MENTAL HEALTH SERVICES for children and adolescents urgently need to be regulated, the Mental Health Commission (MHC) has warned.
The majority of mental health services in Ireland currently fall outside the scope of regulation set out under the Mental Health Act 2001, the Oireachtas Health Committee heard today.
The committee is discussing issues with the governance and operation of Child and Adolescent Mental Health Services (CAMHS).
A report published in July by Dr Susan Finnerty, then-Inspector of Mental Health Services, found some CAMHS are “inefficient and unsafe” due to a lack of governance, inadequate funding and failure to reduce preventable harm to young people attending the services.
The report also found evidence that some teams were not monitoring antipsychotic medication in accordance with international standards, and that some children were taking medication without appropriate blood tests and essential physical monitoring.
Dr John Hillery, Chairperson of the MHC, today called for Finnerty’s recommendations to be implemented as soon as possible.
He told the committee: “Under the 2001 Act, the statutory scope of mental health regulation is limited to inpatient services for children and adults, which are estimated to make up only around 1% of mental health services in Ireland, a statistic that continues to surprise many people.
“This means that every other mental health service in the State, including community CAMHS, is not regulated under the framework of the 2001 Act.
“Most of the professionals who work in the services are regulated by the professional bodies established to do so but the systems, the premises and the providers responsible for those systems and premises are not.”
Professor Jim Lucey, who succeeded Finnerty as the Inspector of Mental Health Services, also addressed the committee today.
Lucey, who took up the role a month ago, said “you cannot have a healthcare industry without an independent regulation”.
We wouldn’t do it in any other walk of life, let alone the one that obtains the largest largest tranche of our wealth.
Minister for Public Expenditure Paschal Donohoe yesterday said that Budget 2024 will provide a total allocation of €22.5 billion for the public health system. The mental health budget for next year is €1.3 billion, with just €13 million for new services.
Lucey said professional accreditations “are all very fine”, but service regulation needs to encompass the whole healthcare system.
“The concept of service regulation – independent, verifiable – according to international standards only exists in only one area, and that is 1% of the service.”
Lucey said an independent regulator needs to be appointed to ensure best practice standards are met.
“Believe me, I know mental health care works. I know that our children need that mental health care, but I know that Dr Finnerty was right when she said that she could not tell the parents of Ireland that their children were getting that standard at present,” he added.
In her report, Finnerty made 49 recommendations including for the “immediate and independent regulation of CAMHS by the Mental Health Commission”.
She said the State and the HSE must “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”.
Dr Finnerty’s nationwide review of services was established after revelations in 2022 of major shortcomings in care provided to children attending CAMHS in south Kerry.
Immediate change needed
Hillery today called on the HSE, with support from the Department of Health, to “immediately start to put together a formal strategy for this restructure of CAMHS”.
“The implementation of the recommendations made by Dr Finnerty cannot wait, that independent monitoring of their implementation must be established immediately so that the public can be assured that steps are being taken to ensure the safe and comprehensive delivery of mental health services to children and young people in Ireland,” he said.
Hillery noted that the Inspector of Mental Health Services does have the statutory power to “visit, inspect and report on any premises where a mental health service is being provided”.
However, he added that “neither the Inspector nor the Commission have the powers to set standards and ensure services comply with these standards by way of monitoring and enforcement”.
David Walsh, the HSE’s National Director of Community Operations, told the committee the HSE is open to extending the MHC’s remit in terms of regulation of the sector.
Walsh said many of the recommendations in Finnerty’s report “are already being progressed” as the HSE implements Ireland’s national mental health policy, Sharing the Vision, as well as recommendations contained in Dr Seán Maskey’s reports in CAMHS in south Kerry.
He noted that the MHC has raised concerns about children and young people receiving treatment via CAMHS, including that a number of patients had been “lost in the system”.
In Finnerty’s interim report last January she noted that, in some cases, children were not seen for a review for up to two years since their last appointment.
“I can assure the committee that the HSE has taken these concerns very seriously. Specific concerns raised were promptly addressed,” Walsh said.
“Specifically, there are no children or young people ‘lost to follow-up’, and there are currently no active concerns with regard to these cases.”
He said the HSE has completed a review of open cases that have not been seen in the last six months by their CAMHS teams and those who have been prescribed neuroleptic (antipsychotic) medication.
Some 576 cases out of an overall caseload of 20,000 were identified.
“Contact has been made with all those concerned to assure they are receiving appropriate care, reflective of their current and future needs,” Walsh said.
If you have been affected by any of the issues mentioned in this article, you can reach out for support through the following helplines. These organisations also put people in touch with long-term supports:
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