Dáil Éireann Debate, Thursday - 21 September 2023
3. Deputy Mark Ward asked the Minister for Health for an update on the Government’s response to the Mental Health Commission’s reports into CAMHS; if the Government will accept and implement the 49 recommendations made by the Mental Health Commission; and if she will make a statement on the matter. [40786/23]
Amharc ar fhreagraSince the recess, there have been several reports by the Mental Health Commission on child and adolescent mental health services, CAMHS. They have highlighted a failure in governance, risk management, clinical governance, staffing and access to treatment, among other matters. Overall, the reports are a damning indictment of how we care for vulnerable children. I ask for an update on the Government's response to the Mental Health Commission's report on CAMHS? Will the Government accept the 49 recommendations made by the Mental Health Commission?
The Mental Health Commission report is a welcome contribution to a common objective of improving CAMHS services. As the Deputy will be aware, and as I have said previously, when Dr. Susan Finnerty and the Mental Health Commission informed me last year that they were about to look at CAMHS, I asked them to expand their review. I also funded what was necessary in this case.
I welcome the reports. Of the 49 recommendations, many are already being progressed under work streams arising from the Sharing the Vision Implementation Plan 2022 to 2024, the Maskey report, the CAMHS operational guideline, COG, audit and the national audit of prescribing practices. 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 2015 - 2024. While challenges and issues have been identified in the community healthcare organisation, CHO, reports, is important to note that across each CHO, the hard work and dedication of the many staff working in the front-line service are acknowledged and recognised by the Mental Health Commission.
Three recommendations sit with the Department of Health, with a further two recommendations requiring departmental review and input. In relation to the recommendation requesting that there be a national clinical programme and clinical lead for the mental health of asylum seekers, refugees and migrants, I am not in a position to support this recommendation. It is important that appropriate supports and expertise are available throughout our mental health service to anyone who requires them. I am not in favour of a segregated approach.
In relation to the immediate and independent regulation of CAMHS by the Mental Health Commission, a key element of the mental health Bill will be the expansion of the commission’s regulatory remit to include community residences and services, including CAMHS services. There is a clear process in place for the development of the mental health Bill and its introduction in the Oireachtas as a priority. It is currently receiving priority drafting for the third time and four drafters are working on it. I will elaborate in my next contribution.
I want to give the Minister of State some facts. Waiting lists for initial assessments for CAMHS have almost doubled since the Minister of State took the reins in mental health. Hundreds of children have been waiting for more than a year for an appointment with CAMHS. The report also shows issues around monitoring of anti-psychotic medication. In some areas, only 50% of children had appropriate levels of monitoring of their antipsychotic medication. There are no national standards for monitoring this medication.
The report also pointed out the long waiting times between referrals and assessment for high-risk factors, which include deliberate self-harm, suicidal intent, suicidal ideation and eating disorders. Children were waiting for more than 200 days, or more than half a year, after being referred for suicidal ideation. Children were also waiting 100 days for a referral for eating disorders. Children were waiting in some areas for more than 190 days after a referral for deliberate self-harm.
I will ask the Minister of State again about the 49 recommendations. Does she accept this report in its entirety? Which of the 49 recommendations will she implement?
I will address a couple of points. The Deputy stated the waiting list had doubled. It has, and there are now 3,900 children on the waiting list, although it reduced in July. What the Deputy did not say is that there were 33% more referrals to CAMHS during the Covid-19 period, that the teams saw 21% more children and that there were 225,000 appointments last year.
It is important to put that on the record of the Dáil.
In response to the Deputy's question on antipsychotic medication, we now have a new clinical lead for CAMHS, which we never had before, namely, Dr. Amanda Burke, who has 30 years' experience. She is an executive clinical director. She took up her post in August and I have met her several times already. As of Monday of this week, we have a new national youth mental health office. That was never the case in the HSE previously. Dr. Donan Kelly took up the post on Monday. I look forward to meeting him next week.
The Minister of State mentioned 33% more referrals to CAMHS. She is right that there have been more referrals but there were also more children referred to CAMHS and not accepted because they did not meet the criteria. That is right across the board. It is different in different CHO areas. In one CHO area, the acceptance rate will be 60% or 70% but in the neighbouring CHO area, the acceptance rate will be an awful lot lower. We need to have uniformity of care because a postcode lottery of care has developed under this Government.
I am going to talk about just one of the recommendations, No. 1. It is that: "The immediate and independent regulation of CAMHS by the Mental Health Commission must be put in place to ensure" that the Mental Health Commission has the statutory powers to oversee CAMHS. The Minister of State mentioned that in her previous intervention. People cannot wait. Children cannot wait for this legislation. Deputy Cullinane and I have submitted legislation to the Bills Office and it will come before the Oireachtas very soon. Will the Minister of State accept recommendation No. 1 and support us on this matter?
Recommendation No. 1 relates to the immediate and independent regulation of CAMHS by the Mental Health Commission. As I said, a key element of the Mental Health Bill will be expansion of the commission's regulatory remit to include community residences - about 1,200 people live in community residences all over the country - and services, including CAMHS services. That has been agreed and the Mental Health Commission is aware of it but we need legislation to put it in place.
I have the legislation.
A clear process is in place for the development of the mental health Bill. Recommendation No. 2, which follows on from No. 1, states that the implementation of these recommendations must be monitored by the Mental Health Commission. The commission intends to publish a yearly report on progress of implementation. While I welcome the focus on service improvement in CAMHS, it is the role of the Department of Health to ensure that key performance metrics for HSE services are met. The functions of the commission, as set out in section 33 of the Mental Health Act, do not include a function to oversee or monitor performance. I want to get the legislation in place as soon as possible and I also want the Mental Health Commission to have oversight of the CAMHS teams.
