The Ombudsman for Children has criticised the State for what he described as a “profound violation of children’s rights” in the areas of mental health and disability care, in correspondence to the Government.
In a letter to the new chief executive of the Health Service Executive (HSE), Bernard Gloster, who was appointed to the role in December, the Ombudsman, Dr Niall Muldoon, said the HSE had “seriously failed in its duty to uphold the rights of children, to the best possible healthcare”.
The letter, dated in March 2023, was obtained by The Irish Times under the Freedom of Information (FoI) Act.
The “poor availability” of therapeutic services within primary care and the HSE’s child and adolescent mental health service (Camhs) over the past 20 years had “meant that very many children have not had their rights upheld”, Dr Muldoon wrote.
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The Ombudsman, who acts as an independent watchdog for children’s rights, said this was “particularly obvious in the geographical disparity in what services are offered and, in effect, means many children are punished for becoming ill in the wrong location”.
There were “too many children waiting beyond six months for an initial appointment” and “justifiable concerns about the quality of care received once a child accesses the available services”, he said.
The Ombudsman referred to the Interim Report of the Mental Health Commission, published in 2023, and the Maskey Report, published in 2022, which “shone a stark light on the poor service that many children receive once they are accepted into Camhs”.
The interim report published this year found that more than 100 mentally ill children, including some on medication, were left for up to two years without care by Camhs.
The report identified serious risks to the safety and wellbeing of children accessing Camhs, including 140 “with open cases [who had] been lost to follow-up”. While not identified in the report, the 140 open cases are known to be in the community health area (CHO) which covers Clare, Limerick and north Tipperary.
The Ombudsman urged the HSE to “begin the process of joint work or joint funding in regard to children’s mental health, with the Department of Equality” to ensure early intervention.
“The lack of interagency co-operation has been a constant frustration and challenge for children and their families. The HSE has too many siloed agencies and services within their own aegis who do not, and apparently will not, work together to ensure the best interest of the children they are charged to care for,” Dr Muldoon said.
Another area of concern for the Ombudsman’s office was the overall care and provision for children with disabilities across the HSE.
“The examples of rights being ignored are numerous and include children with scoliosis deteriorating while they wait for operations, and children waiting for assessments of needs just so that they can begin to access services to help them thrive and reach their potential,” Dr Muldoon said.
The Ombudsman’s office had been contacted by “distressed parents, medical professionals and teachers” who shared stories of parents who “deeply love and care for their children but feel they have no choice but to leave them behind in emergency departments, respite centres and schools simply because they cannot cope”, the letter said.
Parents felt that the only way they could access services for their disabled children was to “walk away from them”.
“We have seen documented evidence of repeated pleas for help from the HSE such as increased home packages, respite care, residential support but they are either non-existent or completely inadequate,” Dr Muldoon said.
The Ombudsman said there had been an “apparent dereliction of duty by the State, through the HSE” in these areas, adding that he found it “particularly galling” that there was an “ongoing disregard as to how to fix these issues” as they were “not new”.
In response to a request for comment from The Irish Times, the HSE said it “acknowledges that there are deficits in current youth mental health service provision“. In response to these deficits, the HSE “has prioritised targeted improvements and investment over recent years, including building capacity in Camhs and youth mental health, developing specialist services and clinical programmes, suicide prevention, investing in mental health in primary care, modernising forensic services and developing digital platforms for accessing services”, a spokeswoman said.
A spokesman for the Department of Health said the Government “remains committed to the development of all aspects of mental health services nationally, including those for children and young people”.
The overall mental health budget increased by 20 per cent during the term of the current Government, and €5 million has been allocated to a new pilot programme of counselling and mental health supports in “a series of primary schools”, commencing in September 2023.
