24, Jan 2023 - Press Release 'IASW responds to Independent Review of the provision of CAMHS Services'.

 Social workers call for end to the ‘postcode lottery’ in children’s mental health services, which has failed children and families so badly

 IASW response to the Independent Review of the provision of Child and Adolescent Mental Health Services (CAMHS) in the State by the Inspector of Mental Health Services, Interim Report.

 The Interim Report from the Mental Health Commission (MHC) on the organisation and provision of Child and Adolescent Mental Health Services (CAMHS) is stark and disturbing in its findings. Social workers welcome the publication of this report, which identifies serious problems and shines more light on CAMHS failings, and their impact, many of which were evidenced in the Maskey Report last year. The fact that so many children and their families have been harmed and had basic human rights denied, in terms of accessing and in the delivery of what is meant to be therapeutic health services, is of the deepest concern to the IASW. 

Commenting following the release of the MHC interim report, IASW Chairperson, Vivian Geiran stated: 

Given the depth and widespread nature of the critical issues identified in this latest report on CAMHS, it is clear the service as a whole is not fit for purpose and radical change is required to even begin to put things right. This is in spite of the best efforts of so many CAMHS professionals, including social workers, who struggle every day to deliver the best services possible to children and their families across the country. Despite those best efforts however, there have been significant and ongoing violations of children’s rights, in far too many instances. The ‘postcode lottery’ of mental health services for children must end and we must ensure that all children are able to access a high quality service, when they need it, regardless of where they live. We need urgent action to ensure that all CAMHS teams are working on the basis of evidence-based policy and not those that are left up to the decisions of individual CAMHS teams. In addition, while effective ‘talk-therapies’ are currently available on an ad hoc basis, their provision should be developed and standardised, to reduce over-reliance on medical interventions. 

The MHC Report draws attention to children’s right to enjoy the highest attainable standard of physical and mental health, under Article 24 of the United Nations Convention on the Rights of the Child (UNCRC), which was ratified by Ireland in 1992. In the CAMHS areas reviewed by the MHC, this right has been breached for many children.  The MHC Report reflects the consequences of sustained neglect to adequately prioritise and fund primary care and children’s mental health services by successive governments.   

A rights-driven response to the findings of the Interim MHC Report will demand a major transformation of our services. Neither primary care in its present under-resourced form nor CAMHS as currently structured appear to have the leadership or the capacity required to meet these challenges. There is an onus and a legal obligation on all of us to ensure a bold transformation of youth mental health services is realised, one that will address the deep problems and concerns raised by the MHC Report. In building a framework for change, we need to listen to children and their parents, thereby ensuring that Articles 12 and 24 of the UNCRC are integrated into every aspect of CAMHS. 

The IASW welcomes the Mental Health Commission call for an immediate clinical review of all open cases in all CAMHS Teams. We also welcome the Mental Health Commission call for an urgent national response, as it considered this could not wait until their final Report, expected later this year.  As part of the government’s response to the MHC report, the IASW is also calling for: 

• Immediate steps to be taken to implement evidence-informed practice in all CAMHS teams. As a start, the HSE must ensure the immediate and consistent implementation of existing operating guidelines as a minimum.
• A plan to address long-term staffing issues, including by improving access to staff training and increasing the number of clinical placements in CAMHS.
• Ring-fenced budgeting for CAMHS, as well as national planning that integrates all government funding to services for youth mental health programmes.
• Clarity on how services are managing mental health referrals and ensuring a ‘one door’ system for referrals to the HSE.
• Urgent development of an adequate IT infrastructure to allow for digital filing and case management, which in turn would assist with service planning.
• Move from a predominantly medical model to a rights-based model of service delivery.
• Review of the inadequate and outdated over-dependence on the consultant psychiatrist for team leadership and consideration of a move away from this model, which is failing: Propose enabling other professional disciplines / team members to be clinical / team leads.
• CAMHS to come under the regulation of the MHC.

We should also look to the evidence from the one HSE CHO area that was not identified as having an issue, including the deployment of an appropriate number of senior posts, good governance structures and access for staff to relevant training.

IASW Spokesperson: Vivian Geiran via office on 086 0241055

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Note: A copy of the Interim Report arising from an Independent Review of the Provision of CAMHS in the State can be found here: https://www.mhcirl.ie/publications/interim-report-arising-independent-review-provision-child-and-adolescent-mental-health