Mental Health Commission raises concerns at provision of services for children in Limerick

A REVIEW of the public health service provision for children and adolescents with mental health issues has identified major problems with the service in the Limerick region.

The inspector of mental health services with the Mental Health Commission has put together a 54-page report.

It identified a number of areas of concern at what is being provided by HSE Community Healthcare Mid-West for its Children and Adolescent Mental Health Services, or Cahms for short.

“Serious concerns” were raised over the capacity of some Cahms teams to provide a safe service to vulnerable children.

On occasion, children were left without a renewal of prescription until the consultant psychiatrist returned to duty.

Two children waited for four and six days respectively in University Hospital Limerick’s emergency department before being assessed.

With staff shortages and a high turnover of workers, those that remain in the service are facing “burnout”, the report from the inspector warns.

Staff members themselves told the inspector they feel it’s an “unsafe service” due to the lack of staff, long waiting lists and cases not being followed up.

Camhs is a service which provides assessment and treatment for young people and their families who are experiencing mental health difficulties.

Administered by HSE Community Healthcare, it’s divided into geographical areas, with Limerick grouped with Clare and North Tipperary.

With a budget of €7.8m, it has a remit to serve some of the 96,266 U18s across the region who may need mental health support.

Each year, the Mental Health Commission, whose role it is to foster and promote high standards of care and good practice, carries out inspections of all the areas.

The commission can make recommendations, but crucially has no statutory powers over community mental healthcare services.

As part of the June 2022 inspection, the Mental Health Commission spoke with parents and the young people who have experienced the Camhs service in the Mid-West.

It also randomly selected clinical files belonging to young people who have a diagnosis of Attention-Deficit Hyperactivity Disorder, or ADHD, plus those with eating disorders, mood disorders, and patients prescribed anti-psychotic medication.

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A huge area concern of the inspector was the way the Camhs service in the region is staffed.

They said a management team responsible for overseeing the Camhs service “was not functioning as a management team”.

“Neither the consultant psychiatrists nor psychologists attended (team meetings) and some of the members were not working in Camhs but were on the team due to their seniority in their discipline. It was unclear as to the actual function of this team and why it continued to be in place if it was not adhering to its terms of reference,” the report reads.

With no clinical director, management of the service was described as “disjointed”.

“We had serious concerns about the capacity of some teams to provide a safe service for young people,” the inspector added.

Other concerns were raised about children who were lost to follow-up following the unplanned leave of a senior clinician in February 2021.

An internal review by Cahms highlighted the fact 140 children were not receiving follow-up appointments.

A large number of children, some of whom were on medication, had open cases with Camhs which had not been followed up.

“It is difficult to see why this should have happened apart from serious deficiencies in clinical governance, including lack of clinical audit, and lack of adequate oversight and risk,” the inspector added.

Reduced staffing levels - which during the inspection were only at two-thirds of the recommended number - also left it difficult for line managers to release staff for training.

High numbers of staff on annual leave had also depleted the service, and restricted the range of therapies available. It was as a result of this, the number of children awaiting assessment remained high.

As of February this year, there were 210 children awaiting initial assessment in Limerick alone.

Parents who made contact with the Mental Health Commission expressed concern over the waiting times to receive support, the absence of any other service while on the waiting list and the difficulty making contact with someone from Camhs in the region in an emergency.

“They said phones were not answered, messages were left and not followed up, and there was no call-back from some of the teams. They talked about their frustration and distress at what they perceived as a lack of a functioning service. There was no support or advocacy for families while waiting for Cahms,” the report reads.

The Mental Health Commission found there was no eating disorder team covering Limerick, Clare and north Tipperary.

“There was an insufficient number of staff trained in family-based therapy which is considered an essential intervention in treating children and young people with eating disorders,” it’s stated, adding there was “no evidence” changes were imminent.

The report raised concerns over internet connectivity. Each day, it was claimed, a clinician could waste up to 45 minutes on accessing information which would normally be available.

The Mental Health Commission inspector said they are impressed with the “dedication and commitment” of staff working at Camhs in the region to deliver a safe service and offer as wide treatment as possible.

“However, the stress and consequent burnout many staff experienced has led to difficulties retaining staff and attracting new recruits.”

“Existing staff worked long hours to continue to provide a service and this is not sustainable,” they added.