Sign in. It’s quick, free and it’s up to you.
An account is an optional way to support the work we do. Find out more.
IN 1966 A first-time Minister with no cabinet approval announced the introduction of free education in Ireland. Donogh O’Malley’s brave move changed Ireland’s destiny by providing opportunities for children who would never have had the means to complete school. In turn, he provided Ireland with the opportunity to reach its potential as a global player economically with a highly skilled labour force.
Brave thinking of this kind is needed again to address what is an absolutely failed Child and Adolescent Mental Health Service. In much the same way that Donogh O’Malley’s bold move benefited both children and Ireland as a nation, real leadership now can create a new mental health service that will not only save children’s lives but also help them to contribute to the country as a healthy adult.
This week the Mental Health Commission Independent Review told us that they cannot provide an assurance to all parents in Ireland that their children have access to a safe, effective and evidence-based mental health service. If these children are not safe, then they are at risk.
Adjustments or adaptations will not cut it when it comes to the problems that currently exist with our Child and Adolescent Mental Health Services (CAMHS). The Mental Health Commission Independent Review has recommended the immediate regulation of CAMHS and the creation of a comprehensive strategy, and even these strong recommendations may not be enough.
What is needed is a totally new vision and a new approach.
A radical and brave mental health service for children will widen the professional leadership. The current model of care places the onus on the consultant psychiatrist and all clinical responsibility rests with them. In international practice, this is considered an outdated model and most countries have moved toward a more multi-disciplinary leadership approach. It is also unsustainable with the current limited medical workforce.
A radical and brave mental health service for children will investigate and address professional misconduct when doctors who prescribe the wrong drugs for children, or who put a child on repeat medication and do not follow up to review, are falling below acceptable standards. They should be referred to the Medical Council and other professionals who fall below acceptable professional standards should also be held to account. That is how we can begin to rebuild trust with the children, parents and carers who rely on this service.
A radical and brave mental health service for children will fully commit to governance and oversight. The Mental Health Commission report details governance and oversight failures at the highest level of the HSE. It outlines cases where children were at risk of harm, where one CAMHS area accepted only 38% of referrals, where 140 children were ‘lost to follow up’ and where none of this was uncovered by the HSE itself.
A radical and brave mental health service for children will ensure that all children in all areas receive the same service. It will ensure all staff are doing the same thing when faced with the same situations or problems. It will follow the same referral criteria and guarantee the same quality of care.
That is not the case at present as there are 73 teams with different leaders and different ways of carrying out their business.
A radical and brave mental health service for children will widen the therapeutic framework to include their family and environment. Many CAMHS teams have carried out outreach work in schools and homes to better provide for the child in their care. This work should be developed and expanded. When a CAMHS team recognises the context of a child’s life and engages with their environment (parents, siblings, friends) then they are more likely to improve the outcome for that child.
As a psychologist, I am fully aware of the range of difficulties children suffer with their mental health and I know that early intervention is the best way to ensure a healthy adult. Having worked with many children and families directly affected by sexual abuse, I have seen the powerful impact of a consistent, safe and well-trained service to those children, both in specialised services and in Primary Care.
However, successive governments have failed to build up the Primary Care element of services for children with mental health difficulties. There is evidence of silos existing in the provision of children’s mental health services with too many barriers blocking the operation of a holistic service based on the need of the specific child. The report specifically highlights the needs of vulnerable children such as Travellers, LGBTI+, Intellectual Disability and Refugees.
Children deserve a child-centred, evidence-based, safe and consistent CAMHS service. This report says there has been a breach of children’s right to the highest attainable standard of mental health. Long waiting lists, lack of appropriate therapeutic interventions, “lost” cases and difficulties in primary care and disability services are all evidence of this breach. Little to no progress has been made in remedying this.
In 2022 only 5.2% of the overall health budget of €20bn was spent on Mental Health (both adults and children). This is significantly below the 10% previously recommended by Slaintecare, and the World Health Organisation (WHO) recommended 12%. It is also a decrease from 2021 when 5.6% of the overall health budget had been allocated to mental health. However, the real issue is that the HSE does not know how much they actually spend on children’s mental health in Ireland. The only figure we have certainty on is that, in 2022, they spent €137m on CAMHS, which is significantly less than 1% of the overall health budget.
