Urgent investment in child and adolescent mental health services (CAMHS) is needed in order to prevent any further increase in mental health difficulties among young people following the Covid pandemic, a leading consultant has warned.

According to Prof Fiona McNicholas, a consultant in child and adolescent psychiatry in Children’s Health Ireland Crumlin and the Lucena Clinic in Rathgar, while those under the age of 18 had a much lower susceptibility to symptomatic (Covid) infection and death, “the effect on their mental health had not been so benign”.

In fact, restrictions imposed during the pandemic in this country “have been recognised as the most severe and longest lasting”. For young people, this included school and college closures, sporting venue closures and severe restrictions placed on social gatherings.

Ireland was one of only six EU countries to shut both primary and secondary schools from March to September 2020.

Writing about this issue in the Irish Medical Journal, Prof Mc Nicholas pointed to the results of a large, collaborative study by the Department of Health and SpunOut.ie, which looked at the impact of Covid on 2,000 young people aged between 15 and 24.

It found high rates of psychological distress among young people. Large-scale studies in the UK backed up these findings. They reported an increase in “probable mental health disorders” – from 10.8% in 2017 to 16% in 2020.

One study involving young people with prior mental health difficulties found that many reported a deterioration in their mental wellbeing as the pandemic progressed.

Prof McNicholas acknowledged that there had been an initial reduction in presentations after people were told to stay at home in 2020. However, many countries, including Ireland, then reported “ a subsequent and disproportionate rise in cases with mental health concerns”.

“Attendances at a Dublin paediatric hospital showed a continued increase in mental health presentations despite overall attendances for other reasons being lower. Referrals to specialist CAMHS showed a consistent rise post summer, with referrals peaking at a 180% increase by November,” she noted.

She also pointed to anecdotal reports from clinicians, which suggested “an increase in referral complexity, with more youth presenting with suicidal ideation”.

There was also a 66% increase in eating disorder admissions to paediatric hospitals and a 51% increase in admissions to child psychiatry units between 2019 and 2020.

Prof McNicholas warned that prior to the pandemic, referrals to CAMHS were already increasing and this further demand as a result of the Covid pandemic “will create a new crisis”.

She pointed out that funding and resourcing for CAMHS remains “well below” the recommendations made in the Government’s mental health policy document, A Vision for Change, with clinical staffing levels only at 58% nationally.

Furthermore, psychiatry has the highest consultant vacancy rate of all medical specialties in Ireland, with 32% of posts currently vacant and 20% being vacant for longer than three years.

Prof McNicholas noted high rates of burnout and high levels of dissatisfaction with government investment and management among CAMHS consultants nationally.

She also noted that while the government has acknowledged a need to prioritise mental health, “mental health services remain skeptical as to the extent and speed of any planned reform”.

She called for a “true commitment to investment in equitable and accessible mental health services from cradle to grave, enshrined in Sláintecare, and a budget which plans for it”.

“Let us hope that the unique needs of the young are no longer neglected. We all share a collective responsibility, as individual members of the public and within our professional bodies, to advocate for nothing less than a full and meaningful commitment to a broad spectrum of CAMHS,” she added.