Concerns raised in CHO1 CAMHS review

21 challenges in this specific region and six areas of concern highlighted.

The Mental Health Commission (MHC) has this morning published individual reports into the provision of child and adolescent mental health services (CAMHS), flagging 21 challenges in this specific region and six areas of concern that need to be addressed.

Staffing issues, dysfunctional team work, failures to review and monitor clinical files, one being more than 12 months out-of-date, as well as poor accommodation were among the issues highlighted.

As of March 2023, there were 447 potentially vulnerable young people awaiting access to services in CHO 1, which covers Sligo, Leitrim, Donegal, Cavan and Monaghan.

There are eight CAMHS teams in CHO 1- in Sligo, Leitrim, one each in South and North Donegal, Inishowen, Cavan, Monaghan, and also a Cavan/Monaghan Centre Team.

At the time of our Review, the Governance Group in Cavan/Monaghan was fully operational, but the Governance Groups in Sligo/Leitrim and in Donegal were not yet operational.

According to the MGC report, alignment of CAMHS catchment areas with the Community Health Networks is ongoing, as part of the South Donegal catchment area falls under the care of Sligo/Leitrim CAMHS.

It sets out that there are a number of risks to safety and well-being of children and young people attending two teams in CHO 1. These had been “escalated” by team members through their line management and the area management teams were “aware of these risks”.

A “number of complaints” were also been raised by staff on these two teams, and by a “small number of parents” also.

It says that “risk had increased” due to staff resignations, leaving one team depleted of staff, apart from the consultant psychiatrist, nursing staff, a social care leader and speech and language therapists.

Historical complaints were screened in line with HSE policy, and “designated support contact persons” have since been put in place.

Meanwhile, within clinical files the MHC found some children and young people had not been

“reviewed regularly or had adequate monitoring of medication”. This was despite an audit of clinical files by the services themselves, as well as a direction to audit open files by the HSE

following the publication of the Independent Review of the Provision of Child and Adolescent

Mental Health Services (CAMHS).

“It is difficult to see how such an audit of all files could miss what we discovered within our

sample of 10% of caseloads. In view of this, a review of all clinical files on the current caseload

of one team was immediately requested by the Inspector. We also provided the identification of

children who required urgent further follow-up to the service.”

The report adds: “It was obvious that clinical risk was poorly identified and managed within the governance structure, leading to concerns about the safety and well-being of children. The risks were not identified to us by the area management team, but left for us ‘to find out’ at team level through clinical file review and meeting individually with team members”.

The risks to the safety and well-being of children and young people were escalated to the Assistant National Director of Mental Health due to the urgency of the situation, and that “individual

risks” identified due to lack of clinical review have been communicated to the Head of Mental

Health for “immediate action”.

Elsewhere one team had occupational therapist, no psychologist and at the time of review, no social worker either, while one team’s headquarters were cramped with a waiting area on the corridor.

“It was dark and dilapidated in appearance,” said the report.

The Inspector’s overall independent review into CAMHS, which she commenced in April 2022 - and included the publication of an interim report in January 2023 – was published on July 26, 2023, complete with 49 recommendations for the State across the nine CHO areas.

“Due to the seriousness of the concerns raised by the review, the Inspector recommended that a comprehensive strategy for CAMHS and all other mental health services for children be prepared; that the implementation of the report recommendations must be monitored by the MHC; and that CAMHS should be immediately and independently regulated by the MHC.”

See next week's newspaper for full report.