Adolescent mental health services reach breaking point

Staffing has hit such a low point in Cork City, potentially suicidal children can’t be guaranteed they will be able to access the emergency specialist care they need, write Claire O’Sullivan and Eoin English

Adolescent mental health services reach breaking point

THERE have been complaints for years that, due to widespread understaffing in Child and Adolescent Mental Health Services (CAMHS), children and teenagers had to be suicidal before they could secure timely access to mental health treatment.

If your teenager was in thrall to an eating disorder or refusing to leave their bedroom because they felt so low, he or she would most likely be added to a waiting list to see a CAMHS team and they could be on that waiting list for anything from three months to over a year.

However, staffing has reached such a low point in Cork City that potentially suicidal children attending Cork’s biggest hospitals can’t be guaranteed that they will be able to access an emergency CAMHS team.

And in the community, some of the CAMHS multidisciplinary teams in Cork are operating with less than half the staff members they ought to. Staffing ranges from full teams in some parts of Cork to just 42% of staff in others.

In Kerry, none of the teams are fully staffed with the HSE stating that staffing ranges from 55% to 73% of recommended levels under the Vision For Change blueprint for mental health services.

Last Monday week, there was no CAMHS psychiatrist at either Cork University Hospital or the Mercy University Hospital. These hospitals look after patients from the South Lee and North Lee catchment areas.

This meant any potentially suicidal children or teenagers could not get emergency specialist care.

“There was literally nobody [from CAMHS] to see these kids other than during office hours in a scheduled clinic. Imagine, a 15 or 16-year-old suicidal teenager turns up at one of these EDs, and there is no psychiatrist to see them,” a source said.

According to the HSE, in Cork and Kerry, staffing shortages in CAMHS are so acute that there are:

  • Three consultant psychiatrist vacancies;
  • Two registrar posts are vacant;
  • There are 4.5 psychologists posts unfilled (one full time and one part-time staff on statutory leave);
  • Three occupational therapist vacancies (two staff members on leave);
  • One nursing vacancy;
  • 13 social work vacancies, with eight of these positions vacant due to staff leave.

These chronic gaps have not only let down distressed children and their parents who find themselves at emergency departments. They have also led to inertia in community clinics that are supposed to provide a lifeline to vulnerable young people. There are 568 children and adolescents on waiting lists for help in Cork and Kerry

  • In the North Cork catchment, there are 93 waiting for treatment with 51 of these waiting three to nine months for help;
  • In CAMHS South Lee, there are 248 on waiting lists with 42 waiting six-nine months to be seen by one of the three teams. Another 33 are waiting nine to 12 months;
  • In North Lee, east, west and north there are 89 on waiting lists most waiting 0-3 months;
  • In CAMHS West Cork, there are 80 children on the waiting list for treatment with half of them waiting three to 12 months to be seen;
  • In CAMHS in North Kerry, there are 14 on the waiting list, while in South Kerry that stands at 44 — with 22 waiting three to 12 months.

The HSE has said it is doing all it can to remedy the shortages but that the impact of the staffing shortages has been more acute since the beginning of the year.

To be clear, the lack of staff has deteriorated to the point that, never mind not being able to hire consultant psychiatrists, it wasn’t able to fill gaps in its non-hospital consultant doctor (NCHD) on-call rota last week due to vacancies and staff leave.

Since March 25, it said it has not been possible to “guarantee as responsive a service to the EDs” as it would like.

“Despite ongoing and strenuous recruitment efforts, we do face difficulties in filling posts, particularly for consultants and psychologists. There’s a Europe-wide shortage of consultants,” a spokeswoman said.

“Recruitment efforts have included repeated advertising of positions and the use of agencies in Ireland and the UK who have contacts in Europe and beyond.”

Derek Chambers, chief executive of ReachOut Ireland, which provides mental health support to young people, said that his organisation would like to see more resources put into online community supports so less young people would need to go to CAMHS.

And the advocacy group, Mental Health Reform said seven-days-a-week direct-access mental health clinics, supported by around the clock telephone support, would make a huge difference to care in the community.

“This is an efficient and effective way of responding to someone with a mental health need in the local community, and could be rolled out within two years,” said Shari McDaid, director.

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