Dr. Philip Dodd:

I will deal with the issue of mental health and intellectual disability diagnosis, or dual diagnosis. It is a particular focus of Sharing the Vision. Two models of care for adults with intellectual disability and mental health issues and for children were recently published, that is, the CAMHS intellectual disability, ID, model of care and the adult mental health of intellectual disability, MHID, model of care. Since 2015, approximately 150 staff have been recruited into supporting the provision of the service throughout the country. It has been difficult to recruit in the CAMHS ID area in particular. It is a particular focus of recruitment endeavours, especially in the area of training more psychiatrists to take on the role of consultant child and adolescent psychiatrist with a special interest in intellectual disability.

With regard to the access for people with autism and mental health difficulties, the published CAMHS clinical operating guideline from the HSE published in 2018 clearly sets out the appropriate pathway for people with autism. If a child with autism is presenting with significant mental health problems of a moderate or severe level, it is appropriate that they be referred and seen by CAMHS teams. It can become difficult, clinically, to decipher whether the behavioural presentation of the individual is primarily a mental health issue or related to difficulties the child has with autism and various environmental triggers and difficulties.

Best practice suggests good engagement between the CAMHS ID team, the CAMHS team and the network area disability team to work out the primary needs of the child and then to work out what service is most appropriate. There is a particular recommendation in Sharing the Vision that looks to that as an area of service improvement. The HSE is looking at that example of an integrated care challenge across children's services.