Urgent need for staffing in Children’s mental health services - Seanad Public Consultation Committee report

In order that the equity and accessibility of mental health services for children be enhanced, the Committee makes a number of key recommendations which should be given appropriate consideration in the upcoming review of A Vision for Change, the policy framework for the delivery of mental health services for a 10-year period to 2016.

The submissions received by the Committee reinforce previous findings that there is a chronic failure by the HSE to recruit psychiatric nurses and consultant child psychiatrists to operate the existing bed compliment in Ireland, matched with a refusal to alter pay agreement structures and working conditions to attract employment.

Primary Care should be urgently staffed with the level of psychologists recommended in A Vision for Change and updated in accordance with child population data in 2017, according to the report which recommends that 180 child and adolescent psychiatrists should be in post by 2020 applied by reference to need in each Community Health Organisation area. It also says that the two-tier remuneration for nurses and consultants qualified post-2012 should cease.

In relation to access to services, the report recommends:

• Clinical Assessments at Tier 2 should be delegated to Psychiatric Nurses to immediately reduce CAMHS waiting lists
• Initial Assessments ought to be considered as a means of triaging waiting lists and filtering referrals to appropriate services
• Waiting Lists should be triaged in accordance with urgency and need
• CAMHS referral criteria should be expanded to include children with intellectual disabilities
• CAMHS must be extended nationwide to children up to the age of 18
• Admissions to Adult Psychiatric Units should be prohibited
• CAMHS out-of-hours service must be extended across all CHO areas for acutely ill children and adolescents
• CAMHS ought to measure geographic need for services and distribute services in accordance with need and not solely population size

Seanad Leas-Chathaoirleach and Committee Chairman, Senator Paul Coghlan said: “I believe that the recommendations set out in this Report are a valuable and timely input into the review of mental health services currently under way. I hope that the recommendations in this Report will be taken on board by the Government, and I look forward to engaging with the Minister of State at the Department of Health with special responsibility for Mental Health when the report is debated in Seanad Éireann.

Finally, I would like to pay particular tribute to Senator Joan Freeman for proposing this topic for discussion and for acting as Rapporteur in the drafting of this report, which was adopted by the Committee. Senator Freeman is to be commended for her tireless work in helping vulnerable people. I also wish to thank all the members of the Committee for their engagement in this public consultation.”

Report rapporteur Senator Joan Freeman said: “Every child under the age of 18 years in Ireland has the right to life, survival and development. Every child should have a fair chance in life. Unfortunately, the submissions made to this Committee suggest that the restricted allocation of resources to mental health services for children and adolescents do not appear to prioritise needs based, timely services, nor does the allocation of resources takes account of the greater need for mental health services in areas of deprivation.

“Dr Geoffrey Shannon, Special Rapporteur on Child Protection, told the Committee that when the State takes a child into its care, it is saying it can do a “better job”. He hastened to add that when the State fails that child, it fails them “a second time”. I would like to acknowledge the exceptional strength of the parents who submitted and presented to the Committee. The submissions received from parents reflect the traumatic consequences this can have. We have raised expectations only for those expectations to be dashed in the context of poor communication between agencies and the failure to deliver on services.

“This Report not only reflects the serious flaws in Children’s mental health services but also the solutions to these issues. As Rapporteur, It is my hope that the recommendations by this Committee go some way towards re-thinking the vision for mental health services for children in Ireland in the near future, with a renewed energy to aim for the impossibly high standard of treatment we demand for our own children.

“The vision in A Vision for Change should not just be a vision, it should be a reality.”

You can read the report here.