Of the 49 recommendations made by the Mental Health Commission (MHC) in their Child and Adolescent Mental Health Service (CAMHS) report, the HSE have reported that approximately 40 of the 45 recommendations that fall under their remit are in progress. A number of these recommendations also relate to new service developments which are dependent on further investment. Responsibility for 4 recommendations (Recs. 1, 2, 14 and 19) lie with the Department of Health. Broadly, these relate to:
Recommendation 1: The immediate and independent regulation of CAMHS by the MHC must be put in place to ensure that all children have access to evidence-based and safe services, regardless of geographical location or ability to pay.
• The Government recognises the importance of ensuring all mental health services, both inpatient and community, and both adult and child and adolescent, are fully registered, regulated, and inspected by the Mental Health Commission in its role as the independent regulator of mental health services.
• Under the Mental Health Act 2001, the Mental Health Commission registers, inspects, and regulates all inpatient mental health services, including inpatient CAMHS. The current Mental Health Act 2001 does not include any provisions for the registration or regulation of community mental health services and therefore, it is not considered that the Act provides the necessary legal basis to expand the Commission’s regulatory remit.
• The expansion of the Mental Health Commission’s role into regulating all community mental health services, including community CAMHS, is being addressed in the forthcoming Mental Health Bill. This new Bill is a complex and lengthy piece of legislation. It will provide the necessary legal underpinning to ensure that the Mental Health Commission can regulate all community services. Additionally, the Bill will overhaul the involuntary admission and detention process, modernise provisions related to consent to treatment, provide enhanced safeguards for people accessing inpatient treatment, and provide a new, discrete Part that relates exclusively to the care and treatment of children and young people.
• Drafting of this Bill has been prioritised and it is now in its final months of drafting. It will be introduced to the Oireachtas in the summer legislative session, which begins in April.
Recommendation 2: The implementation of these recommendations must be monitored by the MHC who must publish a yearly report on progress of implementation.
• The Mental Health Commission play a vital role in the independent monitoring of mental health services in Ireland. The Department welcomes the Commission’s focus on service improvement in CAMH services, particularly on foot of this report, however it is the role of the Department of Health to ensure that key performance metrics for HSE services are met, that investment is used for agreed service developments, and that policy recommendations are reviewed and enacted as appropriate. 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 the performance of the HSE outside of services registered as approved centres nor do they grant an implementation function on the Commission. It is for the Minister and Department to either accept or not accept the recommendations arising from the Inspector’s report and for the Minister and Department to set any targets or goals for the implementation of any such recommendations, in consultation with the HSE and the Commission as appropriate.
• The Department of Health has a key role in policy development, service development, and performance management. Officials in the Department of Health meet with senior HSE executives every month in the context of performance monitoring. A standing item on the performance agenda is child and adolescent mental health services (CAMHS), as well as progression and publication of the HSE audits arising from the Maskey Report. The Department have reviewed the 49 recommendations and in collaboration with the HSE continues to discuss the recommendations from this report at performance meetings as deemed appropriate.
Recommendation 14: The budget allocated to CAMHS must be increased to develop adequately resourced teams and appropriate facilities within CAMHS.
• The HSE in their response to the Commission indicated that this was a matter for the Department of Health. It should be noted that the operational prioritisation and financial allocation of the HSE’s Budget is a matter for the HSE, which is reviewed and sanctioned by the Department as part of the annual estimates and National Service Plan processes.
• Year-on-year funding for mental health services increased from €1.221 billion in Budget 2023 to nearly €1.3 billion in 2024, and with a strong focus on investing in child and youth mental health. This is the fourth consecutive year of an increase for mental health services, and highlights in real terms the importance this Government places on the mental health of those living in Ireland.
• CAMHS receives €146.5 million in dedicated funding annually. In addition to this, approximately €110 million in funding is provided by the Government to community-based mental health organisations/NGOs each year to deliver supports and services. A significant proportion of this is dedicated to supporting young people. I recently announced a further €10 million in funding for mental health to support the delivery of clinical programmes and youth mental health. This again highlights the Government’s recognition of mental health as a central component to overall health, and to reform youth mental health care in line with the policies Sharing the Vision and Connecting for Life.
• Examples of service initiatives under Budget 2024 for Mental Health include:
- Additional staffing for CAMHS teams to improve access to services and reduce waiting lists.
- Expansion of multi-disciplinary CAMHS Hubs Teams to complement traditional service models.
- Further development of specialist mental health teams providing essential services.
- A new Youth Mental Health app.
Recommendation 19: The Draft Overarching National Standards for the Care and Support of Children using Health and Social Care Services, jointly produced by MHC and HIQA should be finalised at Ministerial level and implemented in practice.
• Separate to the MHC Report process, HIQA and the MHC developed the Draft Overarching National Standards for the Care and Support of Children using Health and Social Care Services standards and submitted them for Ministerial approval in July 2022. These high-level draft standards relate to all children using the health service (i.e., Acutes, Disability, Primary Care, Mental Health etc.) and are designed to complement any current standards or guidelines.
• Officials in the Department have met with Minister Butler in relation to the standards to consider the impacts around legislation, monitoring, future resource provision, and draft standards that are wider than just mental health.
Further detailed consideration of these recommendations will continue.
