Mattie McGrath (Tipperary, Independent) | Oireachtas source

The interim report on child and adolescent mental health services published earlier this week, while deeply alarming, was unfortunately not in any way surprising. Families up and down the country with children and young adults experiencing mental health difficulties are all aware of the huge failings within CAMHS.

The CAMHS report shows that a radical overhaul of mental health services for young people is urgently required. I fully agree with the views of Mental Health Reform that the crisis in CAMHS requires an urgent national co-ordinated response. The Government must absolutely prioritise urgent recruitment within the service, particularly in the area of CAMHS intellectual disability specialists. My office has, unfortunately, been inundated in recent months with families of children and young adults who have been left in limbo, pushed from pillar to post and, quite simply, desperately failed by a system that is supposed to assist them when their children and young adults reach their lowest points in their life. It is just so sad.

My experience of the greatest failings is that when these vulnerable children have a dual diagnosis - our must vulnerable children - they are being failed even more dramatically as no one wants to take responsibility. Disability services say they do not have the expertise. I salute the staff who are in these services. The vast majority of them, who are doing their very best, do not have the capacity to support children who are displaying mental health difficulties. CAMHS has pushed these children back to disability services claiming that their autism is the reason for their difficulties and that they, therefore, do not have the capacity or expertise to support them. It is particularly clear that these children, and their families, are being failed and they are the responsibility of the Government. Recruitment difficulties is not a sufficient excuse to leave children in desperate situations with no support or assistance.

The lack of CAMHS intellectual disability, ID, specialists is a serious failing and must be urgently addressed. I welcome the recent appointment of a new CAMHS ID specialist in CHO 5 who serves south Tipperary. However, she needs a full team around her and the absence of appropriate CAMHS ID units in this country is simply appalling. The experience of families that have come to me in tears and in fear for the lives of their children is an abusive situation. The State is literally abusing these families and putting them in the most awful of situations. I do not say that lightly.

I dealt with a case involving a teenager who is self-harming, has been out of school for long periods due to extreme levels of anxiety and is expressing suicidal thoughts. It seems that because of a diagnosis of autism, CAMHS can offer no supports. The services say that the issue is the autism diagnosis and that it is a matter for disability services. Disability services say they cannot support this child through these mental health difficulties. The child is left in limbo and the only option is for the child to present to the paediatric ward or the accident and emergency department of Tipperary University Hospital, TUH, which can give no support. A CAMHS specialist may or may not attend. Having spent two weeks in hospital, this child was sent home with "a safety plan" for the parents that basically consisted of "if you or your child's life is in danger, call emergency services". That is just awful. That was the extent of the services available for this child. The mother reported sleeping on the floor outside of the girl's bedroom every night as she feared for her life and his life.

I have been dealing with another case, involving a teenager of 15 years of age who is experiencing severe mental health difficulties. I am sure the Minister of State comes across such cases every day of the week. The CAMHS psychiatrist refused to see this child. Again, the service said that autism is the reason for the child's difficulties. Despite being admitted to St. Patrick's University Hospital in Dublin for a period of ten weeks, the CAMHS psychiatrist discharged the child and refused to see him stating that the child had no treatable mental health diagnosis. The time given to assess this child by the CAMHS psychiatrist was a mere ten minutes - deich nóiméad. It took ten minutes to say that he had no treatable mental health difficulties despite having spent ten weeks in a mental health unit for adolescents. Again, this child presented to TUH in a very severe state. He waited four days for a psychiatrist to come to carry out an assessment. The CAMHS psychiatrist came and, again, said it was a matter for disability services due to the child's autism diagnosis. Thankfully, after much representation and phone calls, another psychiatrist came to assess the child and he has finally been taken under the care of CAMHS and is being seen by a psychiatrist. However, the fight continues with disability services for them to provide supports to deal with the other side of the child's diagnosis, as he has a dual diagnosis.

Another case is that of a young 14-year-old child who had no access to a psychiatric assessment following the retirement of the CAMHS ID psychiatrist in CHO 5.

Thankfully, after much lobbying by the child's parents, the HSE approved funding for the child to be assessed by a psychiatrist who travelled from the UK. This psychiatrist described this child's case as one of the most challenging and difficult to manage presentations he had encountered in over 30 years as a consultant practising in a city of 3 million people.

While the mother of this child had regular interaction with the psychiatrist, she was left to administer huge doses of medication with little to no clinical oversight or monitoring of the child's vitals. This child requires an urgent residential placement yet they wait and plead for the most basic of services and limited respite. This family is left in circumstances that no family could or should have to endure. They have been in crisis for almost two years but they have gone beyond crisis. The mother is facing extreme burnout and they have to fight and fight for limited supports. They need urgent intervention and supports from this State and they are being failed. The parents will not rest until the child receives an urgent residential placement. It is so badly needed. Procurement is spoken about. They cannot get houses and staff. It is an awful situation. We have had several meetings with this family and the HSE.

Another case I dealt with involved a primary school-aged child attending CAMHS. He was prescribed high levels of medication that made him physically sick. When he ultimately refused to take the medication because of how ill it made him, he was immediately discharged from CAMHS. It could offer him no further assistance other than medication.

I could go on and list many other cases with which I am dealing and I thank my staff for dealing with these traumatic cases but, unfortunately, it is the same story. CAMHS could offer no supports. "Present to the emergency department" is the answer people are faced with. We all know a emergency department is not a nice place even if you are in full health and only have a cut finger or a broken bone. I do not need to tell anyone here that advising a child with autism experiencing severe mental health difficulties to attend his or her local emergency department is not in any way appropriate. It is hugely inappropriate for both the child, his or her family, the staff and management in that hospital and other patients. The setting is not appropriate and will often only lead to further distress for the child and could lead to distress for other children attending paediatrics but this is the best that our current mental health services can offer.

The families with which I have been dealing, and they are many, do not want to bring their children to the emergency department and cause them and others further distress. Their love and care for their children are being abused daily by the HSE. The HSE get away with wilful neglect of our most vulnerable because they know these families will not abandon their children despite how utterly burnt out they are. I wish we could see light at the end of the tunnel but we cannot. We must fight on for these people and have a national response to sort this out. These are just a few cases. They are told to present to Tipperary University Hospital or other emergency departments and they get no services.

Our most vulnerable children are being failed and we cannot stand back and say "sorry we don't have the staff or the expertise". We cannot watch them being pushed from pillar to post. This requires a full overhaul and I am pleading with this Government to take this matter seriously because the distress being caused to families, their children and their communities is awful. I am begging the Government to do something because as somebody said earlier, it is 20 years too late. It just has to happen.

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