Dr. Brendan O'Shea:

In preparing for this presentation, we consulted our colleagues within the ICGP and, in particular colleagues in the Deep End group. Some of their feedback, when asked about their experience in this area of care, was that they were actually pretty good at working through the problems with these families when they come in but that they are eaten alive for time, that if they spend 40 minutes with an adolescent, the man with the prostate cancer, arthritis or dementia or the lady with diabetes and hypertension in the waiting room, gets left out, that their practice nurse is deadly with these kids, especially the girls, but that she is hopelessly backed up and that it is a real pity because children and teenagers know them and even though adolescents find any interaction with adults challenging, most get on well with them when they make and sustain contact.

We have seven recommendations for consideration. Briefly, we recommend that a review of the referral structure for all childhood mental health problems, with an emphasis on the needs of children as they present in general practice, is undertaken and this should be informed with a formal input form families and as far as practically possible children and adolescents themselves. We also recommend that an out-of-hours CAMHS is put in place to cater for acute presentations in the out-of-hours setting and we recommend that close consideration should be given to integrating this with GP co-operatives. Those co-operatives are one of the few parts of the health system that stay switched on after 5 p.m. They are muscular organisations. They field 1 million consultations in the out-of-hours setting and a strand of CAMHS integrated into this would be well worthwhile considering. We recommend that as general practice is the principal referring agency and also the service to which these children and family will be referred back, far tighter liaison where the GP team is enabled to participate in an effective multidisciplinary process is essential.

At present, we have major manpower problems in general practice. We need more general practitioners and we need many more practice nurses. Having more general practitioners and more practice nurses will allow people to engage in the process at the lower end of the pyramid before problems become more neglected, delayed, complex and severe.

We observe that general practice is the only part of the health system with electronic medical records and we recommend that child and adolescent mental health services, CAMHS, and the rest of the health care system should, in 2017, be using electronic medical records. It is inexplicable that this is not already the case in this State.

Regardless of configuration, all mental health services for children must be sufficiently staffed to carry out work in a timely manner and we should not have children and their families waiting and disimproving over months. The distribution of teams and resources must not be solely on the basis of population, but must have a deprivation weighting to account for greater need in such areas. Saying a certain amount of resources in Bray will do the same in Clondalkin or parts of Newbridge simply does not work out.

Rather than creating a stand-alone psychology service, psychologists, counsellors and family therapists should be allocated to specific general practitioner, GP, practices or groups of practices. We know that the majority of general practice is delivered by two, three and four doctor teams. Any of these teams, particularly in areas of deprivation, would be well able to and would benefit from having family therapy, counselling and child psychology located in the practices, where most of the children and families live in close proximity.

Community-based services should be sufficiently resourced to get in earlier into the lives of these vulnerable children, adolescents and their families.

I thank the committee for requesting input from the Irish College of General Practitioners. We strongly recommend this focus, which is pragmatic and centred on the needs of the families and children and not on the considerations of the health care professions. We also see that there is a bigger question for society. Why is the rate of suicide among adolescent males increasing? What is society putting in place for younger families and for children? We certainly have some of the answers in the health care professions, but society has other answers to provide as well.