Mental health services 'should provide for the children who need them', says Ombudsman for Children

The Ombudsman for Children, Dr Niall Muldoon, today appeared before the Seanad Consultation Committee on Children’s Mental Health Services.

Dr Niall Muldoon outlined the need to overhaul mental health services, putting children’s needs first and foremost.

“At the moment the mental health services a child receives very much depends on what the system can offer, rather than what the child needs. The child must make do with what is available," he said.

“The services children receive depend on the area where they live, the primary care supports available there, whether or not there is a psychiatrist working in the area and a range of other factors. The last thing on the list seems to be the child, and their individual and immediate needs. The children do all the adapting and compromising because the system never will. That must change.

“Children’s mental health services should provide for the children who need them, when they need them and in the way they need them.

“Children should not have to wait until they reach the point of self-harm or suicide attempts, so there is a physical manifestation of their mental ill health, before supports are made available.

“Children have a right to be heard, and in the area of metal health where the feeling of not being understood, or feeling that they don’t matter is often at the very core of their illness, this move is even more important. We need to talk to young people, consult with them and get their views. A new, standalone Children's Vision for Change, which includes a time-framed implementation plan, is needed.

“Communication and collaboration between agencies interacting in the area of mental health for young people is not good enough at present. We have had numerous complaints about Child and Adult Mental Health Services (CAMHS) teams refusing to take referrals when a child moves house – that is a systems issue. We have also had complaints about children being referred by one psychiatrist to an adolescent bed but being sent back because the residential service psychiatrist disagrees with the referral – that is a systems issue.

“I know that there are at least 15 so called ‘unfillable’ psychiatrist positions around the country. Any proposed legislation or new policy ideas that may come out of this consultation must, in my view, take on this issue and we must think creatively about how to overcome this problem.

“Young people are thankfully now talking more about their mental health, but are we calling them out of the shadows only to leave them exposed in the sunlight because the services to support their needs simply aren’t there?

“As a psychologist I am acutely aware of the importance of appropriate early intervention. This is a vital ingredient in a well working mental health service for children. Universal, accessible and evidence-based prevention and early intervention mental health services are needed at primary care level across all communities.

“As a nation we committed to protect and promote children’s rights when we signed up to the UN Convention on the Rights of the Child in 1992, and we built on that commitment when we passed the Children’s Referendum in 2012. The Irish State therefore has a duty to fulfil the right to health of all of our children as per Article 24 of the UNCRC.

“Nelson Mandela said ‘there can be no keener revelation of a society's soul than the way in which it treats its children’. This should be our mantra in all the work that we do, especially for some of the most vulnerable young people suffering from mental health issues.”

Update 4.30pm: A psychiatrist has told the Seanad there is a 'postcode lottery' when it comes to mental health services for young people.

The Seanad is hearing calls for the improvement of Child and Adolescent Mental Health Services, or CAMHS.

More than a quarter of the country is lacking an out-of-hours service.

For its part, the HSE says it is proving extremely difficult to recruit nurses and doctors, despite best efforts at home and abroad.

Consultant psychiatrist Matthew Sadlier says the Irish Medical Organisation has identified deficiencies nationwide.

"With specific problems identified in the CAMHS teams in Mayo, Roscommon and Wexford. Many CAMHS teams work with as little as one third of the compliment of staff required under [strategy document] 'A Vision for Change'," he said.

"Often teams nationwide share staff members, thus rendering the full extent of understaffing ambiguous. This is creating a virtual postcode lottery in the country, whereby services dependant upon the patient's address rather than need."

Earlier: The founder of Pieta House has made an impassioned plea for better services for young people with mental health difficulties.

The Seanad Public Consultation Committee on Children and Adolescent Mental Health Services is hearing from medical, therapeutic and children's rights experts this afternoon.

One issue which is regularly raised is the admission of young people to adult mental health services.

Senator Joan Freeman appealed to her colleagues for help.

"If I could describe us as a body, and you are the doctor, and we're dying. We're dying, but it doesn't seem to matter," she said.

"Not that it doesn't matter to you on a personal level, but you don't seem to hear us. Mental health services is dying."

Senator Joan Freeman


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