Without help, many children carry their problems into adult life, says Paul Gilligan.
Year after year in this country, too many children and young people experiencing mental-health difficulties do not receive the age-appropriate, timely services or supports they require. Along with the additional psychological and social damage this causes the young person, there can be a detrimental effect on their parents, family, school and community. Also, the stigma regarding those with mental-health difficulties is enhanced.
Every year, the HSE produces a performance report outlining that more than 1,000 children and young people wait more than three months for a first appointment. More than 200 must wait more than a year. Up to 100 young people are placed in adult in-patient units, despite this being an infringement of their basic human rights.
The annual reports of the Mental Health Commission outline how most services do not reach the quality standards defined in legislation and that few child and adolescent teams have a full, multi-disciplinary complement. Last year, a Seanad committee heard direct evidence from families who have been failed by the system. While the deficiencies cannot be addressed overnight, there appears to be a deterioration, year after year.
We know what needs to be done: A 24/7, out-of-hours, rapid assessment service for children and young people, which can be delivered centrally via modern ICT capabilities, should be established; and, complimenting this, a small number of psychiatric, intensive-care, in-patient units must be put in place in the four largest cities.
To support these two new structures, we need to fully staff the existing child and adolescent mental-health teams, deliver at least the number of in-patient beds outlined in a Vision for Change, and establish a comprehensive primary-care counselling network. Ensuring these services meet Mental Health Commission standards and regulations is vital.
Similar to the system in place for cancer care, a temporary child mental-health tzar should be appointed, backed up by a suitable budget, expertise and power to engage existing services and to establish the services required.
Some believe the solution lies in developing more preventative and community supports, as many of the children awaiting mental-health assessments may not require specialised mental-health inputs.
These types of services could easily be delivered by voluntary organisations, such as ISPCC/Childline and Barnardos, and by schools, which have a key role to play. Adequate financial support must be given to these organisations and the statutory, voluntary, and independent service providers need to work together. This would certainly address the needs of a percentage of the children and young people on waiting lists.
However, the children we are failing the most are those with the most serious mental-health difficulties. These are the most vulnerable. When it comes to children’s welfare, Ireland has a poor record. In recent years, we have begun to rectify this by passing a constitutional amendment on children’s rights and by starting to treat children and young people as citizens.
However, with our children’s mental health care, we seem unable to break through old stigmas and biases.
There is no commitment at a political level to addressing the problem, with the financial cost of developing the full range of treatment services presented as the key barrier. This leaves the HSE, which is the main service provider, incapable of providing the services and having to defend the indefensible. The fact that different Government departments are responsible for different components of children’s mental-health care adds to the problem.
Children experiencing mental-health difficulties, and their parents, face immense challenges to get a service. These parents are often reluctant to lobby or agitate, fearing they will in some way be blamed for their child’s difficulties or will be viewed as “troublemakers”. As a result, they do what Irish people do best: Try to cope on their own until the difficulties reach a crisis point. Without help, many children carry their difficulties, untreated, into adult life.
For others, the fight is too great.
Mental health difficulties can be treated successfully, particularly if identified early.
Ireland is a small country with a highly skilled, committed, mental health workforce and a vibrant, dedicated voluntary sector. Today’s children and young people are better educated, more empowered, and more resilient. Parents are more dedicated, informed and equipped to raise their children and they are supported by a world-class education system.
Failing to provide children and adolescents experiencing mental-health difficulties with the services they require is shameful. We are facing societal challenges, but none are more worthy or are more capable of being resolved than this. Much has been done to acknowledge and address the mistakes of the past; we must ensure we do not fail the children of today.
Paul Gilligan is a clinical psychologist, CEO of St Patrick’s Mental Health Services, and author of Raising Emotionally Healthy Children.