Leading Psychiatrist says wider mental health services essential for young people post-Covid
Consultant Psychiatrist says access to community services crucial as post-Covid mental health issues rise amongst young people;- Around 3,760 children and adolescents awaiting an appointment with Child and Adolescent Mental Health Service – a 62% increase compared with pre-pandemic levels;
- New HSE data obtained by IHCA confirms 28% of Consultant Psychiatry posts are vacant or filled on a temporary basis; more than 1 in 3 CAMHS Psychiatry posts not filled as needed;
- There has been a worsening in children’s mental health which has been exacerbated by Covid-19 and subsequent lockdowns;
- Surge in referrals and an increase in very sick young people, particularly those with eating disorders, self-harm and suicidality;
- Dr Elaine Lockhart: “Lockdowns really removed children from their usual routine, structure and predictability. They couldn’t meet friends and access activities and that triggered quite an increase in those seeking care.”
A leading Consultant Child and Adolescent Psychiatrist says children and young people need better access to mental health services, particularly within their own communities.
Irish trained Dr Elaine Lockhart, who is the Chair of the Royal College of Psychiatrists Child and Adolescent Faculty based in Scotland, says she has seen a worsening in children’s mental health which has been exacerbated by Covid-19 and its associated lockdowns.
Speaking in a new video as part of the Irish Hospital Consultants Association’s (IHCA) Care Can’t Wait campaign, Dr Lockhart says she has witnessed a surge in referrals and an increase in very sick young people, particularly those with eating disorders, self-harm and suicidality. These referral patterns have also been observed in Ireland.
Latest figures from the Department of Health confirm that there were 3,759 children on the Child and Adolescent Mental Health Services (CAMHS) waiting lists at the end of December 2023.1 While this is a reduction from the record high of around 4,400 recoded last year, it is still an increase of approximately 6% (+203) since the end of 2021 and almost a two-thirds increase (+1,432 or 62%) in the CAMHS waiting list compared with pre-pandemic levels at the start of 2020.2
Consultants say that the difficulty in filling permanent Consultant Psychiatry posts and growing hospital and mental health capacity deficits against increases in demand are the root causes of the unacceptably long waiting lists. New data released to the IHCA under the Freedom of Information Act confirms that 156 (28%) of the 548 approved permanent Consultant Psychiatry posts in Ireland were either vacant or filled on a temporary or agency basis on 1 March 2024.3 This consisted of 52 totally vacant posts, 28 posts filled by agency staff, a further 74 posts filled on a temporary/locum basis and two posts of ‘unknown’ status which are likely vacant. In Child & Adolescent Psychiatry, more than a third of approved permanent Consultant posts (44 posts or 35%) were either vacant or filled on a temporary basis at the end of 2023.4
Dr Lockhart, a UCD graduate currently practising as a Consultant Psychiatrist with the Greater Glasgow and Clyde Learning Disability CAMHS team, says that it is imperative specialist mental health services are in place for the most unwell children, given the surge in referrals of children with eating disorders, self-harm and suicidality.
However, the former clinical advisor to the Scottish government also stresses that children and young people require access to services in their communities, including getting support and advice within a school setting.
“What we were seeing before Covid was an increase in social inequality which can be toxic for children’s mental health. And although social media can be real force for good, vulnerable children can be really harmed by being online. So, things were getting worse before Covid.
“But then the lockdowns really removed children from their usual routine, structure and predictability. They couldn’t meet friends and access activities and that triggered quite an increase in those seeking care. That was something we hadn’t seen before.
“While specialist mental health services must be in place for those who are most unwell, what many children are looking for and require is access to services where they can get advice in schools and community settings,” said Dr Lockhart.
The IHCA has already stated that the mental health budget needs to be approximately 10% of our overall health budget, as promised in Sláintecare. However, the Government currently commits just 5.6% of the total health budget on mental health, which is half the European average.
Consultants have highlighted that it is not possible to provide appropriate urgent inpatient care to children and adolescents due to a severe lack of CAMHS beds and the fact that just over half of the 72 available beds are open at any one time. Approximately 42 CAMHS beds are operational across all four units in counties Dublin (2 units), Galway and Cork at any given time. This followed the closure of 11 beds at the Linn Dara Unit in May 2022, which still remain closed. This falls far short of the 130 CAMHS beds recommended in ‘A Vision for Change’.
“The very fact that our benchmarks for staffing and bed levels are rooted in an 18-year-old mental health policy points to a lack of priority given to addressing this issue over the past two decades,” said a spokesperson for the IHCA.
ENDS
Dr Elaine Lockhart’s comments were made in a new video released on social media today by the IHCA as part of its #CareCantWait campaign.
The video is available here and below.
NOTES
1. Minister of State Deputy Mary Butler during a Dáil debate on the Mental Health (Amendment) Bill 2023, 27 February 2024: https://www.oireachtas.ie/en/debates/debate/dail/2024-02-27/16/.
2. HSE PQ response to Deputy Peadar Tóibín, 31 January 2023; https://www.hse.ie/eng/about/personalpq/pq/2023-pq-responses/february-2023/pq-4887-23-peadar-toibin.pdf; Appendix to HSE PQ response to Deputy to Peadar Tóibín, 23 November 2022; https://www.ihca.ie/_fileupload/PQ%2058978-22%20Deputy%20Peader%20Toibin%20re%20CAMHS%20Wait%20list%20for%20past%205%20years%20Appendix.pdf.
3. HSE NDTP FOI response to the IHCA, 12 April 2024: https://www.ihca.ie/_fileupload/hse-ndtp-foi-response-to-ihca-12042024-c172-24-response-tables-01-03-2024.pdf.
4. HSE NDTP Medical Workforce Analysis Report 2023-2024, April 2024: https://www.hse.ie/eng/staff/leadership-education-development/met/plan/medical-workforce-report-23-24-digital.pdf.
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