THE FACT OF THE MATTER
PAUL HOPKINS
Our story last week that up to 8,000 children and adolescents are awaiting psychological assessment paints a disturbing picture of our health care system.
Indeed, there would be none who would disagree with Taoiseach Micheál Martin describing a review of the care of more than 1,300 children at the HSE-run South Kerry Child and Adolescent Mental Health Service as “very, very serious” and “unacceptable”.
That the report’s finding that 46 children suffered “significant harm” and “demands a fundamental review” across the country. Our Special Report this week on Page 15 only worsens matters.
The Taoiseach told the Dáil the report was a “damning indictment of the service” provided under CAMHS. That was on the very same day Health Minister Stephen Donnelly and under-fire Department of Health Secretary General Robert Watt jetted out to Dubai to attend a health expo as controversy continues over the latter’s €295,000 salary. Mind you, not as exorbitant as HSE boss Paul Reid’s €420,000.
A lack of resources does not necessarily seem to be the crux of the matter. When ‘A Vision for Change’ was published in 2006 on the future for psychiatric services, the number of CAMHS teams was 40 and there were six inpatient beds for child and adolescent patients.
Now there are 73 teams and some 70 beds, with more to come at the long-waited-for National Paediatric Hospital and very specialised beds in the mental health service in Portrane, Co. Dublin.
That said, one could argue that our national mental health budget for last year was just 5.1% of the total health budget, with just 1% allocated to children’s mental health. The World Health Organisation (WHO) recommends 12%, while our long-awaited proposed Sláintecare recommends 10%.
The UK spends 13% of their budget on mental health. The Government need to increase spending to 10% by 2024, according to lobbyists Mental Health Reform.
Those working in mental health in Ireland are the lowest in numbers compared to other countries affiliated to the Organisation of Economic Co-operation and Development (OECD). Currently, that number is 30% short of what is needed to run mental health hospitals and clinics efficiently.
And remember it is a junior practitioner at the centre of the South Kerry saga.
Staff shortages result in long waiting lists, lack of precise therapies, and negative effects on treatment and continuity of care. Investment now in more psychologists, social workers, occupational therapists and peer support is needed.
Investment, too, in primary care would improve access to psychology services, counselling, and social workers, with early intervention playing a critical role in reducing more serious mental health challenges.
This time last year there were more than 2,700 children and teens on a waiting list for CAMHS.
As South Kerry has shown only horrifically too well, poor access to primary care psychological services can result in inappropriate referrals to CAMHS, where resources are stretched and totally inadequate.
Mental Health Reform, also, says there are significant gaps in advocacy supports for people with mental health difficulties. National advocacy services need to be funded in hospitals, prisons, residences and in the community.
As the Kerry cases show, a stand-alone practitioner — and a junior one at that — with a huge waiting list and little or no support is not an attractive scenario for recruitment. There is, too, the fear of being a lone soldier in a culture of litigation.
The clinical aspect is the easy bit; navigating the system, the ‘mess’ with no proper service in place, is hugely unattractive.
There was a time once in Ireland when one’s mental health was not talked about. He or she was a bit ‘different’, ‘odd’ even. Now, we thankfully do talk about it. But talk is not enough. Action is needed.
Before the two-year pandemic lockdown, one in three of Third level students in Ireland was suffering “extreme levels of anxiety” and had had a formal diagnosis of a “mental health difficulty” at some point in their life, says a survey by the Union of Students in Ireland (USI).
The survey found that 38.4% of students suffer extreme levels of anxiety, 29.9% depression and 17.3% from stress. Almost a third, 32.2%, have had a formal diagnosis.
Those young people and others have had a hard time of it with two years of pandemic anxiety and uncertainty. Their mental health could well be the ‘silent pandemic’. We must reach out and show our children and our young people that their problems, however daunting they might seem, are not insurmountable.
We seem to have lost our way somehow. A dedicated mind shift is called for, else we risk repeating the sins of the past.
