€40m needed to rectify Child and Adolescent Mental Health Service staff shortages

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The staffing deficit in the specialist teams that are treating children who have mental health difficulties is so great that €40m would be required to bring them to the levels recommended by the Government’s national mental health policy.

Child and Adolescent Mental Health Service (CAMHS) teams are operating at 56% of levels recommended in ‘A Vision for Change’ (VFC), the blueprint for mental health reform, which is currently being “refreshed”.

The figures, obtained by Sinn Féin health spokeswoman Louise O’Reilly, identify a shortfall of 513 clinical posts in CAMHS, vis-a-vis what VFC recommended. More than two in five posts are unfilled, including in psychiatry and psychology, nurse specialists in mental health, social worker posts, and therapy posts.

Ms O’Reilly said the figures “are really, very, very poor”.

“If you consider that ‘Vision for Change’ was published in 2006, and that the population has grown substantially since, you can see that they never, ever came close to fully staffing those teams,” she said.

Jim Daly, junior minister with responsibility for mental health, said there were 222 CAMHS posts “at various stages of the recruitment process” as of January 2019. He said that, “of all posts advertised in the last two years, only half have been filled, due to lack of applicants or lack of appropriate qualifications... or because candidates refuse the post or withdraw from the recruitment process”.

Mr Daly also said the “refresh” of VFC “is essentially complete” and “publication is imminent”.

He said it would not be as “rigid and prescriptive” as the original VFC and would, instead, “be very outcomes focused”.

Ms O’Reilly said the idea the “refresh” may not set targets “really means they have given up; they are not putting the requisite effort into mental health services”.

Mr Daly said that his focus was on “trying to reorientate the system” through early intervention to prevent issues “escalating up to CAMHS”. This included the appointment of 114 assistant psychologists and 10 advanced nurse practitioners in mental health.

Mr Daly said he plans to announce details of a €3m “resilience fund”, whereby community mental health groups can apply for funding to promote resilience, as well as introducing a single telephone line for mental health referrals, operated within the National Ambulance Service. To address a shortage of consultant child and adolescent psychiatrists, they were considering the provision of a service online.

“Take a 14-year-old child with psychosis coming to an emergency department,” said Mr Daly. “We can’t have a consultant psychiatrist waiting in the ED for that one presentation.

Down the line, we will be looking at having a consultant psychiatrist in an office and a screen on a cart in the ED to assess, diagnose, and prescribe.

Ms O’Reilly said all EDs should at least have a psychiatric liaison nurse, as per VFC.

“It’s a chicken-and-egg situation,” she said. “If the services existed, people wouldn’t find themselves in the ED.

“But even where there are psychiatric liaison nurses, they don’t always have somewhere to refer children to.”

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