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One in three kids hospitalised with mental health issues treated in adult wards

The practice can be “very frightening” for young people, according to one expert.

TREATING CHILDREN WITH mental health issues in adult psychiatric units constitutes “a major violation” of their human rights, the head of the Children’s Rights Alliance has said.

The charity’s chief executive, Tanya Ward, said the practice was unacceptable and could prevent children from making a full recovery from mental illness.

Some 50 children were admitted to adult facilities in the first six months of this year, according to new figures obtained by Fianna Fáil.

The figure represents just under a third of the total number of young people admitted to inpatient units.

The majority of minors treated in adult wards (47 out of 50) were 16 or 17 years old.

Some 30% (15) were discharged either the same day or within two days of admission, while 60% (30) were discharged within a week.

Fine Gael and Labour had committed to ending the practice in the Programme for Government agreed in 2011.

High suicide rates

Ward told TheJournal.ie that she was not surprised by the admission numbers, saying Ireland’s high teenage suicide rate is an indicator of the unsuitability of current services.

“Children who need to be admitted to psychiatric care should be cared for by specially trained staff in children’s units,” she said.

Being admitted to an adult unit can be very frightening for young people.  Some of them will likely face mental health issues for their whole lives, so it’s very important that their first engagement with mental health services is a positive one.

The practice has also been criticised in the past by the Mental Health Commission, whose code of practice states that no child under the age of 18 should be admitted to an adult unit except for in “very exceptional circumstances”.

In a 2013 report, the state’s mental health watchdog said it was “a most unsatisfactory situation”.

Some 91 minors – representing just over 20% of all child admissions – were treated in adult psychiatric wards that year.

‘Untold stress’

Fianna Fáil TD Colm Keaveney today said the practice “causes untold stress not only to the children themselves but to their families and to the staff working in these units”.

Young people with mental health issues “should be cared for in an appropriate setting”, he said.

In a statement, a spokesperson for the HSE said there are a range of factors that can influence the clinical decision to admit minors to adult units.

“Some of these admissions relate to a crisis admission where no adolescent bed is immediately available,” she said.

Distance to the nearest CAMHs in-patient unit can also be a factor when immediate clinical assessment and treatment may be the requirement.   In some cases, the presenting clinical needs of the young person (who may be nearly 18 years old) may be more appropriately assessed and treated in an adult unit.

Read: Online counselling offers easy-to-reach support for depression and anxiety >

Column:  Living with anxiety is difficult enough without being told to cheer up >

Originally published: 17.40

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25 Comments
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    Mute mary carey
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    Aug 10th 2015, 5:51 PM

    Iv been treated by both the child and adult mental health services. If a “child” aged 17 turns 18 while inpatient or while under the care of CAMHS – they are immediately transferred. I was.

    It isn’t that 10 year olds are in adult psych units. And while they are in adult units while under 18 – they are one to one nursed and segregated from adult patients at all times.
    Obviously I don’t agree at all with minors being in an adult facility – but some context is reqd. They are very nearly old enough to be in an adult unit, which is then deemed suitable for them – literally overnight.
    What is required is psych services for young adults…. 18-25 or something. For transitioning from one service to the other.

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    Mute littleone
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    Aug 10th 2015, 5:30 PM

    Sadly. This is a consequence of paying back bankers debt that was not ours. So many services cut or closed. Once again children suffer.

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    Mute Sgt Pepper
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    Aug 10th 2015, 6:20 PM

    It’s a consequence of years of mismanagement within the health service and no-one has ever succeeded in reforming it.

    70
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    Mute John Shaft
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    Aug 10th 2015, 6:52 PM

    Meanwhile public servants reject payrise

    16
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    Mute Beachmaster
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    Aug 10th 2015, 5:37 PM

    Don’t worry. A pic of Leo Varadkar holding puppies will be released soon.

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    Mute Michael Mc Gauley
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    Aug 10th 2015, 6:06 PM

    Totally unacceptable. A total disgrace

    35
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    Mute Alan White
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    Aug 10th 2015, 10:12 PM

    Hi Michael, what do you plan to do to address the situation? (Besides the honorable, brave and upstanding action of posting on an internet comment section.)

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    Mute Tiffany Mary O'Brien
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    Aug 11th 2015, 9:34 AM

    What plan would you have to address the situation ,Alan ?

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    Mute Kerry Blake
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    Aug 10th 2015, 8:02 PM

    Enda and his mates will be along shortly to say things are improving…

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    Mute Terry McClatchey
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    Aug 10th 2015, 11:30 PM

    This is not too much of a problem if those affected are almost 18 and therefore just technically children while others with an earlier birth date may be less mature. Worryingly a small number a reported (3 of 50) were under 16. Schizophrenia typically has an onset in late adolescence so the 18th birthday is a bit on an arbitrary cut-off. Ideally there would be young adults units specialising in care from perhaps 16-21. Those who are 19/20 have more in common with 16/17 year olds than with adults of 30+.

