Youth mental health services could be scaled back in some areas to reduce risks to children - HSE

Child and adolescent mental health services (Camhs) could be scaled back in some regions to improve safety and reduce serious risks to the children accessing them, senior HSE officials have said.

Dr Amanda Burke, executive director of mental health services in Galway and Roscommon, told the Oireachtas subcommittee on mental health that it was “not a popular one to tackle” but there was a need to “take a hard look” at the Camhs care model given the issues identified in a recent Mental Health Commission report.

During a session on the commission’s interim review of the service, the committee heard that none of the 73 Camhs teams was fully staffed, all had a “risky” paper-based filing system, staff felt “burnt-out” and “isolated” and that adverse media reporting prevented recruitment of a consultant psychiatrist for the north Kerry region.

The commission’s interim report on Camhs, published last month, identified serious risks to the safety and wellbeing of children accessing the service in four of the five community health organisation (CHO) areas reviewed. It found poor monitoring of medication, children waiting days in emergency departments for psychiatric care, and children left unreviewed on antipsychotic medication for years.

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Dr Burke said the HSE was “going to have to take a hard look at the model we are pursuing at the moment which is trying to provide everything everywhere”.

Under Camhs’s current model of care, she said, responsibility for every child’s care was “vested” in the consultant psychiatrist managing each team.

“There needs to be a consultant psychiatrist available everywhere,” she said. It was “commonplace” in other jurisdictions that clinical governance was “shared” between a consultant psychiatrist and a team co-ordinator.

[ My daughter thinks someone in our home is trying to kill her. I called Camhs. No availability ]

Full multidisciplinary Camhs teams could not be provided in each area, she added. It would be “much safer” to have fewer centres of excellence.

“It’s not a popular one to tackle, because what it means is you cannot provide the same service in every geographical area.

“Personally, I think if you cannot fill a properly staffed team over a number of years, well then... you need to change your model of care. We need to look at evidence ... and the evidence base for therapy is for people who do a lot of the therapy and see conditions a lot, not for someone who is only seeing one or two [cases of a condition] a year.”

She detailed her preference for centres of excellence with core staff in nine “hubs”. Staff could travel to hold clinics locally, in a “hybrid model”.

“We can ... do clinics and we can have a centre of excellence for particular, more rarely occurring illnesses. For example, we need a good solid programme for early intervention in psychosis. It’s rare but it’s really serious... the same with eating disorders... I favour a programmatic approach and I feel that really strengthens governance. To do that, we are going to have to take a hard look at the model we are pursuing at the moment which is trying to provide everything everywhere,” she said.

[ The Irish Times view on the report on child mental health services ]

The HSE had four Camhs hubs “in development” and would seek funding to establish five more, HSE chief operations officer Damien McCallion said.

Mark Ward TD (Sinn Féin) asked why the Camhs service in CHO 6 (Dublin south, Dún Laoghaire, Wicklow), was found by the commission to be safe.

Jim Ward, head of mental health services, said the key difference was the Camhs there, run by St John of God, had an IT system. “That is something that clearly, we absolutely want and we have taken steps... of putting in a system that can work across Camhs,” he said. A decision on an interim IT system for Camhs would be made “in coming weeks”.

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Dr Burke added: “One of our biggest deficits at this time is we are completely paper-based.” This was “risky” as “files can get lost”. Mr Ward said it was “bonkers” in the 21st century.