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

Robertson M., Duffy F., Newman E., Prieto Bravo C., Ates H.H., Sharpe H.

Early reports suggest that lockdown measures associated with the COVID-19 pandemic (e.g., social distancing) are having adverse consequences for people's mental health, including increases in maladaptive eating habits and body dissatisfaction. Certain groups, such as those with pre-existing mental health difficulties, may be especially at risk. The current study explored perceived changes in eating, exercise, and body image during lockdown within the United Kingdom, using an online survey (n = 264). There were large individual differences in perceived changes in eating, exercise, and body image in this period. Women were more likely than men to report increasing struggles with regulating eating, preoccupation with food and worsening body image. Those with a current/past diagnosis of eating disorders reported significantly greater difficulties in regulating eating, increased preoccupation with food, exercise thoughts and behaviours and concern about appearance, even when compared to those with other mental health and developmental disorders. Ongoing research to explore individual differences in the trajectories of change in eating, exercise and body image as lockdown measures ease will be important for understanding the full psychological impact of this pandemic and improve service and public health planning going forward.

Ougrin D., Wong B.H., Vaezinejad M., Plener P.L., Mehdi T., Romaniuk L., Barrett E., Hussain H., Lloyd A., Tolmac J., Rao M., Chakrabarti S., Carucci S., Moghraby O.S., Elvins R., et. al.

To examine the differences in hospital emergency psychiatric presentations for self-harm of children and adolescents during the covid-19 lockdown in March and April 2020 compared with the same period in 2019. Retrospective cohort study. We used electronic patient records from 23 hospital emergency departments in ten countries grouped into 14 areas. We examined data on 2073 acute hospital presentations by 1795 unique children and adolescents through age 18. We examined the total number of emergency psychiatric hospital presentations and the proportion of children and adolescents presenting with severe self-harm as our two main outcome measures. In addition, we examined sociodemographic and clinical characteristics and clinical management variables for those presenting with self-harm. To compare the number of hospital presentations between 2020 and 2019 a negative binomial model was used. For other variables, individual participant data (IPD) meta-analyses were carried out. Emergency psychiatric hospital presentations decreased from 1239 in 2019 to 834 in 2020, incident rate ratio 0.67, 95% CI 0.62–0.73; p < 0.001. The proportion of children and adolescents presenting with self-harm increased from 50% in 2019 to 57% in 2020, odds ratio 1.33, 1.07–1.64; p = 0.009 but there was no difference in the proportion presenting with severe self-harm. Within the subpopulation presenting with self-harm the proportion of children and adolescents presenting with emotional disorders increased from 58 to 66%, odds ratio 1.58, 1.06–2.36; p = 0.025. The proportion of children and adolescents admitted to an observation ward also decreased from 13 to 9% in 2020, odds ratio 0.52, 0.28–0.96; p = 0.036. Service planners should consider that, during a lockdown, there are likely to be fewer emergency psychiatric presentations. Many children and adolescents with psychiatric emergencies might not receive any service. A focus on developing intensive community care services with outreach capabilities should be prioritised.

Ayton A., David.Viljoen, Ryan S., Ibrahim A., Ford D.

Aims and Method: This is a longitudinal cohort study describing the demand and capacity for specialist inpatient treatment of patients with severe eating disorders covering a population of 3.5 million. We compared and the impact of the pandemic and the outcomes between different inpatient services.Results: Between July 2018 and 1 November 2020 there were 293 referrals. 97% were female. 93% had a diagnosis of anorexia nervosa. 19.5% of referrals were below BMI 13, and a further 40% had extreme malnutrition. Referrals and emergency admissions to acute hospitals have increased by 20% since the pandemic. Waiting times have doubled from 33 to 67 days.A novel integrated CBTE model has shown better outcomes and shorter length of stay compared to traditional eclectic treatment.Clinical Implications.The pandemic has worsened the mismatch of demand and capacity, causing increasing serious risks and this needs to be addressed as a matter of urgency.

Marques de Miranda D., da Silva Athanasio B., Sena Oliveira A.C., Simoes-e-Silva A.C.

The coronavirus disease (COVID-19) affected virtually all countries. Uncertain about the health risk and an increasing financial loss will contribute to widespread emotional distress and an increased risk of psychiatric disorders shortly. Posttraumatic, anxiety, and depression disorders are expected during and aftermath of the pandemic. Some groups, like children, have more susceptibility to having long term consequences in mental health. Herein, we made a comprehensive and non-systematic search in four databases (PubMed, Scopus, SciELO, and Google Scholars) to answer the question: What are children's and adolescents' mental health effects of the pandemic? Furthermore, which features are essential for mental health in a pandemic? Results: Seventy-seven articles were selected for full text read, and 51 were included. Children answer stress differently, depending on the development stage. High rates of anxiety, depression, and post-traumatic symptoms were identified among children. Discussion: Symptoms were as expected. New supportive strategies have appeared during this pandemic, but there is no measure of its effectiveness. Some groups seem to be more vulnerable to the mental health burden of the COVID-19 pandemic, and the mitigation actions should prioritize them. The school's role appears to be revalued by society. This review seems to pick good targets to prioritize mitigation actions aiming to spare children not only from the severe cases of COVID-19 but also to help them to deal with the mental health burden of the pandemics.

