Dr. Aileen Murtagh:

I am a consultant child and adolescent psychiatrist with St. Patrick's Mental Health Services. I formerly worked as a consultant with the HSE's child and adolescent mental health services, CAMHS. I am accompanied by Ms Carol McCormack, who is a clinical nurse manager in Willow Grove adolescent inpatient unit. We welcome the opportunity to respond to the committee's invitation to provide information on the operation of adolescent mental health services at St. Patrick's Mental Health Services, which consists of three approved centres with a total inpatient capacity of 293 adult and 14 adolescent beds. Community mental health services are provided by a network of Dean Clinics in Dublin, Galway and Cork. The service works to provide the highest quality of mental health care, promote mentally healthy living, develop mental health awareness, advocate for the rights of people who are experiencing mental health difficulties and enhance evidence-based knowledge.

The 14-bed Willow Grove adolescent inpatient unit provides specialist multidisciplinary evidence-based care to young people between the ages of 12 and 17. It accepts referrals nationally and offers intensive inpatient management for a range of severe mental health difficulties, including mood, anxiety and psychotic disorders, often with associated suicidality and self-harming behaviour. There are specific eating disorder recovery programmes for anorexia and bulimia. Young people may have associated neurodevelopmental difficulties, including attention deficit hyperactivity disorder or autistic spectrum disorder. Each young person has an individual care plan which is reviewed weekly by the multidisciplinary team and discussed with the young person. This ensures there is an individualised and person-centred package of care. Service quality is assessed through annual inspections by the Mental Health Commission and the quality network for inpatient CAMHS. In September 2017, electronic health records were introduced to the adolescent service. In the national context, the 2016 annual report of the Mental Health Commission highlighted 68 admissions of children to adult units in 2016. The shortage of operational beds in dedicated child units was a contributory factor in this regard. There were 76 registered beds in HSE child units, 66 of which were operational. The recommendation in A Vision for Change, based on population data from the 2011 census, is that there should be 118 child and adolescent inpatient beds. Each year, a small number of children are sent by the HSE to the UK for highly specialised inpatient treatment which is currently not available in this country.

A part-time adolescent community service in the Dean Clinic in Lucan offers outpatient care to young people between the ages of 12 and 17 who have mild or moderate mental health difficulties. This services offers assessment and a range of evidence-based therapeutic interventions, including cognitive behavioural therapy, supportive psychotherapy, psychiatric review, pharmacotherapy, family support, dietician advice, occupational therapy and a psychology skills group based on dialectical behavioural therapy concepts. There is also a subspecialist outpatient service offering assessment of gender identity. In addition, there is an adolescent Dean Clinic in Cork offering psychiatric input and individual cognitive behavioural therapy. All referrals are reviewed by a consultant psychiatrist on the day of receipt. The inclusion and exclusion criteria that are in operation are based on expertise and available resources to ensure our service meets the needs of young people. Due to the demand for our service, there is usually a waiting list in operation and it can vary in length in accordance with service demand. The current waiting list for the Dean Clinic in Lucan is three to four months.

A new system of nurse-led prompt assessment of need by means of telephone triage was introduced earlier this year to signpost the most appropriate service for adolescents. We have observed a number of recent trends. Some GPs are concurrently referring to local HSE CAMHS and St. Patrick's Mental Health Services outpatient services to request a service from the organisation that can offer the most rapid appointment to an adolescent. As a result of this increased number of referrals, young people who are admitted to paediatric medical beds can remain there for extended periods of time - sometimes weeks - while a suitable inpatient mental health bed is awaited. When public inpatient units are at capacity, CAMHS outpatient services may refer concurrently to public and independent inpatient units in the absence of private health insurance, with the HSE indicating a willingness to fund admission to St. Patrick's Mental Health Services. We have noticed an increase in HSE-funded inpatient admissions to Willow Grove, particularly in the last year and a half.

In St. Patrick's, the Changing Minds Changing Lives Strategy 2018-2022 envisages an expansion of the Willow Grove adolescent service to 20 inpatient beds, development of a comprehensive day programme and enhancement of the work of the adolescent Dean Clinics. We hope this information is helpful and we are happy to answer any questions.