Dr John Hillery – Many children unnecessarily on CAMHS waiting lists due to lack of other interventions
Over 2,400 children waiting for child mental health services but many should not be on the list at all for this ‘catch-all service’, says Dr John Hillery and many senior practicioners.
This article by Michelle McDonagh was published on the Irish Times on 4th July 2017.
There are currently 2,419 children and young people with mental health disorders on the waiting list for the Child and Adolescent Mental Health Service (CAMHS), 218 of whom are waiting for more than a year.
Many of the 2,400-plus children on the Child and Adolescent Mental Health Services (CAMHS) waiting list should not be on the list at all, however it has become “a catch-all service” in the absence of any other services, say leading mental health professionals.
Anne O’Connor, national director mental health, HSE, points out that CAMHS was never designed to be a catch-all service, but to cater for children and adolescents with severe and enduring mental illnesses.
The problem is that CAMHS takes everybody because there is nothing else there,” says O’Connor. “In an ideal world, the first step for a young person who presents with a mental health problem is to get help in school, to go to their GP and get access to a primary care-based psychology or family counselling service. Our mission is actually to keep people out of CAMHS.”
O’Connor says the HSE is trying to develop alternative pathways to treatment for the large number of children with diagnoses such as autism and ADHD on the CAMHS waiting list. On May 30th this year, the Oireachtas Committee on the Future of Healthcare published Sláintecare, its proposal for a 10-year strategy to “radically transform” healthcare in Ireland. It recommends that €47 million be invested in the CAMHS teams by year five of the plan, and the resourcing of a universal child health and wellness service at a further cost of €41 million over the first five years.
Spending on the delivery of mental health supports in the context of national concerns about this issue remains “scandalously low” at 6 per cent compared to other countries such as the UK (12 per cent) and Canada and New Zealand (11 per cent), according to the College of Psychiatrists of Ireland (CPI).
Dr John Hillery, consultant psychiatrist and president of the CPI, says that many of those on the CAMHS waiting list do not need to be assessed by a psychiatrist, and that other interventions at primary care level would be more appropriate for children and adolescents with less severe mental health problems – however, the services are simply not there at the moment.
He points out that the issue of recruitment currently facing the CAMHS and general psychiatry services is an international one. Over 80 posts across the CAMHS teams nationwide remain unfilled – these include consultant psychiatrist, psychologist and clinical nurses specialist posts.
The terms and conditions of working for the HSE are a major issue, according to Dr Hillery, and even getting paid can be difficult.
I recently discovered that my registrar had not been paid for two months, so I had to write letters and send emails to try to get him paid. This is a regular occurrence that does not encourage people to come into the Irish health service and it would not be tolerable in the private sector. It’s embarrassing when you are looking at these highly trained young people, often with mortgages and young families, not getting any money into their pockets but still coming in to work” says Dr Hillery.
To attract people back from abroad where they enjoy better pay, have more predictable hours and a better quality of life than they would in Ireland, Dr Hillery says the key issues to be addressed are pay, quality of life, proper training pathways and support for lifelong learning.
Anne O’Connor acknowledges the impact that key medical and nursing vacancies are having on the delivery of CAMHS services, particularly in the Dublin area.
Medical vacancies is a big issue for us, and a challenge we have been battling for a number of years. In CAMHS at any one time, there is upwards of 20 per cent of vacant consultant posts, and consultant pay has been reduced since the Financial Emergency Measures in the Public Interest (FEMPI) Act 2015 came in. This is an international challenge, we are not alone. Australia and Canada have equal or worse problems than us.”
O’Connor points out that through significant investment in CAMHS, they have been able to develop and fund 69 new posts in psychiatry, but 39 of these remain unfilled.
“You could argue that the pay rate and scale is not high enough, and we are not offering enough to attract people home from overseas. We have been in discussions with the Department of Health and the Department of Public Expenditure and Reform as we have to get their approval if we want to go above the current pay scale.”
Jane Johnstone, an Irish Autism Action advocate based in the south-east of the country, believes in a prevention based approach.
As a psychotherapist herself, Johnstone says that rather than focusing on what’s wrong with the services, we should be asking what’s causing the mental health distress in children and young people and is there a way we can stop it.
If we focused more on wellness and inclusion, particularly for children with autism, I believe we would have far fewer people presenting with mental health problems and if the counselling services were put in place on onset of depression, anxiety, etc many crisis situations could be avoided. If people had access to counselling at GP level as envisaged in Vision for Change, they wouldn’t be ending up in A&E in a crisis, and being sent home in an even more vulnerable position,” she says.
Johnstone points out that there is no holistic relationship between the HSE’s disability and mental health services and she believes there should be a separate specialised service for young people with disabilities and mental health issues.
Click here to read the College of Psychiatrists of Ireland submission to the Seanad Public Consultation Committee on Children’s Mental Health Services in Ireland 2017.