Leeb R.T., Bitsko R.H., Radhakrishnan L., Martinez P., Njai R., Holland K.M.

Published reports suggest that the coronavirus disease 2019 (COVID-19) pandemic has had a negative effect on children's mental health (1,2). Emergency departments (EDs) are often the first point of care for children experiencing mental health emergencies, particularly when other services are inaccessible or unavailable (3). During March 29-April 25, 2020, when widespread shelter-in-place orders were in effect, ED visits for persons of all ages declined 42% compared with the same period in 2019; during this time, ED visits for injury and non-COVID-19-related diagnoses decreased, while ED visits for psychosocial factors increased (4). To assess changes in mental health-related ED visits among U.S. children aged

Tromans S., Chester V., Harrison H., Pankhania P., Booth H., Chakraborty N.

Background The coronavirus disease 2019 (COVID-19) pandemic has had a profound impact on both the physical and mental well-being of the global population. Relatively few studies have measured the impact of lockdown on utilisation of secondary mental health services in England. Aims To describe secondary mental health service utilisation pre-lockdown and during lockdown within Leicestershire, UK, and the numbers of serious incidents during this time frame. Method Data pertaining to mental health referral and hospital admissions to adult mental health, child and adolescent mental health, intellectual disability and mental health services for older people were collated retrospectively from electronic records for both 8 weeks pre-lockdown and the first 8 weeks of lockdown in England. Serious incidents during this time frame were also analysed. Results Significantly (P < 0.05) reduced referrals to a diverse range of mental health services were observed during lockdown, including child and adolescent, adult, older people and intellectual disability services. Although admissions remained relatively stable before and during lockdown for several services, admissions to both acute adult and mental health services for older people were significantly (P < 0.05) reduced during lockdown. Numbers of serious incidents in the pre-lockdown and lockdown periods were similar, with 23 incidents pre-lockdown, compared with 20 incidents in lockdown. Conclusions To the best of our knowledge, this is the first UK-based study reporting patterns of use of mental health services immediately prior to and during COVID-19 lockdown. Overall numbers of referrals and admissions reduced following commencement of COVID-19 lockdown. Potential reasons for these observations are discussed.

Racine N., Cooke J.E., Eirich R., Korczak D.J., McArthur B., Madigan S.

Prior to the novel coronavirus (COVID-19) pandemic, the international prevalence of child and adolescent mental illness, across all mental disorders, was 13.4% (Polanczyk et al., 2015). As a result of COVID-19, children and adolescents have experienced unprecedented interruptions to their daily lives and it is anticipated that these disruptions may be precipitants of mental illness, including anxiety, depression, and/or stress related symptoms (Lee, 2020). In order for governments and policy makers to plan, and allocate resources for child and adolescents mental illness, a rapid review of the research is recommended (Tricco et al., 2017). The aim of the current study was to conduct a rapid review of child and adolescent anxiety, depression, and traumatic stress experienced during the COVID-19 pandemic. Risk and protective factors for child and adolescent mental illness were also examined. The review was registered with PROSPERO [CRD42020184903] and followed PRISMA guidelines. Searches were conducted in PsycINFO, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, and MEDLINE up to May 26th, 2020 by a health sciences librarian. PsycArXiv, a repository of unpublished pre-prints, was also searched using the key terms “COVID-19″ and “mental health”. The initial search yielded 3405 non-duplicate abstracts, which were reviewed for study inclusion. Study inclusion criteria were as follows: (1) empirical study; (2) written in English; (3) data collected during COVID-19; (4) sample < 18 years of age; and (5) data on the prevalence of mental illness symptoms and/or factors associated with mental illness symptoms were available. Reliability between coders on 20% of titles/abstracts ranged from .78 to .96 %. In total, 175 full text articles were reviewed and six met full inclusion criteria (See Supplementary Material 1). A description of study characteristics can be found in Table 1 . Consistent with recommendations for rapid reviews (Garritty et al., 2020; Tricco et al., 2017), narrative results were extracted by a primary coder and 20% checked by a secondary coder. Reliability between coders was 100%. Table 1 Study characteristics.

Vindegaard N., Benros M.E.

