Richard Hogan: The current state of our mental health services is the scandal of our time
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This country has been gripped by the RTÉ pay scandal for several weeks.
But the real scandal is the current state of our mental health services. It is the scandal of our time.
Last week the Mental Health Commission released a damning report, having investigated the reality of the provision of services to vulnerable children and families in this country.
Frighteningly, the inspector outlined that she could not provide assurance to parents accessing the Child Adult Mental Health Service (CAMHS) that the service they would encounter would not only be unhelpful, but might, in fact, be deleterious to the mental health of that child or family.
To think that families at their most vulnerable, most in need of help, turning to our national services in those desperate moments, find that what they encounter distresses them further.
Now, that is a scandal, and is a shocking indictment on what is happening in this country. And far more significant than a broadcaster's wages.
I have met families for far too many years in my clinic who all articulated the horror stories of what happened to their family when they finally accessed CAMHS, or when TUSLA became involved in their life.
The first problem they all describe was how long it took to actually access the service, months, and in some cases years.
But finally, hope as they entered CAMHS. However, what unfolded next was chaotic and rendered the family hopeless.
To think that our services are making families less hopeful - increasing the deterioration of a child’s mental health is something we cannot sit back and allow to continue.
If only we could put all that scrutiny and time we put into RTÉ into this issue, and force the government at the highest level to take action, we might actually be able to solve this issue.
The report uncovered some very dark aspects of CAMHS practice.
It illuminated poor risk identification and management and more importantly, when serious risk was identified, there was evidence of poor to no response.
Again, children at high risk were being ignored or not followed up with. Shocking.
It also showed that there is a postcode-lottery aspect to the service.
Parents and children living in south Dublin are in a better position than those living in Waterford or Wexford.
Kids in south Dublin are invested in more than other areas in this country.
South Dublin children receive €126 while those in other parts only receive €60.
All children are equal, but some are more equal than others. I’d really love to hear an explanation for that.
Poor planning? Or is it by design? I think someone has to really answer that question.
The report also found that there is a wide variation in services provided by CAMHS throughout the country. Again, it all depends on where you live.
There is a lack of clinical leadership, there is no coherent standard of service, and there is a lack of central planning to provide child-centred care.
There is a massive failure to find and recruit key staff and huge turnover of staff. The burnout that professionals experience trying to provide a good service to their clients was also brought into focus.
The report found so many failures, I am highlighting what I think are the most pertinent ones.
But thankfully the report also provided us with what needs to be done to address these systemic failures.
Nobody working in CAMHS wants what is currently happening to families and children to continue.
There are very good professionals working in CAMHS but they are caught in a bind; they are attempting to provide a good service while the medical model they are stuck using is outdated.
We need a root-and-branch restructuring of our services. And this report gives us a road map on how to achieve it.
It outlines 49 key recommendations.
The first aspect of all of this is that this report must not be placed on a Junior Minister's desk.
With all due respect, this is far too important and requires input from the highest level of government and the HSE board.
The government must ensure that regulation of CAMHS is placed under the Mental Health Act, as recommended by the inspector.
This would provide the MHC with the statutory powers required to immediately work with stakeholders and clinical staff to develop standards and implement the changes our services so desperately need.
We need a comprehensive strategy for CAMHS and all other Community Health Organisations.
The changes outlined by Dr Finnerty must be independently regulated.
We have seen time and again that the HSE cannot regulate itself and must have oversight from an external body. This would ensure swift and effective change.
The lack of a national director for mental health has contributed to this mess.
Why has it been so difficult to attain a high-quality candidate for this role? This stuff isn’t rocket science.
Fundamentally, we need strong clinical leadership, ring-fencing of funding, appropriate ICT systems, robust governance, and better recruitment of highly qualified staff.
If these pillars were in place families would finally stop suffering.
For too long children and families accessing CAMHS in this country have encountered a chaotic and disjointed service.
To think that families at their most vulnerable have to battle to meet a service; currently, they have to be in crisis before even being considered eligible for CAMHS.
Anyone working in the mental health field knows that early intervention is crucial to prevent crises from occurring. The irony here is terrible.
Children and families are suffering needlessly at their most vulnerable times.
This scandal must not be swept aside and become just another report that went nowhere.
Our children deserve better and we have the money. We just need the political will.
