I welcome the opportunity to raise this issue and ask that the Minister join me in welcoming the recently published report from Amnesty International, Mental Illness – the Neglected Quarter. It is not generally known and appreciated that up to 20% of children and adolescents suffer from a disabling mental illness. The chief medical officer at the Department of Health and Children concludes that epidemiological studies show that as much as 18% of the child population under the age of 16 years will experience significant mental health problems at some period of their development and that some 3% to 4% will actually suffer from a psychiatric disorder such as anorexia nervosa or a crippling obsessive compulsive state. The range of childhood mental illnesses includes depression, anxiety disorders, eating disorders, attention deficit hyperactivity disorders and, more rarely, serious forms of mental illness such as schizophrenia and bipolar disorder which begin in childhood.
Given the anticipated level of mental illness in children, the provision of an adequate and efficient children's mental health service should be a priority. Amnesty International concludes that there is limited availability of the appropriate range of services for those in primary care, community care, in-patient centres, day centres, rehabilitation service and outreach services which provide support in the home and school.
There is no central data collection or reporting system on the uptake of children's mental health services at primary care or out-patient level. There is an urgent need for a centralised information bank based on nationally accepted and supported data collection methods, otherwise proper analysis of trends and statistics in relation to the quality or efficiency of service provision cannot be made by the Department of Health and Children or other interested parties.
The World Health Organisation recommends a full range of therapies considered essential to modern psychiatric care, psychotherapy, physio-social rehabilitation and vocational rehabilitation and employment, yet in primary, community and in-patient care there is widespread over-reliance on medication alone as a form of therapy because the range of other therapies and therapists are not available. It has been observed that gaps in the range of services and professionals providing these services have resulted in uneven and restricted availability of psychotherapy and other interventions. This is due to a variety of factors, including a lack of funding for consultant psychotherapy and clinical psychologists posts and insufficient training for certain professionals.
While medication is an essential component of a treatment range, failure to provide the full choice of treatments is inconsistent with the right to the least restrictive or intrusive treatment. The Department of Health and Children working group agreed that internationally acknowledged best practice for the provision of child and adolescent psychiatric services is the provision of a multidisciplinary team. Many of the child psychiatric teams currently in place do not have a full complement of team members. Psychologists, mental health social workers and occupational therapists are widely unrepresented. Each member of a team supplies a unique and essential service and incomplete teams cannot, by definition, supply a quality service, despite their best efforts.
On patient services, health boards have no policies or procedures for children or adolescents requiring in-patient treatment. There is a large discrepancy between the actual and required numbers of appropriate acute psychiatric beds for children. The 2001 working group report recommended that 89 beds be provided, 35 for children aged six to 12 years and 54 for adolescents aged 12 to 16 years. Currently, there are 35 beds in three children's centres for those under 16 years of age.
Why does the national waiting list initiative, whereby hospitals must publish waiting lists, exclude the mental health sector? There is no convincing explanation for this. Consequently, unlike other health sectors, no figures are published for waiting times for acute in-patient admissions to psychiatric institutions. This is inconsistent with the requirements to provide care and treatment in accordance with standards for other ill persons. Because of the changing profile of problems with age, child psychiatry services have found that the mid-adolescent age group, 13 to 15 year olds, has a propensity to take priority over younger clients. This is primarily due to their higher rate of emergency presentations with acute illness and suicide attempts and so on.
I hope the Minister of State will make known his views on the full report, not my extractions and quotations from it.