• COVID-19 patients displayed high levels of PTSS and increased levels of depression. • Patients with preexisting psychiatric disorders reported worsening of psychiatric symptoms. • Higher levels of psychiatric symptoms were found among health care workers. • A decrease in psychological well-being was observed in the general public. • However, well conducted large-scale studies are highly needed. During the COVID-19 pandemic general medical complications have received the most attention, whereas only few studies address the potential direct effect on mental health of SARS-CoV-2 and the neurotropic potential. Furthermore, the indirect effects of the pandemic on general mental health are of increasing concern, particularly since the SARS-CoV-1 epidemic (2002–2003) was associated with psychiatric complications. We systematically searched the database Pubmed including studies measuring psychiatric symptoms or morbidities associated with COVID-19 among infected patients and among none infected groups the latter divided in psychiatric patients, health care workers and non-health care workers. A total of 43 studies were included. Out of these, only two studies evaluated patients with confirmed COVID-19 infection, whereas 41 evaluated the indirect effect of the pandemic (2 on patients with preexisting psychiatric disorders, 20 on medical health care workers, and 19 on the general public). 18 of the studies were case-control studies/compared to norm, while 25 of the studies had no control groups. The two studies investigating COVID-19 patients found a high level of post-traumatic stress symptoms (PTSS) (96.2%) and significantly higher level of depressive symptoms (p = 0.016). Patients with preexisting psychiatric disorders reported worsening of psychiatric symptoms. Studies investigating health care workers found increased depression/depressive symptoms, anxiety, psychological distress and poor sleep quality. Studies of the general public revealed lower psychological well-being and higher scores of anxiety and depression compared to before COVID-19, while no difference when comparing these symptoms in the initial phase of the outbreak to four weeks later. A variety of factors were associated with higher risk of psychiatric symptoms and/or low psychological well-being including female gender, poor-self-related health and relatives with COVID-19. Research evaluating the direct neuropsychiatric consequences and the indirect effects on mental health is highly needed to improve treatment, mental health care planning and for preventive measures during potential subsequent pandemics.

McIntyre A., Tong K., McMahon E., Doherty A.M.

AbstractObjectives:This study aimed to assess the impact of COVID-19 on presentations to an acute hospital with self-harm.Methods:All presentations to University Hospital Galway with self-harm were assessed during the peak period of the coronavirus crisis in Ireland, over the 3 months from 1 March to 31 May 2020. These data were compared with presentations in the same months in the 3 years preceding (2017–2019). Data were obtained from the anonymised service database.Results:This study found that in 2020, the rate of presentation with self-harm dropped by 35% from March to April and rose by 104% from April to May, peaking from mid-May. When trends over a 4-year period were examined, there was a significantly higher lethality of attempt (p < 0.001), and significant differences in diagnosis (p = 0.031) in 2020 in comparison with the three previous years. The increased lethality of presentations remained significant after age and gender were controlled for (p = 0.036). There were also significant differences in the underlying psychiatric diagnoses (p = 0.018), notably with a significant increase in substance misuse disorders presenting during the 2020 study period.Conclusions:COVID-19 showed a reduction in self-harm presentations initially, followed by a sharp increase in May 2020. If a period of economic instability follows as predicted, it is likely that this will further impact the mental health of the population, along with rates of self-harm and suicidal behaviours. There is a need for research into the longer-term effect of COVID-19 and lockdown restrictions, especially with respect to self-harm.

McAndrew J., O’Leary J., Cotter D., Cannon M., MacHale S., Murphy K.C., Barry H.

AbstractObjectives:To determine if the initial COVID-19 societal restrictions, introduced in Ireland in March 2020, impacted on the number and nature of psychiatry presentations to the emergency department (ED) of a large academic teaching hospital.Methods:We examined anonymised clinical data of psychiatry presentations to the ED during the initial 8-week period of COVID-19 restrictions. Data from corresponding 8-week periods in 2018 and 2019 were also extracted for comparison.Results:Psychiatry presentations to ED reduced by 21% during the COVID-19 restrictions, from 24/week to 19/week when compared with corresponding periods in 2018/2019 (Poisson’s Rate Test estimate of difference −5.2/week, 95% CI 1.3–9.1, p = 0.012). Numbers attending for out-of-hours assessment remained unchanged (81 v. 80), but numbers seeking assessment during normal hours decreased (71 v. 114). We observed increased presentations from the <18 age group, but decreased presentations from the 18 to 29 age group (Pearson’s Chi-Square 20.363, df = 6, p = 0.002). We recorded an increase in anxiety disorders during the initial COVID-19 restrictions (31 v. 23), and a reduction in alcohol disorders (28 v. 52). The proportion of presentations with suicidal ideation (SI) or self-harm as factors remained unchanged.Conclusions:Rates of emergency presentation with mental illness reduced during the initial COVID-19 restrictions. This may represent an unmet burden of mental health needs. Younger people may be experiencing greater distress and mental illness during the current crisis. More people sought help for anxiety disorders during the COVID-19 restrictions compared with corresponding data from 2018 and 2019.

