Mental health services for young people need real change

Chronic underfunding and understaffing need to be addressed

Jigsaw, a mental-health charity funded by the Health Service Executive, aims to advance the mental health of young people aged between 12 and 25 through advocacy, strengthening community response and early intervention.

Jigsaw has to constantly fundraise and has done everything from sponsored abseiling to developing a partnership with Lidl.

Fair play to Lidl for getting involved. But what does it say about mental-health service provision for young people in this country that such a vital service relies on sponsorship from a German-based discount supermarket chain to balance its books?

Jigsaw currently has 13 centres, with two more planned, which offer brief, effective intervention for young people suffering from – among other things – depression and anxiety. It is by no means a nationally available service although Jigsaw would love if it was.


Day hospitals offer intensive structured clinical programmes for young people with complex mental-health difficulties

Parents seeking help for a child who is anxious or depressed may be told that there is no Jigsaw service in their area but to try the primary-care psychology service instead. But the psychologist in the service is on maternity leave or has retired, so there is no service there.

The GP then refers the child to the Child and Adolescent Mental Health Service (CAMHS) and disbelieving parents discover that there is a waiting list of up to a year unless the child is in crisis and in need of immediate help.

So they turn to another charitable service partially funded by the HSE such as Pieta House, which is supposed to be a service for those in suicidal distress and those who self-harm. Only those who have the means to access counselling or psychiatry privately can avoid this cycle. Yet again, it is the less well-off who lose out.

Waiting lists

According to figures released to Social Democrats co-leader Róisín Shortall, 7,429 children and teenagers are waiting for appointments with a public-health psychologist. Some 2,266 have been waiting for more than a year.

The worst waiting lists are in north Dublin and Cork/Kerry. Naturally, the longer someone waits for timely intervention, the more likely it is that her or his mental health will deteriorate.

This kind of dysfunctionality illustrates the unintended irony in the title of the 2006 mental-health strategy document A Vision for Change. Much of it has remained a vision and never become a reality.

CAMHS has been in a chronic state of underfunding and understaffing for more than a decade. Take just one example: Aontú leader Peadar Tóibín points out that A Vision for Change mandates one CAMHS team per 50,000 people. That means Meath, where he is a TD, should have five teams. It has three. According to A Vision for Change, those three teams should have six clinical psychologists. There are three.

But there are no vacancies, presumably because of what is euphemistically called a “recruitment pause” in the HSE.

Nationally, CAMHS has 57 per cent of the staff allocation that A Vision for Change suggested it should have in 2006. In the meantime, referrals increased by more than 40 per cent from 2011 to 2019.

This week, there are again reports of children being admitted to adult mental- health units, which are completely unsuitable for a young person in distress. (There have been more than 30 such admissions this year so far.)

These figures are a disgrace but they are the inevitable result of a system limping along at every level. The lack of day hospitals is another such gap.

More pressure

Day hospitals offer intensive structured clinical programmes for young people with complex mental-health difficulties. When a day hospital is not available, these young people seek more frequent CAMHS appointments, which mean that children and adolescents with less severe needs get pushed farther down the waiting lists. For example, Lucena in Rathgar has a webpage describing its day hospital service, but that service no longer exists.

A lack of dedicated services for young people with autism has put CAMHS under even more pressure. These young people are not mentally ill but need a significant amount of time and specialised services, and CAMHS tries to fill the gap.

Mental Health Reform (MHR), a coalition of more than 70 member organisations, has lobbied for years for 24/7 crisis-intervention services for children and young people. The absence of such services leads to highly distressed young people queuing in emergency departments, which certainly would not help anyone’s mental health.

It is not as if the Government is doing nothing. There has been some recruitment and some areas have very short waiting lists. But that is little comfort for the individuals and families who are in need. Behind every cold statistic there is a family begging for help. The spectre of long-term mental-health issues looms in the absence of timely intervention.

Kate Mitchell, MHR's senior policy and research officer, believes it is essential that the many gaps in services are addressed in the revised mental-health policy due to be published before the end of the year.

However, she correctly points out that any initiative must be accompanied by the necessary funding and the monitoring mechanisms to ensure its implementation.

Right now, frantic families are seeking support. Maybe we could call this new mental-health strategy Real Change, instead?