: "The ERHA in conjunction with Our Lady's Hospital for Sick Children is quantifying the range of psychiatric services required for children and adolescents and their most appropriate location."
There are only 20 beds in the State for children under 16 with psychiatric problems and a lack of adequately resourced outpatient services means there are waiting lists of more than a year in some areas.