Mentally ill children not receiving timely care is ‘unacceptable’, Tánaiste says

A report that found the Child and Adolescent Mental Health Service (Camhs) left more than 100 mentally ill children without care for up to two years highlights an “unacceptable” situation, Tánaiste Micheál Martin has said.

The Mental Health Commission on Monday published an interim report which identified serious risk to the safety and wellbeing of children accessing Camhs, including 140 with “open cases” who had “been lost to follow-up”.

These cases are known to be in the community healthcare organisation (CHO) that covers Clare, Limerick, and north Tipperary, though this is not identified in the report.

The report states that the children were in need of an appointment but not contacted, with some reaching their 18th birthdays without a discharge or transition to adult services.

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Asked about the report’s findings on his arrival at a meeting of foreign affairs ministers in Brussels on Monday, Mr Martin said: “I think it’s unacceptable. Very, very concerning.

“I think we have to look at governance issues again in respect of the mental health services,” he continued. “No child should be lost in the system. So there’s very serious issues... I think the reviews have highlighted that now.”

Mr Martin said there had been “significant investment” in child and adolescent centres over the last decade but that overall the progress in improving mental health services provision in Ireland was “clearly not good enough”.

“Historically, Irish mental healthcare was institutionalised, and there was a certain tardiness in moving towards more primary and community care based models, too much emphasis on acute care within mental health,” he said.

“We’ve made a lot of progress in 20 years compared to where we were as a country in respect of mental health, but clearly not good enough in respect of the report that has just been published.”

‘Significant deficits’

Minister of State for mental health Mary Butler said that there had been “extensive engagement” between her department, the HSE and the Mental Health Commission regarding the findings of the interim report, but she also expressed concern about “the significant deficits” identified.

Ms Butler told RTÉ radio’s Today with Claire Byrne show that she was particularly concerned about governance within the system and the fact that there was not an IT system in place covering the whole country. She said she found it difficult to believe that a paper based system was still being used in some community health areas given the need for real time data.

Prof Anne Doherty, vice president of the Irish Hospital Consultant Association, said the “consequences of failing to have the necessary level of staffing and required frontline supports across our health service have once again been cruelly exposed” in the report.

She said some 29 per cent of child and adolescent psychiatry posts were vacant or only filled on a temporary basis and urgent action was needed on this issue.

“The failings identified in the interim report unfortunately come as little surprise to consultants working in frontline mental health services on a daily basis and who have been desperately highlighting the need for more specialists and greater capacity across the board for years,” she said.

“Our system is letting some of our youngest and most vulnerable patients down, putting their health and safety at risk.”

Staff retention issues

The College of Psychiatrists in Ireland said “poor governance structures” as well as staff recruitment and retention issues had led to this outcome.

“Decades of poor resourcing, wholly insufficient funding, lack of basic ICT that includes electronic data management and patient record systems, and no meaningful implementation of official plans to either recruit or retain doctors in psychiatry, have led to the situation we are facing today, particularly in Camhs,” the college said.

“Reviews and regulation are critically important but cannot have the desired effect if we do not have the doctors available to staff these crucial services, and the appropriate ICT, clinical and managerial structures nationwide, to include child and adolescent psychiatrists.”

The Health Service Executive (HSE) said in a statement that it had identified all the people concerned from the report and they had now received appropriate care.

Damien McCallion, HSE chief operations officer, said “a major Camhs improvement process is under way”.

“In the case of all children where concerns have been raised by the Mental Health Commission in their report, these have been managed directly by the service caring for them,” he told RTÉ's Morning Ireland.

However, he said limited consultant cover remained an issue, but the level was increasing. Delay times varied around the country, but reviews were being conducted and training and recruitment were ongoing, he added.

Mr McCallion said “clearly” there were issues with the different teams around the country and there were also issues with staffing levels and the Camhs IT system, though a project is underway to develop a national reporting system.

Prescription audit

The HSE’s national lead on integrated care has told of how a prescription audit by every CAMHS team is expected to be completed in the next few days with a “correct follow up” process to be put in place once the results have been externally validated.

Dr Siobhán Ní Bhriain told RTÉ radio’s News at One that the families of all 140 children who were “lost” in the system have been approached and mechanisms have been put in place for treatment. A review of all 20,000 open cases has also commenced, she said with those who have been waiting longer than six months viewed as a priority, it is expected that the review will be completed by May this year.

On the same programme, Dr Tom Keane expressed concern that the Mental Health Commission report was based on a sample of only 10 percent of cases – 600 – which meant there were 6,000 cases that had not been examined. It was “terrifying” that there remained safety issues about the number of children “lost” in the system where their cases had not been followed up.

Finding qualified staff was the main issue of concern, he said, adding that Camhs needs ‘segregated’ funding, separate from central mental health funding.

Meanwhile, Psychiatric Nurses Association (PNA) general secretary Peter Hughes said the latest report highlights a Camhs service that is failing children and young people, families, communities, and staff.

Mr Hughes said a national survey conducted by the PNA last November revealed over 700 mental health nursing staff vacancies in mental health services generally throughout the country, but also pointed to the worsening staffing crisis within Camhs with 27 vacancies in Linn Dara in Dublin, 12 in Cork CAMHS and seven in Galway.

“All of these staffing shortages are feeding back into the crisis in the provision of Camhs services both in community and inpatient facilities at a time when demands for those services are growing throughout the country. We already know that a number of staff at the 16 bed Camhs unit at Eist Linn in Cork are due to leave and as yet there is no indication how the HSE proposes to replace these staff which could lead to a further reduction in Camhs beds. We also have 10 Camhs beds in the new National Forensic Mental Health Service in Portrane and 20 beds planned in the new National Children’s Hospital but with no indication as to how these services will be staffed.”