The opening of a mental health unit for children and teenagers is a radical departure in treatment – but is it enough?
IN A country where Victorian-era mental health institutions are still commonplace, the new HSE child and adolescent mental health unit in Merlin Park, Galway, marks a radical departure.
Large windows dominate the four connected buildings of the unit, which provide views of a wooded area nearby and several play areas, complete with swings and roundabouts. Many of the bedrooms have French doors leading directly out into gardens. The 20-bed unit has large play and arts areas, a woodwork room and a gymnasium. A small apartment is available on site for parents who travel long distances to visit their children.
“The bright atmosphere here in the unit is very uplifting and should help in a therapeutic sense. This building also goes some way to further de-stigmatise mental health problems for young people,” said Dr Delia McGuinness, clinical director at Merlin Park.
The opening of the new €8.8 million unit is a key part of HSE efforts to implement the recommendations in the Government's 2006 strategy for mental health services, A Vision for Change. This overturned the traditional practice in Ireland whereby 16 and 17 year olds were cared for in adult mental health facilities by proposing that everyone under 18 years of age should be treated at designated child and adolescent mental health units.
A code of practice drawn up by the State regulator, the Mental Health Commission, stipulates that children under 16 years should not be placed in adult facilities. From tomorrow, this code of practice will be extended to all children under 17 years of age and from December 1st, 2011, it will be extended again to all teenagers under 18.
There are already concerns that the code of practice is being violated by the HSE even before it is extended to these new age cohorts. The commission recently appointed an external consultant to undertake an inquiry into decisions this year to admit nine children under 16 years of age to adult facilities in the Limerick region. It is concerned the admissions may amount to a breach of the code of practice, which allows for the placing of children in adult facilities only under “exceptional circumstances”.
Amnesty International, which is part of the Children’s Mental Health Coalition, a group of 50 organisations campaigning for better mental health services for young people, said the new unit in Galway was welcome. But, it warned, teenagers would continue to be admitted to adult facilities because of the lack of funds.
“It is of serious concern that in the first nine months of 2010, 120 children and adolescents under aged 18 were admitted to adult units, including 13 children under age 16,” said Karol Balfe, Amnesty International Ireland’s mental health campaign co-ordinator.
She said staff shortages on 55 existing community child and adolescent mental health teams, which were operating at 70 per cent of recommended staffing levels, was a serious problem.
A new University of Limerick study by Dr Patrick Ryan and Dr Marcia Ward found children placed in adult mental health units were scared of the “unpredictability” of living there. This often resulted in “self-imposed isolation” and boredom. In many instances, teenagers felt they were a burden on an adult ward because of a requirement to assign a one-to-one nurse to them and the impact this had on the care for other patients, according to the study.
Martin Rogan, the HSE's assistant national director of mental health, admitted there was a gap between the current capacity in the mental health services and the strategy set out in A Vision for Change. But he said the new Galway unit and a new 20-bed unit for children and adolescents due to open in 2011 were a "major leap forward", which showed the priority that was being placed on young people.
When the Galway and Cork units open in the New Year, the bed capacity in child and adolescent mental health units will reach 50 beds – half of what the A Vision for Changestrategy said was needed to prevent young people being placed in adult units.
The real challenge will be finding the resources to add new capacity when the proportion of total health spending on mental health is falling – from 6.7 per cent in 2009 to 5.3 per cent in 2010.
Mr Rogan said it was “very difficult” to get new resources in the current climate, but he insisted the HSE was doing everything it could to implement the policy.
Whether this is enough to satisfy the commission’s code of practice remains to be seen.
TEEN’S LIFE IN AN ADULT UNIT
“Well they make you feel like a child so you act like a child, don’t you? They treat you like a child but they want you to act like an adult, it doesn’t make sense does it?
“Here we will treat you like a two year old, oh you are 17, now act like it. If you don’t take the tablet, we will come down and force you to have an injection. If you misbehave, we will take all your stuff off you, which they did.
“I was allowed a magazine for half an hour a day, telly for half an hour a day, and I was allowed out of my room for 10 minutes a day. They said it was because I was causing too much trouble and messing around. This was the second time after a few weeks and I was bored, so frustrated.
“I had to have all my meals in my room. I wasn’t allowed to talk to any of the other patients or interact with anyone, so I had to be by myself all of the time.
“They take away everything, not only your stuff but any sort of confidence or pride or dignity. They take all that away, you are left with nothing. Its really degrading they watch you do everything . . . it makes you feel so stupid.
“You are someone who needs to be on a special [one-to-one nurse] and they have all this extra paperwork to do. Do you know when I was in my room it was near reception and I heard them once , ‘Oh my God, there is another child coming in’, that’s the way they feel about it.
Extract from interview with teenager placed in adult psychiatric unit contained in the University of Limerick research paper.