A CHILD WHO who was “depressed anxious and suicidal” had to wait a year for a mental health appointment, according to their mother who was interviewed for a report into mental health services in the west and north of the country.

The child’s mother said they had to access emergency departments in general hospitals in order to be given a mental health assessment. 

Another parent in the same area said that when she asked a question about her child’s future she was told by a clinician that it was “above my pay grade” and that other inappropriate comments were made to her.

The claims form part of a report into Child and Adolescent Mental Health Services (CAHMS) in the Sligo, Leitrim, Donegal, Cavan and Monaghan areas.

The Mental Health Commission (MHC) this morning published individual reports into the provision of CAMHS in each of the nine community healthcare organisation (CHO) areas of the Health Service Executive (HSE).

The reports have already fed into the final report of the review into CAMHS carried out by the Inspector of Mental Health Services and published by the MHC last month.

That report found that the UN Rights of the Child may have been breached for children with mental illness. 

It states that long waiting lists, lack of capacity to provide appropriate interventions, “lost” cases, lack of emergency and out-of-hours services, difficulties in accessing primary care and disability services and the absence of monitoring certain medications all point to a possible breach of Article 24 of the UN Convention on the Rights of the Child, which was ratified by Ireland in 1992.

The publication of the report follows an interim review by the MHC, published in January of this year, which found that a large number of children and adolescents seeking mental health treatment don’t receive necessary follow-up care, with many ending up “lost” in the system.

Individual reports published 

Following the publication of the wider report, the MHC has this morning published the reports into the nine individuals CHOs that make up the state’s services across the country.

In general, the individual reports conform with the findings of the wider investigation into the state’s child and adolescent mental health services.

Long waiting lists for a child to get an initial assessment, staff shortages and high staff turnover are some of the main issues that were highlighted. A lack of suitable IT systems and proper governance structures are also common issues.

However, the individual reports show many of the specific issues that individual services face as well as the concerns raised by patients and their families.

While many of those interviewed praised individual staff members and consultants who they said worked hard, they also raised various issues with the services on offer.

In the Galway, Roscommon and Mayo CHO, some parents said their child had been discharged from CAMHS because “they had refused consent for medication for their child” and said they had “nowhere else to go for help”.

According to the report:

One parent spoke of the constant fear that their child would be discharged. Some parents felt that their child was discharged too quickly from CAMHS.

In the Limerick, Clare and North Tipperary areas a number of consultant psychiatrists and team members told investigators that the service was unsafe due to a lack of consultant cover.

“There were 10 Dangerous Occurrence incidents from one team reported as a result from February 2022 and June 2022,” the report states.

Staff in this area were working beyond their contracted hours, and the team told investigators that they were “fire-fighting” to keep the service running and that they were “running on empty”.

There were an unknown number of children’s cases still open that had not been reviewed.

In the Cork and Kerry areas one mother said that her child had suffered severe side-effects from medication. According to the report:

Two sets of parents told us about their children’s diagnoses, treatment and medication changing every time there was a change of doctor, which was frequent due to locums being in place. Others told us that they were told that if their child did not take medication, they would be discharged with no other treatment offered.

Parents also expressed “extensive frustration” at the lack of Autism Spectrum Disorder (ASD) services on offer. 

One parent said she wrote “begging letters” to CAMHS so her child would be seen. 

Recommendations 

The reports also outlined some of the positive changes that individual services have made since the publication of the interim review in January of this year.

The overall report from the investigation published in July made 49 recommendations in total.

Primarily, it recommended that the immediate and independent regulation of CAMHS by the MHC must be put in place “to ensure the State and the HSE act swiftly to implement the governance and clinical reforms to help guarantee that all children have access to evidence-based and safe services, regardless of geographical location or ability to pay”.

In a statement last month, the Health Service Executive said:

“We are genuinely sorry for anyone who has had a bad experience of our services. It is the responsibility of all in the HSE management, medical, nursing, allied health professionals and administrative staff to work together and change if we are to make services more responsive in both access and quality of outcome,” the statement said.

Damien McCallion, HSE Chief Operations Officer, said the report points to deficits and shortcomings in the service provided to children and families, “and we acknowledge these and have a programme of work now to address these issues”.

With reporting from Jane Moore