Child and Adolescent Mental Health Details

HSE publishes Third Annual Report of Child and Adolescent Mental
Health Services (CAMHS)

·         16,080 Irish children (1.55% of population under 18 yrs.)
availing of Community Child and Adolescent Mental Health Services
·         7,849 new cases were seen by community CAMHS teams between
October 2010 and September 2011,compared with 7,561 in the previous 12
months
·         45% of referrals are seen within 1 month of referral and 69%
within 3 months
·         Numbers waiting for CAMHS services down by 20%
·         61 multi-disciplinary Child and Adolescent Mental Health Services teams in place

Minister of State with responsibility for Disability, Equality and
Mental Health; Kathleen Lynch, T.D. today, 1st December 2011, launched
the Health Service Executive’s third annual report on Child and
Adolescent Mental Health Services (CAMHS).

In launching the Report, Minister Lynch welcomed it and said that
“youth can be a very vulnerable and traumatic time in one’s life and
it is a period when 75% of mental illness emerges.  We must therefore
ensure the provision of early intervention for any young person
experiencing mental health issues, because we know that early
intervention leads to the best health outcomes and reduces the
likelihood of a long term debilitating mental illness.  I am committed
to ensuring the implementation of ‘A Vision for Change’ and in this
context I am particularly keen to advance service provision for young
people. The HSE has made considerable progress in the delivery of the
Child and Adolescent Mental Health Services including in-patient where
required but also and most importantly improvement in the community
based services.”

The report provides a comprehensive update on the development of
mental health services for young people and outlines progress in the
development of HSE’s CAMHS services as outlined in the “A Vision for
Change” policy. The CAMHS annual report provides important information
on the number of new cases seen, waiting times for an appointment with
a specialist, and the types mental health problems presenting to
services, by age and gender.

This Report also includes information on the inpatient admission of
young people under the age of 18 years, in addition to information on
the instance of deliberate self harm presenting to hospital Emergency
Departments in this age group.

Most children and adolescents enjoy good mental health, but studies
have shown that 1 in 10 children and adolescents suffer from mental
health disorders. Mental health disorders in childhood are the most
powerful predictor of mental health disorder in adulthood.

The information in the CAMHS annual report guides service planning for
the future to ensure that we can respond appropriately to emerging
trends and the mental health needs of our young people. The annual
report means that the HSE has the comprehensive information from which
to monitor the mental health of our young people and which will inform
the development of services which respond to their needs.

The expansion of Child and Adolescent Mental Health Services (CAMHS)
and the number of teams are key recommendations of the 2006 policy
document “A Vision for Change”. CAMHS provide specialist mental health
assessment and treatment to young people adopting a multidisciplinary
approach.  A characteristic of CAMHS teams is that they can draw on
their multidisciplinary makeup to undertake comprehensive and complex
assessment and treatment approaches. In addition, they can provide
packages of care where more than one professional or intervention is
required in order to meet the needs of young person and their family
or carers.

Key Findings

Number of CAMHS Teams

“A Vision for Change” recommends 99 CAMHS teams, based on the 2006
census. There are currently 61 multi-disciplinary Child and Adolescent
Mental Health Services teams in place.

New cases seen and total number of active cases

A total of 7,849 new cases were seen by community CAMHS teams in the
period October 1st 2010 to September 30th 2011, compared with 7,651
for the previous 12 months. Of the 7,849 new cases seen 720 (9.2%)
were aged 16/17 years. In September 2011 the total number of active
cases was 16,080 (1.55% of the population under the age of 18 years).

Waiting Times to be seen

Over this period almost half (46%) of all new cases were seen within 1
month of referral and 69% were seen within 3 months. 12% of new cases
waited between 3 and 6 months for their first appointment, 11% waited
between 6 and 12 months and 8% had waited more than 1 year to be seen.

All community CAMHS teams screen children and adolescents referred to
their services on the basis of the urgency of need. Children and
adolescents in need of an urgent appointment are seen as a high
priority while those with a lower acuity need may have to wait for
longer.

Waiting lists down – Decrease of 20% on waiting list

A total of 1,897 children and adolescents were waiting to be seen by a
CAMHS team at the end of September 2011. This represents a decrease of
20% from the total number waiting at the end of September 2010
(2,370).

Of those waiting 35% were waiting less than 3 months, 25% were waiting
between 3 and 6 months for an appointment and another 25% were waiting
between 6 and 12 months. 78% of the community CAMHS teams had a
waiting list of less than 50 cases at end of September 2011.

Increase in staffing in CAMHS Teams

61 teams are in place in November 2011, 56 community teams (an
increase of 6 from 2010), 2 day hospital teams and 3 paediatric
hospital liaison teams. The total staffing of the 56 existing
community CAMHS teams is 464.74 whole time equivalents (in 2009 this
figure was 456.11), which is 63.8% of the recommended staffing
complement for this number of teams. There is variation in the
distribution and disciplinary composition of the workforce across
teams and regions.
In-depth review of activity occurring in November 2010

In the course of the month of November 2010, a total of 7,907 cases
were seen, 7,136 (90.2%) of these cases were returns and 771 (9.8%)
were new cases. A total of 14,859 appointments were offered, 11,953
appointments were attended, with a resulting non attendance rate of
19.6%, increasing from 16.1% in 2009.

Analysis of the data collected indicated that;

* Adolescents from the 15 years of age group continue to be the
most likely to be attending community CAMHS, followed by children aged
10 to 14 years.
*  Adolescents aged 16/17 years constitute 13.4% of the caseload
reflecting the practice of CAMHS teams keeping on open cases after
their 16th birthday in addition to the 16 (29%) teams that accept
referral of young people over the age of 16 years.
* The ADHD / hyperkinetic category (33.9%) again was the most
frequently assigned primary presentation followed by the Anxiety
category which accounted for 15.3%
* The ADHD / hyperkinetic category peaked in the 4 to 9 years age
group at 43.2% of cases in this age group, dropping to 22.5% of
adolescents in the 15 to 17+ year age group.
* Depressive disorders increased with age, accounting for 23.5% of
the 15 to 17+ year age group.
* Deliberate Self Harm, which increased with age, accounts for
8.4% of the primary presentations of the 15 to17+ year age group,
however deliberate self harm / suicidal ideation was recorded as a
reason for referral in 22% of the new cases seen.
* Eating disorders increased with age, accounting for 4.8% of the
primary presentations of the 15 to 17+ year age group.
* Males constituted the majority of primary presentations apart
from Psychotic Disorders (49.1%), Depression (37.6%), Deliberate Self
Harm (28.9%) and Eating Disorders (14.7%).
* 27% of cases were in treatment less than 13 weeks, 12.3% from 13
to 26 weeks, 14.9% of cases were in treatment from 26 to 52 weeks and
45.8% greater than 1 year.

In addition 353 young people were seen by the day service and hospital
liaison teams in November 2010.

Dr Brendan Doody, Consultant Child and Adolescent Psychiatrist and HSE
National CAMHS Advisor commented “In order to meet the mental health
needs of our growing young population it is essential that we have the
necessary information to guide development of services such that
effective interventions are delivered by appropriately resourced and
skilled teams”

The 2010 – 2011 Third Annual Report of Child and Adolescent Mental
Health Services is available to download at www.hse.ie