We have recently heard of the bulging “public coffers” and the potential they offer. It has rightly been described as our first-ever moon shot, a chance to do something we were not in a position to do before. If €50 million-plus of that moon shot is to be well directed, there is nowhere better to aim it than towards the children of the nation and their mental health services.
Those services are not what anyone in Ireland expects and there would be no disagreement to invest in them. To illustrate the problem, the Mental Health Commission has just published the review of Child and Adolescent Mental Health Services in Ireland (Camhs). This review was to provide an independent expert view by the inspector of mental health services of the provision of Camhs in Ireland following the findings of the shocking Maskey report on South Kerry Camhs in January of 2022.
The latest report finds areas of good practice and good treatment of children throughout Ireland. However, more worryingly, the report reveals that children in many parts of the country with severe mental illness are being denied access to essential mental health services, and it discloses serious and ongoing concerns with corporate and clinical governance within the HSE.
Unfortunately, this is at a level where the inspector of mental health services states that she “cannot currently provide an assurance to all parents or guardians in all parts of Ireland that their children have access to a safe, effective and evidenced-based mental health service”.
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Having been involved in the regulation of services for many years, including the nursing home sector (after the Leas Cross scandal) and the charities sector (after the Console scandal), I know that to resolve the problems identified, the State and the HSE need to accept the problems, but – and perhaps more critically – implement the recommendations and solutions. Fixing the Camhs system requires a comprehensive and strategic commitment to action from the State and the HSE including ensuring services are regulated and properly funded.
The inspector’s report evidences that many children in Ireland in 2023 are not receiving appropriate treatment in a timely way. Parents are frustrated and heartbroken at the lack of services. Clinicians want to help these children but are frustrated that there is not enough money invested in this key service and early intervention. That is our moon shoot.
There is no question that there continues to be significant resourcing challenges, not least in the area of staffing. But the report is clear that the HSE needs to invest in its current staff to retain them, while ensuring good governance and ICT systems to enable them to deliver services, rather than leaving staff to struggle without full multidisciplinary teams.
The Mental Health Commission sincerely hopes the State responds strongly to this report to ensure that no child lingers on waiting lists or receives a suboptimal service. Strong and immediate action is required. The recommendations must be accepted and implemented.
The report has 49 recommendations. Only until all 49 recommendations are implemented can parents be assured that children in all parts of Ireland are receiving the safe and effective care and attention to which they are entitled. It is what we all want and what any Irish person will tell you they think their tax should be spent on.
While the failures are clear and obvious, so too are the solutions. Invest and ringfence the money required, reform the governance in the HSE and ensure independent oversight; this shall ensure that all care is in accordance with operating procedures and that we invest in supporting staff. Do this and we are on a pathway to the future, and we can finally look forward to a system of mental healthcare for children and adolescents that is fit for purpose with the child and their family at the centre.
By investing in specialist services for children, we improve outcomes for individuals, communities and the country. A plan to make this happen is essential as is the regulation of Camhs to ensure a minimum standard of care and treatment is provided nation wide.
This plan needs to be funded. As noted, at the outset, the report indicates that a minimum of €50 million extra per annum is required to ensure all children receive equal treatment from a full team of clinicians.
From whichever angle you look at mental healthcare in this country, it is clear it has never received the priority it deserves. If we are to finally remedy that, some key measures must be taken.
The Government, the Ministers, the Department of Health and the HSE face many challenges and requests. However, what we simply cannot deny is that children in Ireland who experience mental illness must be provided with the services they need to regain their health in their own community. This is not a new concept. This notion has not come from a new policy. This is something that has been recognised, accepted, and requested time and time again by parents, families, carers and mental health staff for more than 20 years.
Our country has a dark past in relation to protecting children. Our current generation of politicians, public servants and clinical staff must rise, and we believe can rise, to the challenge of ensuring that history is not repeated.
John Farrelly is chief executive of the Mental Health Commission