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'We're lingering in no-man's-land': Parents decry mental health services facing their children

The final report into Child and Adolescent Mental Health Services found a range of failures across the system.

PARENTS HAVE DECRIED the state of the country’s Child and Adolescent Mental Health Services (CAMHS) following the publication of a damning new report.

The study into the provision of the service by the Inspector of Mental Health Services, Dr Susan Finnerty, was published by the Mental Health Commission (MHC) today and found that the state cannot currently provide assurances children have access to a safe, effective and evidence-based service.

She described it as a “failing system that needs a radical overhaul” to have any chance of providing fulsome care to people through its regional Community Healthcare Organisations (CHOs).

Parents who spoke to The Journal, some on condition of anonymity, outlined the worsening state of their children’s health amid the long wait for treatment.

They said they have been “actively encouraged” to find treatment through private counselling for conditions ranging from self-harming to suicidal ideation.

One mother in Wicklow said her 15-year-old daughter had been “bounced from pillar to post” by CAMHS.

“I’m a single parent and private counselling is something I cannot afford, and my daughter is so disillusioned by the whole thing that she no longer wishes to participate in therapy,” she said.

Since then, she has “essentially been trying to counsel her myself”, but added that she holds no experience or qualifications in this.

I’m just doing what I can to keep an open mind without judgement and keep that channel open with her. So far so good, but there are dark days too. The non-existent system has completely failed us. I continue to worry even more for her as she gets older.

In Donabate, Fiona Cosgrave said efforts to have her son Isaac seen by the north Dublin CAMHS service have left her increasingly “hopeless” at the situation.

The 11-year-old has been on the service’s waiting list for a year-and-a-half now, having previously been diagnosed with moderate autism and moderate to severe intellectual disability.

“We’re lingering in no-man’s-land,” she said.

Cosgrave also said the service has told the family they will not accept Isaac has mental health issues “despite his self-harming getting progressively worse”.

Reacting to the report, she said: “It’s incredibly hard to articulate how I feel about this but I’ve been through all of the emotions and if I had to say to Leo Varadkar how I feel, I would say I’m determined to hold someone accountable for this and I won’t rest until it’s done.

“If any child in the country gets sick tomorrow, they can go to their local hospital and get treatment. We’ve been told that our children are ineligible for treatment and they must remain sick. How is that fair?”

fiona isaac Fiona Cosgrave and her son Isaac

Fiona added that parents are increasingly trying to organise and would have taken note of the MHC’s findings that the failures in the service point to a possible breach of human rights for children.

Long waiting lists, lack of capacity to provide appropriate interventions, “lost” cases of children, lack of emergency and out-of-hours services, difficulties in accessing primary care and disability services are among the reasons cited by Dr Finnerty that Article 24 of the UN Convention on the Rights of the Child, which was ratified by Ireland in 1992, may have been breached.

Dr Finnerty noted the absence of monitoring certain medications in CAMHS as another cause for concern which may breach Article 24.

“I can’t wait for when politicians are back around on the doorstep. I think they bank on us being too tired to fight back. But we’re not that tired that we can’t mobilise,” Fiona said.

Following consultations with medical practitioners, it was recommended that the family try for a psychiatric assessment and treatment through CAMHS.

The family learned of the existence of CAMHS-ID teams, for people with an intellectual disability.

However, these teams, officially launched last September, remain “some way short” of their necessity staffing level according to the Mental Health Commission – at just 23% of the recommended staffing level.

Overall, the vast majority of CAMHS teams were found to be significantly below recommended staffing levels, with some being 50% below staffing.

“The cost and inaccessibility of psychiatrists here have us looking abroad for treatment,” Fiona said, adding that the price of a private assessment for her son Isaac would cost the family €2,000.

“Isaac is a happy little boy a lot of the time but he’s hurting himself. He has a great life in a lot of ways but he could have an even greater life if he got what he needs,” she added.

Waterford parent Leslie Hughes founded a mental health charity in the region – called Laochas – the Warrior Soul Project – as families grappled with a buckling system.

