Patrick Costello (Dublin South Central, Green Party) | Oireachtas source

While I agree with the calls by many of the Deputies here about the importance of increased funding, much of the increased funding going into CAMHS will not make a blind bit of difference if we do not fix many of the structural problems that are there. In my experience as a child protection social worker trying to interact with CAMHS, the services are just not fit for purpose as they are currently put together. I have heard other GPs complain about standard operating procedures being inconsistently enforced and needlessly restrictive. They are drawn in such a way that they can be used as a gatekeeper to stop young people coming in through the doors and to keep people off these waiting lists.

I have seen, dealt with and supported constituents who have had referrals to CAMHS refused, with no reason given. When I go looking for a reason, all of a sudden they get offered an appointment. As a social worker I have dealt with young people who are experiencing very real pain and trauma, and they have been told by CAMHS "No no, this is simply behavioural, it does not fit the profile of this service." I have seen cases where young people are referred on to community services that do not exist. If CAMHS is not there to support young people in need in a time of trauma and a time of mental health difficulty, what the hell is it there for? In my experience, and I have no doubt that this is also the experience of social workers across the State, CAMHS is simply gatekeeping and trying to keep referrals away from the service. In the past I would have said that if one could not use medication, they did not want to take it. Now, this recent report in Kerry is very worrying particularly in that vein.

There are other problems. CAMHS provides automatic discharges if a young person does not engage. This is a terrible policy because it ignores homeless children who may have difficulty engaging in geographically based services when they do not have any geographic home. It ignores the difficulty of young people in trauma and mental health difficulty who cannot leave their room. CAMHS has refused to meet with them. I have been on the phone begging CAMHS staff to leave their offices and to come to meet a young person, whether in their home or at a neutral third venue, just to start building that relationship and to bring them into the therapeutic clinic, but CAMHS has refused to do so.

Even if one can overcome all of these things and overcome all of this gatekeeping and attempts to restrict people, there are huge waiting lists, as other Members have spoken about. If one can get through the waiting lists, quite often at the end of them there is no service. I look back at my own time as a student social worker when I worked briefly in CAMHS. A lot of the work I did was around autism spectrum disorder assessments. At the end of it, we would present the diagnosis to the family and the family would ask "What services do we get now?". We would shrug and say "Well, we do not do that, here's the community service." Again, the community services just do not exist. The joined-up services referred to by Deputy Richmond are just not there. The standard operating procedure, the referrals process and the gatekeeping by CAMHS render CAMHS as it is currently operating simply not fit for purpose. All the money in the world will not change that unless we drill into those issues too.

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