About 20 years ago, I attended a press conference where the then minister for health, Micheál Martin, noted that when he went to visit a town, he would often find a local delegation looking for more hospital services. But he never found one looking for more mental health services.
That’s worth remembering as we reflect on the dismal state of mental health services for children and adolescents as revealed in the report by Dr Susan Finnerty, the inspector of mental health services.
Ultimately, politicians in a democracy prioritise what the electorate wants badly enough to vote on it. So it’s up to us to keep demanding change in the mental health services.
The report paints a dismal picture with mental health services for children and young people limping along, often unable to meet needs in any way that could be described as adequate.
- We have the child waiting for four days in an emergency department for a psychiatric assessment.
- We have children arriving at adulthood (18) without having been transitioned into the adult services.
- We have children whose cases seem to have been lost and not followed up.
We are due to spend €1.2 billion on mental health this year, which is something over five per cent of the health budget. (The World Health Organisation recommends 12 per cent.) But the share of this money that goes to the child and adolescent service isn’t ring-fenced so they are essentially in a competition with the adult services.
Changing this – stipulating their share and protecting it – may be the first most helpful that can be done.
We should acknowledge that staff in these services for young people are themselves overwhelmed. They are subjected to paper-based record keeping which, in this day and age, is like being told to do your work with both hands tied behind your back.
They don’t have the amount of supervision they need and supervision is a crucial form of support as well as of management. Also, we don’t have enough psychiatrists who are trained to work with children.
In looking at all of this, I think we need to remember also the families of the children concerned. In Keith Duggan’s report in The Irish Times on January 26th, we read of a 10-year-old child with many distressing symptoms and who at one stage could not dress, eat or go to the bathroom. The family had to fight its way through ‘a bewildering cycle of waiting lists and referrals’ for services.
Another parent whose child had a diagnosis of ADHD and was put on a two-year waiting list to be seen in Limerick. A young person referred to adult services at 18 years of age had still not been seen by anybody in those services two years later. Her mother complains that she was told by the child and adolescent service that nobody in the adult services would look after her because she has Autism Spectrum Disorder and takes medication for psychosis.
I was going to write that you couldn’t make it up. Really, though, I wish it was made up but it isn’t.
I mentioned families earlier and it doesn’t take much reflection to appreciate the chaos and stomach-churning anxiety that parents and siblings must experience when they see a family member going through these experiences.
On top of that, they have the stress of dealing with mental health services that often are too overwhelmed to do what they are supposed to do.
Government needs to begin responding by ring-fencing the budget for the child and adolescent service and it also needs to commit to getting spending up to that 12 per cent recommended by the World Health Organisation. Even the UK, with all the issues it is undergoing, slightly exceeds the WHO target.
The report by Dr Susan Finnerty is the latest in a series of wake-up calls on our mental health services for our young people.
This time we need to wake up.
- Padraig O’Morain (Instagram, Twitter: @padraigomorain) is accredited by the Irish Association for Counselling and Psychotherapy. His next book, Acceptance - create change and move forward, is published in March; his daily mindfulness reminder is available free by email (email@example.com).