In 2022, there was widespread shock at the findings of a review of the care received by almost 1,300 children and young people at South Kerry Child and Adolescent Mental Health Services (Camhs). The review, led by Dr Seán Maskey, found “unreliable diagnoses, inappropriate prescriptions and poor monitoring of treatment and potential adverse effects”.
No extreme or catastrophic harm had been caused to the children in the review period, but hundreds received “risky” treatment from one junior doctor and “significant harm” was caused to 46 of them. The report highlighted how there was a prolonged absence of a lead clinical consultant, no effective oversight for supervision, and failures of regional and national HSE management structures to address the risks for children and adolescents attending the service. These risks had been repeatedly notified to the HSE. It was clear that the most vulnerable in our society, children and young people affected by mental illness, were the ones directly affected by these issues.
In the months that followed, the then-government promised a review, and reform. The Mental Health Commission (MHC) published a damning report in 2023 on the governance and management of Camhs in this country. The Inspector of Mental Health Services, Dr Susan Finnerty, reported that “ineffective governance ... is contributing to inefficient and unsafe Camhs ... failure to manage risk, failure to fund and recruit key staff ... and failure to provide a standardised service across and within CHOs [community health organisations]”. Dr Finnerty “[could not] currently provide an assurance to all parents or guardians in all parts of Ireland that their children have access to a safe, effective and evidence-based mental health service”. This was despite the “excellent and skilled staff” who underpin the service.
Camhs is a critical service that aims to provide assessment and treatment for tens of thousands of young people a year who are experiencing moderate to severe mental health illness. Reading these reports, it is obvious we are not able to currently provide these services in a satisfactory manner. This is why a major overhaul of the management and governance of the Camhs services across the country is urgently needed.
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[ Hundreds of children waiting more than a year to access mental health servicesOpens in new window ]
Governance of publicly provided mental health services in this country lies within the HSE. The MHC report revealed what was long known on the frontline: that teams are massively under-resourced and understaffed. The majority of Camhs teams operate with a skeleton staff. Addressing the lack of staffing was prevented by the HSE recruitment embargo in October 2023, and barriers continue at this time with the HSE Pay and Numbers strategy from 2024, which has resulted in a decrease of HSE staff working within the community sector.
[ ‘We can’t recruit’: Psychiatrists propose Camhs reforms to improve patient careOpens in new window ]
It is well documented that mental health problems in childhood and adolescence are associated with detrimental impacts on development through to adulthood. These effects can be seen in our everyday lives. This is what makes changes to the Camhs system an economic as well as a health-related imperative. A 2016 WHO-led study in The Lancet Psychiatry found that for every £1 that is spent on mental healthcare for adults, there could be a cost-saving equivalent of £4. Imagine the economic impact a properly funded service for children and young adults in this country could have. Camhs, at its best, can be a force for both social improvement and economic growth. That is simply not the case at present.
The trust of families who have had difficult experiences with Camhs has been shattered. The mission of the College of Psychiatrists is to promote excellence in mental health services, so following the reports on Camhs, we set up a working group to dig into the problems the service faces. Our view is that key changes are needed in administration and organisation. Resourcing will always be a challenge, but our new policy document says what Camhs is crying out for is solid structures for governance and management. This includes having a specialist consultant leading each Camhs team; staff receiving Camhs-specific training to ensure optimal standards of care; and all members of a team being clinically accountable to the consultant. We also propose the appointment of clinical service managers to each Camhs team to manage the provision of services, facilitate audits of those services and enact performance reviews. At present, these are left to chance.
These are substantial reforms that will transform the ability of the teams in Camhs to work for the patients they treat. The HSE’s streamlining of care into new RHAs (regional health areas) is continuing this year, which is why we see this as an essential time to reform a service that we should all be proud of. Children and young people who experience mental illness cannot afford to continue to wait. While childhood is short, the impact of mental illness in childhood can be lifelong.
This generation of young people is facing greater mental health challenges than any preceding generation. The Government’s own estimate is that as many as one in five people aged 10-19 meet the criterion for a mental health disorder. It is critical we make sure we have systems in place to provide our young people with the care and support they so desperately need. We cannot afford to settle for Camhs structures, governance or resourcing that strive for anything other than excellence. Their childhoods won’t stand still while we wait for change to magically occur.
Dr Patricia Byrne is chair of the CPSychl faculty of child and adolescent psychiatry
