Variation in child mental health services across HSE is ‘unacceptable’

The level of variation in Child and Adolescent Mental Health Services (Camhs) across the HSE is “unacceptable”, chief executive of the Mental Health Commission John Farrelly has said.

The commission has published reports on services in nine community healthcare organisation (CHO) areas following a major report on the overall operation of Camhs in July. The individual reports, published on Thursday, provide more detail of problems inspectors found in certain regions.

Among the issues identified was record keeping, with the Cork/Kerry area service failing to recover a misplaced clinical file. The overview report in July stated the continued reliance on paper-based records across the State’s youth mental health services was a “significant burden” on already overstretched staff.

Speaking on RTÉ radio’s Morning Ireland on Thursday, Mr Farrelly said the individual regional reports were necessary so the HSE could do the work that was required in each area while awaiting a new strategy on the regulation of Camhs. The reports set out the strengths and quality initiatives of each region but also the challenges being seen all over the country, with 140 of these identified across the nine regions, he said.

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There were also 45 areas of concern in relation to clinical or quality issues that could not wait. “So we escalated nationally for the HSE to mitigate the risk,” Mr Farrelly said.

Among the concerns were consultants working part time, the operational hours of services and children being left without prescription renewals.

[ https://www.irishtimes.com/health/2023/08/31/audit-fails-to-find-misplaced-corkkerry-area-camhs-file/ ]

Citing “systemic issues across the country,” he highlighted “the [inadequate] digital infrastructure, the lack of risk management [and] the variation in budgets” as factors.

“If you look at budgets across the nine areas, some areas are funded 100 per cent better in other areas. If you look at waiting lists, the waiting lists in some areas are 200 per cent more than in other areas. The level of variation isn’t acceptable if we’re to have quality and safety.”

He stressed, however, there was “a lot of high quality work going on”.

“What we’ve done is we’ve identified the key issues and like any good process, you identify the issues, you’re not afraid to look at the issues and then you put a process in place to fix it.”

Staffing levels were based on a State policy that was nearly 20 years old, he said. “We’ve moved on in terms of the provision of services for children. So we need to look at the multidisciplinary team that’s needed.” There were high-functioning areas and high-functioning teams in areas, he said, adding the problem was that level of service was not replicated across the country.

Mr Farrelly pointed out that the commission did not have the power to monitor or regulate the changes required. “It’s not like if it was an adult in-patient centre, we could do something.

“We need to put in place a strategy based on the 49 recommendations. The inspector has recommended that the commission should oversee that and the inspector has also recommended that regulation of Camhs will make the services safer.”

[Immediate regulation of Camhs must be a priority, warns mental health inspector]

Regulation of Camhs under the 2001 Mental Health Act would empower the Mental Health Commission to take enforcement action against its providers – primarily the HSE – where failings put children’s safety at risk.

The publishing of the reports into the individual centres has revealed that a data protection breach in the CHO for Cork and Kerry has been reported to the Data Protection Commissioner.

The report said that in some teams in the facility, the storage of clinical files is “not safe from a data protection breach”. According to the report, files were not maintained in a “safe, coherent and logical way with potential risks in communication of clinical information, confidentiality and the danger that some vital information will be missed”.

A similar concern was reported in the CHO for Sligo, Leitrim, Donegal, Cavan and Monaghan. According to the report, “there were concerns in some teams about safe management of clinical files, including files missing on the days of our review, loose continuation sheets being used, safe transport of files and the general condition of files.”

The report for CHO 7 – which serves Kildare/West Wicklow, Dublin West, Dublin South City, and Dublin Southwest – stated that “there are no electronic clinical files” when listing the challenges facing the organisation. “Due to the low number of administration posts, clinicians carry out administrative duties, reducing their clinical time with young people,” says the report. “This contributes to a reduction in clinical time available and an increase in waiting lists.”

Nationwide, CHOs reported problems in both recruitment and retention of staff, leading to longer waiting times and poorer access to resources for patients. In the CHO serving southeast Dublin, East Wicklow and Dún Laoghaire, “minimal action” has been taken to address staffing issues on the core Camhs team, says the report.

According to the report, the accommodation for Laois/Offaly services is in a “190-year-old former district asylum” that is “not an appropriate location for children and young people”.

The report states there is “no waiting room and families wait on corridors. There are soundproofing issues, peeling paint, mould on some walls and leaking roofs. There is no wheelchair access, and the number of rooms restrict expansion of the service”.

Anyone concerned about a young person engaging with Camhs should call the HSE on 1800 700 700.