Mr. Damien McCallion:

I thank the Chair and members for the invitation to meet the Joint Sub-Committee on Mental Health to discuss the interim report on provision of child and adolescent mental health services that was recently published by the Mental Health Commission. The Chair introduced my colleagues so I will not repeat their names.

Mental health is influenced by many different factors. While the continued enhancement of specialist mental health services is important, the mental health of our young people depends on a broad public health approach that builds on collaboration across the health services, education sector, statutory and voluntary bodies and with our community. The age of onset of mental health difficulties typically falls around the late teenage years and early twenties. Adverse early childhood experiences can be a significant predictor of serious mental health difficulties in later life. In the development of youth mental health services, it is therefore critical that we prioritise the promotion of good mental health, intervene early when problems develop and ensure clear pathways to community-based mental health services are available to those who need supports. CAMHS is a specialist mental health service for approximately 2% of children and young people who have a moderate to severe mental health disorder. For these children and young people it is particularly important to have access to integrated and person-centred supports provided by a multidisciplinary team of skilled professionals. I acknowledge there are service deficits in access, capacity and consistency in the quality of services we provide. On behalf of the HSE I apologise to any child or young person who has not received the standard of care they are entitled to expect.

However, our CAMHS teams receive almost 22,000 referrals every year and deliver almost 225,000 appointments for children and young people who need support.

CAMHS is challenged by a growth in demand for services coupled with the impact of ongoing staff retention and recruitment difficulties. Between 2019 and 2022, referrals to CAMHS have increased by 16% while the total number of appointments seen has increased by 10% in the same period. At the end of December 2022 there were 4,293 children and young people waiting to be seen. That represents an increase of 21% compared with the previous year. We continue to manage capacity proactively through waiting list initiatives, specifically targeting areas of the country with particular challenges, and those waiting longest. In the period from June to the end of December 758 additional cases have been seen and taken off the CAMHS waiting list. The intention is to continue this initiative in 2023. Every effort is made to prioritise urgent cases so that referrals of young people with high-risk presentations are addresses as soon as possible. This is often within 24 to 48 hours. In 2022, 92.7% of all urgent cases were seen within three working days and 63% of all referrals were offered appointments and seen within 12 weeks. The severity of presenting symptoms, as well as an assessment of risk, is always taken into account in regard to waiting times. However, we recognise that some people are still waiting too long for access to services either in primary care or in CAMHS services. We have seen significant increases in demand for all of our youth mental health services, further adding to the waiting lists in some areas.

There has been a significant investment in youth mental health services and CAMHS over a number of years to meet increased demand and to improve services for children and young people with mental health difficulties. Within the past six years, €22.6 million of development funding has been directed to enhance CAMHS, bringing the total funding to approximately €137 million. Since 2013 an additional 18 CAMHS teams have been established and close to 325 additional whole-time equivalent posts added to the workforce. There are currently 73 multidisciplinary CAMHS teams in place providing important assessment and treatment services. Alongside these target enhancements of capacity in our CAMHS teams we have invested in telehealth, eating disorder teams and inpatient care. Importantly, we have also invested in services such as Jigsaw and primary care psychology for children and young people with mild to moderate mental health difficulties who do not need access to the specialist mental health services that CAMHS provides.

Launched in 2019, the CAMHS operational guideline is another central output from the service improvement and is the standard against which we hold teams to account. The interim report into CAMHS was published by the Mental Health Commission on 23 January. Alongside the national audits arising from the Maskey report, it is an important and welcome contribution to our ongoing work to improve services. The interim report is based on review by the Inspector of Mental Health Services of CAMHS provision in five of our nine community health organisations. Arising from the review the Mental Health Commission has raised both general concerns about the provision of CAMHS and specific concerns regarding a number of children and young people within the care of CAMHS teams in a number of our CHOs. I can reassure the committee that the HSE has taken and will continue to take all concerns very seriously. Any concerns regarding children and young people in its care are promptly and comprehensively addressed.

Of the specific cases referenced by the Mental Health Commission there are no children or young people not being followed up and there are currently no active relevant concerns in regard to those cases. If any parents or young people have concerns about the care they are receiving they should in the first instance contact their CAMHS team and key worker or the HSE’s information online. The HSE has immediately commenced implementation of the recommendation that was for the HSE, which is a clinical review of all open cases not seen in the past six months by a CAMHS team and also those who have been prescribed neuroleptic medication. This review is under way in teams throughout the country and will provide assurance that these children and young people are receiving appropriate care reflective of both their current and future needs. Those impacted by this review will be contacted directly by the relevant CAMHS team. This process is targeted for completion by the end of May this year.

Building on ongoing initiatives, we will move to consolidate and expand our youth mental health improvement programme. The programme will further build capacity within our CAMHS teams in tandem with the continued focus on early intervention and upstream youth mental health services. It will also prioritise the need for fit-for-purpose IT infrastructure, modern premises and support CAMHS teams to operate on the basis of a shared governance model where each clinician works with the full scope of his or her practice. In all aspects, we will have a focus on innovation and on fully utilising telehealth technologies to improve and optimise access to care.

The improvement of mental health supports for our young people will need a co-ordinated response including all aspects of our services, directed by national mental health policy and supported by multi-annual investment. Within the HSE, this programme will be led by two new roles, namely, an assistant national director for services in CAMHS and a clinical lead for youth mental health.

Both roles have been advertised and are the subject of a recruitment process.

Youth mental health will continue to be a key priority for the HSE and will be guided by the Sharing the Vision Implementation Plan 2022-2024. This implementation plan provides a three-year roadmap for the continued development of mental health services. The HSE's work to deliver Sharing the Vision will be driven by a strong outcomes focus and a commitment to report on progress in an open way, including among other things, the online publication of quarterly status reports.

The HSE will continue to collaborate fully with the commission in order to ensure the timely completion of the review. It is welcome that the interim report also highlights that many young people and their families have received excellent care and treatment. The final report will provide an opportunity for the commission to highlight good practice so that learning can be shared throughout the service. At the same time, we acknowledge the deficits in current service provision, including with regard to access, capacity and consistency in the quality of services we provide to children and their families. However, we are not waiting for the final report. We continue to make investment and work in all our CHOs to implement improvements in our youth mental health services for children and their families.