We have reached the end of the line with the current CAMHS service. Small changes will not generate the improvements that are needed. A radical and brave reimagining of our mental health services for children is what is needed. I would urge Health Minister Stephen Donnelly to look to Donogh O’Malley and commit to that brave step. This is what our children deserve.
Dr Niall Muldoon is Ireland’s Ombudsman for Children.
330+ million citizens and these are the best 2 America could come up with. ?.
@Raymond Dennehy: came straight to the comments for this. Like is there literally no one else who could join in debates so they could see what they’re missing out on. And knky have 2 parties is wild.
@Raymond Dennehy: I’m American and I agree 100% with this. I thought they were both terrible choices then and even worse now. I know how I’m voting in November but there are so many better candidates on both sides.
@Ray Dunne: Sounds like an English football Commentary getting the excuses ready before the match. Do ye think that ye might riot in the Donbas this time instead of D.C. All of Russia will flee to Siberia.
@Raymond Dennehy: America is full of lunatics. Always has been and always will be.
@Ray Dunne: grow the fk up, ye absolute child.
I love these nursing home debates.
@reg morrisey: No doubt both will be pumped up on top tier ‘Mr. Burns’ drugs.
Morto to be a Yank but comedy gold for the world
@Derek O Gorman: It’s better than the Superbowl lol.
@Louis Jacob: anything is better than that gick
@Derek O Gorman:I live in NY. Originally from Ireland. I used to think that way too.. Until 2020, I realized he was right the whole time. It was then I woke up.
@Seamus Balfe: Did you tho? Maybe it’s another ‘dream’ of being awake, like the one you were in before.
@Derek O Gorman: now our lot ISN’T great by Far least Trump gives a dam about America as our skum sold us out to Europe ffs
Will Biden fall over do you think?
@David O Brien: unlikely as he will not be cycling onto the stage
@David O Brien: more likely someone will need to hold Trumps hand if case there is any stairs to contend with
@David O Brien: He’s a president, not an athlete.
@Dave Harris: no, no. Lets be clear, this is not about ‘policy’ OR political difference, it’s soley about Trumps ego and how entertaining he can be on a stage, there is much more in common here with a sporting occasions or reality TV than say ‘trying to make society better’ or some such rubbi$h
@David O Brien: A lot of immigrants to the US will be hoping Trump has a major cardiological episode, particularly a lady from Slovenia.
@David O Brien:
With the wedges in Trump’s shoes it’s more likely we will see the leaning tower topple over.
@Stephen Brennan: Try harder
@David O Brien: It will be cardboard cut outs with superimposed mouth sync.
@Colm O’ Shea: or women near,,,
Will Biden manage to not poop his pants or trip over the scenery, these are the big questions?
@Jonn: in fairness there is only 4 years between both of them, it’s not as either of them are spring chickens!
@Colm O’ Shea:
That’s true,and it’s a sad reflection of America and it’s broken electoral system that these two are the choices,but nevertheless Biden is clearly a wreck, way past his sell by date,at least Trump can string a coherent sentence together without the aid of a teleprompter!
@Jonn: trump appears to have severe mental health issues. His fondling and assaults on women, fraud. The list goes on. Oh and I forgot to mention a wannabe dictator
@Jonn: Trump can string a coherent sentence together, i must be listening to a different person.
@johnabc:
Maybe try listening to Biden,on one of his increasingly rare public outings..he makes Trump sound like Martin Luther King at the top of his game!
@brian madden:
I’d have thought the term ‘dictator’ would apply more to the politician weaponising a hugely corrupt legal system, using dubious lawfare to hobble your opponent and keep them tied up in court rather than out campaigning? When are we going to see Biden in court for his families corrupt and very lucrative Ukrainian shenanigans?