“Reading the final report on CAMHS gives me an overwhelming feeling of sadness and frustration,” she told The Journal.

Hughes said families reading the report will find it saying “what many have painfully discovered for themselves, that there is simply no immediate help available to them” in CAMHS.

“They must wait several months and even then, the help is limited sometimes to medication, which is not always monitored with follow up appointments, something as a parent I have experienced myself.”

Hughes said the group has seen first-hand the “soul-destroying” effect it has on families to hear that they will have to wait several months before being seen, if at all.

“In many cases the young person’s mental health can deteriorate leading to frightening episodes while waiting with no service to offer them support while they wait,” she said, adding that organisations like Laochas do their best to bridge the gap, but she stressed tha it’s time for the “HSE to step up and start providing a more efficient holistic service with support for families and aftercare”.

“There is no doubt that there are fantastic professionals working within the service who are doing their best but as it stands and has been for some time it is not fit for purpose,” she said.

Recommendations

Dr Finnerty said that there is “a postcode lottery” in CAMHS with “very little access” to CAMHS depending on where the young person lives, and made 49 recommendations in total.

Primarily, it recommends that the immediate and independent regulation of CAMHS by the MHC must be put in place “to ensure the State and the HSE act swiftly to implement the governance and clinical reforms to help guarantee that all children have access to evidence-based and safe services, regardless of geographical location or ability to pay”.

It also recommends that there must be oversight of CAMHS and all other mental health services for children and adolescents by the HSE Health and Safety Committees.

A comprehensive strategy for CAMHS and all other mental health services for children must be prepared and approved by the HSE Board “due to the seriousness of the concerns raised by Dr Maskey’s report and this report”.

Among the other recommendations, the report states that the health service should reinstate the post of National Director for Mental Health in the HSE “as a matter of urgency” while alternative models of care must be considered by the HSE in providing clinical leadership.

It recommends that each CHO must have a clinical director for CAMHS and that each team must have a team or clinical coordinator dedicated to coordinating children and young people’s care.

Minimum staffing levels

The Psychological Society of Ireland (PSI), which has 4,000 members, welcomed the report but warned that more needs to be done to replace the “current fire-fighting with a fit-for-purpose service”.

PSI President Dr Anne Kehoe said that her members see “traumatised children entering a traumatised system” which is failing to deliver the service and supports needed.

“For a CAMHS service that is fit-for-purpose it needs to be resourced to the levels required. We need minimum safe staffing levels for CAMHS teams to operate under, similar to the system used in acute inpatient units,” Dr Kehoe said.

She added that the PSI strongly endorses the three key themes of the report, regarding resources, risk management and rights based care.

The Psychiatric Nurses Association (PNA) described the review as extremely worrying but not surprising.

PNA General Secretary Peter Hughes said there are a number of “red flags” relating to all aspects of the provision of CAMHS, adding that report “has to be the final wake-up call for urgent action” for the service.

Mental Health Reform said the report is a “stark reflection of the systemic failures” in Ireland’s mental health services, with the lack of standardised treatment across the services described as extremely concerning by CEO Fiona Coyle.

“Every child should have access to high-quality, appropriate mental health care regardless of where they live. We need strong leadership, accountability, and immediate action to address these challenges,” Coyle said.

Sinn Féin health spokesman David Cullinane claimed that the report is a “national scandal” for the government, citing its findings that the state cannot currently provide an assurance parents and guardians’ children have access to a safe and evidence-based service.

“Waiting lists for CAMHS have increased by 112% since 2020, with 4490 young people waiting on first-time CAMHS appointments and 752 waiting for longer than 12 months,” the Waterford TD said.

“The government must now take control of this situation and deliver the resources and the safe and effective services that our children and young people need..

The review was carried out of 1,178 files across all CAMHS teams between January 2021 and March 2022 while a review of CAMHS teams’ facilities was also conducted.

The review team also met with all 75 CAMHS mental health teams and six speciliast teams, individual staff and management within CAMHS, and parents and young people with experience of CAMHS services.

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