TDs have raised concerns that child and adolescent mental health services have to “compete” for basic funding, in the wake of a “damning” report published by the Mental Health Commission.
There have been calls for action since a report into Ireland’s child mental health services found it to be disjointed, difficult to access and lacking in monitoring and follow-up care in some cases.
Acceptance rates of referrals to the Child and Adolescent Mental Health Service (Camhs) varied regionally between 38 per cent and 81 per cent, according to the Mental Health Commission’s interim report published on Monday.
It also found that some teams were not monitoring children on antipsychotic medication, that most services had no IT system to manage appointments, and there was no ring-fenced funding for Camhs.
A look-back review into cases in North Kerry Camhs has also been commenced, following concerns raised at those services, and the HSE is reviewing all open child and adolescent cases which have not been monitored for at least six months.
Sinn Féin TD Mark Ward said that hiring an assistant national director was “simply not good enough” and that a national director for mental health within the HSE was needed to coordinate services.
He said that it was “downright scandalous” that children who should have had a review of prescriptions or monitoring of medication did not have an appointment for up to two years.
“For one team, there have been 140 ‘lost’ cases (to follow-up care). This is a complete mess and children were put at unacceptable risk,” he said.
Labour TD Duncan Smith said the report was “one of the most damning reports to have been presented to government in living memory”.
He raised the outdated IT system for follow-up appointments and said the lack of monitoring children on “very heavy drugs” without Ireland having its own national standards was “very worrying” and an “absolute scandal”.
“We need action to ensure there’s a proper audit done, that there’s no child or adolescent person out there that is on antipsychotic medication that was not getting the required supportive clinical care – be it blood tests and physical checks,” he said.
He also told the Dáil that it was “incredible” there was no ring-fenced funding for Camhs, and that it had “to fight, to compete with other health services for funding”.
“So what we have – at the earliest point in someone’s life when they have mental health difficulties – we have a service that is competing with other health services for basic funding,” he said.
He said that the “limited understanding” in some teams as to what constituted a risk and the “haphazard documenting of risks” showed “why this report is damning”.
While acknowledging the failures, Minister for Health Stephen Donnelly denied there was a “total systems failure” and said the interim report “explicitly states that many people are receiving excellent care and treatment”.
Minister of State for Mental Health Mary Butler said that “many of the findings in the interim report relate to specific operational issues within Camhs teams that have been recognised and resolved by the HSE”.
“But young people and their families have the right to expect a service from Camhs that is person centred and that meets the needs in a timely manner,” she added.
“Any single instance that falls short of the high standards that patients and their families should rightly expect is an area of concern.”
Great to be joined by representatives of @adhdireland @Shineonlineirel @ISPCCChildline @MHReform @lustforlife @ChildRightsIRL @Belong_To & @PietaHouse before the debate on the damming report into CAMHS by @MHCIreland pic.twitter.com/WSy9TcJXeQ
— Mark Ward T.D. (@Wardy1916) January 26, 2023
Ms Butler requested a look into all Camhs areas after a report carried out by Dr Sean Maskey found that the care received by 240 young people in South Kerry Camhs “did not meet the standards which it should have”.
Dr Maskey found “unreliable diagnoses, inappropriate prescriptions and poor monitoring of treatment and potential adverse effects” which exposed children unnecessarily to the risk of significant harm.
Significant harm was caused to 46 children and adolescents, including weight gain, sedation and elevated blood pressure.
The HSE apologised to the families and children involved.
Ms Butler told the Dail on Thursday that despite a fully funded consultant psychiatric post being advertised at South Kerry Camhs since 2016, it “is unfortunately still vacant”.
“Although extensive efforts to recruit this post have been undertaken, the HSE do not envisage this post being filled in the short-term, due to a shortage of qualified personnel applying in the area.”
She also said that a screening exercise into cases at North Kerry Camhs had been carried out and “a relatively small number of files” were found to require a full review, and that a full look-back review would now take place.
Representatives from organisations including the umbrella group Mental Health Reform, the ISPCC, ADHD Ireland, Shine, A Lust for Life, Children’s Rights Alliance, BeLonG To and Pieta were in the Dáil public gallery to watch the debate.