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Providing 24-hour child and adolescent mental health services: demand and outcomes

  • Patricia Byrne (a1), Lorna Power (a2), Carole Boylan (a1), Mohammed Iqbal (a3), Margo Anglim (a1) and Carol Fitzpatrick (a1) (a2)...
Abstract
Aims and method

The provision of 24-hour specialist child and adolescent mental health services (CAMHS) is a key target for service commissioners. However, a lack of data exist on models of service delivery or levels of need for out-of-hours specialist CAMHS to guide service development. We aim to describe a model of 24-hour service provision and provide information on the demand for and outcome of assessments of a service in Dublin, Ireland, using a 6-year retrospective case study design.

Results

A total of 468 emergency presentations occurred during the study period; 80% presented with self-harm or suicidal ideation. Two-thirds presented outside of working hours. All presentations received a specialist CAMHS consultation. Over 50% required admission to a paediatric ward and 80% required onward referral to specialist CAMHS.

Clinical implications

There is a need for a 24-hour specialist CAMHS and this allows increased rates of specialist assessment and onward referral for a high-risk group.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Patricia Byrne (patricia.byrne4@hse.ie)
Footnotes
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Declaration of interest

All authors work in a specialist liaison psychiatry service.

Footnotes
References
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2 Royal College of Psychiatrists. Acute In-patient Psychiatric Care for Young People with Severe Mental Illness. Recommendations for Commissioners, Child and Adolescent Psychiatrists and General Psychiatrists (Council Report CR106). Royal College of Psychiatrists, 2002.
3 Irish College of Psychiatrists. A Better Future Now. Position Statement on Psychiatric Services for Children and Adolescents in Ireland. The Irish College of Psychiatrists, 2006.
4 Department of Health and Children. A Vision for Change. Report of the Expert Group on Mental Health Policy. Stationery Office, Dublin, 2006.
5 Royal College of Psychiatrists. Building and Sustaining Specialist Child and Adolescent Mental Health Services (Council Report CR137). Royal College of Psychiatrists, 2006.
6 Jacobsen, LK, Rabinowitz, I, Popper, MS, Solomon, RJ, Sokol, MS, Pfeffer, CR. Interviewing pre-pubertal children about suicidal ideation and behaviour. J Am Acad Child Adolesc Psychiatry 1994; 33: 439–52.
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Providing 24-hour child and adolescent mental health services: demand and outcomes

  • Patricia Byrne (a1), Lorna Power (a2), Carole Boylan (a1), Mohammed Iqbal (a3), Margo Anglim (a1) and Carol Fitzpatrick (a1) (a2)...
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eLetters

A Comprehensive and Specialist CAMHS Service Model

Imran Mushtaq, Locum Consultant Child & Adolescent Psychiatrist
31 October 2011

Byrne et al1 describe a model of a specialist child and adolescent mental health service (CAMHS) which provides 24 hours service including out of hours. We must congratulate them on this unique study and using a model, which combines a traditional 'on call' psychiatric provision with paediatric liaison model of service delivery. However, we would like to make few points here and also request the authors of the paper, to clarifythree issues for us.

The authors said they were unable to find any published evidence regarding demands or an experience of a 24/7 specialist CAMHS or how in clinical practice in U.K and Ireland, service models are implemented. However, a British study was published last year, in The Psychiatrist, highlights on some of the aspects' of the service model and analysed the cyclic variations in demands of out-of-hours services in child and adolescent psychiatry and considered it an important factor for service planning. (2) Hillen and Szaniecki's study, included 323 individuals recruited from three London teaching hospitals, over four years and described that out of hours, bedside assessments were required in 37% cases. There were 50% more referrals in the spring compared to the rest of the year but not more referrals than usual during the holidays, a finding, which is also seen inthe current study.

Firstly, we would like to know about the retrospective case study design as it is not clear in the paper and authors claimed that data was collected prospectively on all presentations during the period reviewed.

Secondly, 52% required admission in general pediatric wards but therewas no information given regarding any psychiatric admission and one wouldassume that 7 patients who presented with psychotic symptoms might have been admitted to a psychiatric unit.

Finally, we know that inter-team and inter-agency cooperation is recognised as an important building block for all services for children and their families. It provides a forum to share and discuss ideas (3) as well as encourages greater understanding of the respective services (4). Interdisciplinary liaison appears to carry many advantages but it has bothclinical and resource implications (5), more so in the current climate whereavailability of funds is limited, we would be interested to know how the authors dealth with it.

References:

1. Byrne P, Power L, Boylan C, et al. Providing 24- hour child and adolescent mental health services: demand and outcomes. The Psychiatrist (2011), 35. 374-379

2. Hillen T, Szaniecki E. Cyclic variations in demand for out-of-hours services in child and adolescent psychiatry: implications for service planning. The Psychiatrist (2010), 34. 427-432

3. Mattsson A. Child psychiatric ward rounds on paediatrics. Journal of the American Academy of Child Psychiatry (1976). 15. 357-365.

4. Brown A, & Cooper AF. The impact of a liaison psychiatry service on patterns of referral in a general hospital. British Journal of Psychiatry (1987). 150. 83-87.

5. Block J, Wright B, et al. Pediatric liaison service. Psychiatric Bulletin (1999). 23, 528-530

Authors:

1.Dr. Imran Mushtaq, Locum Consultant Child & Adolescent Psychiatrist, Driffield-CAMHS Union Street, Driffield, YO25 6AT.

2.Dr. Muhammad Nabeel Helal, Speciality Registrar (ST5) Child & Adolescent Psychiatry,Westcotes House, Westcotes Drive, Leicester, LE3 0QU.

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Conflict of interest: None declared

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