The reduction in the numbers of children admitted to adult psychiatric units is a priority for the HSE Mental Health Services and for myself. It is fully accepted that admission to an age appropriate facility is in the best interest of the child.
Where a child requires admission to an in-patient bed, a bed in a Child and Adolescent Mental Health Services (CAMHS) unit is sought in the first instance. A decision to admit to an adult unit is made only if a CAMHS admission is not feasible. Where such admissions take place HSE Standard Operating Procedures apply. An admission to an adult unit must be advised to the Mental Health Commission and is generally to a separate area in the adult unit with appropriate supervision.
Most child admissions to adult units are for children in the 16-17 age bracket. The HSE advises that admission to an adult unit may often be more appropriate for the individual and to avoid any impact on younger children in CAMHS in-patient units. Children admitted to adult units are provided with special support by the HSE.
Progress in this area has been significant since 2008 when there were 247 such admissions to adult units in that year. This declined to 81 in 2017, despite a background of increasing demands overall on Child and Adolescent Mental Health services. CAMHS has seen a 26% increase in referrals between 2012 and 2017.
It is important to note, that the number of admissions does not necessarily equate to the actual number of children admitted, as an individual child may be admitted on more than one occasion in any given year. In 2017, there was a total of 307 CAMHS admissions, of which 226 (74%) were to age appropriate units and 81 (26%) of admissions of Children were to Adult Units. The temporary closure of some CAMHS beds, such as the Linn Dara Unit in Dublin, influenced the admission rates to adults units in 2017.
In terms of bed days used, in 2017, based on the most recent figures available, 96.9% of bed days used were in Child and Adolescent Inpatient Units. Performance generally continues to be above the HSE Service Plan target figure of 95%, and indications are that where a child has been admitted to an adult acute in-patient unit, the length of stay has been kept to a minimum.
The HSE Service Plan allows for some operational flexibility surrounding emergency placements in Adult Units, particularly where very short-term placements take place. Full account is taken of all relevant factors such as the preferences of all those involved, and geographical factors relating to access or visiting. In this context, the HSE continues to closely monitor on a weekly basis all child admissions to adult units with a view to minimising such admissions.
I and departmental officials regularly meet with the HSE to review various mental health issues including the potential for further improvement on age appropriate CAMHS admissions. Relevant data is regularly published on the HSE website and is subject to regular monitoring by the Department of Health. Bearing in mind all the circumstances, I am satisfied that, where children have to be placed short-term in adult mental health units, the Executive makes any special arrangements necessary to protect and monitor these young people.