There is a growing mental health crisis among the children and young people of Ireland, experts believe. Demand for Child and Adolescent Mental Health Services (Camhs) increased by 33 per cent between 2020 and 2021, while simultaneously seeing 21 per cent more cases during the same period.
The services were already stretched before the pandemic but experienced a significant surge as a result of Covid-19.
Camhs has waiting lists that can see some children waiting up to two years for an appointment. The number of children on the list waiting to access the service increased from 2,755 in December 2020 to 4,434 at the end of February 2023.
According to sources working in general practice, this situation means many doctors feel the only option available to them when a child presents with mental distress is to prescribe antidepressants.
This is reflected in Health Service Executive (HSE) figures, which found a total of 15,113 prescriptions for antidepressants were issued to children aged 15 and younger last year, up 130 per cent on the 6,541 issued 10 years earlier.
Mac MacLachlan, professor of psychology and social inclusion at Maynooth University, said there are questions as to whether children this young should be on antidepressants at all.
“If they are, they should only be on a short-term basis and should always be accompanied by a therapeutic intervention which is not drugs based,” he said.
Prof MacLachlan said it raises the issue of a “pill for social ills”, stating that many young people go through periods of depression because of bullying, a feeling of marginalisation or problems at home.
“It’s not always the case that younger people want to share those problems so when they go to a GP, they’ll say ‘I don’t know what the cause is’ and then the GP might be more inclined to think if there’s no obvious cause, then we’ll just give them drugs,” he added.
The impact of Covid-19 on youth mental health is often spoken about and it is something Jigsaw youth mental health charity sees first hand.
“That reintegration back into society [after the pandemic] has been very very difficult. They have been forced to adapt and now, there is a feeling that they’re being forced to reintegrate,” Mike Mansfield, director of communications and fundraising at the charity, said.
Adding to this, according to Mr Mansfield, young people are finding it “really tricky to compartmentalise” their concerns about worldwide concerns, taking the stress on to their own shoulders.
“All research, all studies, all data tells us that young people are struggling to cope more with day-to-day struggles. They’re looking at what’s going on around them. They’re looking at everything from a macro level: global conflict, climate change, there’s a famine there,” he said.
Camhs has received significant scrutiny in recent years. In January of this year, Dr Susan Finnerty, the chief inspector of mental health services, said the immediate regulation of Camhs must be a “priority” due to “serious risks to the safety and wellbeing of children” engaging with it.
In 2022, meanwhile, a report by Dr Sean Maskey on south Kerry Camhs found 240 children received substandard care and 46 were harmed.
Prof Elizabeth Barrett, a liaison psychiatrist in the Child and Adult Mental Health Services in Dublin and a member of the Irish Hospital Consultants’ Association, said understaffing, increasing demand and under resourcing are all contributing to the pressures on the system.
“Funding levels are really, really low so I think we should ask ourselves if we’re taking ourselves seriously. There’s a lot of political discussion but the funding levels remain low,” she said.
“So, what’s happening on the ground is families are experiencing really long waiting lists. For clinicians on the ground, it’s really frustrating and distressing. And, when there aren’t enough clinicians, the burnout rates are very, very high.”
Fiona Coyne, chief executive of Mental Health Reform, the national coalition of organisations campaigning to transform mental health and wellbeing, said the system is “in crisis”.
“Drugs can and, in many cases, they do, play a role in young people’s mental health,” she said. “But, I think it’s also really crucial, especially for younger children, that they get access to talking therapies and things like that and the medication isn’t just being used as a substitute when other treatments are not available.”
A spokesman for the HSE said over recent years, the HSE has “prioritised targeted improvements and investment in Camhs and youth mental health” including building capacity, developing specialist services and clinical programmes, suicide prevention and investing in mental health in primary care.
“The establishment of a national office for youth mental health is an immediate priority for the HSE,” he said, adding that within the past six years, €22.6 million of development funding has been directed to enhance youth mental health services.