Camhs: At risk-children will remain vulnerable to being ‘disappeared’ in Ireland unless attitudes change

Children who present with problems in Ireland have traditionally been “disappeared”, Dr John Hillery, consultant psychiatrist and chair of the Mental Health Commission (MHC), said on Wednesday.

“They have been seen as having behavioural problems, or as being bold, or doing things because they are in an environment that causes it.”

They have not been treated as “individuals” with rights, but instead have “tended to be sidelined”, he said. “They end up out of school,” he said. “They get forgotten. They disappear.”

Dr Hillery was speaking at the publication of the commission’s devastating report on how the HSE’s child and adolescent mental health services (Camhs) is failing children and their families.

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His words came just hours after the publication of two other equally damning reports on services apparently losing, forgetting and failing some of our most vulnerable children.

In one, the Health Information and Quality Authority (Hiqa) found children alleging sexual assaults in one of the poorest areas of the State were waiting over a year for initial social worker assessments.

A Tusla child protection manager in the Dublin South West/West Wicklow/Kildare region told Hiqa inspectors that staff were “firefighting” and “robbing Peter to pay Paul” as they attempted to allocate insufficient staff resources between children in care and those awaiting allocation of a social worker.

The report provides disturbing examples of children, referred to Tusla, left without even a preliminary assessment, including two children under eight who were left for so long that it appeared social workers were “unable to determine” where they now lived.

In another, Hiqa inspectors found the “quality and safety of the services” for more than 200 unaccompanied children seeking international protection “required significant improvement”. Here too, children did not have “timely access” to services. In 15 of 27 case files reviewed, the child was waiting to be allocated a designated social worker.

Across the three reports, authors heard staff at the front lines with children were chronically under-resourced, under-supported and burnt out.

The MHC found Camhs teams “were significantly below the recommended staffing levels” with some below 50 per cent of recommended level. There were particular shortages in occupational therapists, social care leaders, advanced nurse practitioners, clinical nurse specialists, psychologists, speech and language therapists and social workers, while in five Community Healthcare Organisations (CHOs), no team had a team co-ordinator, the report says.

Some teams had no consultant psychiatrist – the post that leads teams – with this post covered by rotating consultants or locums “which has implications for... continuity of care”.

Hiqa found “the lack of leadership and governance was evident” in the service, which was focused on “crisis responses”. This was from the report on services for unaccompanied minors, but it could have been in any of the three.

Camhs is a national service. While children and adolescents – those aged 18 and younger – account for 24 per cent of the population, Camhs receives just 12 per cent (an estimated €137 million a year) of the overall mental health budget. And while adult mental health services are regulated under the Mental Health Act 2001, Camhs is not regulated.

Regulation means the MHC has statutory powers to inspect adult mental health services and take enforcement action where adults’ rights are being violated. There is no body or organisation that has such power to ensure children’s rights are vindicated. This, 11 years after the children’s rights referendum was passed.

It was important to note, said Dr Susan Finnerty, chief inspector of mental health services and author of the report, that Ireland ratified the UN Convention on the Rights of the Child in 1992. Article 24 recognises children have the right to “the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health”.

“Sometimes when we were doing this review it was difficult to see those rights were being respected,” she said.

She makes 49 recommendations, chief among them that Camhs be regulated “immediately”; that a “comprehensive strategy for Camhs and all other mental health services for children” be drawn up urgently and signed off by the HSE board; and that these recommendations by overseen and monitored by the MHC.

How depressing then that the response from the Minister responsible for mental health, Mary Butler, made no mention of regulating Camhs or of a strategy for the service in any of the nine paragraphs or 755 words of her response to the report?

Until this attitude to our most at-risk children changes, it would appear they remain vulnerable to being “lost” and “disappeared” across multiple services.