Northern Ireland Tier 4 Child and Adolescent Mental Health Services: A Survey of Admissions to the Child and Family Centre, January 2001–April 2004

Abstract

In-patient care, provided at Tier 4 level, is a specialised field aimed at provision of high-quality care for young people with serious mental health problems. This survey investigates how the regional in-patient unit for children in Northern Ireland functioned. A retrospective investigation was performed of cases admitted under the care of the lead clinician in the unit during the three-year period from January 2001 until April 2004. There were 115 admissions to in-patient care during the period investigated, 14 of these being re-admissions. Sixty-one young people were from within the Eastern Health and Social Services Board area, 16 were from the Northern Health and Social Services Board area, another 16 were from the Western Health and Social Services Board area and the remaining eight were from the Southern Health and Social Services Board area. The mean length of stay was 10.5 weeks. Nineteen young people admitted were emergency referrals. Forty-five young people fulfilled diagnostic criteria for more than one ICD-10 diagnosis. Thirty-seven young people had experienced permanent parental separation. Ten young people were exposed to violence within the parental relationship. Five young people were on the Child Protection Register and 13 were looked-after children. Eighteen mothers had a history of depression. Eight fathers were noted to have a history of substance misuse and four received other psychiatric diagnoses. In 11 cases there was documented evidence of trauma other than abuse. In conclusion, the Child and Family Centre aims to provide a comprehensive and equitable Tier 4 service for young people and their families. Issues such as distance from the unit affect equity. Future service planning should bear this in mind. Tier 4 adolescent services should be developed to meet the needs of the older adolescent population. Family therapists, child psychotherapists, occupational therapists and dieticians should be recruited as a matter of urgency. There is a need for better liaison with adult mental health services. Northern Ireland requires appropriate therapeutic residential and or community service provision for severely disturbed children.