Ireland’s mental health services need an overhaul

A 16-year-old girl self-harmed at school two weeks ago in Co Louth. It was the fourth such incident she had been involved in.

She was rushed to hospital where she received medical treatment and her father was informed that she then needed to be admitted to a residential care unit for psychiatric care. 

For nine days, he sought in vain to identify a facility that would take her in as an emergency case, having to sit in Tallaght Hospital Emergency Department for days until it was raised in the Dáil and the minister for mental health intervened. Finally, she was admitted to a unit where she is now receiving treatment.

It was a saga played out in real time for thousands of listeners on Irish local radio station LMFM and brought home to many the crisis situation that exists in mental health care in this country. The anguish and pain of the distraught parent, fighting the system to literally keep his teenage daughter alive, evident to all.

Sadly, it is not an isolated case of the state failing our youth. A report was published on January 23 into the Child and Adolescent Mental Health Services (CAMHS) which found many children and young people being let down by a system that is in place to deal with moderate to severe mental illness.

The head of the Mental Health Commission, John Farrelly, was damning in his assessment. The report, he said, “shows clear failings of governance and oversight with no evidence that a national coordinated approach is being taken to caring for children with a mental illness.”

Frankly, it’s a service that is totally unfit for purpose.

Failings identified included chaotic governance that resulted in confusion and frustration among staff. That in turn contributed to inefficient and unsafe CAMHS services and inability to manage risk and recruit staff. 

This has inevitably led to long waiting lists with nearly 4,300 awaiting assessment and treatment at the turn of the year, an increase of 60 percent since 2020. Of those on that list, over 10 percent have been waiting for over a year to see a psychiatrist.

So dealing with long waiting lists led to unsafe situations such as the early use of medication rather than waiting and providing support to allow distressing situations to resolve with time. This would be the case, for instance, after a teenage relationship breakup.

But even more concerning are the so-called “lost children.” These are patients who, following an initial consultation, failed to receive any follow-up appointments to review their medication and monitor their prescriptions.

This means that there are children taking prescription medication for their mental health that may not be suitable for them in their current state of mind. Alternatively, there are children out there in need of prescription medications who are not getting them. 

Even worse, these included some who had reached their 18th birthday with no planning, discharge, or transition to adult services, with no advice about medication to take. Lost and forgotten.

Except their problems are not disappearing, and according to the College of Psychiatrists of Ireland the health service is “now seeing astronomical number of young people self-harming.”

The college warns that we are now in the middle of “a hidden epidemic.” More worrying is the fact that increasing numbers of incidents of self-harm among children aged 10-14 years indicate that the age of onset of self-harm is decreasing.

The existing healthcare infrastructure is not sufficient to meet the demand for mental health care among young people. What’s difficult to understand is why alternative pathways are not being explored. 

While CAMHS primarily adopts a medical approach, there are other potential treatment routes that could be explored. Primary care teams are the initial contact with the patient. It is critical that prevention and early intervention needs are served at this stage.

For this to happen multidisciplinary teams have to be developed and additional psychotherapists, psychologists, and mental health nurses need to be recruited. Clearer lines of communication between the various services are necessary. However, this is counter-cultural as the whole health service is bedeviled by poor communications and empire building.

In dealing with the teenager in Louth, the Minister for Mental Health Mary Butler said that there shouldn’t be a need for parents to contact politicians to ensure proper treatment for their children. Now, whose fault is that, minister?

Fianna Fáil during the last general election made reform of mental health services a major campaign theme and in government took over the position of minister for mental health. While their performance in government so far has fallen far short of their promises there are indications that this is changing. 

Additional funding was made available in the recent budget and that has been welcomed by campaigners. It marks a change in priorities as mental health has suffered from chronic underfunding over the past few decades.

But there is a long road ahead, and in the interim we are left with a service that is close to a shambles.

Is CAMHS fit for purpose? Based on the reviews and reports into its shortcomings the answer has to be that, as currently constituted, it is not. 

Young people and their families at a time of great stress and mental illness put their faith in a service, and did not receive the support which they required and deserved, and which they were entitled to expect. Not only that but a significant number were harmed by their experience. 

While undoubtedly there are committed and dedicated professionals within CAMHS, tellingly the report highlighted instances where staff did not escalate issues because they felt “there was no point” and nothing would be done.

For every time that staff did not report a case, there was a child in need and a family in crisis. It is really not good enough for our children.

*This column first appeared in the February 1 edition of the weekly Irish Voice newspaper, sister publication to IrishCentral. Michael O'Dowd is brothers with Niall O'Dowd, founder of the Irish Voice and IrishCentral.