Children will be ‘lost’ as youth mental health services ‘creaking at the seams’

Children in psychiatric distress will continue to be “lost” and “disappeared” without urgent legislation to regulate the Health Service Executive’s youth mental health services, the chair of the Mental Health Commission has warned.

Consultant psychiatrist Dr John Hillery made the comment yesterday at the publication of a blistering report, which found the HSE’s child and mental health services (Camhs) is “creaking at the seams, with increasing risk to children for whom the service is provided”.

The service is led with “poor governance”, characterised by “failure to manage risk, failure to fund and recruit key staff, failure to look at alternative models of providing services ... and the failure to provide a standardised service,” said Dr Susan Finnerty, chief mental health inspector.

Her report found that staff are burned out, working beyond contracted hours and do not feel supported. The “distress and frustration of families ... trying to access a Camhs service or any mental health service for their child, was profound,” she added.

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The Independent Review of the Provision of Child and Adolescent Mental Health Services looked at the service across all nine community health organisations (CHOs), and followed Dr Finnerty’s interim report, which was published in January due to her grave concerns about what was emerging in the five CHOs that had been inspected up to that point.

There were “unacceptable variations” in care depending on location, the report said, and it was “difficult to see this as anything except a postcode lottery for children and their families”.

Inspectors found that one team had 140 “lost” cases – where children were left without follow-up and their cases ‘lost’. These had been identified by the HSE before the inspectorate’s review and all 140 children had been contacted “and no adverse impacts have been identified for any”, a HSE spokeswoman said.

“Another team in another CHO did not follow up their patients for up to two years despite these children being on continuing medication,” the report adds.

Earlier this week, a 15-year-old boy affected by the care he received at South Kerry CAMHS had a settlement of €92,500 approved by the High Court. The HSE is facing hundreds of further claims alleging inadequate treatment from the service.

Dr Hillery said children with mental health difficulties have been for too long “discriminated” against – seen as “being bold” or having “behavioural problems”, tending to get “put out of class” and “disappeared”. He said Dr Finnerty’s report was “probably the most important report” the commission has published.

Calling for immediate, interim regulatory powers, authorising the commission to inspect Camhs services and take enforcement action to address failings, he said the crisis was “too important to wait” for the forthcoming Mental Health Bill.

“This is an issue for the Cabinet and the relevant Ministers ... We would be looking for the Taoiseach to take a lead on this,” he added.

Welcoming the report, Minister of State for mental health Mary Butler said: “The need to expand the commission’s regulatory function is already being addressed in provisions of a new Mental Health Bill, which is currently being finalised as a priority for introduction to the Oireachtas.”