Dr. Blánaid Gavin:

I am a consultant child psychiatrist and I will pick up on the points made by my colleagues. Service provision in CAMHS is of grave concern to all those working in it. One of the fundamental issues that arises regularly, and has a direct impact in terms of the retention issues which have been mentioned already, is the fact it is a very harrowing experience to be placed in a position where children are presenting with acute mental health conditions where there are treatable evidence-based interventions yet the practitioners are not in a position to provide those interventions in a timely way. It is an incredibly helpless and harrowing position.

Much of the discourse that occurs about CAMHS has a quality that appears to be personalised in regard to the CAMHS system and does not reflect the fact that those working within the system can only work within the system as it is currently established. There are many issues of contention within that system. Clearly, CAMHS does not and should operate as a silo and is dependent on an array of additional services. However, within the current standard operating procedures there is an assumption of multiple layers of care and availability that quite simply do not exist. This adds to the significant barriers to access that parents experience on an ongoing basis, and also squeezes the available resources and expertise within CAMHS that should be targeting the severe end of the mental health spectrum.

There was a request at the outset for truth. The essence of truth is obviously the availability of facts, which are dependent on data. Unfortunately, there is no data available in regard to what is happening in CAMHS. To speak the truth we must have information and data that tell us what are the quality outcomes and what are the differences that the services make, so we can look at how good a service we are providing, where we need to input efficiencies and where we need to become more effective. This has a dual purpose. It has the purpose of recognising and rightfully commending the excellent work that is ongoing in CAMHS, and the effectiveness of the multiple evidence based treatments that are available and from which children benefit. If the message is consistently about the negatives, it disempowers people in terms of access and makes people more helpless in terms of the conditions with which they are dealing and struggling daily. In addition, in the absence of data that specifically seeks to find out what the services are doing we run the risk of continuing to provide a lottery both in access to services and in the nature and quality of the service that is provided. In many cases, people liken service provision currently to the roll of a dice. While there are known effective treatments available in line with any standard medical interventions, it is not clear where and how they are accessible and how many children benefit from their input. It is a cornerstone of any quality service internationally or nationally that there is a drive to establish the practice exactly. There is no oversight of any of that.

Much of the focus to date has been on the idea of throughput and driving increased numbers without looking at a system-wide change and the quality of service provision. Key to quality is the integration of the voice of the service user and parent, which must inform the changes and the system-wide overhaul that is necessary. This requires not just tweaking but a root and branch change, with international expertise being brought to bear.

They are changes that require the most thorough oversight of the available international evidence to ensure that we have a service fit for purpose for the generations to come.