‘Immediate investment’ needed in CAMHS – College of Psychiatrists

Immediate investment and development are required for Child and Adolescent Mental Health Services (CAMHS) to support transformation in this sector, the College of Psychiatrists of Ireland has stated.

The College was responding to the findings of the final report on the provision of CAMHS by the Inspector of Mental Health Services, Dr Susan Finnerty, which was published today.

In her report, Dr Finnerty stated she cannot currently provide an assurance to all parents in Ireland that their children have access to a safe, effective, and evidence-based mental health service.

The Inspector’s independent review into CAMHS was commenced in April 2022 and an interim report was published in January 2023. The final report includes 49 recommendations. Due to the seriousness of the concerns raised by the review, the Inspector has recommended that a comprehensive strategy for CAMHS and all other mental health services for children be prepared and approved by the HSE board.

Despite targeted improvements by the HSE to solve some of the issues, the Inspector states in the report that it is a major concern that there are ongoing and serious deficits in CAMHS which is increasing the risk to children and young people.

And while she acknowledged that there are good CAMHS services in the State – calling out in particular “the excellent and skilled staff” who provide services as the “main CAMHS asset” – she stated: “I cannot currently provide an assurance to all parents or guardians in all parts of Ireland that their children have access to a safe, effective, and evidence-based mental health service.”

Responding to the report today, the College of Psychiatrists of Ireland said it identifies the serious and ongoing challenges that staff working in CAMHS and the children and families seeking the support of CAMHS have faced.

According to the College: “The report acknowledges the hard work being done by dedicated staff in CAMHS who are trying their best to meet demand without the requisite basic resourcing and management structures required, such as minimum staffing levels and supports, dedicated funding, robust governance and risk management structures, basic administrative systems and appropriate premises.

 “The College has been highlighting many of these deficits for many years.  We acknowledge and welcome commitment from the Department of Health and the HSE to implement necessary reform.”   

Dr Patricia Byrne, Chair of the College’s Faculty of Child and Adolescent Psychiatry, commented: “There is no time to waste. Immediate investment and development are required for CAMHS services to support transformation in this sector.”

She said this involves:

• The implementation of basic administrative IT systems to move away from paper-based filing and provide a centralised storage solution.
• Appropriate staffing of each multi-disciplinary team, including the resourcing of the requisite number of administrative support staff.
• Increased funding of mental health services as a whole (minimum of €2 billion is necessary) with appropriate ring-fenced funds devoted to CAMHS.
• New and improved governance structures so that risks can be regulated and monitored.
• An extensive national recruitment and retention strategy for all mental health services including child and adolescent psychiatry.
• Parallel development of other services and supports in disability, primary care and community care to ensure CAMHS can provide the appropriate specialist care for patients who have a moderate to severe mental illness. Relevant integration and communication links need to be developed between all services.

The College has welcomed the introduction of new national HSE posts for child and adolescent psychiatry and CAMHS. “Now, it is critically important that the Government and the HSE urgently address the serious identified deficiencies in resourcing and corporate management structures for CAMHS, to enable dedicated staff to do their jobs effectively,” according to the College.

HSE response

The HSE stated it acknowledged the “real concerns the report raises in areas such as service delivery, staffing and governance as well as specific concerns regarding children and young people in the care of CAMHS”.

“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.”

Mr Damien McCallion, HSE Chief Operations Officer, said: “When we received the interim report late last year, we took the action necessary to address issues in relation to specific service users. However the interim and final reports also point to deficits and shortcomings in the service we provide to children and families, and we acknowledge these and have a programme of work now to address these issues.

“While investment in CAMHS and youth mental health service improvement has grown over the past decade, we know improvements still need to be made and we are determined now to make substantial changes and improvements in the mental health services provided in Ireland to children and adolescents.”

He said the next steps the HSE is taking include:

• Progressing a new HSE Child and Youth Mental Health Service improvement programme
• Establishment of a new national office for Child and Youth Mental Health which will lead out on this programme to provide leadership, oversight and enhanced governance to services.
• Appointment of both a National Lead and a National Clinical Lead (CAMHS Psychiatrist) for Child and Youth Mental Health to lead this office and the service improvement programme.

He said the HSE CEO and national leadership will be having detailed discussions with the Mental Health Commission (MHC) to “ensure our plans are realistic, timebound and achievable and we have the full support of the Department, Minister Butler and Minister Donnelly in that effort”.

Mr McCallion also referred to a number of “targeted learning initiatives” undertaken by the HSE.

• An audit of prescribing practice around the country “which in the main said there was no evidence of over-prescribing” and that most patients (95 per cent) had their medication prescribed by a consultant or in consultation with a consultant.
• An audit of adherence to the CAMHS operational guidelines “which in the main said all teams were aware of the guidelines and all teams were in the process of implementing the guidelines”.

As recommended by the MHC interim report, the HSE had also completed a review of all open cases where there had not been follow up appointments in the previous six months, and of those who had been prescribed neuroleptic medication. “Out of an overall caseload of close to 20,000 children and young people, a total of 576 open cases were identified.  We have contacted all of these, ensured they are receiving appropriate care and we have not identified harm caused to any of these individuals.”

The Inspector’s report can be read at the following link – Mental Health Commission publishes final report on Child and Adolescent Mental Health Services | Mental Health Commission (mhcirl.ie)