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.

BACKGROUND: 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. AIMS: 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. METHOD: 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. RESULTS: 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). CONCLUSIONS: 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.

Tackling a long waiting list in a child and adolescent mental health service.

OBJECTIVE: Long waiting lists have a negative impact on client satisfaction, staff moral and referrer's opinion of the service. The aim of this project was to decrease a waiting list from a maximum wait of more than one year to a wait of no more than six weeks. METHOD: We introduced three simultaneous initiatives to decrease a long waiting list; (i) an individually led triage system (ii) setting-up an attention deficit hyperactivity disorder (ADHD) specialist team and (iii) division of the residual waiting list between team members. These initiatives were introduced and analysed over a ten month period. The study period ran from 1/3/2004 to 31/12/2004. RESULTS: The waiting time to first appointment was significantly reduced. At the beginning of the study there were 62 people waiting to be seen and each had waited an average of 122 days with a waiting time range of 0-449 days. At the end of the study, there were 19 people waiting with a mean waiting time of 19 days and a range of 0-168 days. CONCLUSIONS: The single most powerful intervention was the triage system. The ADHD clinic allowed referrals to be streamlined in a very structured and efficient way. The division of the residual waiting list was not as onerous as it first appeared. The service saw more referrals then ever during the study period. Referrers and families appreciated being seen more quickly. By removing the burden of the waiting list from staff the potential for creative thinking around further development of the service increased.