Dr. Maria Migone:

I am joined by my colleague, Dr. Glenda Kavanagh, from the Lucena Clinic, which is one of the child and adolescent mental health services, CAMHS, in Dublin. We cover a catchment area with a population of approximately 646,000. Under A Vision for Change, we are supposed to meet the needs of the 2% of children with the most severe mental illness. This includes, among other conditions, children with major mood disorders, psychosis, severe eating disorders and debilitating anxiety disorders. This group of children requires specialist intervention. The purpose of our attendance is to highlight the lack of staff in CAMHS when compared with the recommendations set out in A Vision for Change, the increase in referral numbers to our services and the lack of access to inpatient beds.

The Health Service Executive has indicated that increasing the age of referrals to child and adolescent mental health services to 18 years will increase the works for CAMHS teams by 100% because rates of mental illness in the 16 to 18 years age group are much higher than in younger age groups. The number of presentations to accident and emergency services with self-harm is high, with the highest number in the 15 to 19 years age group. The number of referrals to children's services of young persons with self-harm and suicidal ideas has increased significantly. The recent CAMHS annual report showed that those presenting with self-harm and suicidal ideas accounted for approximately 70% of referrals among children.

The rate of suicide in children in Ireland is also very worrying. Suicide rates for boys are the fourth highest in Europe and the highest in Europe for girls. We should, therefore, prioritise mental health services for people in this age group.

We will cite the example of psychology posts in our service to highlight the staffing difficulties we face. Based on United Kingdom figures, our service should have 63 psychologists. Based on the more conservative figures in A Vision for Change, we should have 26 psychologists, whereas we have only 8.6 psychologists. We only refer children for admission to adult units as a last resort and do so very rarely.

We will highlight some of the reasons for the lack of inpatient beds for children and ways in which we could avoid some child inpatient admissions. On the first issue, it is proving difficult to recruit and retain child psychiatrists to work here. Without a consultant, some of the inpatient units have been forced to reduce their numbers by half because other people have had to step in to try to fill the empty posts. The reason is that working conditions in Ireland have been compared unfavourably with those in other English speaking countries. As a result, we are unable to retain senior staff and trainees are moving abroad. In addition, many consultant colleagues in Dublin have left permanent posts in recent years. Others are on long-term sick leave or have chosen to emigrate. If staffing for CAMHS could be improved, we would be better able to retain some of these senior staff.

It is also difficult to recruit and retain nursing staff to work in child and adolescent mental health services, including the inpatient CAMHS units, especially in Dublin. This is leading to beds being closed, which increases the number of children inappropriately ending up in adult mental health units. Some emergency staff are moving to other parts of the country where housing is less expensive. We should adopt the approach taken in other countries and consider ways of attracting staff to live in the capital.

From the point of view of trying to reduce admissions of children aged under 18 years, access to acute day hospitals would allow psychiatrically unwell children to receive more intensive intervention in the community as opposed to being admitted to hospital. While these services require large numbers of staff because they are highly labour intensive, they are a much cheaper option that admitting children to inpatient units. If CAMHS funding was ring-fenced, these services could be developed.

The multidisciplinary staff who work in our teams are dedicated and hard-working. Our service has experienced a significant increase in referrals recently, details of which I submitted to the committee. The number of referrals in the past ten years increased by between 50% and 365% per annum, with no increase in the number of staff on our teams. On the contrary, the number of staff has reduced in some areas. It is very difficult to work in such conditions and we are unable to deliver the service we would like to deliver.