Underfunded primary care has pushed CAMHS to breaking point

New governance and management structures are needed to reform our child and adolescent mental health services

The 2025 child wellbeing report, published by the United Nations (UN) last month, found that Ireland’s youth “are among the least happy in the developed world”. We rank in the bottom half of 43 OECD and European Union countries for mental health (24th).

Most mental health issues that arise for children and young people can and should be treated comfortably in primary care settings designed for such issues. The child and adolescent mental health service (CAMHS) was established to treat young people with moderate-to-severe mental illness and, in theory, should cater to about 2 per cent of the population. However, perennial underinvestment in primary care means many children are instead referred to CAMHS. This places the service providers under pressure to become a catch-all for any young person presenting with a mental health issue, despite their own well-documented resourcing and governance problems. The inevitable result is a shocking and unacceptable delay in treatment for seriously ill young people who need it as a matter of urgency.

Data from the HSE confirms that we find ourselves in a crisis. As of 2024, over 18,500 children and young people were waiting for primary care psychology services. Of these, more than 7,500 had been waiting over a year for an initial appointment. In some Community Healthcare Organisations (CHOs), families have faced waiting lists of up to seven years, meaning a 12-year-old child would reach adulthood in the time it would take to attain an appointment.

More than 73,000 children with developmental needs are reported to be on waiting lists for primary care services, which include speech and language therapy, physiotherapy, occupational therapy, and primary care psychology. Primary care therapies for mild-to-moderate illness should be the foremost defence in our mental health strategy; however, they have collapsed under pressure. It is no exaggeration to call this an emergency.

Paper

The College of Psychiatrists of Ireland recently published a detailed paper calling for new governance and management structures for CAMHS. It also highlighted the essential need for the development of primary care and school-based services. Formal, meaningful links across all levels of mental health services must be established. This would help to ease lengthy waiting lists, improve access to appropriate interventions and provide quality care for young people and families.

Investment in primary care is essential to improving outcomes. Family therapy, play therapy, and youth counselling often end up being provided by a mix of independent organisations, with uneven coverage and no coordination with primary care services on a national level. UNICEF Ireland has recently called for this situation to be addressed, saying that the Government needs to take targeted action to protect child wellbeing and increase investment in mental health services in schools.

Meaningful links between schools, GPs, counsellors, and CAMHS could be introduced to ensure children get the right help at the right time. Strengthening the frontline of our mental health system is necessary to stem the flow of all cases being pushed towards CAMHS. 

A young person stuck on a waiting list with a minor mental health difficulty can deteriorate and end up with a more serious disorder. Neglecting to strengthen the first point of contact means children end up more severely ill and for a longer period of time. Properly funded supports in primary care settings would help detect problems early and prevent their escalation. A well-staffed network of family therapists and youth workers across the country would also help this cause.

According to the aforementioned UN report, one in three Irish 15-year-olds were reported as having ‘low life satisfaction’. This is the at-risk group that we are failing to reach because of gaps in our system. The sector urgently needs proper resourcing, funding, and governance to offer patients the standard of care they deserve. The Government must begin its work with haste, because Ireland’s youth deserve better than a system that can only react when a child becomes critically ill. In failing to build stronger links between primary care services and CAMHS, we continue to condemn children to years of needless suffering.