THE HSE HAS 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 accepts the findings of an interim report of Child and Adolescent Mental Health Services (CAMHS) that many children and young people end up “lost” in the system.

There are now calls for the the Minister for Mental Health Mary Butler to make a statement in the Dáil on the issues highlighted in the system.

The interim report, authored by the Inspector of Mental Health Services, Dr Susan Finnerty, was published by the Mental Health Commission (MHC) today.

It found that children and young adults who should have had follow-up appointments via CAMHS – including for review of prescriptions or monitoring of medication – did not have an appointment for up to two years. 

Tánaiste Micheál Martin said the findings were “unacceptable” as “no child should be lost in the system” of the State’s mental health services.

Speaking in Brussels, Martin said governance in mental health services needed to be considered.

“I think it’s unacceptable, very, very concerning,” he said, “I think we have to look at governance issues again in respect of mental health services.

“A lot of investment has gone in, over the last decade or so there’s been significant investment in child CAMHS centres. The numbers going forward for treatment has increased very significantly, the referrals have increased very significantly, but still, no child should be lost in the system.”

He said that while Ireland has “made a lot of progress in 20 years” in terms of provision of mental health services, “we’re clearly not good enough in respect of the report that has just been published”. 

‘Clearly significant issues’

Some people also didn’t receive any advice about medication, or get follow-up appointments for review of prescriptions or monitoring of medication.

Addressing the findings this morning, the HSE’s chief clinical officer Damien McCallion said there are “clearly” significant issues in the CAMHs service. 

He said that any parents or guardians with a concern or query about their child currently attending CAMHS can call the HSE at 1800 700 700 to arrange for someone from the child’s CAMHS team to contact them if necessary. 

“A key recommendation of this interim report is that the HSE undertakes a review of cases within the CAMHS service that remain open – these are cases where a young person remains in the service but has not been seen for six months with a particular focus on physical health monitoring for those young people who have been prescribed neuroleptic medication.

“The HSE is putting the necessary plans in place to carry out this review so that we can be assured that children and young people in our service are receiving appropriate and timely care reflective of their current and future needs.

“We will arrange further clinical follow-up for any child where that may be required from this review and will make direct contact with parents or guardians as necessary.”

He said there were a number of reasons behind children “falling out” of the system, with staffing levels highlighted as one of those.

“The commission has also has other areas of concern such as the IT systems and the systems that are there, and we know that something there is a project underway to put in a new national record system that would support mental health and and other services,” he told RTÉ Radio One’s Morning Ireland programme.

He said he is “very conscious” that many CAMHs teams are under resourced in terms of the total staff that they have”, which “impacts on the parents and families but also on the children’s themselves”.

McCallion added that a range of actions planned includes the hiring of a national lead clinically and operational lead that “will help drive the changes that are clearly needed”, with advertising soon to start.

“We are not happy with the issues that have been identified and the service that’s there. But that’s no reflection as a center staff who have worked really hard and continue to work hard to try and deal with some of the issues that they face and challenges in,” McCallion said.

He added that the service has tried to focus in on urgent cases, “so urgent referrals are seen within three days in over 90% of the cases”.

Lack of consultants

Vice President of the Irish Hospital Consultant Association (IHCA) and consultant liaison psychiatrist Professor Anne Doherty said the failings identified in the report come as “little surprise” to consultants working in frontline mental health services on a daily basis.

“The HSE’s own data shows that our services are missing at least a third (29%) of the required Child & Adolescent Psychiatry Consultants, as these permanent posts remain vacant or filled on a temporary basis,” Doherty said.

“Health service management’s decade-long failure to adequately and safely staff our Mental Health Service or provide the capacity needed to ensure that patients receive essential care is now starkly coming to the fore.”

Doherty said the system is “letting some of our youngest and most vulnerable patients down, putting their health and safety at risk”.

“A key response to this crisis is filling the one-in-three vacant permanent Consultant Psychiatry posts urgently, but as we know it is increasingly difficult to do so.

“Antiquated systems, a lack of inpatient beds and outpatient facilities, escalating waiting lists and diminishing staffing numbers have created a Mental Health Service that Consultants simply don’t want to work in. And despite these issues being consistently highlighted, little action is being taken.”

She said immediate action is needed to fill all CAMHS consultant posts with Child and Adolescent Registered Specialists and fully staff the teams to the level required “in order to provide timely, essential care to children”.

“We must prioritise the mental health of our younger generations now if we are to avoid continued future crises,” she added.

Sinn Féin spokesperson on Mental Health Mark Ward has called on the Minister for Mental Health to give a statement and answer questions in the Dáil following the publication of the damning interim report.

‘Lost children’

Ward has also asked for the Oireachtas Mental Health Committee to meet urgently with the HSE to discuss the crisis in children’s mental health, and added that it is clear that CAMHS is not working and that an urgent strategy is needed to tackle the crisis.

