Teenagers experiencing acute mental health crises are having to wait “up to a week” in crowded emergency departments in Irish hospitals, a new report has revealed. The report from the Mental Health Commission (MHC) has outlined “substantial variations” in the level of mental health services provided in hospital emergency departments across Ireland, and says steps need to be taken to enhance access to care – especially out of hours.
51,000 people in Ireland tried to access mental health services for the first time last year through hospital emergency departments and medical wards. The report from the inspector of mental health services warned that many Irish hospitals do not have adequate staff or resources to meet annual demand.
The report, released on Thursday, is authored by the Inspector of Mental Health Services, Professor Jim Lucey – and based on a 100% response from each HSE hospital in Ireland, with an emergency department or a minor injury unit. The report, ‘Acute Mental Healthcare in Hospital Emergency Departments in Ireland’ presses for an increase in the range of acute mental health services to improve urgent access and unscheduled mental health care.
It highlights a lack of space in most EDs, and substantial delays when assessing patients. The services for children are especially problematic, with many facing “prolonged and inappropriate waits.” The report calls for investment in primary and community services, as well as in EDs.
It points out that according to the HSE National Clinical Programme for Self-Harm and Suicide Related Ideation, mental health services in emergency departments are to be delivered 24 hours a day, seven days a week – however, this is not being delivered. It notes that an emergency mental health service is not available in any injury unit, with no consistent level of mental health service across a range of emergency departments in Ireland.
The Mater Misericordiae University Hospital Emergency Department in Dublin is one department which is experiencing “major” problems with provision for 16-17 year-olds, without input from CAMHS in the emergency department service, the report said.
Due to an access of CAMHS beds, acutely unwell 16–17-year- olds with a first episode of psychosis are being forced to wait for “up to one week,” remaining in the emergency department or an acute medical setting due to a lack of access to CAMHS beds, according to the report.
At Beaumont Hospital in Dublin, patients aged between 16 and 17 and with acute mental health care need may spend “several days” in the emergency department there awaiting transfer to an appropriate mental health care facility. At Cavan General Hospital, a survey respondent highlighted that its emergency department experiences major issues involving young patients with mental health difficulty, between the ages of 15 and 18, presenting in crisis situations, especially those young people seeking a place of safety.
Such crises can persist for several days or more, according to the survey response, with staff feeling insufficiently resourced to manage such patients.
The ED St Vincent’s University Hospital in Dublin is struggling, according to the report, with being “significantly underresourced” in comparison to Irish national mental health policy and international best practice recommendations.
The closure of the emergency department in St Columcille’s Hospital, Loughlinstown, downgrading that facility to an IU, is also correlated with an increase since 2013 in urgent mental health presentations to SVUH’s emergency department, the second highest nationally in terms of self-harm – and with little corresponding increase in terms of resources.
Portiuncula University Hospital ED can see significant delays with mental health patients referred for admission to an acute psychiatry bed. According to the hospital, mental health patients may wait in the PUH emergency department on a trolley from several hours to up to seven days in some instances – a practice which it says has increased post-Covid.
“Several mornings each week two to three mental health patients can be found waiting in PUH emergency department to be reviewed by the psychiatry service based at Roscommon University Hospital,” the review adds.
The survey points to standards of mental health assessment for children in emergency departments across the country as something that does “not exist.” Delayed mental health assessment for young people is pointed out repeatedly, leading to the “inappropriate and prolonged” placement of children in emergency departments or acute medical wards. This, it says, is not only a waste of resources but poses a risk to staff and young people.
Speaking on Morning Ireland, Prof Lucey, author of the report and inspector of mental health services, said that there isn’t a dedicated acute mental health service available to people in most Irish hospitals, saying there was a need for 24/7 access to children and adults.
“Survey respondents report numerous cases of prolonged and inappropriate placement of children in emergency departments, and in acute medical wards,” he said. “These persistent gaps in services are consistent with those identified in recent national reports on the challenges faced by young people accessing acute mental health services.”
He said that someone with mental health issues should be treated the same as someone presenting with cardiac issues.
“We decided to reach out to all the emergency units in the country and asked them what they could tell us about their experience in providing for emergencies in mental health. This is the commonest cause of death for under-50s in the country. Mental health issues are not insignificant. The response to a surgical issue would be an emergency surgical response – if you go in with a fracture, you get a surgical answer to the fracture, but if you’ve a fractured mind and you present yourself to an emergency room, you may be waiting.”
“We found a huge difference between day and night […] after tea time, after the end of business hours, you’re going to be waiting until somebody on call comes, possibly until the next Monday (if it’s a weekend).”
He said thousands of people were going to national emergency hospitals to find there was no service after 5pm.
“We need substantial and immediate response to emergency need. If you have a fractured leg, it should be the same when you have a fracture in the mind.”