Child Mental Healthcare Tops My Wish List

Last Updated on Wednesday, 12 October 2011 10:21 Written by Natural Health Team Wednesday, 12 October 2011 10:21

Health Information about Child Mental Healthcare Tops My Wish List

Imagine your child is acutely ill with a severe asthma attack or a life-threatening heart condition. Your GP tells you the child needs immediate medical attention to keep him or her alive until such time as the illness can be treated. Then he gets on the phone to find out where you should take the child to get the urgent attention as soon as possible.

Ten hours later the doctor is still on the phone. He is ringing hospitals around the country, begging his colleagues to find a bed for your child, while also trying to tell you how to keep him or her stable until this urgently needed treatment can be located.

In the end he finds a bed, but it is in a psychiatric hospital that has no respiratory or cardiac expertise, much less the equipment or medication your child needs. But he tells you, from bitter experience, that this is the best offer you are going to get from the healthcare system of a first world country in 2007.

If you don’t think this could happen, just change the details. Imagine the emergency is psychiatric and the only help on offer is a bed in a large, public medical ward of a busy and understaffed general hospital. This is a situation that mental health personnel and patients encounter almost daily. Just because the crisis is psychiatric rather than medical doesn’t mean the threat to life is any less serious. Indeed, the peril, as we know from a succession of recent tragedies, might not even be confined to the life of the patient.

Say that patient is your 16-year-old daughter who is profoundly, determinedly suicidal and needs a bed and treatment in a psychiatric ward as a matter of urgency. This is not merely your amateur, overanxious diagnosis -a consultant psychiatrist who specialises in the care of children and adolescents is alarmed enough about her condition to recommend immediate in-patient treatment. He is the one making the phone calls. He is the one who spends those 10 hours on the line pleading with colleagues to find her a bed while trying to help you care for her and keep her safe. And, in the end, he is the one who tells you that there is no option for you but to take her to the A&E department of your local hospital because, inadequate though that solution is, at least she will be under professional care.

Dr Kieran Moore, one of the country’s handful of experts trained specifically in the psychiatric care of children and adolescents, described this experience to me on Newstalk Radio just a few days ago. That scenario happened to him when he sought help for a teenage girl recently, as her distraught parents struggled to keep her from killing herself. He was so angry and frustrated by the deficiencies highlighted by this too-common incident that he contacted my radio show in the hope of galvanising public opinion behind his cause.

The treatment of mentally ill youngsters in this country is, as he put it, beyond an emergency. There are fewer than 20 public beds available for them in the entire country when there should be at least 100. Waiting lists for assessment and treatment of illness such as attention deficit hyperactivity are up to four years in some parts of the country. That means the narrow window of opportunity for addressing this particular disorder is being lost with drastic and heartbreaking consequences for the youngsters and their families.

The government’s mental health wish list, Vision for Change, recommends that there should be about 40 clinicians providing out- patient child and adolescent psychiatric care for areas with a population of about 130,000, instead of the six at present. Funding to improve the service was frozen in 2006, and yet providing one full, out-patient multidisciplinary team costs just E1m a year. It is hardly an enormous outlay given the obvious advantages of diagnosing and treating mental illness at the earliest stage.

Another woman I spoke to last week gave a graphic illustration of the effects of this critical neglect. Her son began to show signs of depression in his early teens, but there was little help available. By his late teens he had made a couple of serious suicide attempts and was close to death on one occasion. Now in his late twenties, he has become frighteningly aggressive towards his elderly parents who live with him in a remote rural area. He has told his mother that he will slit her throat, a threat she takes so seriously she has removed all sharp implements from the house.

She has contacted the gardai on a number of occasions, but, beyond advising her to keep her car keys to hand, there is little they can do until he acts on his threats. He refuses to get help, will not submit to assessment and has warned her that he will come back and kill her if she seeks to have him hospitalised against his will. And, as was highlighted by the appalling tragedy in Dublin last weekend in which Michael Hughes was brutally killed in a frenzied and apparently unprovoked attack, it is extremely difficult to force an unwilling adult to co-operate with either an assessment or treatment unless there are compelling grounds to override his or her free will and consent.

Mentally ill people can be duplicitous and manipulative, often able to maintain a veneer of capability that can confound even trained professionals. Mental healthcare providers repeatedly point out that their discipline is the poor relation of the health system, vastly underresourced and underprioritised when compared, for example, with the state’s cancer strategy. But the difference between a cancerous tumour and a mental illness is that you can see a tumour, x-ray it, measure it, delineate it and take a scalpel and cut it out. But psychosis doesn’t show up on a scan and often the gravity of a mental condition is not fully appreciated until it is too late.

We have seen too many cases in recent times in which hindsight made a catastrophic outcome appallingly predictable. Where the disintegration of a personality could have been identified and successfully prevented with early intervention. But in many cases we are not talking about the revelatory miracle of hindsight, we are talking about the perfectly foreseeable results of unconscionable negligence. That is why it makes so much sense to invest in tackling mental illness before it becomes too late, and that is why targeting and prioritising the mental health of children and adolescents is so important.

Mentally healthy children don’t bully, don’t binge on drink and drugs, don’t drop out of school and roam with gangs, don’t commit suicide, don’t descend into hopeless lives of crime and violence and abuse, don’t end up costing the state more than E100,000 a year to keep them in prison. God knows how many doomed lives a single E1m multidisciplinary mental health team could save each year.

Minors’ consent is obviously not as crucial to their treatment as that of adults, so, once a parent or guardian gives approval, they can get the help they need and get it at a stage in their development when it can be of optimal effect.

Instead of allowing troubled children to remain the poorest of the health service’s poor relations, we should demand they become one of our most urgent, most cherished priorities.

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