“The publication of a damning Interim Report into CAMHS has shown that we have now gone way beyond crisis point when it comes to our children’s mental health,” Ward said. 

“Only last week I raised the issue that the number of children waiting on an appointment with CAMHS has increased by 86 percent under this government.

“Of major concern is the situation of the ‘lost children’ identified in this report. This pertains to children and young people with open cases, who have been lost to follow-up. 

“Ultimately the report describes a situation of children, who should have had follow-up appointments, including review of prescriptions or monitoring of medication, waiting for an appointment in some cases for up to two years.”

He said this was “completely unacceptable”,  with one CAMHS team alone seeing 140 “lost children”.

“Everything must be done to identify these children immediately to ensure that they receive the appropriate mental health treatment,” he said.

People Before Profit TD Paul Murphy said it is “imperative” that the Minister for Health Stephen Donnelly and the Minister for Mental Health answer questions in the Dáil on the “shocking revelations” in the report.

“There is an almost complete lack of mental health services at the primary care level, so children with mild conditions are being pushed into the CAMHS system which is completely overwhelmed and under-resourced,” Murphy said.

“This issue comes back to the under-resourcing of mental health services in this country. The mental health budget in this country is 5% of the overall health budget. In comparison, Sláintecare calls for it to be increased to 10%, and the WHO recommends 12%.

‘Letting children down’

“The government is letting children down and many are suffering greatly from the failure to fund an adequate mental health service.”

Social Democrats co-leader Róisín Shortall has also called for Minister Donnelly to answer questions in the Dáil in relation to the report.

“It is time that the Government stopped wringing their hands about dysfunction within the health service and actually did something about it,” Shortall said.

“The children who are being failed by CAMHS will not get their childhoods back. It is a national scandal that some children have been seriously harmed by CAMHS, rather than helped.”

Shortall said it is “notable” that some of the issues highlighted in the report could be addressed if the Sláintecare plan was implemented, “particularly, the implementation of Regional Health Areas”, she added.

“The report notes that Community Health Organisations (CHOs) are unable to plan for the services they need locally because HSE budgets are centralised. Recruitment is also centralised, meaning local services have huge difficulty in hiring the staff they need at the time they need them.

“Minster Donnelly must now come to the Dáil and answer questions about this latest damning report into CAMHS – and tell us what he intends to do about it. This is an interim report, but the response from Government must be immediate.”

The Department of Health told The Journal that the Minister of State for Mental Health and Older People has noted the interim report’s findings and passed on thanks to Dr Susan Finnerty for the work to-date.

“Following on from several meetings to discuss the Maskey Report earlier in the year, I asked the Mental Health Commission to expand the remit of their thematic report to take cognisance of the Maskey Report which had been recently published,” Minister Mary Butler said.

The Fianna Fáil TD said she acknowledged the serious concerns highlighted.

“On-going and extensive engagement between my Department, the HSE, and the Commission regarding the findings of the Interim Report continues to take place.

“It is essential that the review of open cases takes place to ensure that all children and young people are receiving the appropriate care they need. I would like to thank all CAMHS staff for their cooperation with the Mental Health Commission and the HSE as they carry out these important audits and review.

“Acknowledging the serious concerns raised in the report, I would like to remind all CAMHS service users and their families that many of the findings relate to specific instances for some children and young people.

Concerns for report

The College of Psychiatrists welcomed the interim report, however it noted some concerns it had around what the report factored in as causes of the failings in CAMHs.

“We are concerned that it does not adequately take account of poor governance structures and support systems, and the significant doctor recruitment and retention crisis in our mental health services at present.

“Decades of poor resourcing, wholly insufficient funding, lack of basic ICT that includes electronic data management and patient record systems, and no meaningful implementation of official plans to either recruit or retain doctors in psychiatry, have led to the situation we are facing today, particularly in CAMHS.”
 
It added: “Despite the College calling for inspection of community mental health services, including CAMHS, this has not occurred as it has for approved centres. 

“Regrettably, had the necessary inspections and reviews taken place years before now, the distressing and upsetting situation for all those waiting for and in CAMHS, including serious shortfalls identified by the Maskey Report into South Kerry CAMHS, would have been uncovered and highlighted for action before now.”
 
The college said the service provided by CAMHS is equivalent to hospital level services, and that the same support structures, and patient/ family -friendly appropriate clinic buildings, are needed for consultants and multidisciplinary teams practicing in both these service locations.

“This would ensure that best evidenced practice, driven by appropriate expertise, is the foundation of the patient-centred care provided.”
 
It said it includes, at a minimum, integrated governance structures, involving consultant child and adolescent psychiatrists at national level, driving policy and within the local management and community care organisations planning and operating the services.