Stretched to the limit: Children with mental illness treated as “second class citizens”

The Covid-19 pandemic has drawn public and political attention to the Irish health system and the courageous work of health workers on the front line. Before the pandemic struck, reporters from The College View identified and examined some of the major pre-coronavirus challenges faced by the Irish healthcare system, including waiting lists for some chronic conditions, the dependence on locums (doctors in temporary positions) in short-staffed hospitals, and the difficulty some parts of the population – Travellers, the homeless – have in accessing healthcare. These stories present facts and context to understand the Irish health system has been stretched to its limit as it deals with the effects of Covid-19.

Children suffering with mental illnesses in Ireland are treated as second-class citizens, says a child psychiatric consultant.

Dr Kieran Moore, a paediatric mental health consultant in Our Lady’s Children’s Hospital in Dublin, said facilities, resources and access to healthcare are all substandard for this group of patients.

He said that as a result: “Patients with medical psychiatric illness are treated as second-class citizens by the health service executive.”

Moore previously worked as a paediatric mental health consultant in Slaney House, Wexford, for a number of years.

While working in Slaney House, Moore encountered a number of difficulties which lead to his resignation from his position in the facility.

He said: “It was always viewed as ‘office space’ rather than a proper clinic and was treated as such by management.”

Moore believes that because Slaney House wasn’t seen as a “proper” clinical service, it was not subject to normal hygiene rules in healthcare facilities and “the dirt at times was disgusting”.

He said it was also difficult to get a stethoscope let alone an appropriate room to examine patients or facilities to take bloods.

Dr Moore said: “A number of patients need ready access to a consultant paediatric cardiologist or paediatric neurologist. You can imagine how difficult or impossible it is to access these services away from a hospital.”

Assessment of the child and adolescent mental health services (CAMHS) units across the country is carried out according to their Community Health Care Organisation (CHO) areas. The figures gathered from these assessments are compared to the Vision for Change plan which was implemented in 2006, aiming to build a framework for providing services for people with mental illness.

According to this plan, Wexford is meant to have approximately 42 full-time staff. During Dr Moore’s time working in the county, he endured “at least a year where there were four of us providing the service for the whole county”.

Linda Hederman is an art therapist who has worked in schools for 12 years with 6 to 18 year-olds, including those with special needs and in disadvantaged areas. She said there is a “huge lack of services unless children [are] suicidal”.

She said: “[There is] mostly a very short time frame kids will be seen for. We need three times the amount of CAMHS services to what there is presently.” She also said that CAMHS can refuse children with mental health issues who have significant absences from school.

The Wexford Mental Health Warriors is a group that was formed in order to campaign for facilities and professional staff for CAMHS services in Wexford. One mother, a member of the group, has been outspoken on the experience she had when her 14 year old son needed access to CAMHS.

When her son was in the Department of Psychiatry in Waterford, he was kept in a small room where “he was only allowed out for an hour a day… for his safety”. The Mental Health Commission was told that her son was educated when he was in the hospital, however she believes he was not.

She said: “When I questioned the mental health commission their answer to me was ‘we only make the rules’, they don’t care if they’re enforced or not.”

Although she described the staff as “hardworking”, she said the building at Slaney House was not fit for purpose.

Dr Kieran Moore said there were no proper examination facilities in Slaney House, Wexford.

He said: “Quite frequently the blinds might not even shelter a patient from the outside car park. All this was said to management both verbally and in writing many many times, but very little if anything happened.”

Further issues included “the inevitable wear and tear, not enough room (the obscenity of five staff being in one small room),  re-wiring occurring with wires being left in the shape of a noose for weeks in clinical rooms and a lack of safety for the very few patients that were violent. The building was not fulfilling any of the safety criteria for a service seeing patients with medical psychiatric illness.”

The Irish Medical Organisation (IMO) stated in a 2018 report that poor working conditions as well as uncertain career progression are barriers that are resulting in a declining Irish medical workforce, particularly impacting consultants.

The IMO said that failure to improve consultant contracts has led to the decline in successful recruitment of Irish consultants. In recent years there has been a 30 per cent salary reduction for new entry consultants.

Moore said “there is also the problem of lots of doctors working as consultant paediatric / child and adolescent psychiatrists who are not trained in the specialty and many consultants think what is the point in training for so many years when someone who is not trained can get the same money and pay.”

Of the five doctors in specialist training with Dr Moore, only one remains “reluctantly”  in Ireland.

Moore stated in an open-letter to The Irish Times that “the unpalatable truth is that working conditions and salaries in other countries are far superior.”

In order to resolve current issues within the system, he believes “the government should end the unfair and self-defeating two tier salary for new consultants.”

Should this happen, it should improve funding for training colleges and incentivise trained consultants specialists to be trainers, according to Moore.

“If this does not change, the potential for significant clinical risk opens up more and more.”

A move of the CAMHS facilities in Wexford to the Arden House property has been promised by the government since 2017, according to the current Fianna Fáil spokesperson on mental health, James Browne.

Although Kieran Moores’ position as a child psychiatric consultant in Wexford remained unoccupied for over 18 months after he left, it has now been filled. Browne said the existing CAMHS facilities at Slaney House were a “serious obstacle” in attracting a replacement for Moore, after he left the position after 16 years.

Browne told the Dáil in January that the HSE have spent nearly a quarter of a million euro in rent on Arden House which has remained un-occupied due to numerous delays.

“It’s terribly disappointing to see a building lying vacant while its rent has reached that figure. For almost two and a half years, the government has been making promises to open the new centre and yet it remains un-open,” said Browne.

The HSE have been contacted for a comment regarding Slaney House.

Rachel Power, Shauna Power, Beibhinn Thorsch

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