Dr. Yvonne Begley:

I thank the Seanad Public Consultation Committee for the invitation to attend.

In 1998 I was fortunate to get my dream job as a child and adolescent psychiatrist with CAMHS, child and adolescent mental health services, in Limerick, having trained in London and spent eight years as a general practitioner in Hackney. When I arrived in Limerick in 1998, there were ten staff; now we have 66.

Fifteen years ago I set up a child and adolescent emergency system based on two simple principles. First, a young person and his or her family, teacher or GP who needs to access our service should be able to do so on the same day. The second principle involved continuity of care. If a young person comes to the service in crisis and speaks to somebody about being suicidal, he or she continues to see that person who is his or her key worker until he or she recovers and is discharged from the service. He or she does not have to tell three or four people his or her innermost thoughts and feelings. He or she does not have to keep repeating his or her story. They are the two principles that underlie our emergency system which is accessible between 9 a.m. and 5 p.m., Monday to Friday. Out of hours, there are excellent crisis psychiatric nurses who will also see children and adolescents in Limerick University Hospital, as well as a 24/7, all-year-round consultant child and psychiatric on-call rota to ensure consultant expertise is available.

From my position as a psychiatrist in the mid-west for 18 years, if Senator Joan Freeman’s legislative proposal that children no longer be admitted to adult beds is passed, my job will become a nightmare. The last time I had a patient on the adult ward in Limerick, Ward 5B, was in April. She was admitted, having lacerated herself with a Stanley knife and required 74 stiches. She told me that if she went home, she would hang herself. She was refused access to the usual inpatient admission unit we use in Galway, as well as units in Dublin and St. Patrick’s Hospital. Like every other patient I have admitted to the adult ward in the past 18 years, with the full consent of her parents and family, I admitted her to the ward until a more suitable alternative was found. The nurses on the ward are wonderful. They are kind, caring and human. They actually cleared the gym and a little garden to allow the patient in question to have access without being bothered by any of the other patients.

What has not been talked about is the agony of seeing a member of one’s family lose his or her mind. The only reason a person is admitted is he or she is beyond reason. Speaking as a mother, if one of my children was beyond reason and suicidal, I would be glad if the Ward 5B nurses helped me to detain them until they saw sense again. I would not be complaining as they would still be alive.

People have spoken about the lack of money for our services. It would be a way of improving the services we provide. Another item of which we are short is managerial time and attention. The current management body in the mid-west has no child psychiatrist on it. The people whom I look after are in no position to talk about what is happening to them and their backs are to the wall. They need advocates who can speak for them. Child psychiatrists around the country need a voice in management circles. I would like 25% of managerial time to be given to my service. Limerick was the only place which did not receive an inpatient unit as recommended in A Vision for Change. If someone would like to help us build one, we would be happy enough.