McDonnell T., Nicholson E., Conlon C., Barrett M., Cummins F., Hensey C., McAuliffe E.

This study outlines the impact of COVID-19 on paediatric emergency department (ED) utilisation and assesses the extent of healthcare avoidance during each stage of the public health response strategy. Records from five EDs and one urgent care centre in Ireland, representing approximately 48% of national annual public paediatric ED attendances, are analysed to determine changes in characteristics of attendance during the three month period following the first reported COVID-19 case in Ireland, with reference to specific national public health stages. ED attendance reduced by 27–62% across all categories of diagnosis in the Delay phase and remained significantly below prior year levels as the country began Phase One of Reopening, with an incident rate ratio (IRR) of 0.58. The decrease was predominantly attributable to reduced attendance for injury and viral/viral induced conditions resulting from changed living conditions imposed by the public health response. However, attendance for complex chronic conditions also reduced and had yet to return to pre-COVID levels as reopening began. Attendances referred by general practitioners (GPs) dropped by 13 percentage points in the Delay phase and remained at that level. While changes in living conditions explain much of the decrease in overall attendance and in GP referrals, reduced attendance for complex chronic conditions may indicate avoidance behaviour and continued surveillance is necessary.

Kofman Y.B., Garfin D.R.

The novel coronavirus (SARS-CoV-2) and the associated disease it causes, COVID-19, have caused unprecedented social disruption. Due to sweeping stay-at-home orders across the United States and internationally, many victims and survivors of domestic violence (DV), now forced to be isolated with their abusers, run the risk of new or escalating violence. Numerous advocates, organizations, and service centers anticipated this: Upticks in domestic violence were reported in many regions soon after stay-at-home directives were announced. In this commentary, we delineate some of the recent events leading up to the reported spike in DV; review literature on previously documented disaster-related DV surges; and discuss some of the unique challenges, dilemmas, and risks victims and survivors face during this pandemic. We conclude with recommendations to allocate resources to DV front-liners and utilize existing DV guidelines for disaster preparedness, response, and recovery. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Gunnell D., Appleby L., Arensman E., Hawton K., John A., Kapur N., Khan M., O'Connor R.C., Pirkis J., Appleby L., Arensman E., Caine E.D., Chan L.F., Chang S., Chen Y., et. al.

The mental health effects of the coronavirus disease 2019 (COVID-19) pandemic might be profound1 and there are suggestions that suicide rates will rise, although this is not inevitable. Suicide is likely to become a more pressing concern as the pandemic spreads and has longer-term effects on the general population, the economy, and vulnerable groups. Preventing suicide therefore needs urgent consideration. The response must capitalise on, but extend beyond, general mental health policies and practices.

Walsh O., McNicholas F.

Management of the high rates of medical and psychiatric complications, including self-harm and suicide, associated with anorexia nervosa requires regular clinical review. However, during the current pandemic, face-to-face clinical assessments carry the risk of infection and transmission in this vulnerable cohort already compromised by low weight and lowered immunity. This paper describes how one service has had to adapt usual care during the COVID-19 pandemic without contributing excessively to carer burden or compromising patient safety.

Crawley E., Loades M., Feder G., Logan S., Redwood S., Macleod J.

In the UK, paediatricians are increasingly concerned that parental worries over visiting healthcare centres are leading to a drop in vaccination rates and the late presentation of serious illness in children. This is likely to cause avoidable deaths and illness in the short and long term, a form of collateral damage from the COVID-19 emergency. In Italy, hospital statistics show a substantial decrease in paediatric emergency visits compared with the same time in 2018 and 2019 of between 73% and 78%.1 In April 2020, both the Clinical Commissioning Groups and the Royal College of Paediatrics and Child Health provided guidance for general practitioners and paediatricians in England that the threshold for face-to-face assessment hospital referrals in children should not change because of the COVID-19 pandemic.2 This intervention is welcome; however, we remain concerned about wider, perhaps less immediately visible collateral damage of strategies used against COVID-19 on vulnerable children. The Cambridge dictionary defines collateral damage as the ‘unintentional deaths and injuries of people who are not soldiers, and damage that is caused to their homes, hospitals, schools, etc’. In the fight against coronavirus, children are being put at risk, in order to reduce the spread of a disease that mainly causes direct harm to adults. One of the unique characteristics of the COVID-19 pandemic is the low hospitalisation and mortality rate (

Manolopoulou T.

Sculco C., Bano B., Prina E., Tedeschi F., Bartucz M.B., Barbui C., Purgato M., Albanese E.

