It's known that treating children in adult psychiatric units is inappropriate, writes Carl O'Brien
Like much of the mental health sector, progress in providing psychiatric services for children and adolescents can be measured in reports, taskforce studies and planning documents which are gathering dust by the year.
Whether it was the Commission to Inquire into Mental Health (1962), Planning for the Future (1984), or the Department of Health Working Group on Child and Adolescent Services (2001), they share a common fate: progressive solutions, but little sign of implementation.
However, children with mental health problems, say psychiatric groups and campaigners, can't afford to wait in the queue for adequate services.
The psychological damage caused by long delays in getting assessments and failing to obtain appropriate counselling or treatment is well documented in trauma research.
By the standards of the health service generally, the needs of young people in need of specialised psychiatric in-patient services are modest.
Figures suggest that around 2 per cent of adolescents have a major psychiatric disorder, which equates to almost 3,000 16- to 18-year-olds. There are no exact figures on how many children suffer from major mental health problems.
However, while up to 30 per cent of all health disability is related to mental health problems, mental health services received only 6.8 per cent of the health budget. This was a decrease from 10.6 per cent in 1990.
The results, at least in the area of child and adolescent mental health, are stark.
There are just 20 in-patient beds with specialised services for children or adolescents in the entire country, with experts suggesting there should be at least 120 beds.
There are an estimated 2,000 children waiting several months for psychiatric assessments, even though the prevalence of deliberate self-harm and attempted suicide increase with age throughout adolescence.
There are around 50 consultant child psychiatrists, although the Irish College of Psychiatrists says this number should be doubled. And there are no specialist in-patient services at all for older adolescents aged between 16 and 18.
There is also a dearth of information in determining how serious the shortcomings in the service really are.
An internal Northern Area Health Board memo on psychiatric services in the Dublin area, obtained under the Freedom of Information Act, reads: "For a number of years psychiatric services maintained a waiting list for the different service requirements, however, as adequate resourcing was not forthcoming and the annual recommendations requiring new resources, [ as] indicated by the Inspector of Mental Hospitals Reports, [ were] not met, it was felt a demoralising exercise."
The Department of Health's working group on child and adolescent psychiatry, which issued its first report four years ago, acknowledged that treating children in adult units was inappropriate.
It said: "Existing adult services are not resourced to deal with adolescents. They lack appropriate multidisciplinary input which would centre around family, school and social interventions."
It went on to recommend better outreach services, more day hospital treatment for those who do not require in-patient admission, more child and adolescent psychiatrists backed by multi-disciplinary teams and the development of in-patient adolescent units around the country.
Progress in implementing these findings has been slow.
None of the new in-patients units has been built, although the Department of Health says 19 child and adolescent consultant psychiatrists have been appointed since 1997, and additional funding will be provided next year for the "further enhancement" of multi-disciplinary, consultant-led teams in the child and adolescent psychiatric services.
Up until now the Inspector for Mental Hospitals has been raising concerns about the slow pace of change.
He was limited to raising his frequently damning findings in an annual report, without any further legislative powers.
That may be about to change, however. Under powers available under the Mental Health Act (2001), the Mental Health Commission is currently assessing the standard of service offered by hospitals and in-patient units.
It has the power to de-register or close down any facility not meeting proper standards.
The Mental Health Commission, in its most recent annual report, already sounded a warning bell when it said in-patient facilities for children and adolescents were "wholly inadequate" and that new units were urgently required.
In the face of public criticism, followed by the real threat of the closure of psychiatric units, health authorities could soon find themselves wiping the dust off a succession of reports and implementing their findings sooner rather than later.