The controversy over the Child & Adolescent Mental Health Services (CAMHS) in Kerry has placed a spotlight on the services nationally.
The question is raised as to whether there are comparable problems or deficiencies elsewhere.
The Kerry report did not point to resource issues but rather clinical oversight and management.
One issue is the difficulty in some areas in recruiting and retaining CAMHS staff, in particular permanent consultant psychiatrists.
The Irish Hospital Consultants Association estimates that about one in three consultant psychiatrist posts were vacant, or filled on a temporary or agency basis before the Covid pandemic.
We know the pandemic has increased pressure on mental health service demands.
Permanent consultant psychiatrist posts assist with continuity of service and the doctor gets to know the patients well over time.
The marketplace is part of the problem. English speaking consultant psychiatrists are much sought after and can get much better pay and conditions in places like Australia.
The job in CAMHS is also difficult and intense. In rural areas, the full support services for staff may not always be there.
It is not just about having permanent consultant psychiatrists. The CAMHS teams need to be fully staffed with psychologists, nurses, social workers, occupational therapists, speech and language therapists and others.
While the Kerry report has shocked people, it is important to note that there have been improvements in the CAMHS.
Vision for change
When A Vision for Change was published in 2006 on the future for psychiatric services, the number of CAMHS teams was around 40 and there were about six inpatient beds for these child and adolescent patients.
Now there are now 73 teams and around 70 beds, with more to come on stream at the new National Paediatric Hospital and very specialised ones in the National Forensic Mental Health service in Portrane, in Dublin.
Fewer patients have to be sent to the UK for care now.
The HSE says it is working on increasing the number of specifically CAMHS trained consultants.
It said it is committed to the continued development of quality, clinically effective and safe mental health services for children and adolescents.
HSE figures suggest that a small percentage of around 2% of the population require access to the Child & Adolescent Mental Health Services and 1% will need admission.
The HSE said that every effort is made to prioritise urgent referrals so that young people with high risk presentations are seen as soon as possible and this is often within 24 to 48 hours.
GPs have reported difficulties in accessing the CAMHS and say some patients have to go to emergency departments to access services.
The CAMHS system does not currently come under the statutory oversight of the Mental Health Commission.
But in light of events, the Commission is studying the Kerry CAMHS report and may ask the Minister for Health to extend its remit.
The national audit of CAMHS services and the application of standard operating procedures will take some time to complete.
The scope of it is still being worked on by the HSE.
The outcome of the review will be awaited with great interest.