ObjectivesTo quantify access to health services during the COVID-19 pandemic and measure the change in use between the prepandemic and the pandemic periods in a population with assessment of psychological distress or diagnosis of mental disorders.Data sourcesWe developed and piloted a search syntax and adapted it to enter the following databases from 1 January 2020 to 31 March 2023: PubMed/MEDLINE, PsycINFO, Web of Science, Epistemonikos and the WHO International Clinical Trials Registry Platform. We reran the searches from the end of the original search to 3 December 2024.DesignWe systematically screened titles, abstracts and full texts of retrieved records.Eligibility criteriaWe included observational studies on any populations and regions, covering health services such as doctor visits, hospital admissions, diagnostic examinations, pharmaceutical therapies and mental health (MH) services. Only studies using validated scales to assess psychological distress or mental disorders as defined in the Diagnostic and Statistical Manual of Mental Disorders were included.Data extraction and synthesisWe extracted data using a purposefully designed form and evaluated the studies’ quality with the Newcastle-Ottawa Scale. We measured the incidence rate (IR) of access to health services and the IR ratio (IRR) between the prepandemic and the pandemic periods. We calculated contacts days and catchment areas in the different periods. We used the random effects DerSimonian-Laird inverse-variance model and calculated heterogeneity with statistics I² and τ². We computed pooled IR and pooled IRR and tested the hypothesis of no variation (IRR=1).ResultsWe retrieved 10 014 records and examined the full text of 580 articles. We included 136 primary studies of which 44 were meta-analysed. The IR of access to services during the pandemic was 2.59 contact months per 10 000 inhabitants (IR=2.592; 95% CI: 1.301 to 5.164). We observed a reduction of 28.5% in the use of services with negligible differences by age group and type of services (IRR=0.715; 95% CI: 0.651 to 0.785). We observed significant differences in effect sizes across studies (τ2=5.44; p<0.001 and τ2=0.090; p<0.001).ConclusionBy considering MH, our study provides consolidated evidence and quantifies the reduction in the use of health services during the COVID-19 pandemic.PROSPERO registration numberCRD42023403778.

Ching B.C., Downs J., Zhang S., Abdul Cader H., Penhallow J., Voraite E., Popnikolova T., Wickersham A., Parlatini V., Simonoff E.

BackgroundSystematic reviews have suggested mixed effects of the COVID‐19 pandemic on the mental health of children and young people. However, most included studies focused on the general population and were cross‐sectional. The long‐term impact on those with pre‐existing mental health and/or neurodevelopmental conditions remains unclear. Thus, we conducted a systematic review and meta‐analysis to examine the longitudinal impact of the pandemic on the mental health of this clinical population and potential explanatory factors.MethodsOvid Medline, Embase, APA PsycInfo and Global Health databases were searched between 1 January 2020 and 3 August 2023 (PROSPERO CRD42022383546). We included longitudinal studies that compared mental health symptoms between pre‐ and during pandemic and/or during pandemic timepoints in children and young people (≤18 years old) with pre‐existing mental and/or neurodevelopmental conditions. Outcomes included internalising, externalising and other symptoms. Risk of bias was rated using an adapted tool. Included studies were narratively synthesised and multi‐level meta‐analyses were conducted where the number of studies was sufficient.ResultsWe identified 21 studies (N = 2,617) from 6,083 records. Studies differed across countries, diagnoses, measures, informants and timepoints. All had overall moderate‐to‐high risk of bias. Narrative synthesis found mixed evidence of symptom change, with individual studies showing increase/reduction/no change. Factors such as diagnosis, baseline symptom severity, age and sex/gender may explain variation in outcomes. Multi‐level meta‐analyses were feasible for a limited number of outcomes and found no significant changes in internalising and externalising symptoms pre‐ versus during pandemic or internalising symptoms between 2020 pandemic phases, and high heterogeneity was noted.ConclusionsThe impact of the pandemic on the mental health of children and young people with pre‐existing conditions varied according to individual and contextual vulnerabilities, which were not fully captured in pooled analyses. Further research needs to investigate longer‐term impacts and better stratify this vulnerable population.

Dhonnagáin N.M., O'Reilly A., O'Brien G., Dooley B.

