The Bermuda Hospitals Board (BHB) intends to move the home of Child and Adolescent Services (CAS) to the site formerly known as St. Brendan's, as burgeoning demand for such therapy means CAS has outgrown its present home in Montrose Cottage, on Berry Hill Road in Paget, beside KEMH.

The understands there is strong opposition from staff at all levels to a move which would see children treated in an adult psychiatric environment, but they have been informed that the plan will be going ahead over the next 12 months, despite their written objections.

A position paper, compiled by the staff and obtained by this newspaper, concludes that there is "an inherent danger in mixing children with seriously and persistently mentally ill adults" and brands the move to MWI "a serious retrograde step". The paper has been submitted to the BHB.

Senator Gina Spence-Farmer, the Opposition spokesman on youth, has expressed horror at the plan, saying that children's safety will be jeopardised and they will be hurt by the stigma attached to receiving therapy at a mental institution.

Health Minister Patrice Minors yesterday referred all questions on the matter to the BHB, the hospitals' governing body, which made the decision.

Patrice Dill, executive director of MWI, said yesterday: "Child and Adolescent Services is scheduled to undergo an upgrade in order to expand the scope of services they offer.

"It is anticipated that this initiative will be completed within a year. Decisions regarding the expansion of services provided by CAS are made by Bermuda Hospitals Board and are based on the best interests of our clients."

Sen. Spence-Farmer has started a campaign to encourage residents to express their opposition and intends to hand out a paper emblazoned with the words "Bermuda's Children Need Your Voice". It asks: "Should children's mental health treatment be provided here?" over a picture of the MWI building.

CAS was set up in 1986 and was originally based at St. Brendan's Hospital, until 1991, when it was moved to Montrose Cottage. It provides psychiatric and psychological care for youngsters between the ages of four and 19. Treatment entails family and group therapy, as well as counselling. In-patient care is provided in some cases.

"The children will be treated just a few steps away from sexual offenders, drug abusers and seriously mentally unwell people," Sen. Spence-Farmer said. "There is a serious safety issue here.

"You can't lock up children in a room in a mental institution. That is not going to help them. Our children need to be protected.

"There are men and women in there coming out of really heavy situations and who have serious mental problems. How can you even think of putting children anywhere in the same building?"

She said it was ethically and morally wrong to bring troubled children onto a premises where adult psychiatric treatment was taking place. Referrals of children who might benefit from CAS treatment would decrease if they were to be treated in an unsuitable environment, the Senator added.

Staff had objected, but their terms of employment prohibited them from speaking out publicly, Sen. Spence-Farmer said. She added that workers' complaints had been filed with Ombudsman Arlene Brock and through the Bermuda Public Services Union (BPSU).

"I do a lot of grass-roots work and I know a lot of families whose children have benefited greatly from going to CAS," Sen. Spence-Farmer said. "I know a great many people who appreciate and value what they are getting out of it.

"That's why it's such a shame that they want to move something that is working and having a positive impact on our community, moving it to an environment that is not conducive to children's therapy and will bring more stress to them.

"What this is about is protecting our children. I will fight this until they get tired of me."

CAS has a team of nine staff, all trained specifically to work with young people. The professionals' objections spelled out in the paper sent to the BHB include reference to the UN Convention on the Rights of the Child and the Children's Act of 1998.

The Act aims to "protect children from harm, to promote the integrity of the family and to ensure the welfare of children". And it states that the welfare of the child should be paramount, especially when "the child is by reason of his environment or associations exposed to moral danger".

The paper states that "providing child and adolescent psychiatric services in an environment that also provides adult psychiatric and substance abuse services represents a substantial risk to the physical, mental and emotional wellbeing of the clients served by CAS".

And it makes the staff's feelings very clear: "Although funding has recently been made available for in-patient and day hospital services on the St. Brendan's site (in the old Watson ward), the staff at CAS are of the firm belief that this would not be conducive to the emotional, physical and social wellbeing of this client population.

"The key argument of this paper is one that has been established in other jurisdictions since the early 1980s, which holds that children and adolescents are best serviced in a community environment, even when hospitalisation is required.

"It is never in the best interest of this population to have the dual problem of dealing with psychosocial and emotional problems coupled with the stigma that is likely to arise as a result of being treated in a predominantly adult environment.

"The longevity of emotional issues such as shame is likely to have dire consequences to their future recovery, as well as their position in the community, long after the problem which initiated treatment has been resolved."

Taking CAS back to MWI could affect the status of the service, as it would not then comply with best practice standards, as laid out in Britain's Patients' Charter For Children and Young People, which states that children and adolescents are best served in a community setting.

"Currently, CAS enjoys full accreditation status with the chief criteria being safety, accessibility, patients' rights and best practice standards," the paper continues. "It is the intent of CAS staff to continually meet accreditation standards and continually improve the client's quality of life and service provision through service enhancement.

"A return to St. Brendan's Hospital could well be deemed a serious retrograde step and an impediment to the accreditation process."

Sen. Spence-Farmer's fear that parents would be reluctant to refer their children for CAS treatment in MWI is shared by the professionals.

"Most parents already struggle with accepting the fact their children require specialised services," the paper states. "Locating the services within an adult psychiatric environment will not only exacerbate this concern, but is highly likely to become a deterrent to accessing services."

Many children now go to CAS by bus. That would be more difficult after the move to MWI, say staff, as buses run directly to the Devonshire hospital only once in the morning and once in the afternoon. At other times, children would have to disembark at the Collector's Hill / South Road junction or at the Bermuda Squash Racquets Association on Middle Road and walk the rest of the way.

The conclusion expresses the view that "with respect to accessibility and patients' rights, the move will have a detrimental impact on the child's or adolescent's self-esteem and on the parents' sense that their child will be safe. With respect to best practices, children require an environment that is designed to meet both their psychiatric needs as well as their needs as children."

The paper's recommendations include expanding CAS at its current site, utilising the upper and lower levels of Montrose Cottage. Alternatively, it suggests that CAS could expand into another location on the KEMH site and that Gosling ward could be restructured into a paediatric / psychiatric ward for youngsters.

Shadow Health Minister Louise Jackson described the proposed CAS move to MWI as "criminal" as it would result in troubled "children being locked up in an institution meant for adult mentally ill clients".

"This is another instance where Minister Minors is not listening to people and not meeting with people," Mrs. Jackson said. "Communication is by way of a few letters going through her Permanent Secretary.

"These children will perhaps be in a state of distress because of parents divorcing or perhaps because of the transition from a small country elementary school to a large secondary school.

"For them to be locked away in an institution is definitely not the humane or sensible thing to do. I am hoping that common sense will kick in here and that this decision will be changed."