Reports show ‘complete lack of governance’ across mental health system

A report released yesterday, conducted by Inspector of Mental Health Services, Dr Susan Finnerty, shows there 140 "lost" children, in one CHO [Community Health Organisation] alone — the MidWest. File picture

A cascade of critical reports has highlighted deficiencies in mental health services for children, but amongst the outrage, it is not wholly clear who is responsible for the gaps. 

Instead, there is a “complete lack of governance and leadership across the mental health systems” according to advocacy group Mental Health Reform (MHR). This comes as the HSE said on Monday that it expects to recruit a Mental Health Service Director and a Mental Health Lead for Children "very shortly". 

"The job descriptions are being finalised now and we expect to be advertising both within a fortnight," a HSE spokesperson said.

Under the Health Act 2004, the CEO is ultimately accountable at HSE level through a long chain of managers. Stephen Mulvany holds this position on an interim basis, and reports to the HSE Board. They are accountable to health minister Stephen Donnelly.

The managerial chain downwards has, however, changed in recent years so there is no longer a HSE National Director for Mental Health.

Instead, the HSE said mental health services, including Child and Adolescent Mental Health Services (Camhs), now fall under a “national director of community health service operations”. Yvonne O’Neill holds this role which also includes primary care, social care, as well as health and well-being.

However, advocacy umbrella group MHR has questioned the removal of the dedicated mental health lead.

Communications and engagement manager Niamh O’Connor said: “There is a complete lack of governance and leadership across our mental health systems. We all believe that post would help to address a lot of the issues highlighted in the reports.” 

She said staffing, taking responsibility for governance and budgets, among other problems, “requires someone with oversight of the mental health services.”  MHR plan to seek a meeting with incoming HSE CEO Bernard Gloster about this.

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“I think it is very clear from the Maskey Report, the Mental Health Commission annual report from 2021, and the most recent review of Camhs that this integrated approach is not working,” she said.

The chain of accountability continues from Ms O’Neill to nine community healthcare organisations (CHO) around the country.

Assistant National Director Head of Operations Mental Health, HSE Jim Ryan also reports to her, and "oversees day-to-day operational management of mental health services”.  Each regional CHO is under a chief officer. In CHO 4 Cork/Kerry this role is held by Michael Fitzgerald.

During questioning about Camhs services in South Kerry, he told the Oireachtas Health Committee: “In terms of any failure that has happened within the system, of course I have responsibility in regard to those roles.” 

Under the standard operating policy for Camhs "day-to-day operational management responsibilities" are then devolved down to CHO Mental Health Management Teams. These managers work directly with health staff who deliver the service to children.

The policy states this adds up to a “clear management structure” but instead the Mental Health Commission found “a lack of governance in many areas contributing to some inefficient and unsafe Camhs services.”