ABSTRACTIntroductionResearch with integrated youth mental health services (IYMHS) has been criticised for low quality, with difficulties in recruiting and retaining participants in studies which can introduce bias. This feasibility study aimed to investigate the “real‐world research” barriers and facilitators to recruitment and retention arising in a longitudinal study with Jigsaw, the National Centre for Youth Mental Health in Ireland, and to provide recommendations for conducting IYMHS research in future.MethodsA qualitative study was conducted to investigate recruitment and retention difficulties. Participants were young people attending Jigsaw (n = 14) and members of clinical staff (n = 29), who provided feedback on facilitators and barriers to recruiting and retaining participants in a wider youth mental health intervention study. Data were collected via online surveys. Content analysis was conducted on the findings.ResultsFacilitators included the prosocial motivation of young people to support others through research, providing incentives for participants, clear communication and information sharing, and the supportive role of parents/guardians. Identified barriers included the timing of recruitment, communication difficulties, gatekeeping, and reluctance to participate in research. Suggestions provided to address barriers in future were integrating research teams into services, addressing communication difficulties, and timing the recruitment of youth participants appropriately.ConclusionWhere possible, IYMHS should conduct research in person in services to improve communication and reduce gatekeeping. In addition, services should consider remunerating participating young people in research and involve parents/guardians when designing research in this context.

McNicholas F., Adamis D., Minihan E., Dunleavy M., Martin A., Gavin B.

Newman K.L., Sayal K., Ewart C., Lang A., Bhardwaj A., Dubicka B., Marshall T., Thomson L.

Referral processes in Child and Adolescent Mental Health Services (CAMHS) have been reported as stressful and inadequate by young people and parents/carers, who struggle during waiting periods for the referral outcome decision. The Covid19 pandemic was an unprecedented time of distress for young people, parents/carers, and healthcare staff, with increased mental health challenges and stretched staff having to adapt modes of care, thus exacerbating difficulties for CAMHS. This qualitative study aimed to capture the unique lived experiences of young people, parents/carers, and CAMHS staff during the referral process in the peak of the Covid19 pandemic. As part of the STADIA trial, between 2020 and 2022, 109 semi-structured interviews across 8 NHS sites were conducted with young people (aged 16–17), parents/carers, and NHS staff including clinicians, commissioners, managers, and researchers embedded in clinical services. Interviews were analysed using thematic analysis. Three themes were elicited to express young people, staff, and parents/carer experiences of the referral process, CAMHS, and the impact of Covid19: 1) referral as a starting point; 2) changes to methods of appointment delivery and their effect on CAMHS experience; and 3) experiences and evaluation of services. Although CAMHS was seen as the pinnacle of mental health support, there was dissatisfaction with waiting times, limited communication, unclear referral processes, and limited clinical capacity and resources for young people, parent/carers, and staff. Covid19 forced CAMHS into adapting to a hybrid model of care, increasing accessibility for young people, parents/carers and staff and highlighting areas for improvement. Secure and consistent support and increases in staff resources are essential to address challenges with CAMHS delivery and improve the experiences of young people, parent/carers, and staff.

McNicholas F., Gavin B., Sellers R., Ji I., Zhang X., Browne W.V., Harold G.

Abstract Background Epidemiological samples provide opportunity to understand the development of mental health trajectories to better understand whether such epidemiological data can help to plan and modify service delivery for youth mental health. Variation between countries is not well understood and thus applying evidence from other countries to national strategies limits support service policy and planning. We therefore examine developmental patterns of youth mental health across different countries using the Growing Up in Ireland (GUI) Cohorts, with comparison to existing UK longitudinal cohort data (Millennium Cohort Study, MCS; Growing up in Scotland, GUS). Methods Youth mental health problems within each cohort across development (5–17/18 years) were assessed using parent reported Strengths and Difficulties Questionnaire (SDQ) scores. Using latent growth curve analyses, we examined trajectories of emotional, conduct, and hyperactivity problems for boys and girls, separately for each cohort. Results Across cohorts, we observed similar developmental patterns for emotional, conduct, and hyperactivity problems. However, the GUI emotional problems in Ireland emerged earlier than in the UK. By adolescence, GUI emotional scores were similar to the UK, suggesting that the differences in emotional problems between the ROI and UK had narrowed by adolescence. Covariates also had different associations with youth mental health trajectories across cohorts. Conclusions Utilizing multiple nationally representative cohort longitudinal datasets can help inform clinically meaningful conclusions and potential recommendations on population level multi-tiered service needs and development in the area of child and adolescent mental health support and future provision.

O’Connor M., Griffin C., Corrigan J., Somers C., Delaney M., Larkin F.

This retrospective chart review aimed to identify the intersection between young people with Autism Spectrum Disorder (ASD)’s needs and CAMHS inpatient service needs. A retrospective chart review was conducted on all referrals to a CAMHS inpatient unit over three years ( n = 352). Referrals which specified a formal diagnosis or suspected diagnosis of ASD were identified ( n = 111), and basic demographic data were collected. Young people with either a formal or suspected diagnosis of ASD referred to the unit presented with a wide range of co-occurring conditions. Of these young people, 30 were admitted to the unit and only 6 of them were engaged with an ASD specialist service. Young people with diagnosed or suspected ASD were more likely to be admitted if they presented with suicidality. Males with diagnosed or suspected ASD were more likely to have a diagnosis of OCD while females with diagnosed or suspected ASD were more likely to present with eating and feeding disorders and personality development difficulties. Findings highlight the lack of a clear care pathway for young people with co-occurring autism or suspected autism and complex mental health problems.

