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College of Psychiatrists states CAMHS report has not “adequately” taken account of governance deficiencies

By Reporter - 23rd Jan 2023

The College of Psychiatrists of Ireland has stated the new Mental Health Commission (MHC) interim report on child and adolescent mental health services (CAMHS) has failed to take adequate account “of poor governance structures and support systems”.

While welcoming and supporting the publication of the interim report, the College said it has also not sufficiently addressed “the significant doctor recruitment and retention crisis in our mental health services at present”.

The MHC interim report arising from an independent review of the provision of CAMHS in the State, found that children and young people accessing mental health services with open cases have been “lost” to follow-up care.

The interim report found that in one Community Healthcare Organisation (CHO) alone, there were 140 “lost” cases within the CAMHS team. These children and young adults “lost” within the system did not have an appointment, in some cases for up to two years.

According to the College’s statement in response to the report: “Despite the College calling for inspection of community mental health services, including CAMHS, this has not occurred as it has for approved centres.  Regrettably, had the necessary inspections and reviews taken place years before now, the distressing and upsetting situation for all those waiting for and in CAMHS, including serious shortfalls identified by the Maskey Report into South Kerry CAMHS, would have been uncovered and highlighted for action before now.”

 “The service provided by CAMHS is equivalent to hospital level, consultant-led and multi-disciplinary team care in the community for children and adolescents with moderate to severe mental illnesses. Consultant CAMHS psychiatrists are central to this. The same support structures, and patient/ family -friendly appropriate clinic buildings, are needed for consultants and multidisciplinary teams practicing in both these service locations. This would ensure that best evidenced practice, driven by appropriate expertise, is the foundation of the patient-centred care provided.”

The IHCA said the report has shown health service management’s failure to adequately and safely staff the mental health service or provide the capacity needed to ensure that patients receive essential care.

Commenting on the interim report, IHCA Vice-President and Consultant Liaison Psychiatrist, Prof Anne Doherty said: “The consequences of failing to have the necessary level of staffing and required frontline supports across our health service have once again been cruelly exposed, this time by the Mental Health Commission who deemed the risk to patients within the child and adolescent mental health service so serious that a decision was made to publish an interim report while vital investigations are still ongoing.”

“The failings identified in the interim report unfortunately come as little surprise to consultants working in frontline Mental Health Services on a daily basis and who have been desperately highlighting the need for more specialists and greater capacity across the board for years.”

The HSE has also issued a response to the interim report.

Commenting, Mr Damien McCallion, HSE Chief Operations Officer, said: “This Mental Health Commission report comes at a time when we have a major CAMHS improvement process underway, and we will be putting a senior clinical/operational team in place to drive and support that process. This interim report, as well as the current prescribing review and other ongoing HSE audits in CAMHS, combined with the service improvement work underway, will all contribute to this process.”

“The report makes systemic findings and conclusions, as well as highlighting concerns about the specific care provided to some children. The HSE engaged with the Inspector of Mental Health Services in the course of her work and where specific concerns were identified, we immediately put in place targeted actions plans to address them. In the case of all children where concerns have been raised by the MHC in their report, these have been managed directly by the service caring for them.”

At this stage in the review of the provision of CAMHS, five out of nine Community Healthcare Organisations have been completed. These are CHO 3 (Clare, Limerick, North Tipperary/East Limerick) CHO 4 (Kerry, North Cork, North Lee, South Lee, West Cork) CHO 5 (South Tipperary, Carlow Kilkenny, Waterford, Wexford) CHO 6 (Wicklow, Dun Laoghaire, Dublin Southeast) and CHO 7 (Kildare/West Wicklow, Dublin West, Dublin South City, Dublin Southwest.)

The Inspector of Mental Health Services’ review is continuing with the remaining four CHO CAMHS, and this will involve further meetings with young people, parents, and stakeholders. These areas CHO 1 (Donegal, Sligo/Leitrim/West Cavan, Cavan/Monaghan) CHO 2 (Galway, Roscommon, Mayo) CHO 8 (Laois/Offaly, Longford/West Meath, Louth/Meath), and CHO 9 (Dublin North, Dublin North Central, Dublin Northwest).

The Inspector’s final Report is due for publication later this year.

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