UN convention 'may have been breached for many children with mental illness' in Ireland 

The report highlights the lack of a ring-fenced budget nationally.

The Inspector of Mental Health Services said she could not assure all families in all parts of Ireland their children could access a safe mental health service, writing in a final report by the Mental Health Commission.

Long waiting lists linked to chronic staff shortages, the lack of emergency services or out-of-hour services and other challenges indicate Article 24 of the United Nations Convention on the Rights of the Child “may have been breached for many children with mental illness”. 

Dr Susan Finnerty recommended the Child and Adolescent Mental Health Services (Camhs) be immediately placed under the regulation of the Mental Health Commission, despite the good work in some areas.

Among the key concerns, the report notes are:

• One HSE region inspector had 140 “lost” cases, with an external consultant psychiatrist hired to identify these children;
• Inspectors found “evidence that some teams were not monitoring antipsychotic medication in accordance with international standards (there are no national standards).” This meant some children were taking medication without appropriate blood tests and physical monitoring;
• The difficulty in recruiting and retaining staff has had "a devasting effect" on the number of available Camhs inpatient beds;
• Access to help depended on where a child lived and what team they attended with “a large unacceptable variation” found in waiting lists between some areas;
• Some teams operate out of modern primary care centres but others are in old buildings which are not sound-proofed, lack parking and have insecure spaces for storing clinical files.

“I cannot currently provide an assurance to all parents or guardians in all parts of Ireland that their children have access to a safe, effective, and evidence-based mental health service,” Dr Finnerty warned.

Risks for children

The Independent Review of the provision of Child and Adolescent Mental Health Services follows an interim report in January, which found risks for some children in four HSE regions.

Dr Finnerty said it was “a major concern” that “ongoing serious deficits” continue, despite the HSE making efforts to improve and invest, including developing specialist and clinical programmes for young people.

The report says Article 24 of the United Nations Convention on the Rights of the Child, which says children have a right to mental and physical health standards, “may have been breached for many children with mental illness”. 

She also writes critically of the governance in most HSE regions, known as community healthcare organisations (CHO), saying this is contributing in some regions to “inefficient and unsafe” services.

The report highlights the lack of a ring-fenced budget nationally.

Dr Susan Finnerty said it was 'a major concern' that 'ongoing serious deficits' continue.

“Currently, the HSE cannot provide a report on its annual budget and expenditure within Camhs,” she said, noting the current Camhs budget is estimated to be €137m, or about 12% of the overall mental health budget.

The report found: “The vast majority of teams were significantly below the recommended staffing levels, some below 50% of recommended staffing.” Among the challenges which can follow is the appropriate monitoring of medication.

For example, among children or teens being treated for ADHD: “24% did not have their medication monitored and 5% had their medication partially monitored.” 

Inspectors raised concerns in some HSE regions around children whose antipsychotic medication was not being monitored properly, these have been followed up.

Dr Finnerty praised the young people and their families who helped with this review.

“This had sometimes been distressing for them, but they spoke in order to assist in improving mental health services for themselves and for children and families who may attend Camhs in the future,” she said.

We are aware that many young people and their families have received excellent care and treatment within the often limited resources of the Camhs teams and we found that many teams were innovative in trying to mitigate the risk posed by a lack of staff.” 

The report also highlights a reliance on Excel and Word in three regions, and notes challenges in many areas around “paper-based clinical files being frequently disordered, incomplete, sometimes illegible, with little logic to the filing of documents within them”.

'Poor relationships'

More broadly, she was critical of “poor relationships” between Camhs and other children’s services.

The report says while Camhs is a specialist service for moderate-to-severe mental illness, accounting for about 2% of all children, many children require a variety of services and these links are not always there.

The report makes a series of recommendations, including the overall call for an increased budget to allow for proper staffing, use of IT, better monitoring of medication and assessment of telepsychiatry.

Specifically in relation to emergency services, the report recommends: “Each major hospital and emergency department should have a dedicated liaison Camhs, supported by an on-call Camhs team. This service should be accessible 24/7 via a single point of contact.”