Reilly E.O., Doherty A., Cullen W.

Abstract Objectives: The aim of this study is to assess General Practitioner (GP) trainees’ training experience, and confidence in assessing and managing children and adolescents with common mental health conditions in primary care in Ireland. Methods: An online anonymous questionnaire was distributed to third and fourth year GP registrars enrolled in the Irish College of General Practitioners training schemes. The online questionnaire evaluated participants’ training experiences and confidence levels in key areas of child and adolescent mental health in primary care. Results: Sixty participants completed the survey out of 406, yielding a response rate of 14.8%. The majority (88%) reported no formal training or experience working in Child and Adolescent Mental Healthcare Services (CAMHS) during their GP training scheme. Responses indicated that many participants rated their competency, skills, and knowledge in essential areas of Child and Adolescent Mental Health as needing improvement. Similarly, their awareness of referral pathways and specialty services was below expectations, with poor perceived access to services. A large proportion (91.7%) expressed a definite need for further training in child and adolescent mental health disorders. Conclusion: The results highlight the need for enhanced training and support for GP trainees in the field of Child and Adolescent Mental Health, ensuring their ability to effectively and confidently address these common issues in primary care.

Wadoo O., Khan Y.S., Khan F., Latoo J., Chandra P., Iqbal Y., Amro R., Reagu S., Alabdulla M.

FitzPatrick P., George A., Lynch F., McNicholas F.

Abstract Objectives: To compare the characteristics of GP referrals to CAMHS prior to and over the entire pandemic. Methods: All accepted referrals to a Dublin-based CAMHS between January 1, 2019, and June 30, 2023, were examined. Referral letters were anonymised in batches, and information was extracted directly onto a designated proforma. Results: Before the pandemic (January 2019–February 2020), an average of 17.8 referrals were accepted per month, while during and after the pandemic (March 2020–June 2023), this rose to 18.7 accepted referrals per month. Increases were observed in the clinic’s prioritisation of cases during the pandemic period (54.8% v. 41%, p < .001). Referrals post COVID-19 were older (13.1–13.64 years, p = .010) with a higher proportion of females (50.2% v. 62.1%, p < .001). Internalising disorders increased during the pandemic (68.7% v. 78.7%, p = .001), with self-harm referrals also being notably more frequent (18.5% v. 36.3%, p < .001). Referrals for anxiety (43.0% v. 78.2%, p = .004) and eating disorders (0% v.. 6.2%, p < .001) increased significantly. Referrals for psychosis (8.4% v. 4.8%, p = .032) and autism spectrum disorder (ASD) (26.5% v. 18.7%, p = .008) decreased after the onset of the pandemic. Conclusions: Notable increases in referrals for anxiety, depression, self-harm, and eating disorders underscore the impact of the pandemic on youth mental health. Understanding these shifts is crucial for CAMHS to adapt resources and interventions effectively. Clinicians must remain vigilant in assessing and addressing the evolving mental health needs of youths in the post-COVID era, ensuring timely and appropriate interventions, and resources to mitigate long-term consequences.

O'Dea B., Subotic-Kerry M., Borchard T., Parker B., Vilus B., Iorfino F., Whitton A.E., Harris-Roxas B., Wade T.D., de Valle M.K., Glozier N., Nicholas J., Torok M., Braund T.A., Batterham P.J.

ABSTRACTBackgroundGeneral Practitioners (GPs) play a key role in the treatment of adolescent depression and anxiety, but their capacity to provide effective care may be compromised by long wait times.AimTo examine the treatments and recommendations of GPs for adolescent patients with depression and/or anxiety in Australia, their referral practices to specialist care and estimated wait times for these, and the perceived impact of long wait times on GPs, their patients and their treatment.Design, Setting and MethodsAn online survey of 192 GPs in Australia who treated adolescents (12 to 17 years old) with depression and/or anxiety.ResultsGPs frequently referred adolescents with depression and/or anxiety to psychologists. The estimated wait time for psychologists (M: 57 days, SD: 47.9) was four times the proposed acceptable wait time (M: 16.7 days, SD: 27.0). The frequency of medication prescribing almost doubled during the wait time when compared to routine practice (14.6% versus 8.3%, respectively). Almost all GPs (81.8%) increased their level of care due to long wait times but had limited training in youth mental health and knowledge on appropriate strategies to do so effectively.ConclusionThe findings signify the discrepancies between the preferences of GPs for treatment availability in Australia and what they see as the experience for many adolescents with depression and/or anxiety who are referred to specialist care. Greater training, improved communication between referrer and referred services, and digital interventions may help GPs to reduce the negative impacts of long wait times on their adolescent patients.

