Sir,– Prof Brendan Kelly (Letters, August 12th) highlighted a need for political coalition for change in mental health services for children. The concept of Child and Adolescent Mental Health Services (CAMHS) existing as an entirely different entity to Adult Mental Health Services is not something that the general public may be familiar with. This division along with current Mental Health Act has created a gap in urgent access to mental health care for adolescents.
To put things into some context: there is a National Self Harm Register. Based on the first six months of 2014, the incidence of self-harm was recorded by this register as highest – at 559 per 100,000 – among 15-19–year-olds. These figures are based on patients attending emergency departments across the country, a far greater number will attend their GP before reaching this level of crisis.
As an emergency medicine physician I, not infrequently, encounter adolescents and families in crisis situations requiring urgent access to such services out-of-hours. Unfortunately, there is no such out-of-hours service. Although I work in a busy emergency department of a university-affiliated hospital I have no formal referral pathway to a specialist open to me for these vulnerable children and adolescents.
My concern is that an emphasis appears to exist on limiting the number of children/adolescents with mental health problems being admitted to adult institutions; this is the incorrect end-point for legislation to focus on.
The mandatory requirement under the Mental Health Act 2001 that adolescents be seen and admitted to adolescent institutions is laudable, but at present it is not practical. Unfortunately, because it is not practical it is currently also not safe. On a weekly basis I encounter patients who spend prolonged periods in the emergency department or acute medical adult wards because there is no access to timely child and adolescent mental health services.
This is simply not right at an ethical, moral or humanitarian level. The persistent failure to either organise, coordinate, or indeed adequately resource CAMHS is a sad indictment of a healthcare system.
The focus for legislators should be on strategies for reducing actual suicide rates and not establishing unrealistic barriers to pathways of care without real practical alternatives being established.
– Yours, etc,
Dr NIGEL SALTER
Consultant in emergency
medicine
Clontarf,
Dublin 3.