Only 1 per cent of mental health services are statutorily regulated, leading to uneven and unsafe care for children and adults, an Oireachtas committee has been told.
Child and adolescent mental health services (Camhs) are “simply not working” and urgently need to be reformed, according to the Mental Health Commission.
The extent to which the vast majority of mental health services are not legally regulated surprises people, Dr John Hillery, chair of the MHC, told TDs. “This means that every other mental health service in the State, including community Camhs, is not regulated under the framework of the 2001 Mental Health Act. Most of the professionals who work in the services are regulated by professional bodies but the systems, the premises and the providers responsible for those systems and premises are not.
“The inspector of mental health services does have the statutory power to visit, inspect and report on any premises where a mental health service is being provided. However, neither the inspector nor the commission have the powers to set standards and ensure services comply with these standards by way of monitoring and enforcement.”
The committee met on Wednesday to discuss the final report of outgoing inspector of mental health services, Dr Susan Finnerty, on the service. Camhs has been at the centre of controversy since it emerged two year ago that dozens of children in south Kerry with mental health issues were significantly harmed by inadequate care there.
In her report, published last summer, Dr Finnerty said she could not provide an assurance to all parents in all parts of Ireland that their children have access to a safe and effective mental health service. She was critical of a “postcode lottery” for access to services due to a wide variation in the scope and capacity of Camhs teams. She also identified gaps in governance, a lack of clinical leadership resulting in unsafe practices and a lack of central planning to provide child-centred care.
The implementation of Dr Finnerty’s recommendations “cannot wait” and independent monitoring of their implementation must be established immediately so that the public can be assured that steps are being taken to ensure the safe and comprehensive delivery of mental health services to children and young people, Dr Hillery said.
“It is clear to us from her final report that the current systems for Camhs services are simply not working. These systems lack basic management, information gathering and oversight structures that are needed to operate safe and effective services.”
The HSE, with support from the Department of Health, must immediately start to put together a formal strategy for this restructure of Camhs, he said.
Prof Jim Lucey, who has succeeded Dr Finnerty as inspector of mental health services, criticised the absence of uniform standards across the service “from Dundalk to Donegal, from Kilkenny to Killarney”.
Providing healthcare is like running an orchestra, he said; there was no point in investing in the band if one part of it is not working properly.
He said great progress has been made in implementing standards in residential mental health standards. Nine out of every 10 of these achieve 90 per cent of standards.
This progress has not been made in child and adolescent mental health services, though.
“You cannot have a healthcare industry without independent regulation. You wouldn’t do it in any other walk of industry.”
David Walsh, HSE national director of community services, acknowledged there are service deficits in Camhs and repeated earlier apologies to children who have not received a proper standard of care.
Many of Dr Finnerty’s recommendations are being progressed and specific concerns are being addressed promptly, he told TDs. “Specifically, there are no children or young people ‘lost to follow-up’ and there are currently no active concerns with regard to these cases.”
