Referral patterns for specialist child and adolescent mental health services in the Republic of Ireland during the COVID-19 pandemic compared with 2019 and 2018.

Fiona Mcnicholas,Fionnuala Lynch,Maria Migone,James Mcdonald,Edwina Barry,Elaine Healy,Keith Holmes,Therese Thornton,Glenda Kavanagh,Ian Kelleher,Elma Hedderman,Lisa Kelly

doi:10.1192/bjo.2021.48

Fiona Mcnicholas, Fionnuala Lynch + Show 10 more

Open Access

https://doi.org/10.1192/bjo.2021.48

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Abstract

Countries worldwide are experiencing a third wave of the coronavirus disease 2019 (COVID-19) pandemic. Government-imposed restrictive measures continue with undetermined effects on physical and mental health. To compare child and adolescent mental health services (CAMHS) referrals over 11 months (January-November) in 2020, 2019 and 2018 and examine any impact the different phases of the COVID-19 restrictions might have on referral rates. Monthly CAMHS Health Service Executive data were examined, covering a catchment population of 260 560 or 12.7% of all youth (age group 0-18 years) in Ireland. The total number of urgent and routine referrals, appointments offered, rates of non-attendances and discharge outcome are presented. There was a significant drop in referrals in 2020, compared with prior years (χ2 = 10.3, d.f. = 2, P = 0.006). Referrals in 2020 dropped from March to May by 11% and from June to August by 10.3%. From September, both routine and urgent referrals increased by 50% compared with previous years (2018/2019), with the highest increase in November 2020 (180%). Clinic activity also increased from September, with double the number of out-patient appointments offered, compared with previous years (χ2 = 5171.72, d.f. = 3, P < 0.001) and lower (6.6%) rates of non-attendance (χ2 = 868.35, d.f. = 3, P < 0.001). In 2020, following an initial decline, referrals to CAMHS increased consistently from September. Such unprecedented increase in referrals places further strain on services that are already underresourced and underfunded, with the likelihood of increased waiting lists post COVID-19. It is envisaged that once the pandemic is over, resources will be even more constrained, and CAMHS will be urgently in need of additional ring-fenced funding.

Highlights

Countries worldwide are experiencing a third wave of the coronavirus disease 2019 (COVID-19) pandemic
Clinic activity increased from September, with double the number of out-patient appointments offered, compared with previous years (χ2 = 5171.72, d.f. = 3, P < 0.001) and lower (6.6%) rates of non-attendance (χ2 = 868.35, d.f. = 3, P < 0.001)
In 2020, following an initial decline, referrals to child and adolescent mental health services (CAMHS) increased consistently from September. Such unprecedented increase in referrals places further strain on services that are already underresourced and underfunded, with the likelihood of increased waiting lists post COVID-19

Summary

Introduction

Countries worldwide are experiencing a third wave of the coronavirus disease 2019 (COVID-19) pandemic. As with many other countries, the Republic of Ireland (ROI) is entering another year of living with the coronavirus disease 2019 (COVID-19) pandemic and associated restrictions. Unprecedented restrictions were initially imposed on 12 March 2020, following the declaration by the World Health Organization that the coronavirus infection had reached the status of a global pandemic. The direct impact for the 2 049 489 youth population in the ROI was of acute disruption to their lives, changes in their education, with cancellation of exams and a shift to online learning, restricted physical and social distancing and cessation of sporting and training events. The associated high morbidity and mortality of COVID-19 led to fear that the healthcare system would become overwhelmed and the initial 3-month restrictions were adhered to despite lack of understanding as to the exact toll or unintended consequences on children, families and society

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