Mental Health Services

Dáil Éireann Debate, Thursday - 16 February 2023

Thursday, 16 February 2023

Questions (87)

Mark Ward

Question:

87. Deputy Mark Ward asked the Minister for Health if he will set out a timeframe for completing a review of all open and lost to follow up cases in child and adolescent mental health services to address matters raised by the interim report of the Mental Health Commission arising from an independent review of such services; if he will publish a multi-annual funding plan for improving child and youth mental health services; and if he will make a statement on the matter. [7554/23]

Oral answers (6 contributions)

Deputy Mark Ward

I will speak about the Mental Health Commission's report into CAMHS. One of the concerns escalated relates to the 140 children who were lost to follow up. Will the Minister of State set out a timeframe for completing a review of all open and lost cases in CAMHS? Will she publish a multi-annual funding plan for improving CAMHS, including to extend access to CAMHS to young people up to the age of 25?

Minister of State at the Department of Health (Deputy Mary Butler)

I will respond to the Deputy's third question first. As he will be aware, the national implementation and monitoring committee, NIMC, is the oversight body in charge of ensuring Sharing the Vision: A Mental Health Policy for Everyone is delivered. A sub-committee which reports to me every three months has recently been formed. Its reports are on the NIMC website. The sub-committee was in place before this report was published. It was asked to look at children ageing-out of CAMHS at 18. We are looking at extending the age to 21, 23 or 25. I am open to all suggestions. A body of work is being done by public, private and voluntary stakeholders on this.

I will now respond to the Deputy's first question about the timeframe for completing a review.

All areas of concern identified by the commission in carrying out its interim report were escalated immediately by the HSE for immediate action and resolution, including the review of open patient cases which the HSE is undertaking. Several meetings were held with the Minister, Deputy Donnelly, and I and I met all the stakeholders in the HSE.

All CAMHS teams nationally have been asked to conduct a review of all open cases. For the purpose of this review, an open case is defined as a referral that has been accepted and the patient seen for initial assessment and where the patient is currently under the care of CAMHS. A guidance pack and associated documentation has been sent out to all chief officers and heads of service for mental health in the CHO areas this week requesting details on the number of open cases identified through this phase. Each area has been asked to report back on this by 17 March 2023. This is to identify the open cases. Once CAMHS teams have assessed and prioritised those cases that have not been seen within the past six months and have no follow-up appointment scheduled, the HSE has confirmed that a number of steps will be undertaken. I will come back with the details on these. The complete audit will be concluded by the end of May 2023.

Deputy Mark Ward

I thank the Minister of State. As I said I have met the HSE numerous times. It came before the Oireachtas Sub-Committee on Mental Health on Tuesday. It was probably one of the more positive meetings we have had with the HSE. I acknowledge the work done by the staff in CAMHS. They are doing their best. It seemed to be systemic failures that impeded them from doing their best for the children they look after.

An issue that came up at the meeting, about which I was concerned, is that CAMHS has said it has identified 140 children lost to follow-up but it has yet to meet these children and their families. This is the answer that I got on Tuesday. Will the Minister of State give us a timeframe on when this will be carried out? It is of utmost importance that these children and their families are sat down and a plan is put in place for them. It is all right to identify them in paper files but seeing people face-to-face needs to happen.

Deputy Mary Butler

In total there were 168 children lost to follow-up. There were 140 in CHO 3 in the Limerick area. They were identified by the team there before the Mental Health Commission had come in. It was a result of a lack of staff. There were only three consultant psychiatrists working there and at present there are seven. The other 28 were between three other CHOs. My understanding is that the 168 cases, some of whom have been identified, will form part of the review.

Contact will made with the young persons and their parents to invite them to a review appointment with a member of the CAMHS team within the timeframe I have set out, unless urgent concerns are indicated in which case they will be called in much sooner. In relation to expediting urgent cases, the severity of presenting symptoms as well as an assessment of risk is always taken into account. If they no longer need the support of CAMHS, or have aged out, the children should be discharged and care transferred back to the GP. If, despite all attempts, the team cannot make contact with the young persons or their parents the files will be closed and referred back to the GP or referral agent.

Deputy Mark Ward

I thank the Minister of State. Is it possible for the Minister of State to indicate the number of open cases that need to be reviewed? If she has any figures on this I would like to get them.

There is a gap in the system when young people turn 18 and go into adult mental health services. The Minister of State mentioned referring them back to GPs. I do not know whether that is appropriate in all cases. We probably need to extend CAMHS to the age of 25. One of the responses I received from the HSE on Tuesday was with regard to it being a medium- to long-term plan of the HSE to extend CAMHS. Is there a timeframe on this? Is there any way it can be sped up and put in place a lot quicker? The report is of great concern but it could be a catalyst for the substantial changes needed in CAMHS. I will work 100% with the Minister of State to get these changes made.

Deputy Mary Butler

I thank Deputy Ward. I agree that it will be a catalyst. I want to make several points. I asked for all of these audits and reviews to be put in place 12 months ago, as a result of the Maskey report in Kerry. The main concern I had after the report was for the 240 children in Kerry at risk and the 48 who had significant harm caused to them. There were many challenges but the overprescribing did not come through in the report. This has to be looked at. It is something we were worried about.

There are 73 CAMHS team and a 74th team will be put in place in the Wexford area very shortly. The last one we put in place was in Donegal. I met all of the stakeholders last week in Leinster House. Dr. Amir Niazi, of whom Deputy Ward is aware and who answers all of the parliamentary questions, has put great effort into this. I look forward to the final outcome. The seven audits and reviews are under way. We must be aware that they place a large amount of pressure on the teams. My focus and the focus of the Deputy is that the child will be looked after first. There are a lot of pressures on the teams to respond to all of these reviews and audits.