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Senator Freeman launches Public Consultation Committee Report on Children’s Mental Health in Ireland October 2017

In early 2017, I requested a Public Consultation Day in the Seanad to discuss the adequacy of mental health services in Ireland for children. I was granted the day and accordingly an invitation was sent out to the public inviting submissions from parents, service providers and lobby groups operating within the mental health service in Ireland.

The under-funded state of mental health services for children was brought into sharp focus during the Committee’s oral hearings which took place on the 29th June 2017 and 6th July 2017. This is the first time the Houses of the Oireachtas invited in members of the public to voice their experience of mental health services in Ireland.

Interestingly, weeks before the Committee sat, one of four child inpatient units (Linn Dara Inpatient Unit in Ballyfermot) in Ireland for acute mental health problems closed 11 beds, bringing the existing bed compliment in Ireland, with a population of 1.25 million children, to 48 beds. The reasons for the closure cited by the Government were “nurse shortages”To say that it was high time to address these problems would be an understatement.

During the course of the oral hearings, we heard of interested parties. I found the submissions from the parents to be extremely moving and deeply distressing. The parents who submitted to the Public Consultation Committee made clear that waiting lists were a huge obstacle to effective treatment.  Their experiences were, in my view, the most useful yardstick by which the success of CAMHS could and can be measured. Parents have firsthand experience in recognizing some of the obstacles accessing these services at a time of crisis. I hope that this Report gives due weight to those experiences and reflects what is necessary to meet those basic needs.

After the oral hearings were concluded, I set about writing a report to reflect the recommendations discussed by the Commmittee.

What struck me in reading the submissions is that practical, cost-effective change can take place that would address the systemic problems in accessing CAMHS in Ireland. By practical change, I mean institutional re-working of patterns. Take for example the issue of waiting lists for child assessments in Ireland. At the time of writing this report, there are 2,818 children waiting clinical assessment by a Consultant Child Psychiatrist in Ireland. Some 218 of those children have been on that waiting list for over a year. There are insufficient numbers of child psychiatrists to carry out those assessments across multiple CAMHS areas. In her submission to the Committee, Professor Joyce O’Connor, co-author of A Vision for Change, suggested to delegate the clinical assessments to other members of the multidisciplinary CAMHS team at tier 2. For example, the psychiatric nurse who forms part of the team. This would be a practical change would could be implemented in a cost-effective and almost immediate basis.

Some of the submissions received by the Committee reinforced 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.

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

As Rapporteur, it is my hope that the recommendations of the 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.

I echo the wiser words of Dr. Geoffrey Shannon in his submission to the Committee to the effect that when the State offers to provide a public health service to a child and fails to deliver that service, it has failed that child twice. That can have devastating consequences. This failure should not be foisted on our young people when they are at their most vulnerable. These are some of the most vulnerable children, the most vulnerable people, in society. How they are treated and the experiences they have now will have massive implications for their future and, consequently, massive implications for our society. They will become our teachers, politicians and policymakers. They have much to offer our society and how we treat them now is vital.

You can access the report here: