An independent review of the Child and Adolescent Mental Health Services (CAMHS) in the State has said it cannot currently provide an assurance to parents or guardians in all parts of Ireland that their children have access to a safe, effective and evidence-based service.
The 140-page report by Dr Susan Finnerty, the Inspector of Mental Health Services, which covers 2022 and 2023, has been published by the Mental Health Commission.
Given the findings, Dr Finnerty has recommended the immediate and independent regulation of CAMHS by the Mental Health Commission, to ensure the State and the HSE act swiftly to implement the governance and clinical reforms needed, and guarantee that all children have access to evidence-based safe services.
The review found a lack of governance in some areas, which is contributing to inefficient and unsafe CAMHS, a failure to manage risk, a failure to fund and recruit key staff, and a failure to look at alternative models of providing services, when recruitment becomes difficult.
It found that the vast majority of teams were significantly below the recommended staffing levels, some below 50% of recommended staffing.
Some teams were not monitoring antipsychotic medication, in accordance with international standards and the report notes that there are no national standards in place.
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The review looked at a sample of 10% of files.
During the review, the inspectors were informed that one team had 140 "lost" or open cases.
At the time of the review, a limited desktop review by an external consultant psychiatrist was taking place to identify these children.
Dr Finnerty said today that the 140 have been found and there is a plan to see them.
Overall, the HSE said it had identified 576 open cases.
It said: "We have contacted all of these, ensured they are receiving appropriate care and we have not identified harm caused to any of these individuals."
The review found unacceptable variations in the number of children on waiting lists and the length of the waiting lists varied across Community Health Organisations.
This resulted in a lack of staff to conduct therapeutic interventions.
Dr Finnerty said that some staff were working beyond contracted hours, some were burnt out and frustrated.
Some teams had no consultant psychiatrists and work was being covered by a number of different locums, which affected continuity of care.
No ringfenced budget for CAMHS
The report reveals that some CAMHS teams told inspectors that they were frustrated to the point they did not "bother" to escalate risk anymore, as there was no point.
The staff pointed to a lack of audit and review of risk management as reasons.
Most CAMHS services did not have an Information Technology (IT) system that manages appointments, staff rotas or clinical files, or activity reports.
Dr Finnerty also noted that the lack of a HSE National Director for Mental Health had contributed to the difficulties.
She said that clinical leadership was lacking in most Community Health Organisations, although a national clinical lead was being recruited by the HSE.
The review noted that CAMHS depends heavily on a model of care that places the onus on a single profession - the consultant psychiatrist and that all clinical responsibility rests with them.
It describes this as an outdated model, given international practice.
It also points out that there is no ringfenced budget for CAMHS, which has to compete with other health service demands.
These reviews are part of the statutory duty of the Inspector of Mental Hospital Services and the report said it was also cognisant of the findings of the Maskey Review and public concern about the provision of CAMHS.
The Maskey Review published in January 2022, examined the care of more than 1,300 children who attended the HSE-run South Kerry Child and Adolescent Mental Health Service.
It found that 46 children suffered significant harm and a national review of CAMHS was promised by the Government.
