Mark Ward (Dublin Mid West, Sinn Fein) | Oireachtas source

I acknowledge the Ceann Comhairle, the Sinn Féin whip, Deputy Pádraig Mac Lochlainn, the Minister and the Minister of State for agreeing to my request to have this important debate on the agenda today. I begin by thanking Dr. Susan Finnerty and the Mental Health Commission for this report. I welcome to the Gallery representatives from national mental health and children’s organisations, including ADHD Ireland, Shine, ISPCC, Mental Health Reform, A Lust for Life, Children's Rights Alliance, BelongTo and Pieta. I will have a number of questions throughout my speaking time that I ask the Minister to respond to in his closing remarks and if he is unable to, I would like a written response.

As we know, this interim report was published early because of the level of risk to children identified in CAMHS. Have the Minister, the Minister of State, the Department of Health or the HSE asked the Mental Health Commission to delay publishing of this report? If so, when did this happen and why was there a request to delay this report that had identified significant risks to children?

These risks were escalated to the HSE. When I asked the Minister of State, Deputy Butler, about the nature of these risks in December she told me that the HSE did not inform her what they were. When did the Minister of State become aware of the nature of these risks?

There is a huge disconnect between the Department of Health, the Minister and the Minister of State and the HSE. Where does this buck stop? Who is ultimately accountable and responsible for the current crisis in CAMHS? Nobody in a senior role in the HSE or the Department of Health was held accountable despite huge governance issues highlighted in the Maskey report.

Sinn Féin has been calling for the reinstatement of a national clinical director for mental health in the HSE. The role was discontinued in 2016. What was announced this evening is an assistant position. That is simply not good enough. The Minister of State has responsibility for mental health and her colleague is the Minister for Health. They must instruct the HSE to appoint a national director who will be accountable to her and responsible for mental health within the HSE. If I was Minister with responsibility for mental health that is what I would do.

I am going to provide some solutions. First, we need ring-fenced funding for CAMHS. It needs a clear and accountable budget. Sharing the Vision, the Government’s mental health plan, has not been costed and there is no timeframe for implementation. Sinn Féin set out a multi-annual funding plan in our alternative budget. The Government must do the same. That would give CAMHS the autonomy to put in place its own recruitment process that would not have to compete with other healthcare disciplines. The HSE needs to start doing comprehensive exit interviews with all staff who are leaving the service. That would to help identify the problems around staff retention and put measures in place to keep these vital workers in CAMHS.

As the Minister said, children need to move between primary care, disability services and specialist services, such as CAMHS, according to their changing needs. The never-ending waiting lists for children’s therapies are having an impact on children’s mental health. There are more than 13,000 children waiting on an appointment for primary care psychology. We have waiting lists for Jigsaw of up to 20 weeks. There are 4,000 children waiting on an initial appointment with CAMHS. That is an 86% increase in children waiting for vital mental healthcare under the Ministers' watch. I have spoken with families who are frustrated, distressed, and frightened as they try to cope with deteriorating mental health difficulties while left waiting. I am calling on the Minister to put in place a strategy to co-ordinate relationships between CAMHS, community disability network teams, primary care services and NGOs.

As we heard, the HSE is conducting three national audits into CAMHS. They cover the areas of prescribing practice, operational guidelines, and service user experience. Can the Ministers explain how there were no risks pertaining to CAMHS documented on the HSE risk register despite three ongoing audits? Are they aware of any risks to children identified so far by the three HSE audits?

The Mental Health Commission made repeated requests for an action plan for identified risks in the report. The plan, when finally received, was not sufficient to address the risks. In some areas reviewed, there was limited understanding as to what constituted a risk, how it was assessed and how it was escalated. Some CAMHS teams were so frustrated they did not bother to escalate risk as there was no point and that resulted in a haphazard reporting of risks. An urgent training programme on risk management must be rolled out to all staff at all grades in CAMHS.

