Mental Health Commission publishes final report on Child and Adolescent Mental Health Services

In her final report on the provision of child and adolescent mental health services (CAMHS) in the State, the Inspector of Mental Health Services, Dr Susan Finnerty, has said that she cannot currently provide an assurance to all parents in Ireland that their children have access to a safe, effective and evidence-based mental health service.

The Inspector’s independent review into CAMHS, which she commenced in April 2022 – and included the publication of an interim report in January 2023 – has now been finalised complete with 49 recommendations.

Due to the seriousness of the concerns raised by the review, the Inspector has recommended that a comprehensive strategy for CAMHS and all other mental health services for children be prepared and approved by the HSE Board.

Despite targeted improvements by the HSE to solve some of the issues, the Inspector states in the report that it is a major concern that there are ongoing and serious deficits in CAMHS which is increasing the risk to children and young people.

And while she acknowledged that there are good CAMHS services in the State – calling out in particular “the excellent and skilled staff” who provide services as the “main CAMHS asset” – she stated: “I cannot 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.”

The Inspector found that the issue of access to CAMHS, or any mental health service for a child, was causing “profound” distress and frustration to parents who “expressed concern at how their child deteriorated while waiting for an assessment”.

“Parents did not know where they can get help and information about services for their child and felt that a crisis needed to be reached before appropriate services are offered to them, or that they have to battle with services before help is provided,” she said.

She added that many young people and their families are “frustrated, distressed and are trying to cope with deteriorating mental health difficulties while waiting for lengthy periods on waiting lists for essential services”.

Dr Finnerty also found that there are certain groups of children and their parents who have difficulties in accessing CAMHS due to language, culture, stigma, fears and location.

The Chief Executive of the Mental Health Commission, John Farrelly, noted the finding in the report that one of the primary reasons why CAMHS is not functioning as it should is the lack of effective governance and accountability at both clinical and corporate level.

“The report clearly demonstrates that current systems for governing CAMHS services are not working,” he said. “They lack basic management, information gathering and oversight structures that are needed to operate safe and effective services.

“The Inspector has recommended immediate reform of these structures and has also recommended the independent regulation of CAMHS by the Mental Health Commission to help guarantee that all children have access to evidence-based and safe services, regardless of geographical location or ability to pay.

“The Inspector has found that ineffective governance in some areas is contributing to inefficient and unsafe CAMHS, through failure to manage risk, failure to fund and recruit key staff, failure to look at alternative models of providing services when recruitment becomes difficult, and the failure to provide a standardised service across and within CHOs.

“Regulating CAMHS, under the Mental Health Act, as recommended by the Inspector, would provide the MHC with the statutory powers to immediately work with stakeholders and clinical staff to develop standards and rules for the provision of CAMHS community services in Ireland.

“Currently the MHC has powers to intervene and safeguard children in inpatient units. However, there has been no oversight of community services and this will continue to be the case until the Government introduces regulation of CAMHS community services.

“It is clear from the report that there must now be a root and branch rebuilding of CAMHS, “added Mr Farrelly.

“The HSE, with support from the Department of Health, must immediately put together and publish a formal strategy for this rebuild, including how all the recommendations from the Inspector’s report will be addressed and how the implementation of the recommendations will be overseen.”