Tuesday 16 October 2018

Hundreds of children in mental health distress like Milly (11) 'at risk' due to staff shortages

Services for children and teens experiencing mental health problems suffering from recruitment delays and staffing shortages

Children and adolescents who are in severe mental health distress have no access to an out-of-hours psychiatric team in at least 15 counties. Stock Image
Children and adolescents who are in severe mental health distress have no access to an out-of-hours psychiatric team in at least 15 counties. Stock Image
Laura Larkin

Laura Larkin

CHILDREN with mental health difficulties are facing long delays in accessing services due to ongoing staffing and recruitment problems in the HSE.

The harrowing wait for specialist care may be leaving some children, who are in severe emotional turmoil, at risk of self-harm or suicide.

Children and teens who present with mental health problems are referred to the Child and Adult Mental Health Service (CAHMS).

In its quarterly performance review (looking at June-September) the HSE found that 317 minors in four HSE divisions were waiting more than 12 months for their first appointment following a referral.

In CHO4 (which covers parts of Kerry and Cork) 196 children were waiting more than 12 months for an appointment.

A lack of staff and difficulty recruiting is compounding problems with the delivery of services.

In the quarterly report the HSE noted recruitment issues are a "key concern".

“As a result of recruitment challenges in both Medical and CAMHS nursing staff it has been necessary to reduce the numbers of CAMHS inpatient beds," the report states.

“The increases in waiting lists relate significantly to availability of appropriately trained staff including primary care based psychological supports, recruitment difficulties in appointing clinical staff and lack of suitable accommodation for maximum operational effectiveness,” the report states.

In September's monthly report it was found that 67.6pc of children referred were offered a first appointment within three months by Child and Adolescent Community Mental Health Teams. Just 61.4pc of those referred were actually seen.

At the end of September there was 2,333 children waiting for a first appointment.

At an inquest into the death by suicide of a young Dublin girl, Milly Tuomey (11), it was heard that pathways to care for children in respect of mental health is "under-resourced".

Milly Tuomey was
Milly Tuomey was "greatly loved", said her parents

Psychiatrist Dr Antoinette D’Alton told the court during the inquest that suicidal ideation is increasing in children.

In Milly's case she was referred to CAHMS and was given an appointment for January 30, which was brought the brought forward when a 'suicide diary' was discovered by her mother.

Her parents, Fiona and Tim,  in a statement following the hearing, said it was "simply not acceptable" that there was no clinical protocols for when a child has a mental health crisis.

The HSE said it couldn't comment on individual cases.

All referrals to CAMHS are assessed on their clinical presentation and need and referrals that are deemed urgent will be seen as a priority," a spokesperson said.

"The Mental Health Division have developed a Standard Operating Procedure (2015) to inform young people, Parents, Carers, referrals agencies etc. of the role and function of the CAMH’S service. The CAMHS Standard Operating Procedure also outlines the referral response times in respect of referrals to the CAMHS service.

Children and adolescents who are in severe mental health distress have no access to an out-of-hours psychiatric team in at least 15 counties.

No on-call service is available in counties Wexford, Cavan, Monaghan, Sligo, Leitrim, Kerry, Carlow, Kilkenny, Tipperary, Meath, Longford, Westmeath, Laois, Offaly and Louth, according to information obtained in a parliamentary reply by Fianna Fáil spokesman on mental health James Browne.

Work is underway in the Department of Health to look at how 7/7 and 24/7 hours access to mental health services can best be achieved.

The Government has approved 120 new Assistant Psychology posts into Primary Care and it is hoped this will ease the pressure on the services but hiring staff continues to pose a challenge.

Work is also continuing within the HSE to improve the delivery of services and areas where issues exists have been compelled to draw up action plans.

But “despite on-going recruitment campaigns, this work continues to present significant challenges while current vacancies, particularly in CAMHS Consultant posts and increasingly CAMHS nursing posts remain unfilled”, the HSE noted.

It is generally accepted that although Vision for Change made clear recommendations for CAMHS resources, these have not yet been fully realised and current capacity falls short," the HSE said. 

"Despite a net increase in CAMHS staffing from 622 staff in 2010 to 842 staff in 2015, most community CAMHS teams across the country are operating at 50% of that recommended in Vision for Change. This is despite significant investment in CAMHS over the last number of years and intensive staff recruitment efforts.


Problems with CAHMS has been noted several times in the Dáil and the Seanad and has been addressed by a number of junior ministers.

In March of this year a letter to the Health Minister from a 14 year old who was having difficulty securing an appointment with a psychologist despite presenting with suicidal ideation.

She wrote:

“I would like to know why there is no help for children when they ask for it? What can you do or what can be done to stop other children going through this”

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