LAST UPDATE | 13 Jun
SOME YOUNG PEOPLE are not seen by Child and Adolescent Mental Health Services (CAMHS) until they are self-harming or have attempted suicide, according to a new report.
Many children also struggle to access services because they are autistic, according to the report carried out by the advocacy group Families for Reform of CAMHS.
In total, 736 people across Ireland responded to the survey in April. The report was officially launched at the Ombudsman for Children’s Office in Dublin this afternoon.
Nine in 10 parents (92%) who took part in the survey said their child’s mental health deteriorated while they were waiting to be seen by CAMHS.
One parent said their son was not seen by CAMHS “until he actually self-harmed and attempted suicide”.
Another parent said CAMHS only saw their daughter after she ended up in the emergency department, stating: “In the end they took her case because we ended up in A&E in a complete crisis.”
A number of recent reports have highlighted that CAMHS are under-staffed, under-regulated and under-funded.
Seven in 10 parents (70%) who took part in the survey said the fact their child was autistic negatively impacted their access to CAMHS and/or the mental health supports offered to them.
Four in 10 parents (40%) surveyed said their autistic child ended up in the emergency department while on the waiting list for CAMHS (versus 34% of non-autistic children).
The report notes:
The door to CAMHS only opens when a child’s health reaches a critical/emergency point.
A separate report published by the Oireachtas Children’s Committee in May found that young people had been given “inadequate or inappropriate supports” by CAMHS “simply on the basis of being autistic”.
Children with a ‘dual diagnosis’ – when they have a mental health difficulty alongside autism, an intellectual disability, or both – often struggle to access services.
Autistic children are often excluded from CAMHS and instead referred back to their local children’s disability network team (CDNT) – despite the fact they may have ill mental health, the report noted last month.
Today’s report came to the same conclusion, with one parent saying their local CAMHS team told them their child needed to be seen by CDNT services, while CDNT told them to go back to CAMHS.
The parent recalled:
CAMHS said, ‘Autism, try CDNT’. CDNT would reply with ‘ADHD, try CAMHS’. This went on for years until he was terrified he’d finally kill himself.
Another parent said: “[We were] passed back and forth between services – too autistic for one and too anxious for the other.”
Seven in 10 parents (69%) said that when their child was eventually seen by CAMHS, they were discharged before they were “ready”.
One parent said her daughter was discharged because she was suspected to be have Autism spectrum disorder (ASD), despite the fact she was depressed and had suicidal ideation.
Just over half of parents (54%) felt that their child’s autism was “used to try and discharge the child”.
“Every issue was blamed on ASD diagnosis and [at] each appointment they tried to discharge us,” one parent said.
Today’s report also found that most parents (69% of respondents) got a private diagnosis for their child in a bid to get them seen by CAMHS sooner.
However, many families cannot afford to do this. Some parents said they had to take unpaid leave or quit their job to care for their child.
The report states that cost is a “huge” barrier for many families, leaving their child at a “huge disadvantage”.
A quarter of the 700-plus children whose parents were surveyed were on the waiting list for support for over a year. pic.twitter.com/22std5XCyC
— Órla Ryan (@orlaryan) June 13, 2024
Other parents said they could not find a private child psychiatrist who was taking on new clients, or had their child turned away from private practitioners as their needs were deemed “too complex” especially if the child had an intellectual disability.
“Children were and are left in a vulnerable position with nowhere to turn,” the report notes.
When asked by The Journal for comment on today’s report, a spokesperson for the HSE said: “We are sorry to those young people and families who have had a poor experience in trying to access services.”
In order to reform CAMHS and youth mental health services in general, the HSE has developed a three-year action plan.
The spokesperson said this plan is “informed by recommendations of the Mental Health Commission review of CAMHS, audit of prescribing practice, adherence to operational guidance and service experiences”.
The plan is currently “undergoing a period of consultation with key stakeholders”, they added.
The overarching goal is to redesign and deliver services which are safe, effective, easy to access and offer appropriate support at all levels of need.
In terms of the difficulties faced by some young people being referred from one service to another, the spokesperson confirmed that the current system is due to be overhauled.
“One of the key priorities for the Child and Youth Mental Health Office is the development of a single point of access for all child and youth mental health referrals in partnership with disabilities, primary care, and voluntary and statutory agencies.”
Funding for this service was approved in Budget 2024 and test sites have been identified in Community Healthcare Dublin North City and County and Community Healthcare West CAMHS.
The purpose of the single point of access is that all referrals go to one centralised triage committee and an appropriate service or intervention is identified.
“Therefore children and young people do not have to join multiple waiting lists and services work together to provide a suite of suitable mental health assessments and interventions at the most appropriate level,” the spokesperson noted.
Mental Health Reform, Ireland’s leading national coalition for mental health, said it is “extremely” concerned by some of the findings in today’s report.
CEO Fiona Coyle said the report “provides further evidence of the systemic failures in our mental health system”.
“Every child should have access to responsive and effective mental health services.
Unfortunately, many children are being denied timely and appropriate care due to significant issues within CAMHS.
Coyle noted that the Mental Health Commission’s independent review of CAMHS last year “highlighted deficiencies in the services including long delays for treatment, a lack of standardised care, and serious staffing shortages”.
She welcomed the subsequent establishment of the HSE National Youth Mental Health Office, but added that “underfunding continues to be a significant barrier”.
“It is extremely concerning that families had to seek private support while their children were on the waiting list for CAMHS.
Parents should not have to bear the financial burden of private care to compensate for inefficiencies in the public system.
“The lack of early intervention in the services is also deeply troubling.”
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