A 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 interests of the child. This is reflected in the Programme for Government which commits to work to end the admission of children to adult psychiatric units by increasing in-patient beds, as well as examining the model of assigning these beds.
Where a child requires admission to an in-patient unit, 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.
The vast majority of 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 supports by the HSE. 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 this practice.
Progress in this area has been significant since 2008 when there were 247 such admissions to adult units. This was reduced to 50 HSE admissions in 2019, despite a background of increasing demands overall on CAMHS services. In 2008, 25% of admissions were to CAMHS inpatient beds whereas in 2019 this had increased to 86%. It is important to note that the number of admissions does not necessarily equate to the actual number of children admitted in any given year, as an individual child may be admitted on more than one occasion.
In 2019, there was a total of 358 HSE CAMHS admissions, of which 308 (86%) were to age-appropriate units and 50 (14%) of admissions of children were to Adult Units. Of the 50 admitted to Adult Approved Centres, 47, or 94%, were 16-17 years old, with 48% (24) of these discharged either the same day or within 3 days, and 82% (41) within a week.
In terms of bed days used, 96% of bed days used in 2019 were in CAMHS In-patient Units. Performance generally continues to be in line with the HSE Service Plan target figure of 95%, with the length of stay being kept to a minimum.
The HSE indicates that there were 12 admissions of those under age 18 to adult units for the period from January to end May, 2020.
I recently met with the HSE to review various issues relating to mental health, including CAMHS. Bearing in mind all the circumstances, I am satisfied that where children have at present to be placed short-term in adult mental health units, the HSE makes the necessary arrangements to protect these young people and aid their recovery. I will, however, continue to work with the HSE to continue the decrease in admissions to adult units, including maximising the new care options around mental health for young people highlighted in Sharing the Vision - A Mental Health Policy for Everyone.
