Serious CAMHS Deficits Spark HSE Apology

Major shortcomings in the provision of child and adolescent mental health services in the Mid-West have prompted an apology from the HSE.

Serious concerns about the capacity of the Child and Adolescent Mental Health Services to provide a safe service for young people in the region with mental health issues have been highlighted in a new report completed by the Mental Health Commission (MHC).

Responding to the Commission’s critical report, HSE Mid West Community Healthcare stated it acknowledges deficits in the provision of CAMHS and apologises to children and families who have not received the standard of care that they or they expect.

The HSE outlined it continues to progress a targeted series of service improvements in Mid- West CAMHS.

The number of children waiting for a mental health appointment in West Clare has increased sevenfold in the last year up from 12 at the time of inspection in June 2022 to 91 in February 2023.

The waiting list in East Clare jumped from 30 to 43 during the same period.
The MHC report revealed staffing levels across the CAMHS teams were low and did not meet the recommendations of A Vision for Change; it was approximately 70% of what it should be.

“Teams were missing key skilled staff to offer a full comprehensive service. The inability to recruit staff, including consultant psychiatrists, has had a detrimental effect on service delivery, with long waiting lists, lack of consultant cover, and cases being lost to follow-up.

“The use of locums, some of whom are not on the specialist register for CAMHS, to cover vacancies is not a satisfactory response and leads to inconsistency in care, lack of team cohesion and confusion in the CAMHS team.

“No consultant psychiatrist covered other consultants while they were on leave and no locum cover was provided for this period.

“Only one of the consultant psychiatrists worked in a full-time capacity and there was no cover for times when the other consultants were not working.

“This had led to a risk to the safety of children attending the service and multiple incident reports being escalated.

“We had serious concerns about children who had been lost to follow-up, following unplanned leave of a senior clinician in February 2021.

“This situation resulted in children and young people having no identified key worker to ensure arrangements were in place for follow-up.

Following an audit, the Head of Service initiated a desk-top review of cases not being keyworked and identified 140 children who were not receiving follow-up appointments. This review was underway during the inspection.

Measures to address risk included a review of urgent cases by a part-time consultant psychiatrist on the Adult Psychiatry register with the Medical Council on the team and a review by the Executive Clinical Director of files as necessary.

The report stated there was no clinical director for Mid-West CAMHS.

This had the effect of a disjointed management of the service, with each consultant attempting to raise issues, concerns and risks with the Executive Clinical Director, who is not a CAMHS consultant psychiatrist, and whose remit covers all mental health services.

Throughout this process, and before it commenced, HSE Mid West Community Healthcare stated it initiated a series of service improvements within to enhance the CAMHS service and improve the experience of children, young people and families in the Mid West.

It stated the delivery of a high-quality CAMHS service to the children and young people in the Mid-West is a priority.

Improvements include an increased in the number of CAMHS-registered Consultant Psychiatrists in the Mid-West to 6.2 Whole-Time Equivalent (WTE), up from 3.6WTE in January 2022. A further consultant post has been approved and recruitment efforts are ongoing.

Since the beginning of 2022, a total of 16.6WTE have been recruited across Mid- West CAMHS. This includes additional staff in areas including Consultant Psychiatrists, Advanced Nurse Practitioners, Social Workers, Occupational Therapists, Speech and Language Therapists and support staff.

This has resulted in an improved CAMHS service in the Mid West.

A new consultant-led multidisciplinary regional CAMHS Hub is under development. This is an alternative model to providing inpatient care, involving treatment at home or in a day hospital, and is designed to meet the needs of existing CAMHS service users with complex needs from across the region.

A number of staff for this service are already in post, and additional recruitment is ongoing.

An additional CAMHS Team is in development for the Mid-West region. This
will bring the total number of CAMHS Teams to seven.
“The benefits of these service improvements are shown in the MHC’s Independent Review of CAMHS, which was published in July 2023).

“This report’s findings include that Mid-West CAMHS now has the highest provision of Consultant Psychiatrist staffing of any Community Healthcare Organisation (CHO) when compared to the recommendations of A Vision for Change.

“The report also notes strong levels of staffing among Non-Consultant Hospital Doctors, Nursing Staff, Psychologists, Social Workers and Occupational Therapists.”

Mid-West CAMHS reports some of the shortest wait times from when a
young person is referred to the service, until they are assessed.

It has the lowest wait time for young people referred for an assessment relating to eating disorders, and shorter-than-average wait times for all of the other main reasons for referral to CAMHS such as depression, ADHD, anxiety.

It accepts 79% of children and young people on their first referral to the service from their GP, the joint-highest acceptance rate of any CHO area.
Further benefits of these investments can be seen in the overall reduction in
waiting lists across the region.

The total numbers waiting for an initial CAMHS assessment have dropped by 21% since the MHC’s inspection in June 2022, and 16% since February 2023.

This progress would not have been possible without the commitment of staff working in the CAMHS Teams. Any parent or guardian with a concern or query about their child who is currently attending CAMHS should contact their child’s team directly.

Dan Danaher