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    Mute Ellen Metcalf
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    Aug 10th 2015, 6:12 PM

    I find the comment “Some of them will likely face mental health issues for their whole lives, so it’s very important that their first engagement with mental health services is a positive one” disturbing on many levels. Why the “likely”? Is there complacency about the epidemic of long-term mental illness beginning in adolescence, as described in Robert Whitaker’s “Anatomy of an Epidemic”? And why is it “very important that their first engagement with mental health services is a positive one”? Why is it more important than their second, or their tenth or their hundredth? Is it because once established on medication patients find it harder and harder to leave the system?
    I’d like to see some hard evidence that young people treated in specialist youth facilities have substantially better outcomes, including the most desirable outcome of all, which is that their first “engagement with mental health services” is the last.
    I’m not saying it will necessarily be the last for all young people, but it should be for many of them. This, rather than luring patients and their families with positive, pleasant experiences, has to be the priority.

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    Mute Claire W
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    Aug 10th 2015, 7:22 PM

    It’s not saying it makes them better. It’s saying if a young person has a bad first experience they may not seek help again.

    As a person with long term mental health issues, I need to be feel comfortable knowing where to go, trusting doctors or councillors, and admitting myself if I become suicidal.

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    Mute Kerry Blake
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    Aug 10th 2015, 8:04 PM

    Well done Claire good post to someone happily for themselves has no understanding about mental illiness,

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    Mute Juniper
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    Aug 10th 2015, 8:14 PM

    Ellen… Mental Health is so poorly understood by everybody, including physicians. Very little is known about the exact mechanisms that lead to disorders like depression and the like. What is known is that there are certain pathways in the brain that appear to be over or underactive. The drugs that we prescribe are very non-selective in treating just these disordered pathways, rather they have an effect on the entire brain, with some improvement in symptoms as a side-effect. We also know that many of these conditions are chronically relapsing and remitting with current treatment regimens. Some of them are also known to worsen as people get older. Sadly we also know the outcome for some of those who do not seek help – and they can end up putting their lives and occasionally the lives of many others at risk. It would appear to make common sense that if we gain the trust of a young patient with mental health issues, that they would be more inclined to trust their physicians going forward. But I also concede that service needs to be improved for everybody, with consistently high quality delivery across the board.
    Mary’s comment about needing a transitional period between youth and adult services is spot on in my opinion. In my experience, many of those patients feel abandoned by their physicians in a new system, where the new and unfamiliar faces seem to lack the understanding of their disease. Mental health is a very personal thing. Especially when that inner perspective can be distorted by disordered thought.

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    Mute Ellen Metcalf
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    Aug 10th 2015, 8:40 PM

    Kerry, you might disagree with my opinion but I don’t know why you seem to believe I have no experience of mental illness. I was a psychiatric patient (or service user as they’d now call me) for several years. My first contact with mental-health services was in my mid-teens, I was for some time a revolving-door patient and I finally left in my late twenties.

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    Mute Kerry Blake
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    Aug 10th 2015, 8:54 PM

    I said understanding not experience two totally different things. I do also hope Ellen you have got to a level where you are happy.

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    Mute Anon Ymous
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    Aug 11th 2015, 1:12 AM

    I’ve been in the psychiatric system since the age of 15 – I’m 38 now. Just called the Samaritans and they hung up. Help me. Please.

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    Mute Anon Ymous
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    Aug 11th 2015, 1:16 AM

    The only way ‘professionals’ will listen to me if is I hurt myself really badly, or attempt suicide (e.g. hanging or taking *massive* amounts of pills: 120+ :(

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    Mute Anon Ymous
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    Aug 11th 2015, 1:49 AM

    It’s OK; I deserve to die. I ate 4 Pringles.

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    Mute mary carey
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    Aug 11th 2015, 2:01 AM

    Anonymous…. Is this a joke?

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    Mute Edmond OFlaherty
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    Aug 11th 2015, 12:37 AM

    An article in the Sunday Business Post on 9 Aug. reported a comment by Prof. Dinan, Dept of Psychiatry in UCC. He said that progress in psychiatry is modest and I would agree with him. Prozac for example came in the mid-80`s and is still going strong. In fact it is still almost always used in the treatment of depression in teenagers.
    “Newer” antipsychotics for schizophrenia have been found to be little better than old ones and are much more expensive. Psychotherapy is useful but is very expensive, as it is mostly one to one. I like the idea of getting the basic brain chemistry being sorted out and then little or no medication is needed in depression. Here is a typical case of a 30-yerar old woman who is anxious and depressed. She has several of the following: panic attacks, insomnia, low libido, suicidal thoughts , tinnitus, food and chemical sensitivities, is often musical or artistic and cannot take the pill. She often drinks and smokes, is full of fear and often looks for valium. The doctor usually prescribes Lexapro, similar to Prozac, and it does very little for her. The main cause here is high copper which causes adrenaline production and makes her life very miserable indeed. Using nutrients such as zinc one can get many off medication and it is wonderful to see how good they feel when the anxiety and depression goes away and they need only nutrients instead of drugs. For more severe psychiatric conditions a combination of nutrients and a small amount of medication will greatly reduce the need for an in-patient psychiatric service.

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    Mute Juniper
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    Aug 11th 2015, 2:47 AM

    If you could provide the evidence base upon which these treatments work, then you could get them published in a major medical journal. The physicians would sit up and take notice, and patients would subsequently benefit. If your evidence is anecdotal, then please do not mislead the many readers on here. Mental health disorders are hard enough to live with without opportunists taking advantage to make a quick buck.

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    Mute Terry McClatchey
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    Aug 11th 2015, 8:16 AM

    All the key indicators of a charlatan. Pretentious pseudo-science interwoven with half truths. Anyone thinking of buying expensive zinc supplements from Edmond – don’t.

    2
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