An interim report from the Mental Health Commission, on Child and Adolescent Mental Health Services (Camhs) is alarming. Depressingly, it comes as little surprise to many familiar with the service.
Chief mental health inspector Dr Susan Finnerty is to be commended for her clear, unflinching account of deficiencies in the care of mentally ill children. She describes Camhs as “unsafe” and marked by “failure to manage risk, failure to fund and recruit key staff, to look at alternative models of providing services when recruitment becomes difficult, and failure to provide a standardised service”.
The findings of her report are deeply concerning. Among them are: poor monitoring of medication; children waiting days in emergency departments for psychiatric care; children left unreviewed on antipsychotic medication for years; exhausted, overwhelmed and inadequately supervised staff; psychiatrists not trained to work with children; poor clinical governance; and chaotic, paper-based record-keeping.
In one community health organisation (CHO) area 140 children with open cases had been “lost to follow-up”. They needed appointments, and “included children on medication, with some reaching their 18th birthday with no discharge or transition to adult services.” The Health Service Executive (HSE) says all have now “received appropriate care”. In another CHO a child waited four days in an emergency department to be assessed by a consultant psychiatrist.
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Dr Finnerty’s interim report makes two recommendations: that all open cases be reviewed, and that Camhs be regulated under the Mental Health Act 2001. This would empower the commission to take enforcement action where failings occur.
Budget 2023 increased mental health funding to ¤1.2 billion, a historic high to be welcomed. But mental health remains the Cinderella service of our health system, receiving just over 5 per cent of the total health budget, compared with the 12 per cent recommended by the World Health Organisation and 13 per cent allocated in the UK.
The Camhs budget is not ringfenced, meaning Camhs teams compete with those in adult psychiatry for funding. It requires its own, adequate budget. It is unacceptable that vulnerable children are abandoned to a mental health service not fit for purpose. In a young person’s life there is, as Dr Finnerty writes, “a small window of opportunity to provide early treatment of mental illness or distress to prevent long-term difficulties and illness progressing into adulthood”.
Her final report is due later this year. Between now and then Camhs must demonstrate it is capable of meeting its responsibilities to children. If it fails, the Government must regulate it under legislation.