Parent's frustration as boy lingers for over a year without mental health assessment 

A PARENT HAS spoken of “trying to dig deep” for her son to get him seen by mental health services over the past year, as a report lays bare the inconsistent data around referrals for young people.

“He needs a mental health assessment. He is hurting himself, we’ve given them photos of the injuries and they still wouldn’t see him,” Fiona Cosgrave told The Journal.

“How they justify it is that they say they separate behaviours from emotional upset. We lost some of our close family in the pandemic so they’re saying that that’s to blame and his self-harming is from trauma.

“But surely that should be all the more reason to accept him for a mental health assessment.”

A damning report by the Mental Health Commission has noted how acceptance rates range depending on the regional Community Healthcare Organisation (CHO) where a family is situated.

In one region it was over 80% but in another, only 30% of children were accepted for treatment.

‘High level’ of GP referrals declined

The Irish College of General Practitioners has also expressed “deep frustration” at what it called a high level of their referrals to CAMHS (Child and Adolescent Mental Health Services) getting declined by the service.

The findings made up part of an interim report authored by the Inspector of Mental Health Services, Dr Susan Finnerty, which was published by the Mental Health Commission (MHC) yesterday.

“The re-referral rates for CAMHS are high with some children and young people being referred two or three times for the same difficulties,” Dr Finnerty said in the report.

Fiona told The Journal that it has been “sheer frustration” trying to get her 11-year-old son Isaac admitted into CAMHS for the past 18 months.

The family live in Donabate in Dublin and fall under the Dublin North CHO, which is one of the regional bodies which will be audited for Dr Finnerty’s final report later this year.

‘Loving, happy little boy’

Isaac has been diagnosed with moderate autism and moderate to severe intellectual disability, but following consultations with medical practitioners, it was recommended that the family try for a psychiatric assessment and treatment through CAMHS.

“He is such a loving, happy little boy but when things are bad, things are quite bad, and that’s why we’re at this point,” Fiona said.

She said she learned that while there is CAMHS, there is also the CAMHS-ID team for people with an intellectual disability.

But these teams, officially launched last September, remain “some way short” of their necessity staffing level according to Dr Finnerty.

Staff capacity some way off

Her report recorded that “staff capacity is now 23% of recommended levels” – making them almost 140 personnel short.

There were also “very few” CAMHS-ID teams across the CHOs, with two having “no access to CAMHS-ID services”.

“There should be 16 teams across the country, but nationally there are only 4 teams,” the MHC report said.

At present, CAMHS engage with a public health Children’s Disability Network Team (CDNT) which has been working with Isaac.

“The CDNT team has even sent voice-notes of me to CAMHS to outline the work we’ve done and the options we’ve exhausted,” Fiona said.

She has appealed the decision to refuse Isaac in cooperation with the team.

‘Wide variation’

Without being able to get her son accepted into CAMHS, Fiona said her other option is pay privately for a psychiatric assessment but the cheapest option costs about €2,000. 

“I love my child and you’re having to just dig deep to try and get access to somewhere, just so your children have the best of services,” she said.

The “wide variation” in acceptance rates for young people into CAMHS featured in the MHC report.

“Some teams see children with uncomplicated autism despite the fact that autism without concurrent mental illness is an exclusion criterium for CAMHS,” Dr Finnerty said.

Other teams are slow to discharge children due to the lack of alternative services or appropriate adult services available.

“Many teams wrestled with the ethical dilemma of turning away children and young people who did not meet the criteria for CAMHS but for whom there was no timely alternative provision of services.”

She noted that any decisions would impact on already lengthy waiting lists.

The inspector decided to produce yesterday’s interim report due to “the serious concerns and consequent risks for some patients” that were found across four out of the five Community Healthcare Organisations (CHOs) that have been examined so far.

‘Last resort’

People need to remember these are “extremely vulnerable children and vulnerable families”, outlined Keith Rolls, a solicitor who has represented over 150 families following failings at the HSE-run CAMHS in South Kerry.

“Nobody wants to attend CAMHS. It is the last resort for all of these families,” he told The Journal.

But you’re seeing families who are being dragged from pillar to post such that there’s no consistency there.

The Irish College of GPs welcomed the MHC report, saying that it hoped it would be the “catalyst to seismic change” in mental health services for children and adolescents.

Doctors 

GPs expressed “deep frustration” at the high level of CAMHS referrals declined, and
the lengthy waiting lists for essential mental health services for children.

ICGP’s clinical lead for mental health, Dr Aoife O’Sullivan, said GPs experience these deficiencies on a daily basis.

“GPs see children and adolescents with anxiety, ADHD, depression, emotional problems, self-harm and eating disorders. There are huge numbers of children waiting for their first appointment with CAMHS.

“Care needs to be child- centred with an emphasis on working together for the benefit of the child and family.”

In its response to the MHC report, the HSE said it is carrying out a review of children who have not been receiving important follow-up care in the State’s mental health services.

It said it also accepts the findings of the interim report and that it has sought to bolster its personnel with the recruitment of a national clinical lead for CAMHS which it said “will help drive the changes that are clearly needed”.

Responding to the MHC report, the Psychological Society of Ireland (PSI) said it is clear that the current access, governance, and risk management structures are “wholly unacceptable”.

It welcomed the interim report’s “emphasis on the unacceptability of the variance in wait times to access and, furthermore, within CAMHS teams” across the country. 

“The PSI has long advocated for a shared governance structure and distributed clinical responsibility model of mental health service that is more consistent with client centred, recovery-oriented models of practice.

“The PSI concurs with the interim report position that the current model of care, which holds the perception that all clinical responsibility rests with a single profession namely the Consultant Psychiatrist, is ‘outdated’, ‘unsustainable’ and out of line with any international best practice.”