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IRELAND’S PSYCHIATRISTS HAVE issued a “critically urgent” call for a major overhaul of the mental health service for children and young people.
CAMHS (Child and Adolescent Mental Health Services) provides assessment and treatment for young people up to the age of 18 who are experiencing mental health difficulties.
The College of Psychiatrists of Ireland has today called for “major reform of the management and governance of CAMHS” and has published a policy document outlining changes it wants to see.
It said the current governance of CAMHS has “serious deficits”, such as a “lack of clarity as to whom responsibility for action lay between local, regional and national governance structures”.
This “ineffective governance” is also contributing to a failure to manage risk, a failure to fund and recruit key staff, and a failure to provide standardised models of care across the country.
The College of Psychiatrists of Ireland is the professional and training body for psychiatrists in Ireland.
The move is an unusually strong criticism of CAMHS, but the College of Psychiatrists of Ireland said that “trust has been lost in CAMHS” and that new governance and management structures are required as a “priority” to ensure a “high-quality service”.
Dr Patricia Byrne, Chair of the Faculty of Child and Adolescent Psychiatry at the College of Psychiatrists of Ireland said that reform of CAMHS is “critically urgent”.
She noted that CAMHS is “under-resourced, under pressure, and under-performing – and if the recommendations are not implemented, this will continue”.
At a media briefing on the policy document, it was noted that it is “very difficult” to recruit staff, given a recruitment freeze last year and as a result of the pay and numbers strategy which replaced the freeze.
This strategy stated that the employment ceiling in the HSE would be capped at the December 2023 numbers.
Byrne noted that some teams are “seriously understaffed”, and that there had been a failure to fund and recruit key staff.
She also warned that if the recommendations are not acted upon, more young people will be on waiting lists, and “more staff will end up burned out, working in a system not fit for purpose”.
She noted that the damning Mental Health Commission report on CAMHS published in 2023 “identified national deficits in team staffing and lack of minimal required resources to facilitate service delivery”.
The report found that the State cannot provide assurances that children have access to a safe, effective and evidence-based mental health service.
It also found that many children and young people end up “lost” in the system; in one catchment area alone, there were 140 “lost” cases within the local CAMHS team.
Byrne said the report highlighted a “crisis” in CAMHS and that “ineffective governance in some areas is contributing to an inefficient and unsafe” service.
The College of Psychiatrists said this 2023 report details failures in governance at a national and regional level, including insufficient funding and resourcing of CAMHS, serious deficits in digital infrastructure, and chronic and ongoing understaffing.
“Sadly, this has resulted in negative impacts in service experiences for young people and families who require our services, and for the front-line staff trying to deliver care,” said Byrne.
“As such, a major reform of the service is of critical and unparalleled importance to the wellbeing of those patients and their loved ones.”
Elsewhere, the psychiatrists also warn about a “reliance on medication”, without the required therapy to go alongside it.
While Byrne said medication will always be used in line with good practice and governance, she cautioned that some young people may only be able to access medication because of the long wait lists for therapeutic support.
Among the key recommendations within the policy document published today is for all staff working in CAMHS to receive specialist CAMHS-specific training to ensure optimal standards of care.
It also calls for specialist child and adolescent psychiatrists to lead each CAMHS team, as well as the creation of a new senior management role, the Clinical Service Manager (CSM), at a team and regional level.
This would be a senior role supporting and working alongside the consultant, with the ultimate aim of providing a “gold-standard service”.
This is a role that the College of Psychiatrists said it is “really strongly advocating for” and it would be a part-time senior management role to help deliver a “comprehensive, integrated child and adolescent mental health service across CAMHS”.
The CSM would be responsible for efficient management, coordination and administration of each specialist team.
The College of Psychiatrists said that investing in management will improve services and result in better outcomes.
The report recommends that all members of the CAMHS multidisciplinary team should have “clearly defined roles and be clinically accountable to the specialist consultant psychiatrist as the clinical lead”.
There is also a call for an “appropriate digital infrastructure”, noting that many psychiatrists are still using pen and paper.
The College of Psychiatrists of Ireland said this lack of proper digital infrastructure is “associated with governance failings, including patients being ‘lost to follow up’, loss of clinical records, and reductions in the quality of patient records”.
It added that this issue also “significantly increases workload on clinical staff performing administrative duties, further reducing the already under-resourced clinical capacity”.
Dr Lorcan Martin, the president of the College of Psychiatrists, said the recommendations outline “radical new governance and management structures”.
He added that they would “lay solid foundations for the development of a world-class mental health service of which we can all be proud” and he called on the government to “act urgently to implement the recommendations contained in the proposal”.
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