In response to report on mental healthcare in EDs, Prof Matthew Sadlier describes the ‘almost wilful ignorance’ of HSE for failing to address the discrepancy in how a child or adolescent is defined for mental and physical healthcare
Plans to move mental healthcare into community settings will not be enough to ensure that patients in an emergency receive the treatment they need, the chair of the IMO’s Consultant Committee has warned.
Prof Matthew Sadlier, a consultant psychiatrist at Dublin’s Mater Hospital, spoke to IMT after a report from the Mental Health Commission (MHC) found substantial delays, variations in care, and a lack of appropriate space in EDs for the treatment of patients needing urgent mental health care.
Dr Matthew Sadlier
Minister for Mental Health Mary Butler said the report highlighted the need to provide community care pathways, such as crisis resolution teams and out-of-hours ‘crisis cafes’ as alternatives to busy EDs, which she described as ‘the wrong setting for their needs’.
“I have expressed my impatience to the HSE at the pace of change, and so this report from the Mental Health Commission is a timely reinforcement of the need for my Department and the HSE to intensify efforts to expand access to these alternatives to Emergency Departments,” she added.
However, Prof Sadlier believes that such a policy, as outlined in the Government’s ‘Vision for Change’ mental health strategy, does not address the needs of patients who require urgent interventions.
“By moving to this model of dispersion of care, there’s no way you can provide emergency care. And then the emergency care falls back upon the hospital,” he told IMT.
“The Mental Health Commission has a vision that urgent mental healthcare shouldn’t happen in the emergency department – that it should happen in primary care centres and local services should set up these acute assessment units.
Minister for Mental Health, Mary Butler TD
“But if your child has just harmed themselves, are you really going to go onto a website and check ‘where am I supposed to go for this’? Or are you just going to get into the car and drive to your local emergency department?”
Prof Sadlier described as ‘completely unsatisfactory’ a situation where, ‘ if Vision for Change was actually enacted, people would come to an emergency department with a crisis and they’d be redirected somewhere else 30 miles away.’
A more effective way to address the challenges in treating mental health patients, he believes, is to adequately fund the provision of emergency psychiatry in hospitals.
”I fully agree with the Mental Health Commission that, if somebody with a mental health crisis comes to an emergency department, there should be an area in the emergency department designed for them to be seen. But I disagree with them when they think it can be done outside of the emergency department.”
He added: “If have a community centre with two junior doctors and one consultant you can’t provide 24/7 care there. You just can’t. It’s not possible.”
The MHC report, which involved every hospital with an ED or minor injury unit, found that 51,000 people annually access mental health services for the first time through an emergency department.
It highlighted incidents where children with acute mental health crises were left waiting up to a week in EDs, while others are leaving without appropriate care plans, only to return weeks later.
The Mater hospital told the report that it was experiencing ‘major problems’ in providing care to 16- and 17-year-olds, with little if any input from Child and Adolescent Mental Health Services (CAMHS).
Prof Sadlier believes that a significant issue is the ‘almost deliberate, almost wilful, ignorance by management of the HSE over the definition of what is an adolescent’.
He points to a discrepancy where, for mental healthcare, a child or adolescent is defined as anyone under 18, but for physical healthcare in Ireland this definition is restricted to anyone under 16.
“If you are 16 or 17 years of age and you have an urgent mental health problem, you are turned away from a paediatric emergency department,” he added. “You are then forced into having to go to an adult hospital.
“You have a mental health commission who says it is torture for a child to be treated as an adult for mental healthcare, but for some reason it’s not torture to be treated as an adult for physical healthcare.
“You end up in this position where I, as an adult psychiatrist working in a hospital, do my best to treat the 17-year-old who has no other option. But then I get slapped in the face by the Human Rights Council who tell me if I’m torturing the child,” he said.
“I don’t disagree that an under-18 should be treated as a child, but somebody needs to coordinate this rather than just having people at the Mental Health Commission issuing statements saying it is disgraceful that a child is being treated in an adult unit without addressing the reason why.”
Meanwhile, the Irish Nurses and Midwives Organisation (INMO) said the MHC report highlights that EDs are currently unable to meet the demand for mental health services.
“We know there have been many incidents of children under the age of sixteen with acute mental health issues being admitted to emergency departments,” said INMO general secretary Phil Ní Sheaghdha.
“It is not right or appropriate for children who are in mental health distress to be spending up to a week in emergency departments. This is a matter which must be addressed urgently.”
