Richard Hogan: How can Camhs claim to be inclusive when they won't work with autistic kids?

Richard Hogan. Photograph Moya Nolan

I have just finished a six-year piece of research on inclusion. At the end of that long process, I find myself a little more hopeful about inclusion than I was starting out. Inclusion is a very sexy word these days. Nearly all organisations have a DEI (Diversity, Equity and Inclusion) policy.

But in my experience, it can often be a box-ticking exercise. The DEI department doesn’t talk with the HR department, who doesn’t talk with the wellbeing department, so what you get is disconnected policies on inclusion. This type of set-up ensures inclusion remains aspirational. Because true inclusion is an environmental shift.

It is, in fact, a living thing. A way of thinking about others. It is a way of reimaging how we view disability or those who are more vulnerable than us. There is nothing more disabling than the views people hold about disability. Which brings me to why I am writing this column.

On July 26 this year the Mental Health Commission (MHC) released their final report on the provision of Child and Adolescent Mental Health Services (Camhs) in this country.

What they found made for very stark and disturbing reading. I wrote about it at the time. I was worried that it would gain media attention for a week and then disappear like so many other damning reports.

My fears were warranted. Why do we have such short attention span for issues that actually matter? The report found a disturbing array of dysfunction within Camhs. I have to take a deep breath before I list them.

There is no standard of care across the country, a lack of good clinical leadership, a lack of robust governance, a lack of ICT systems, a lack of ringfenced funding, postcode lottery of service. 

Those in south county Dublin are allocated more money than other areas in Ireland, children have to be in crisis before they can be seen by a service that is designed to prevent crisis, poor risk identification and poor follow up if identified, poor monitoring of children on heavy psychotropic drugs, on and on the litany of catastrophic failures went.

To anyone working in mental health, these findings did not come as a surprise. I have sat with so many families, who recounted their horror story with Camhs. But now, since the report, I noticed a new phenomenon; parents desperately confused, not knowing what to do or where to go. One family told me they went to their local GP only to be told: “Don’t go near Camhs, it’s a shit show”.

They felt completely lost, not knowing where to turn. To think that families at their most vulnerable now feel confused about who to turn to for help is a terrible indictment on our wealthy society.

That is why it is so important that we take the 49 recommendations set out by the MHC and fix the problem. It is not beyond us to build a service that helps families. But regulation has to come from an external source. Camhs cannot regulate itself, much the same way the HSE cannot regulate the HSE. That’s a no-brainer.

Camhs has recently released a document setting out its “model of care for Camhs Hubs”. For a document based on “a mental health policy for everyone” it couldn’t be further from the truth.

The exclusion criteria, once again, made for some troubling reading. And once again, I shall take a deep breath as I list all those not included in this service. Children with high levels of disorganisation, children with intellectual disability, children with developmental disorders like Dyslexia (I never realised, myself and my daughter are developmentally disordered, good to know), children with educational needs, children who present with child protection or welfare issues, AUTISTIC children (I put that in capitals because of how shocking that is), children who live in unsafe housing.

I’m left wondering who the hell do they actually see? Children who are doing reasonably well?

The model of care outlined in this Camhs document is an example of a dysfunctional organisation setting their own standards to serve their own interests and political interests, rather than the interests of children. Politicians would be better served in expediting the new Mental Health Act which would give the independent Mental Health Commission the power to set and monitor standards. It is so frustrating to know that 42 bills were prioritised for this Dáil term. Yet, the Mental Health Bill is not being prioritised. 

When will the government put our children first? When will we take their health seriously? Families need support and these Camhs hubs are clearly not the answer.

The document does offer alternative avenues of care for those excluded. Essentially pass the parcel, but children are not parcels. After six years of carrying out research on inclusion, reading this report turned my stomach. This could have been written 20 or 30 years ago.

The labelling of children will
always make inclusion a theoretical endeavour. Labels like “developmental disorder” for children who learn differently is the reason we have so many unhappy children.

Language matters. As a proud
ambassador for the Dyslexia Association of Ireland I have worked incredibly hard to destigmatise the language around dyslexia.

I work with children who have such destructive and negative internalised prejudice about their ability and potential. I desperately try to untangle it.

Only to read this document and see all of that work in vain. It illuminates a glaring prejudice and presupposition about autistic children. What sort of message is that to families?

And this is their proud document of care, after a damning report back in July illuminated the quality of their care. My God!