@Jonn: trump is the one who’s proven to wear nappies to be fair.
@Jonn:
Which sentence was that ?
The world must have missed it.
@Mary.E.:
No, Mary,you just missed it,maybe if you widen your news sources beyond RTE,BBC and CNN you might have more luck.You could start by looking into how Hunter Biden,a man whose main area of expertise is hoovering exotic powders up his nose came to be a director of Burisma,a Ukrainian gas exploration company?
@Jonn:
Joe Biden is the President,not his son and has not been involved.
Trump has given millions upon millions of dollars to all of his family for jobs that dont exist.
His son in law colluded with Putin.
They are all as bad as the old man.
@Jonn: Well Trump is the one that wears nappies
@Jonn: Nah Jill got him pampers
@Jonn: What Trump Policies will you be voting for, assuming you are not a billionaire
@Jonn: Do you think God will forgive Trump for all the Commandments he has broken and will Joe pardon him in 2025. Closer to home, maybe SF should stop calling themselves Republicans.
@Jonn: I’d say. Trump is hoovering a lot more up his big Trumpet Hunter is not running for president so what does that matter. You don’t think Trumps oinky kids are angels do you.
The similarities between Trump and Hitler are striking, their gaining of and holding onto power at any rate.
@Bert Carolan: Except Hitler was 56 when he died.
@Thesaltyurchin: Strange similarity considering Trump never went to war unlike any other America president I can remember!
@Mr G Pickett: the point that Trump never went into war was not because he’s some great lover of peace. It was just a case of timing.
If there was a war that would either stroke his vinal ego or financially enrich himself or family
Politics is so polarised by the media and the candidates themselves. Reasoning is the the other side is gone and now 1/3 of Americans agree that violence is a solution to getting your political gains . Washington DC is modelled on Rome . It looks like the fall of the republic
Americans spend less on food as a percentage of consumer purchases than anyone else on Earth; they pay less for petrol than everyone but Indonesians, Russians, Chinese and Saudis for their gigantic, fuel-guzzling vehicles; inflation in the US peaked at 9% in 2022, while inflation in the euro area peaked at 10.6%; and violent crime in the US plummeted in the first months of 2024 – although Trump’s 34 felony convictions have surely sent the crime rate of ex-presidents to all-time highs. But as most of us know, trying to change someone’s perception with facts is a relatively pointless endeavour. What’s more worth talking about is that so many of the far right’s supporters claim to be “patriots”, while in reality hating almost everything about what their countries really are.
@Jack Hayes:
Is this the ‘you’ve never had it so good’ argument? Have you been inhaling petrol fumes,Jack? Maybe you should check out some of the jaw dropping evidence of US inner cities looking like something out of a zombie apocalypse scenario, with dead eyed lost souls shuffling past boarded up shops and restaurants. The country that spends billions financing proxy wars and genocides around the world is becoming a decrepit 3rd world dump on its own streets!
@Jonn: Trump is not going to fix it with his looper policies on stopping income taxes and bringing in100% tariffs on imported goods. Trump is so hard of thinking he cannot understand that tariffs are paid by American consumers. He thinks the other countries exporting to America pay them
@Jack Hayes: maybe you should come to America and have a look for yourself..
I think it’s funny how people from other countries use the term far right when describing somewhat conservative people. Yet the far left extremists have been shoving pronouns and trans down your throat all over the EU.. And then you celebrate it.. Lol. But France, UK, Argentina, Canada and the US are all starting to wake up. Maybe it’s time for you too?
@Jonn: *gasoline fumes.
@Seamus Balfe: No-one is shoving anything down your conservative throat. You people just spread hate, bile, and lies constantly. You take offence to the existence of people different to you from your skin colour to sexuality or gender. Your politics has nothing to offer the world but hate and bigotry. Right wingers have to use hate to spread their vile message yet have zero proposals to the everyday issues affecting their countries. Its always blame the immigrants, or minorities, or them over there.
Trump will make a fool of senile joe
@John D Doe: Wait….Trump is running against Biden?!!! I thought it was Obama. Trump thinks it is Obama in any case.
