Professor Jim Lucey:

Yes. Deputy Tully mentioned the general hospitals, which has sparked the particular line of comment that our chair is making. It is important to understand that we do not have access to standard setting or regulation of those. The inspector can inspect anywhere where mental health services are provided or mental health activity in the sense of needs is being addressed but we cannot set standards for those locations.

The situation arising where a child is admitted to an adult unit is one that is a breach of our standards. We find approved centres which often, through no better alternative, are forced to do that in breach of that standard but, on inspection and in dialogue with them, we work to encouraging either the proper discharge of that person to a community service or his or her transfer to one of the six approved centres which are designated for the care of young people in the country. We inspect those centres.

This becomes very problematic for many centres. In my four months in this post, I have already come across this. Dr. Finnerty mentions the inequity and the divergence of access that is really problematic. There are several community health organisations, CHOs, that have an approved centre for young people that would be regulated and would provide inpatient mental health services of a standard but there are others that do not. The latter have an arrangement - I shudder to call it a "grace and favour" arrangement - within the service that they can have access to the other unit outside of their county, for example, within a CHO, but these arrangements are often very strained and tenuous, and certainly delays occur then where an individual young person is inappropriately placed within an adult unit. No one wants this to happen. The number of instances are falling. The awareness of that is a good thing and has resulted from the work of the commission and of my predecessor, but it is an unacceptable experience.

There is a nuanced part - I will not go on too long - where young people who are, as we might say, on the cusp of adulthood, in their 17th year, and often physically apparently with the strength and the vigour of a young adult, are nonetheless children. That can be a real problem for services because they simply do not have the appropriate place to care for those people. They often have mixed mental health and personal, social and sometimes intellectual difficulties, with or without the mixture of complex and challenging issues, such as ADHD, or consequences of drug abuse. Unfortunately, their experience of mental health interventions in an adult setting may be their first inpatient exposure to mental health care, and experience from research and from other jurisdictions tells us that the first exposure to mental health care is often the determining one for a future outcome. If it is a bad experience that is a very unfortunate indicator for the likelihood of a successful intervention over time and so we really have concerns about young people being admitted. There are centres that do their best and try to accommodate within an adult setting but, nonetheless, it is inappropriate.