Children with “acute mental health” crises, including psychosis and suicidality, are being left for up to a week in hospital emergency departments (EDs), unable to access suitable care, a report published on Thursday finds.
Meanwhile, distressed mental health patients are leaving understaffed EDs without appropriate care plans, only to return weeks later in a “revolving door” system.
The study from the Mental Health Commission finds “substantial variations in mental health services” across the 35 hospitals’ EDs, “markedly” different standards of assessment depending on when a person presents, and huge variations in facilities and in processes to be seen by mental health clinicians.
The commission surveyed all hospitals, achieving a 100 per cent response rate, between March and December 2024.
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It found a huge imbalance in where the estimated 51,000 people who presented at EDs with acute mental health needs go, with thousands attending the largest hospitals each year and far fewer attending smaller hospitals.
Several hospitals noted particular concerns about the treatment of children and adolescents presenting in distress.
The Mater Hospital in Dublin told the commission it was “experiencing major problems with provision for 16- to 17-year-olds, without input from Child and Adolescent Mental Health Services (CAMHS).” This is in breach of the HSE’s guidelines contained in the National Clinical Programme for Self-Harm and Suicide-related Ideation.
Beaumont Hospital in Dublin said children were assessed by adult mental health teams, but again without CAMHS input.
While some EDs have dedicated assessment rooms for parallel mental health assessment, in keeping with best practice, in many this is “not guaranteed”.
Where there is no “acute medical comorbidity”, there should be alternative facilities for people in mental health crisis to access acute care.
Ten of the 35 hospitals mentioned inadequate staffing, which “inevitably ... contributes to a revolving door” scenario, says the report.
