Mary Butler (Waterford, Fianna Fail)
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The Government is committed to delivering real and tangible solutions to better support the needs of autistic people in Ireland. In answer to the Deputy’s question, treatment for ASD falls under Disability Services, however CAMHS can provide input and support Disability Services if there are mental health issues associated with the ASD. There are no plans for CAMHS to take on ASD cases where there is no evidence of a moderate to severe mental health disorder present.

When deciding if a child or adolescent needs to attend CAMHS, a number of factors are considered by the CAMHS Team. These include consideration of the child or adolescent’s clinical presentation, their level of social and family support and the availability of resources and treatment options at primary care level or within community networks. It is the role of the CAMHS team to decide if the child or adolescent reaches the threshold for community CAMHS.

The Autism Innovation Strategy which is currently in development, will provide for a holistic and agile approach which can effectively respond to our evolving understanding of autism and the wider policy context. The HSE is also working to bring about further improvements for people presenting with or living with autism. Following the commissioning and publication of the Review of the Irish Health Services for Individuals with Autism Spectrum Disorder (the Review), the HSE commenced implementation of a Service Improvement Programme for the Autistic Community based on the recommendations of the Review. A National Autism Programme Board was established with the responsibility for leading the implementation of the Review report recommendations.

In relation to mental health services for children and adults with autism, Recommendation 20 of Sharing the Vision highlights the need for further development of early intervention and assessment services in the primary care sector for children with ADHD and autism to include comprehensive multi-disciplinary and paediatric assessment and mental health consultation with the relevant community mental health team where necessary. This policy recommendation has been developed specifically to ensure that services are aligned so that children and their families can access the most appropriate care and supports, from the correct care providers, as soon as possible.

The implementation of this recommendation is in process. Phase 1 of the piloting of an autism assessment and intervention protocol is complete. This programme requires integration across all services, including mental health, and work is underway to develop a pathway to address recommendations arising from phase 1 and ensure pilot site buy in for phase 2 across all CHOs. It is important to note that mental health services are available to all children in this country, whether or not they have a diagnosis of an ASD or any other condition.

Access to CAMHS for children with ASD is specified in the CAMHS clinical operational guideline (COG), which was published in 2019 and sets out the core functions and remit of CAMHS. As such, any child with a moderate to severe mental health need, who also has a diagnosis of autism, can access CAMHS. There are some children and adolescents who may present with complex needs, including autism, and a moderate to severe mental disorder at the same time. Where the child or adolescent presents with a moderate to severe mental disorder, it is the role of CAMHS to provide appropriate multidisciplinary mental health assessment and treatment for the mental disorder. This may involve joint working or shared care with other agencies, including HSE Primary Care, Children’s Disability Network Teams and other agencies supporting children and adolescents.

In conclusion there are there are no plans for CAMHS to take on ASD cases where there is no evidence of a moderate to severe mental health disorder present.

Mary Butler (Waterford, Fianna Fail)
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As this is a service matter, I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.

As the Deputy may be aware, management and administrative grade staff in the Fórsa union in the HSE commenced industrial action on Friday, 6October. As a consequence of this industrial action, members in these grades are not engaging with political forums or processes. As a result, the question asked by the Deputy may be delayed in receiving a response directly from the HSE.

Mary Butler (Waterford, Fianna Fail)
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The Government is committed to delivering real and tangible solutions to better support the needs of neurodivergent people and people with intellectual disabilities in Ireland. In answer to the Deputy’s question, CAMHS can provide input and support Disability Services if there are mental health issues associated with the disability. However, there are no plans for CAMHS to take on cases for children with disabilities where there is no evidence of a moderate to severe mental health disorder present.

When deciding if a child or adolescent needs to attend CAMHS, a number of factors are considered by the CAMHS Team. These include consideration of the child or adolescent’s clinical presentation, their level of social and family support and the availability of resources and treatment options at primary care level or within community networks. It is the role of the CAMHS team to decide if the child or adolescent reaches the threshold for community CAMHS.

CAMHS is not suitable for children or adolescents where their difficulties are related to learning problems, social problems, behavioural problems or mild to moderate mental health problems. There are many services available to respond to these issues for children and adolescents, for example HSE Primary Care Services, HSE Disability Services, TUSLA, Jigsaw, National Educational Psychology Services (NEPS) and local Family Resource Centres.

CAMHS does not accept the following children or adolescents where there is no evidence of a moderate to severe mental health difficulty present:

• Those with an intellectual disability. Their needs are best met in HSE Social Care/HSE Disability Services for the diagnosis and treatment of intellectual disability. However those children or adolescents with a mild intellectual disability with moderate to severe mental disorder are appropriate to be seen by CAMHS.
• Those with a moderate to severe intellectual disability and moderate to severe mental disorder. Their needs are best met by CAMHS Mental Health Intellectual Disability (MHID) teams, if present.
• Those whose presentation is a developmental disorder (examples of these could include Dyslexia or Developmental Coordination Disorder). Their needs are best met in HSE Primary Care services and/or Children’s Network Disability Teams.
• Those who require assessments or interventions relating to educational needs. These needs are best met in services such as Children’s Network Disability Teams or the National Educational Psychology Service (NEPS).
• Those who present with child protection or welfare issues, where there is no moderate to severe mental difficulty present. These needs are best met by Tusla.

Additionally, CAMHS does not accept children or adolescents with a diagnosis of autism where there is no evidence of a moderate to severe mental health disorder present. The diagnosis and treatment of autism remains the remit of HSE Primary Care and Children’s Network Disability Teams.

Access to CAMHS for children with ASD is specified in the CAMHS clinical operational guideline (COG), which was published in 2019 and sets out the core functions and remit of CAMHS. As such, any child with a moderate to severe mental health need, who also has a diagnosis of autism, can access CAMHS. There are some children and adolescents who may present with complex needs, and a moderate to severe mental disorder at the same time. Where the child or adolescent presents with a moderate to severe mental disorder, it is the role of CAMHS to provide appropriate multidisciplinary mental health assessment and treatment for the mental disorder. This may involve joint working or shared care with other agencies, including HSE Primary Care, Children’s Disability Network Teams and other agencies supporting children and adolescents.

The Programme for Government commits to improving all aspects of CAMHS in line with Sharing the Vision, our national mental health policy and Connecting for Life, Ireland’s national strategy to reduce suicide.

The Mental Health Commission plays an important, independent role in supporting and assisting in the development and improvement of mental health services. CAMHS teams have worked closely with the Mental Health Commission over the last year to develop and implement improvement plans as needed following their Interim and Final Reports on CAMHS across the country. In addition, the HSE continues to progress three national audits in relation to CAMHS arising from the Maskey Report on South Kerry, namely the recently published national review of CAMHS prescribing practice; the national audit of compliance with the CAMHS Operational Guidelines; and a qualitative review of service user experiences being undertaken by UCC. The outcomes of all HSE audits will help to help inform next steps regarding CAMHS.

In terms of the final, full report, the HSE have provided the Department of Health with a full analysis of all 49 recommendations, which sets out the work that has been undertaken, is being undertaken, and will be undertaken to address the issues raised. The HSE responses to the issues raised by the Commission in their report have provided assurances to both Minister Butler and the Department of Health.

The Department of Health notes that the vast majority of recommendations in the report are already being progressed by the HSE under the implementation of Sharing the Vision, Connecting for Life, and the audits and reviews arising from the Maskey Report.