MANY YOUNG PEOPLE appear to have been given “inadequate or inappropriate supports” by Child and Adolescent Mental Health Services (CAMHS) “simply on the basis of being autistic”, according to a new report.

Autistic children are often excluded from CAMHS and instead referred back to their local disability team – despite the fact they may have ill mental health.

As previously reported by The Journal, many young people who are autistic and also experience conditions such as psychosis are referred from one health team to another, delaying vital treatment. 

The Oireachtas Children’s Committee has been examining the treatment of young people with a dual diagnosis and today published its long-awaited report.

‘Dual diagnosis’ is the term used when a person has a mental health difficulty alongside an intellectual disability, autism or both.

The term is also sometimes used in the health service in relation to patients who experience both a substance misuse issue and a mental health difficulty such as depression, anxiety or psychosis.

The committee’s report details the fact that many autistic children struggle to get access to CAMHS, despite the fact they also have a mental health issue.

One parent from the group Families for Reform of CAMHS is quoted as saying:

[I] was told that my child’s suicidal thoughts and plans were not really mental health issues and just their autism.

Another parent said their GP told them “we might want to keep quiet about ASD [autism spectrum disorder] being a possibility if we are accepted”.

‘Lives are on the line’

Kathleen Funchion, chairperson of the Oireachtas Children’s Committee, today said: “Despite the heroic efforts of many working in the sector, disability and mental health supports are not currently being adequately provided by the State, nor have they been for some time.

“This represents a serious infringement of people’s rights and persists, despite increased investment and what appears to be an endless stream of new protocols, pilots, policies, reconfigurations, action plans and road maps.”

Funchion added that the treatment of young people with a dual diagnosis is “of particular concern”, noting the “extra challenges” they face when trying to access support.

This failure in accessing the necessary supports is evidenced by extremely long waitlists, people going to court to have their rights to interventions upheld, others emigrating, reports of parents deferring to Tusla because they cannot cope due to inadequate support.

The Sinn Féin TD added that urgent change is needed.

“Lives are literally on the line and a failure to introduce immediate and meaningful measures now is a failure to do all we can to prevent young lives being lost,” she said. 

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Recommendations 

The report makes a number of recommendations, including the following: 

• An immediate top-up of funding, separate to the existing budgetary allocation, of €25 million should be provided for further implementing Sharing the Vision (the Government’s long-term health plan)
• Separate funding of no less than €25 million should be provided immediately for resourcing organisations in the community and voluntary sector that provide mental health supports and general youth support services
• More “ambitious and measurable” targets should be out in relation waiting lists, satisfaction among parents and young people, good standards of care, and positive outcomes for CAMHS users 
• CAMHS should be exempt from any ongoing and future recruitment freezes

Multidisciplinary approach 

A number of recent reports have highlighted that CAMHS are under-staffed, under-regulated and under-funded.

When The Journal recently asked the HSE about issues some young people with a dual diagnosis face when trying to access services, a spokesperson said that teams across Primary Care, Disabilities and CAMHS have a joint working protocol which “aims to make the referral process between these services more seamless”.

In cases where it appears that more than one service could best meet a child’s needs, “consultation should take place with the other service(s) to determine which is the most appropriate or whether a joint approach is needed”.

When deciding if a child or adolescent needs to attend CAMHS, “a number of factors are considered” including the person’s clinical presentation, their level of social and family support, and the availability of resources and treatment options at primary care level or within community networks.

If a young person presents with complex needs and a moderate to severe mental disorder at the same time, it is the role of CAMHS to “provide appropriate multidisciplinary mental health assessment and treatment for the mental disorder”.

This may involve shared care with other agencies.