Immediate regulation of Camhs must be a priority, warns mental health inspector

Immediate regulation of Child and Adolescent Mental Health Services (Camhs) must be a “priority” due to “serious risks to the safety and wellbeing of children” engaging with it, the chief inspector of mental health services has warned.

Regulation of Camhs under the 2001 Mental Health Act would empower the Mental Health Commission to take enforcement action against its providers – primarily the Health Service Executive (HSE) – where failings put children’s safety at risk.

Dr Susan Finnerty, in a damning interim report on Camhs, also calls for “an immediate clinical review” of all cases where a child has not been seen for six months or more, with particular urgency to identify “open cases of children who have been lost to follow-up” and assess the “physical wellbeing of those on medication”.

Her review across all nine community health organisations (CHOs) comes in the aftermath of last year’s report from Dr Sean Maskey on south Kerry Camhs which found 240 children received substandard care and 46 were harmed.

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Dr Finnerty’s interim review covers five CHOs. She issues this interim report “because of the serious concerns and consequent risks for some patients that we have found across four out of five [CHOs]”.

“The concerns include the risk to safety and wellbeing of children receiving mental health services, management of that risk and lack of clinical governance.”

Concerns are identified across CHOs 3 (Clare, Limerick, north Tipperary), 4 (Kerry, Cork, including west Cork, and North and South Lee), 5 (Carlow, Kilkenny, south Tipperary, Waterford, Wexford), and 7 (Dublin east, Dublin southwest, Kildare, west Wicklow).

Only CHO 6 (Dublin south, Dún Laoghaire, Wicklow) had a safe Camhs, though it is not identified in the report.

The review found “lack of staff with high turnover, lack of capacity to provide needs-based therapeutic programmes, poor monitoring of medication, lack of clinical governance, and long waiting lists all leading to risk to the safety and wellbeing of children”.

Families told the commission “of their child deteriorating on waiting lists, of sourcing expensive and geographically distant private care... They spoke of a lack of contact and reviews with Camhs, of being discharged to no service because they did not want their child to have ADHD medication, and of early discharge before they thought their child was ready.”

Children were left for up to two years on psychotropic drugs without review “with safety repercussions”, while others with open cases were “lost” without follow-up.

In one CHO, 140 children “were lost to follow-up” including “some reaching their 18th birthday with no discharge or transition to adult services”. All 140 children had been contacted “and no adverse impacts have been identified for any”, a HSE spokeswoman said.

Dr Finnerty writes: “All of these issues require a national response rather than a piecemeal ad hoc approach of trying to remedy each situation within each CHO or Camhs team. There is no evidence that a national co-ordinated approach is being taken.

“Instead, we have consultant psychiatrists from different areas seeing children over weekends or online; multiple consultant cover from other teams which is confusing for staff and families alike; CHOs not aware of the budget they have to implement urgent and extensive changes; and only auditing when a crisis occurs and not routinely as a safety and quality improvement.”

While children aged up to 18 make up 25 per cent of the population, Camhs gets just 10.8 per cent of the overall mental health budget, the report notes. And even this is not “ring-fenced” meaning CHOs “cannot plan for the services they needed for Camhs, based on a Camhs budget”.

“There was unavoidable competition between projects for adult and children’s mental health services when looking for funding,” says the report. “Approval for staff was done by the HSE centrally and not locally, making it difficult, based on priorities, to get funding for specific posts.”

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The commission escalated five children’s cases to senior HSE officers “due to risks to the wellbeing and safety”.

It said that while it would “monitor” actions, the commission “has no legal power to enforce any action”.

“Immediate regulation of Camhs under the Mental Health Act 2001 should be a priority,” writes Dr Finnerty.

A HSE spokeswoman said Camhs was “providing care to 20,000 young people nationally and sees 225,000 appointments annually”.

Dr Siobhán Ní Bhríain, national clinical director for integrated care, said Camhs was “critically important to many young people and their families”.

“We know that there are many challenges in the current service... and we continue to work hard to improve the services we provide. This has included further developing Camhs teams and youth mental health responses, developing specialist services and clinical programmes to support children and adolescents experiencing mental health difficulties, further developing our suicide prevention programmes, investing in mental health in primary care, modernising forensic services and building digital platforms for easier access to services.”

Anyone concerned about a young person engaging with Camhs should call 1800 700 700.