Duncan Smith (Dublin Fingal, Labour) | Oireachtas source

The interim report of the Mental Health Commission on CAMHS is one of the most damning reports to have been presented to a government in living memory. There has been discussion of the issue this week, including this evening. The presence of both the Minister and the Minister of State, Deputy Butler, is testament to the issue's importance. It is often the case that evening debates on a Thursday in this Chamber will not attract the presence of the senior Minister, whatever the topic under discussion. The senior Minister is here, along with the Minister of State with responsibility for mental health, because this report is one of the most damning we have seen.

Even on a scan of the report, the key words that occur to the reader are "frightening", "negative", "worrying" and "damning". When one reads the report in detail, there is little to provide any comfort that our CAMHS is not broken. The report states that some CAMHS staff have been found, in some cases, to provide a good service for many young people and their families, who have received excellent care and treatment within often limited resources. That is mentioned at the start of the report and it is accepted. We all know people who have been treated in CAMHS and families who have received a good service. However, the report goes on to deliver its assessment of the community healthcare organisations, CHOs, it examined. It begins with governance, which it describes as "inefficient and unsafe". The report identified a failure to manage risk or fund staff, which is a departmental and HSE issue. It identified a failure to recruit key staff and a failure to look for alternative models to provide services where staff could not be recruited. That shows an inflexibility throughout our health service. We see that reflected in Kerry CAMHS, where a funded position has been in place but not filled since 2016. The statement made earlier by the Minister of State, Deputy Butler, indicates that position will not be filled in the near future. The report also identified a "failure to provide a standardised service across and within CHOs". Even if a CHO is performing well relative to other CHOs, there may still be CAMHS services in the area that are not performing well. The report goes on to state "There is no ring-fenced funding for CAMHS". It is incredible that CAMHS must fight for funding and compete for it with other health services.

Underpinning all of this is early intervention. Such intervention with multidisciplinary teams will help to keep people healthy, safe and out of acute care, ultimately saving the health service time, money and resources. At the earliest point in people's lives when they face mental health difficulties, we have a service that is competing with other health services for basic funding. We have no real integration in children's mental health services and risk management is obliterated in our CAMHS.

The report identified that "risk management was poor, with lack of communication and lack of actions to mitigate risks". It stated "There was limited understanding in a number of teams as to what constituted a risk". That is incredible. Teams that are working do not even know what constitutes a risk. That is why this report is damning. The documenting of risks was described in the report as "haphazard". Individuals and families put trust in our health service, specifically our youth mental health service, and have to read a report that describes the documenting of risks as "haphazard". The report went on to state that "minimalist generalised actions [were] recorded on the CHO risk register".

All teams were found to be significantly below the staffing levels recommended in A Vision for Change. Some were below 50% of the recommended level and all teams were below the recommended level. That has resulted in the long waiting lists we have all heard about in the responses to multiple parliamentary questions. Those waiting lists have been discussed on the floor of the House many times.

The report states "The CAMH service depends heavily on a model of care which places the onus on a single profession i.e., the consultant psychiatrist". That takes us back to the situation in south Kerry and the presentation from the Minister of State, Deputy Butler. This inflexible system cannot change or provide a different model of care and cannot recruit key positions, including the one key position of consultant psychiatrist. That means care for everyone else falls down.

The report also states, "In three CHOs, the digital infrastructure was mostly absent apart from the use of Excel spreadsheets and Word documents." If somebody contacts the offices of any of the Deputies here today, we have a system to record the representation, raise the matter with the relevant Department, the HSE or CAMHS. Our system allows us to set reminders and schedule when to send further emails and letters. We have such a system. It is an old system but it is functional and works. In our health services, according to the report, "Most services do not have an IT system that manages appointments, schedules rotas, maintains clinical files and provides reports on activity." If someone sends a Deputy a report from an occupational therapist or a doctor, he or she can scan it and save it on our systems while the HSE and CAMHS cannot do so because they have no IT system. That is incredible. No one would believe that our health services are dealing with Excel spreadsheets and Word documents. Every eight-, nine- and ten-year-old who goes into his or her first ever computer class learns to use Excel spreadsheets and Word documents. The system in this organisation is more than 30 years old but still functions. We do not even have something of that age and functionality in our CAMHS.

I will move to the issue of medication and the fact that children are being lost to antipsychotic medication without clinical and physical backup. That is incredible and very worrying. Specific medications are not mentioned in the report but we all know which are the most commonly used medications. They have side effects and require regular blood testing. There are international standards but we do not have national standards, and the international standards are not being applied. Not even good, basic care is being applied to these young people who are on very heavy drugs. We have two generations of antipsychotic drugs. There are traditional ones and the newer ones from the 1990s. They are all very heavy and have considerable impacts, including physical impacts, on patients. Young people are being lost. They are being prescribed these medications and are not being given check-ups.

It is an absolute scandal. We need action to ensure that a proper audit is done and that there is no child or adolescent out there who is on anti-psychotic medication and who is not getting the required supportive clinical care, be that blood tests or physical checks. In regard to the mental health reform, it has been doing great work in advocating in this area and supporting Deputies on all sides in providing information. Its key ask is a youth mental health assistant director, which was promised in budget 2023 but has not even been advertised for recruitment. We need a national director for mental health. Why is that not being provided to report directly to the CEO of the HSE? The Government is moving in this direction but is not going far enough. If we are talking about governance we need a co-ordinated strategy at national level. That starts at the very top if we are serious about resolving this and not having this same debate when the full report comes out. In fairness, a reform of the Mental Health Act was mentioned by the Minister of State, Deputy Butler, in her contribution.

There were 140 children lost in the midwest CAMHS system and 46 children in south Kerry suffered significant harm. There are unknown numbers of children and adolescents on heavy medication without the appropriate care. We have seen articles in newspapers this week about individual cases. I met a woman at a local event yesterday whose child is on attention deficit hyperactivity disorder, ADHD, therapies through CAMHS is getting the care but her worry is that next year, she will age out of the service. There is no pathway. There is no ADHD clinical specialist in our CHO. She will age out of the service three months before her leaving certificate examinations, when she turns 18. What is going to be done there? The individual cases will go on and on but as was said by the CEO of the Irish Society for the Prevention of Cruelty to Children, ISPCC, in a letter to The Irish Times, the system "is broken”. That is the only way to describe it.

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