Creation of an out of hours child and Adolescent Mental Health emergency service

Both Wexford and Waterford Counties are badly suffering from the lack of Child and Adolescent Mental Health Services (CAMHS). This is directly connected to the lack of CAMHS consultants to lead these services. Accessing the existing CAMHS services, especially in emergency, is particularly difficult as the waiting lists are ever growing, and therefore delaying the possibility of an early first appointment. An emergency “out of hours” child psychiatric service has been developed, in order to provide help when the CAMHS services are not accessible. Providing a service for under 18 years old patients with mental health issues presenting in Accident and Emergency (A&E) or hospitalised on a Ward (Paediatric, psychiatric or other) and also sometimes “off-site”, it functions with extremely limited resources (a consultant psychiatrist and a doctor in psychiatric training), and therefore needs an efficient triage procedure. The triage tool that was chosen is the Irish Child Triage System (ICTS) that was launched in Ireland by the RCSI in 2016. It operates in Wexford General Hospital (WGH) and in University Hospital Waterford (UHW). Between February and August 2018, every intervention provided by the Consultant Psychiatrist responsible for this “emergency out of hours” service was recorded; this includes interventions on both sites (WGH and UHW), In A&E but also on the Wards (Pediatric, Psychiatric, Medical and Surgical), both face to face consultations with the Consultant but also phone supervisions provided by the Consultant to the Doctor in psychiatric training on call for Psychiatry (UHW). The purpose of this article is to review the first figures of attendance of this new service provided and to discuss its profitability. Within 7 months, a total of 675 interventions was provided by the Consultant Psychiatrist on call for this new out of hours CAMHS service. Keywords: Child and Adolescent Psychiatry- Emergency Department– Out of hours - Ireland- Triage- out of hours- Irish Children Triage System (ICTS)