Sun B., Adamis D., McNicholas F.

Background Rates of acute mental health presentations in youth were increasing pre-pandemic internationally. Longitudinal studies following COVID-19 attest to ongoing deterioration in youth mental health, recognising adverse unintended consequences following public health restrictions. Aims To examine whether the initial post-COVID-19 increase in mental health presentations persisted following the reclassification of COVID-19 to endemic status, accompanied by the removal of most restrictions. Method All referrals to paediatric liaison psychiatry (PLP) between January 2018 and December 2022 in a Dublin tertiary children's hospital were included in the study. An interrupted time series analysis with autoregressive integrated moving average models was conducted, examining referrals with respect to different phases of COVID-19 and application of public health restrictions. Results Some 1385 referrals to PLP were received over the 5-year study. There was a significant decrease in PLP referrals immediately post-COVID-19, followed by a significant and sustained increase as the pandemic progressed and moved to endemic status. Public health restriction phases had a unique effect on those presenting with suicidal ideation, with a significant increase in the number of referrals. There was no effect of restrictions on other clinical profiles. Conclusions Increased referrals for youth with mental health difficulties, reported during the COVID-19 pandemic, persisted into the early endemic stage, after COVID-19 public health restrictions ceased. Specific impacts of restrictions on suicidal ideation referrals require further study. Investment in child and adolescent mental health services remains a priority, and future pandemic response strategies need to examine unintended consequences of any enforced public health measure.

Amro A., Kotkot H.A., Albobali Y., Chandra P., Khan Y.S.

Abstract Background This paper discusses the critical importance of epidemic preparedness and innovations in digital health care by examining the transformative impact on speech-language pathology (SLP) services in a specialist outpatient child and adolescent service (CAMHS). Method This retrospective review analyzes referral data from three periods: pre-pandemic (15 March 2019–14 March 2020), pandemic (15 March 2020–14 March 2021), and post-pandemic (15 March 2021–14 March 2022). Statistical analyses assess trends in referrals and diagnoses during these periods. Feedback was also obtained from Parents of children who received virtual consultations during the pandemic. Results The results reveal an increase in the demand for SLP services during and after the pandemic, with a surge in referrals (increased from 9.7 to 12.9% when compared pre-pandemic to post-pandemic periods; Chi-Square value 3.33, P = 0.068) for children with social communication challenges and autism spectrum disorder. Phone and video consultations were effectively adopted. Feedback from families shows a positive response (69%–98% of participants responded as strongly agreed and agreed on various items listed in feedback form specifically designed in line with the service objectives) to telehealth interventions, with many parents finding virtual consultations effective and helpful. Conclusions The study emphasizes the importance of telehealth SLP services in meeting the increasing demand for mental health interventions among children and adolescents. It suggests integrating telehealth into clinical practice beyond the pandemic and highlights the need for long-term evaluation and addressing potential barriers to access.

Hafid S., Freeman K., Aubrey-Bassler K., Queenan J., Drummond N., Lawson J., Vanstone M., Nicholson K., Lussier M., Mangin D., Howard M.

ObjectiveThe objective was to analyse how the pandemic affected primary care access and comprehensiveness in chronic disease management by comparing primary care patterns before and during the early COVID-19 pandemic.DesignWe conducted a quasi-experimental pre–post design cohort study and reported indicators for the 21 months before and after the onset of the COVID-19 pandemic.SettingWe used electronic medical record data from primary care clinics enrolled in the Canadian Primary Care Sentinel Surveillance Network from 1 January 2018 to 31 December 2021.PopulationThe study population included patients (n=919 928) aged 18 years or older with at least one primary care contact from 12 March 2018 to 12 March 2020, in Canada.Outcome measuresThe study indicators included three indicators measuring access to primary care (encounters, blood pressure measurements and lab tests) and three for comprehensiveness (diagnoses, non-COVID-19 vaccines administered and referrals).Results67.3% of the cohort was aged ≥40 years, 56.4% were female and 53.5% were from Ontario, Canada. Fewer patients received an encounter during the pandemic (91.5% to 81.5%), while the median (IQR) number of encounters remained the same (5 (2–1)) for those with access. Fewer patients received a blood pressure measurement (47.9% to 31.8%), and patients received fewer measurements during the pandemic (2 (1–4) to 1 (0–2)).ConclusionsEncounters with primary care remained consistent during the pandemic, but in-person care, such as lab tests and blood pressure measurements, decreased. In-person care indicators followed temporally to national COVID-19 case counts during the pandemic.