@John D Doe: that’s all he stands for. Belittling those he thinks are less worth than him .Trump just likes the sound of his own slur . He has no manners it’s all about him
@John D Doe: Certainly he will aim to bring it down to his level.
@John D Doe: Yes, razor sharp Don who couldn’t recognize a photo of his own wife.
The Don is 4-5 at best, though powers have him @ 8-13, the vegetable is out to almost 2-1 on betfair.
These debates are absolute bolox. Republicans will say Trump won. Dems will say Biden won, and everyome will vote the same way they intended to beforehand. They achieve nothing.
Mullingar court today, yet another woman damaged physically by a “man”, yet another suspended sentence. The wigs are SO totally removed from normal, everyday life. On and on it goes. Sad. They haven’t learned anything from the adventures of that great theorist, odonnell of Limerick.
Both too old for the job. Maybe the US should adopt the Roman Catholic Churches way of doing things!!! You can’t be elected unless you are under 70 years of age. What both parties need is new blood, preferably under 50 years of age. They should also have to pass physical and mental health screening.
The insane verse the inferm, trying to impress the ill-educated and illiterate. Let’s get ready to rumble!!!
@Louis Jacob: *verses *infirm. I know I know. Morto for me.
@Louis Jacob: *Versus. It’s early. Relax.
@honey badger: Lol. Just waiting for a machine to heat up here. “I’ll just go on the journal to kill some time” Always the wrong move in the morning.
I understand that Americans want to see how both men are able to perform in a debate, but there isn’t going to be much real substance discussed. Would have been better just to let both candidates lay out their cases during their speeches at their party’s national conventions. Biden looks frailer each year. Trump is increasingly making obvious mistakes and has clearly physically aged in the last two years, while showed marked mental decline (pick a public appearance by him at random for proof of this).
@Numinous20111:
Could Trump decline any more mentally than he has always been ?.
@Mary.E.:
Could your command of grammar decline anymore?
I know Biden is too old for the job but not Trump blow my own Trumpet. Big mouth sooner he’s charged the better
Stop the world and let me off , it keeps spinning around and around !!
@Quinny: Just treat it as entertainment and it becomes kind of fun.
How much Adderol and Ritalin can Sleepy Joe handle?
It’s a rigged game. Your leaders are selected not elected. You are not free, you were never free and you will never be free.
The illusion of choice is a powerful one. Too many bad actors in play and not enough of the good guys.
Rumour has it tha Biden will be duper glued to the podium to stop him wandering off to sniff children.
@Paul: Ha ha. That is actually funny.
It would make for great viewing if it degenerated into a wrestling match similar to the one between President Ronald Reagan and Konstantin Chernenko, then Secretary of the Communist Party of the Soviet Union, in the 80s Frankie Goes To Hollywood video for “Two Tribes”…
@William Tallon: That was brilliant, they don’t make videos like that anymore.
Isn’t it great to see that two people from the asylum got jobs, two of Americans great imports
America is doomed.
It’s finished as a superpower.
Hard to believe it has come to this.
Poor Joe.
Standing up for two hours at his age is not easy.
Dark Brandon will make mincemeat of Trump!
@Mick Hanna:
That’s a lotta mince.
Great. I’ll be able to skip the sleeping tablets tonight, I’ll just tune in to the snore fest.
It’s going to be a stormy affair this one
The fiddler vs the diddler
What we know ahead of tonight’s debate is that neither of these guys be it due to age infirmity or just being a danger to society neither should have the chance to lead anything. Those days are long past them.
A choice between Animal and Vegetable!
Ah what can you do when two presidents need to be on oxygen to win. Ah well it happens
The clever students will sort it out.
bye bye sleepy joe
Why can’t they find a younger man or woman? The two of them would want to retire.
rather watch paint dry…
A Giant Douche Vs A Turd Sandwich.
Still though, Go Biden!
@David Guiney: Love that South Park episode so much
This will be history tonight like you have ever seen or unlikely or never see again crazy U.S.A.
have your say