The College of Psychiatrists of Ireland has called for a major overhaul of the management and governance of HSE Child and Adolescent Mental Health Services (CAMHS) across the country.

CAMHS provide mental health treatment services for children and young adults with moderate to severe mental illness.  The service has been involved in significant controversy in recent years, including serious allegations of children being harmed in the care of certain CAMHS services and widespread concerns that lengthy waiting lists are leading to unacceptable delays in the provision of vital care for young patients.

In response, the College formed a special working group to study reforms in the services which has led to the publication of a comprehensive policy document today.

Dr Patricia Byrne, Chair, Faculty of Child and Adolescent Psychiatry, said that reform of CAMHS was now critically urgent.

“CAMHS in Ireland has been beset by chronic underfunding and under-resourcing.  There have been failures to provide fit-for-purpose governance systems to facilitate CAMHS development in line with the Government’s mental health policies (A Vision for Change and Sharing the Vision).”

“The Mental Health Commission reports identified national deficits in team staffing, lack of minimal required resources to facilitate service delivery, failure to implement national policy objectives for comprehensive CAMHS provision, and failures at a national HSE level to respond to risks escalated through the HSE systems,” she said. 

“This has led to variable and, at times, a suboptimal service for children and adolescents who suffer from severe mental illness.  Sadly, this has resulted in negative impacts in service experiences for young people and families who require our services, and for the frontline staff trying to deliver care. As such, a major reform of the service is of critical and unparalleled importance to the wellbeing of those patients and their loved ones.

 “As a developed nation with a healthy budget surplus, it is unconscionable in 2025 that Ireland cannot adequately treat our very vulnerable young people who need help so badly.  Mental health problems in childhood and adolescent are associated with detrimental impacts on developmental outcomes in young adulthood.  Patients, their families, and the doctors and other healthcare staff who work within CAMHS deserve so much better.”

 Key recommendations that the College is proposing include:

– Specialist (Consultant) child and adolescent psychiatrists must lead each CAMHS team.

– A new senior management role, the Clinical Service Manager (CSM), should be created at a team and regional level. The CSM would have a critical role in team co-ordination, service audit and performance review and in facilitating service development at a local and regional level.

– A nationwide network of CAMHS Clinical Directors is needed to fulfil clinical and managerial roles for teams, support regional development of services, and establish two-way links with national management teams.

– Both the Clinical Director and a Clinical Service Manager representative must have membership of the Regional Area Mental Health Management Team to represent CAMHS.

– All staff working in CAMHS should receive specialist CAMHS-specific training to ensure optimal standards of care.

– All members of the CAMHS multidisciplinary team must have clearly defined roles and be clinically accountable to the specialist consultant psychiatrist as the clinical lead.

 Dr Lorcan Martin, President of the College and Consultant in General Adult Psychiatry, said: “The recommendations proposed outline radical new governance and management structures, and they will lay solid foundations for the development of a world-class mental health service of which we can all be proud.”

The College called on the Government to act urgently to implement the recommendations contained in the proposal.

The paper is available here: https://mcusercontent.com/ea59553be3355b7972cbfa3a1/files/4fe3a851-21b3-1961-8ea311328ad7dd8a/CPsychI_A_model_of_CAMHS_Governance_amp_Mgt_Structures_final_.pdf

The President of the College of Psychiatrists has said growing anti-psychiatry rhetoric represents a significant challenge for the profession.

Speaking at the College’s Winter Conference in Limerick last month, Dr Lorcan Martin, Consultant in General Adult Psychiatry, remarked upon “negativity” levelled at the specialty.  

Dr Martin told the Medical Independent (MI) this commentary partly stemmed from the controversial history of the specialty in Ireland and internationally.

He noted, for example, that psychiatry only had effective pharmaceutical treatments from the 1950s. Historically, he said, many people with serious mental illness were consigned to institutions.

“Modern psychiatry is very different. It is an advanced medical specialty,” stated Dr Martin. “Part of it is that we are not seen as scientists or real doctors in some respects, even though we treat very real, very serious illness.”

He also said that psychiatrists only admitted patients involuntarily as a “last resort” and these admissions were not common.

“There is a certain rhetoric that psychiatry wants to ‘lock people up’ and treat them against their will. We don’t want to lock anyone up, but every so often you come across someone that is so seriously ill they don’t know they’re ill, and they’re a risk to themselves or other people…” he stated.

Dr Martin said he had a caseload of several hundred patients, and none of them were inpatients at the time of speaking to MI. He had not had a patient admitted involuntarily in six months.

Now in the second year of a three-year term as College President, Dr Martin described his experience to date as “fantastic”.

He also noted the importance of advocacy on behalf of patients with mental illness.

“Advocacy is really important, particularly for patients. [There was a saying], ‘there’s no votes in psychiatry’ and what that meant was people with mental illness often quietly disappear into the background because they have no-one to speak for them. It was a quote I heard when I started in psychiatry over 30 years ago.”

In this respect, there is a special onus on psychiatrists to advocate on behalf of these patients, he stated.

The College’s Winter Conference heard concerns about under-funding of mental health services and proposed changes to mental health legislation .

For further coverage, see: CPI | The College of Psychiatrists of Ireland | Irish Medical Society

Psychiatrists deeply disquieted by proposed legal changes – Medical Independent

The “perennial inability” to sufficiently fund psychiatric doctors-in-training is having a “detrimental” impact on patients, according to the President of the College of Psychiatrists of Ireland.

Dr Lorcan Martin, a consultant in general adult psychiatry, made the comment as the College’s annual NCHD conference takes place in Dublin today.

According to Dr Martin, the current funding of €1.3 million for doctors to train to be specialists in psychiatry was under 70 per cent of what is needed to meet demand. He said this continuous funding shortfall was a major contributor to psychiatry trainee and specialist consultant burnout, poorer patient outcomes, and significant recruitment and retention problems for mental health services.

“Our psychiatry doctors-in-training are the consultants of the future and they should be given the very best chance to succeed, but instead they are facing a highly stressful and at times unsupportive working environment,” said Dr Martin.

“At present we are underfunded, under-resourced and under-appreciated, and the net result ultimately has been detrimental to Irish patients. There are not enough psychiatrist doctors to meet demand, which makes it harder on those who do stay in this country.”

The College President said psychiatric doctors “have been asked to do more with less for years now, and even though they continually put their own welfare in jeopardy for the sake of their patients, the cracks are visible for all to see”. 

“We urgently need a revised funding and resourcing plan from the Government in order to resolve what has become an untenable situation.”
 
He added that the foundations were in place to provide a best-in-class service for patients.

Dr Martin noted that many of the recommendations in final report from the NCHD taskforce “were already in place in psychiatry”, including publication of statistics, a grievance policy, transparency of eligibility criteria and regionalised training schemes.

The report also recommended regular training of supervisors, which Dr Martin also said the College of Psychiatrists has been doing for many years.