The Mental Health Commission has published its report into the provision of Child and Adolescent Mental Health Services in Community Healthcare settings.
The Commission's report is a damning indictment of the deepening crisis in our mental health services.
'Serious concerns were also expressed about one facility in the Sligo, Leitrim, Donegal, Cavan and Monaghan area, where the management of one team was placing children at risk of being 'lost' in the system.
CHO 1, covering Sligo, Leitrim, Donegal, Cavan and Monaghan, had six areas of concern including that one team had no occupational therapist or psychiatrist; serious concerns about the management of clinical files; and not having up to date reviews of some patients.
There were serious staffing shortages in Cavan/ Monaghan CAMHS where one team had only 65% of recommended staff. Access to speech and language therapy across the three teams was severely curtailed due to a limited number of speech and language therapists.
Cavan/Monaghan CAMHS Service also encountered a period where there were no CAMHS consultants available to the teams. There is no CAMHS out-of-hours service in Cavan/Monaghan which means that emergency departments are often the last resort for children and young people experiencing a mental health crisis. Overall, the report indicates there is a lack of clinical governance in CAMHS across the region.
The failure to manage risk, recruit key staff and provide standardised care is resulting in 'dysfunctional' and 'unsafe' mental health services for children and young people.
Community Healthcare Cavan, Donegal, Leitrim, Monaghan, Sligo has released the following statement:
"On the 31st of August 2023, the Mental Health Commission (MHC) published a regional report entitled “Community Healthcare Organisation 1 (CHO1), Child and Adolescent Mental Health Service Report 2022 – 2023. CAMHS is a specialist service providing clinical assessments and therapeutic interventions for young people under the age of eighteen, who are experiencing moderate to severe mental health difficulties. It is not for everyone; only a small percentage (approx. 2%) of the population would require access to this service. Community Healthcare Cavan, Donegal, Leitrim, Monaghan, Sligo (CH CDLMS), formerly known as CHO1, consists of eight CAMHS teams serving an under eighteen-year-old population of 103,778. Three of the teams are located in Donegal, three in Cavan/Monaghan, and the two Sligo/Leitrim teams are co-located in Sligo Town. The geographical area borders Northern Ireland, is rural and sparsely populated, with high levels of deprivation including poor transport infrastructure and social support".
"We have from the onset acknowledged that significant improvements are required in CH CDLMS CAMHS and have invested regionally funded resources in the absence of national funding. We will continue to advocate for additional funding for our CAMHS teams through the annual national service planning process. All of the teams are experiencing an increase in the volume and complexity of referrals, with services under pressure as demand continues to exceed capacity. Additional recurring investment is required to build capacity to keep pace with the growing demands and increased complexities experienced by our CAMHS teams. The CH CDLMS Executive Management Team is committed to strengthening clinical governance and has decided to progress with the recruitment of a CAMHS Clinical Director and Practice Managers as key elements of the service improvement plan subject to national approval".
"Where concerns were raised by the Inspector of Mental Health Services regarding specific service users, immediate actions were taken to seek and provide assurances to the MHC regarding the safety of those service users. An immediate review of the identified cases was undertaken by an external review team, under the stewardship of a senior and experienced lead clinician. Confirmation was provided to the MHC that the five cases identified were reviewed regularly by their CAMHS team during 2023, with follow-up appointments documented in their files. To provide additional assurances, an additional two hundred and ninety-one open files and twenty closed files were also reviewed by the lead clinician and the review team confirmed that they did not identify any young people whose care was found to be of serious concern. The MHC was provided with the findings of the external review and it is welcome that they have acknowledged this in their report".
"Several service improvement initiatives have commenced including a targeted Wait List initiative programme. The current number of service users waiting for an initial assessment is 320 (31st July ’23) compared to 447 (10th Mar ’23), representing a reduction of 28%. The number of service users waiting more than 12 months for an initial assessment is currently 8 (June ’23), compared to 34 (Mar ’23), representing a reduction of 76%. There is a concentrated focus on team development with tailored CAMHS Risk Management Training and Individual Care Planning (ICP) provided to all CAMHS staff, with over seventy frontline staff attending a facilitated workshop, supporting cross fertilisation of learning and experience. Notwithstanding the progress made, we know there continue to be gaps and weaknesses in the current service, with work ongoing to expedite the recruitment of key frontline staff and to ensure that all teams and line managers are supported in building a culture of compassionate leadership across CAMHS with a focus on greater job satisfaction, enhanced staff wellbeing, job satisfaction, ultimately leading to enhanced quality of care for the service users".
"We encourage anyone engaged with a CAMHS service to stay connected with their team and any parent or guardian with a concern or query about their child who is currently attending CAMHS should either contact their child’s team directly or call HSE Live at 1800 700 700 who will take their details and arrange for someone from their CAMHS team to contact them if necessary".
