Abstract
Aims and methodThe 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.ResultsA 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 implicationsThere 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.
Highlights
The Children’s University Hospital (CUH) provides emergency department services, paediatric in-patient and out-patient services and a multidisciplinary mental health liaison team (MHLT), which is a part of a larger department of child and adolescent mental health within the hospital
A consultant and senior registrar in child and adolescent psychiatry, two senior psychiatric social workers and two clinical nurse managers who have specialised in child and adolescent mental health make up the MHLT
Many different models of 24-hour service provision exist, for example the provision of an on-call system, where psychiatric review is provided as required during and out of hours using a rota system with staff from local child and adolescent mental health services (CAMHS). Such a service may be based within local CAMHS offices or within a paediatric emergency department
Summary
In line with best practice guidelines, a multi-agency protocol has been agreed between the catchment area specialist CAMHS, local adult mental health services and the paediatric service within the Children’s University Hospital (CUH). The CUH policy states that no child with psychiatric symptoms may be discharged from the emergency department without a specialist mental health assessment This is facilitated by the CUH MHLT, supported by an ‘on-call’ rota staffed by consultants (n = 8) and psychiatric trainees (n = 8) who work in either the catchment specialist CAMHS or the department of child and adolescent mental health within the CUH. Each morning a MHLT liaison nurse reviews all emergency presentations over the previous 24 h with emergency department staff, providing a mechanism of ongoing audit to ensure all children who present with psychiatric symptoms receive a specialist mental health assessment, as well as providing support and psychoeducation to emergency department staff regarding psychosocial presentations.
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