Child and Adolescent Mental Health

10% increase in new cases seen by Child and Adolescent Mental Health
Services outlined in the Fourth Annual Report of Child and Adolescent
Mental Health Services (CAMHS)

Minister of State with responsibility for Disability, Equality and
Mental Health, Kathleen Lynch, T.D. today, 4th December 2012, launched
the Health Service Executive’s Fourth Annual Report of Child and
Adolescent Mental Health Services (CAMHS).

In launching the Report, Minister Lynch said “this is an excellent
report which gives us a detailed picture of the current stage of
development of the HSE’s CAMHS services. I was particularly pleased to
note progress in a number of key areas namely the 10% increase in the
number of new cases seen by CAMHS in the period October 2011 –
September 2012, the introduction of new access protocols for 16 and 17
year olds and the continued reduction in the number of children and
adolescents admitted to adult units.

As Minister of State with responsibility for Mental Health I am
committed to ensuring the implementation of “A Vision for Change” and
in this context I am particularly keen to advance services for young
people.  The HSE has made considerable progress in the delivery of the
Child and Adolescent Mental Health Services including in-patient
services, where required, but also, importantly, improving services
based in the community.

To further strengthen the multi-disciplinary nature of Community
Mental Health Teams in both Adult and Children’s mental health
services we are committed to ensuring that, at a minimum, at least one
of each mental health profession is represented on every team. 150 new
posts are being allocated to Child and Adolescent Community Mental
Health Teams. When these professionals take up their posts to enhance
the multi-disciplinary profile of current teams it will facilitate
further progress in the reduction of waiting lists for CAMHS
services.”

The report illustrates the continued progress in developing mental
health services for children, young people and their families. Between
October 2011 and September 2012, 8,671 new cases were seen by
community CAMHS teams compared with 7,849 in the previous 12 months,
which is an increase of 10%. In the same period, there were 9,973
referrals accepted by CAMHS teams, which is a 17% increase on the
previous 12 months.
16,664 Irish children (1.45% of population under 18 yrs.) are availing
of Community Child and Adolescent Mental Health Services. 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. 45% of referrals are seen within 1 month of referral.
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.

Key Findings

Increase in new cases seen

Between October 2011 and September 2012, 8,671 new cases were seen by
community CAMHS teams compared with 7,849 in the previous 12 months,
which is an increase of 10%. In the same period, there were 9,973
referrals accepted by CAMHS teams, which is a 17% increase on the
previous 12 months. Of the 8,671 new cases seen, 967 (11.2%) were
16/17 years of age. Over this period 45% of new cases were seen within
1 month of referral, 66% within 3 months. 10% of new cases had waited
between 3 and 6 months, 7% had waited between 6 and 12 months and 5%
had waited more than 1 year to be seen. 12% did not attend their first
appointment.

Waiting Lists

A total of 2,056 children and adolescents were waiting to be seen at
the end of September 2012. This represented an increase of 159 (8%)
from the total number waiting at the end of September 2011 (1,897).
The total number waiting greater than 12 months decreased by 9%, from
300 to 272. Forty-four (76%) Community CAMHS teams had a waiting list
of less than 50 cases, 10 (17%) had a waiting list of 50 to 99 cases,
2 (5%) had a waiting list of 100 to 149 cases and 1 (2%) had a waiting
list of 150 to 200 cases.

In-depth review of activity occurring in November 2011

In the course of the month of November 2011 a total of 8,479 cases
were seen, 7,724 (91.1%) of these cases were returns and 755 (8.9%)
were new cases. A total of 14,724 appointments were offered, 12,024
appointments were attended, with a resulting non-attendance rate of
18.3%, decreasing from 19.6% in 2010.

Analysis of the data collected indicated that:

·         Children aged 15 years were the most likely to be attending
community CAMHS, followed by the 16/17 year old age group and children
in the 10 to 14 age group.
·         Adolescents aged 16/17 years constituted 16.5% of the caseload.
·         The ADHD / hyperkinetic category (35.7%) again was the most
frequently assigned primary presentation followed by the Anxiety
category which accounted for 18.7%.
·         The ADHD / hyperkinetic category peaked in the 4 to 9 years
age group at 43.8% of cases in this age group, dropping to 23.3% of
adolescents in the 15 years and older age group.
·         Depressive disorders increased with age, accounting for
21.6% of the 15 years and older age group.
·         Deliberate Self Harm, which increased with age, accounted
for 7% of the primary presentations of the 15 years and older age
group, however deliberate self harm / suicidal ideation was recorded
as a reason for referral in 28% of the new cases seen.
·         Eating disorders increased with age, accounted for 5.6% of
the primary presentations of the 15 years and older age group.
·         24% of cases were in treatment less than 13 weeks, 11.5%
from 13 to 26 weeks, 13.8% of cases were in treatment from 26 to 52
weeks and 50.8% greater than 1 year.
Number of CAMHS Teams
There are currently 63 multi-disciplinary Child and Adolescent teams in place.
Child and Adolescent In-patient Admissions
In 2011 there were 432 admissions of children and adolescents up to
the age of 18 years to inpatient units.
In 2008, 65% of child and adolescent admissions were to adult units.
There has been a reduction in these numbers as of September 2012, 25%
of child and adolescent admissions were to adults units. Of these 75
submissions, 15 were subsequently transferred to HSE Child and
Adolescent in-patient units.
Capital Developments
In 2011 the new 20 bed inpatient units at Bessboro, Cork and Merlin
Park, Galway opened replacing the interim unit at St. Stephen’s
Hospital and St. Anne’s inpatient unit. In 2012 the second phase of
development at St. Vincent’s Hospital, Fairview was completed with the
opening of the new 12 bed adolescent unit. Warrenstown inpatient unit
transferred to an interim 8 bed unit at St. Loman’s Hospital,
Palmerstown in May 2012 where a new 6 bed older adolescent unit is due
to open in the first quarter of 2013. Planning application has been
submitted for a new 24 bed in-patient unit at Cherry Orchard Hospital
for the Leinster Region.

Dr Brendan Doody, Consultant Child and Adolescent Psychiatrist and HSE
National CAMHS Advisor commented “The data contained in our CAMHS
Report allows us to focus finite resources on areas of greatest need
and to ensure that young people and their families get the best
possible mental health care. Despite increasing demands for CAMHS
services, the teams are working hard to improve service access and
provide positive outcomes. Their commitment has been demonstrated with
10% increase in the number of new clients seen. We are currently
introducing another 150 Professionals to our CAMHS teams to strengthen
the multi-disciplinary teams and support this important work.”

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.

For those experiencing mental health problems, good outcomes are most
likely if the child or adolescent and their family or carer have
access to timely, well coordinated advice, assessment and
evidence-based treatment. Specialist CAMHS work directly with children
and adolescents to provide treatment and care for those with the most
severe and complex problems and with other services supporting
children and young people experiencing mental health problems.

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”.

To view the report, click here:
www.hse.ie/eng/services/Publications/services/Mentalhealth/camhs20112012.html