I want the Minister to produce a report on the recommended minimum staffing levels in CAMHS. The last time this was done in any meaningful way was in A Vision for Change, 17 years ago. Education and training places must be rapidly increased across higher education to give us a pipeline for CAMHS staff. Children are presenting with more complex needs than ever before. The Minister must invest in early intervention for psychosis.

Staff are working beyond their contracted hours and are burnt out and frustrated. Staff in CAMHS go into this vocation because they want to help vulnerable children. As the Minister said earlier, some excellent treatment has been delivered by these staff in CAMHS. However, the report’s states that CAMHS depends heavily on a model of care which places the onus on a single profession, namely, the consultant psychiatrist. The report states that this is not in line with international best practice. Has the Government considered an alternative model of care?

One area the Government can put in place quickly is an integrated IT system. It is 2023. We should have that at this stage. Most services do not have an IT system that manages appointments and maintains clinical files. Only one CAMHS area had electronic records and these were provided through an independent agency. I understand that this is the St. John of God Hospital in CHO 6. The one CHO area that is operated independently from the HSE passed this review with flying colours. I think that says everything. What engagement has the Department of Health had with St. John of God to see how it manages risks, governance, and IT? That is a conversation that needs to happen.

From my previous career working with people who have addiction problems, I know the value of care plans. They are vital for a person’s recovery and personal growth. Care planning in CAMHS was either absent or of such poor quality to be meaningless. High quality care planning does not require extra resources and it is hard to understand why this was not taking place. This is another area with the proper training that could be resolved very quickly.

One of the most damming parts of the report was the evidence that some teams were not monitoring antipsychotic medication in accordance with international standards because there are no national standards at the moment. Some children were taking medication without appropriate blood tests and physical monitoring which are essential when on this medication. The Taoiseach acknowledged this in the House during the week.

It is of serious concern that in some CAMHS teams children with open cases were lost to follow-up. That means that children who should have had a review of prescriptions or monitoring of medication did not have an appointment for up to two years. That is downright scandalous. These included young people who had reached their 18th birthday with no planning, discharge or transition to adult services or any advice about medication. We need a plan for expanding CAMHS to help young adults up to the age of 25. This is international best practice, but currently we are letting children drop off a cliff edge at 18 years.

For one team, there had been 140 "lost" cases. This is a complete mess and children were put at unacceptable risks. Every resource possible must be put into finding these lost children and making sure an appropriate treatment plan is put in place. A complete clinical audit of every open case must be done as a matter of urgency. I know the Minister said this is going to happen. I would like to see a timeline on that clinical audit. The Government must set national standards for monitoring the use of antipsychotic medications by children and young people. That should be part of new regulations under the Mental Health Act focused on regulating CAMHS. It is clearly needed to ensure that no more children are given strong medication and then forgotten about. Can the Minister commit to implement this solution as soon as possible?

I am one Deputy with one member of staff and in less than ten minutes I have given the Minister and the Minister of State solutions to improve the quality of care in children’s mental health. There is no greater crime than denying a child the right to reach their full potential. Both of the Ministers have numerous staff, special advisers, a whole Department and the HSE at their disposal. Surely they can implement the solutions to keep our children safe. If they cannot do so, then it is time for someone else who has the ability, the strength, and the political will to address this crisis caused by their Government and successive Governments.

I will finish by acknowledging the work that staff in CAMHS do. I deal with them daily. They find the systems are working against them. Recruitment and retention and the panel system of recruitment needs to be looked at. It is something that can and should be done. It is delaying the processes.

How many of the 73 CAMHS teams which the Minister mentioned are in place are fully staffed? It has been stated that 97% of the time CAMHS responds to children in a couple of months. How many of them are responses that go to families to say it will be back in touch in a couple of months to give an appointment maybe this time next year? Some 600 children have been waiting for an initial assessment with CAMHS for over a year, which is not good enough. The Minister said that early intervention is key. We need to put things in place to ensure children get the care they need when and where they need it. A child who gets the early intervention is less likely to need more acute CAMHS care.

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