Dr. Susan Finnerty:

I thank the committee for inviting us. As inspectors of mental health services, my team and I inspect approved centres under regulations, rules and codes of practice. This includes both adult and child approved centres. I will give some feedback on the 2016 inspections regarding children.

In 2016, there were 509 admissions of children to approved centres. A total of 441 of these were to CAMHS units and 68 were to adult approved centres. There are four HSE CAMHS approved centres, one in Galway, one in Cork and two in Dublin. In total, these were registered in 2016 to accommodate 76 beds. However, at the end of 2016, there were only 66 operational HSE beds in CAMHS units. There are also 26 independent beds in St. Patrick's Hospital and in St John of God Hospital. As of the 31 May 2017, there were 59 HSE-registered beds and 51 of these are operational.

As stated previously, there were 68 admissions of children to adult approved centres in 2016, which represents one in seven of all admissions of children. This had decreased from 96 in 2015. However, the number of preliminary notifications received by the Mental Health Commission of admissions of children to adult units from 1 January 2017 to 31 May 2017 was 44, an increase of eight compared with the same period in 2016, when there were 36 admissions of children to adult units.

In 2016, there were 19 adult approved centres admitting children. The age range of children admitted to adult approved centres was between 13 and 17. Some 66% were 17, some 23% were 16 years of age and 12% were 15 or under. The average length of stay was six days and 35% of children admitted to adult units were moved to a CAMHS unit.

Two of those admissions to adult units were detained under section 25 of the Mental Health Act.

We inspect approved centres under the code of practice relating to the admission of children. Section 2.5 of the code of practice states that if adult approved centres are used for the admission of children, the following should apply: policies and protocols are in place for admission, family liaison, parental consent and confidentiality; age appropriate facilities; age appropriate therapeutic programmes; child protection provisions; training for staff relating to the care of children; age appropriate advocacy; advice from the CAMHS. HSE policy is that the child has a single room and one-to-one nursing observation and this was noted to be in place. All adult units that admit children were non-compliant with section 2.5 of the code of practice, leading to the conclusion that adult approved centres are not suitable for the admission of children.

With regard to CAMHS teams, A Vision for Change recommends that there should be two fully staffed CAMHS teams for a population of 100,000. During 2016, I met with the area management teams in each of the nine CHOs. There were a total of 58 CAMHS teams nationally at the end of 2016. No CHO had the required two teams per 100,000. Four CHOs did not have an out-of-hours service at the end of 2016. Children who present to the emergency department out of hours with a mental health difficulty are assessed and treated by non-specialist non-consultant hospital doctors and consultant psychiatrists in the emergency department and it appears that they have no other option but to admit children because of their risk and due to the lack of appropriate services and beds.