Report into regional CAHMS services published

On Thursday, the Mental Health Commission (MHC) published a report into the provision of child and adolescent mental health services in the CH08 healthcare area, which includes Louth, Meath, Laois, Offaly, Longford and Westmeath.

The community healthcare organisation reports from the nine CH0 areas have already informed a final report into CAMHS by the Inspector of Mental Health Services, which was published by the MHC at the end of July 2023.

The CH08 report provides an overview of the strengths within each CHO CAMHS service, the challenges they face, the quality improvements and initiatives that they have put in place, and any areas of concern identified by the Inspector and her team.

As part of the overall review, the Inspector and her team met with the area management teams, each of the CAMHS community teams, and reviewed clinical files in each team within each CHO.

The Inspector and her team also spoke with families and young people who availed of the services, and other stakeholders.

The report notes that there are six community CAMHS teams in Louth Meath, with 605 CAHMS patients on waiting lists in the CHO8 area.

While the report identified that there were no areas of concern within the Community Healthcare Organisation it did note that the CHO faced 18 challenges while also saying that the CHO had shown quality improvements in 8 areas and was strong in a further 14 areas, the most of any CHO in the country.

Looking more specifically at the Louth/Meath area, the report criticised the lack of Out of Hours emergency CAHMS services in the area, saying:

“As CAMHS teams work office hours, there should be an out-of-hours or emergency service in place, should a child with mental health difficulties present in an emergency.

“An out-of hours service should be accessible 24/7 via a single point of contact.

“There is no out-of-hours on-call service in Louth/ Meath. This results in young people waiting for long periods in A&E which is not appropriate for a young person with mental distress or illness or being assessed by an adult mental health NonConsultant Hospital Doctor (NCHD) and being referred to a CAMHS clinic or being admitted to a paediatric ward.”

The report added that paediatric wards are not appropriate places for the treatment of a young person with mental illness, especially as there is no liaison CAMHS team and that there was a lack of ability to source timely admissions to a CAMHS inpatient unit due to the shortage of operational beds.

Infrastructure
Evaluating the infrastructure in north Louth the report said that the facilities are spacious, clean and purpose-built premises and that there is ample space for offices and consulting rooms.

However the report also expressed concerns around confidentiality in South Louth/Mid Louth area, finding that the clinic is based in an old building that is shared with TUSLA and that “files are stored in an unlocked file room within these shared premises. This presents a risk in terms of young person confidentiality.”

When it came to the South Louth East/Meath (ELMS) it found that:

“There is only one large room which is the staff lunchroom, the group room, and the meeting room. Parking is limited and there is no wheelchair accessible space nearby.

“It was explained that the builders are preparing some new spaces that should be available in two or three weeks.

“The rooms are not sound proofed, and conversations can be overheard. There is no wheelchair access to upstairs rooms.

“Therefore, a young person with mobility issues can attend downstairs but cannot attend groups upstairs.”

Information Technology
The report further criticised the lack of patient information system in Louth/Meath, which it said severely hinders management of case files and detailed and incident in which:

“During one team review, it took three staff members three days to identify their caseload for the inspectors in order for them to obtain a 10% sample.

“This lack of IT leads to inefficiency, the risk of not identifying cases that may become lost to follow-up, and the inability to comprehensively audit practice.”

CAMHS Inpatient service
Additionally, the lack of CAMHS inpatient units in CHO 8 as a whole presented problems, according to the report.

It said there were two inpatient services in Dublin that accept referral for inpatient care, one of which, Linn Dara, accepts referrals up to 18 years for the Midlands CAMHS.

For Louth/Meath, Linn Dara accept referrals up to the age of 15 years and the Adolescent Inpatient Psychiatric Unit (AIPU) in St Vincent’s Hospital Fairview accepts young people aged 15-17.

However, the report stated that “ at the time of the review, a number of in-patient beds were closed in both the AIPU and Linn Dara and access to a bed was difficult.

“The referral process to an inpatient CAMHS unit sometimes requires ringing multiple CAMHS inpatients units with the little likelihood of sourcing a place for an urgent case.

“This difficulty results in teams ‘holding’ young people who present a serious risk to themselves in the community.

“The lack of any day hospital within CHO 8 compounds this problem. The HSE may arrange to fund private treatment in private hospitals: Ginesa Suite (St. John of God Hospital) or Willow Grove (St. Patrick’s Mental Health Services) dependent on need, but this can be a lengthy process in an urgent situation.”

Louth/Meath Challenges
Overall the report identified three key challenges for CAHMS services in Louth/Meath.
1. No external agencies such as Pieta House or Jigsaw in Louth/Meath.
2. One CAMHS building has limited office space and requires renovation and rejuvenation of some public and access areas with limited parking facilities for families attending appointments.
3. High prevalence rate of suicide and socially deprived population to support one CAMHS team.

Louth/Meath strengths
The report also identified four key strengths in the CAHMS services in Louth/Meath, which were:
1. The Dialectical Behaviour Therapy (DBT) programme across Louth Meath allowed a treatment programme aimed at helping young people with ongoing difficulties managing intense emotions.
2. Established medication monitoring clinics (weekly in Louth Meath).
3. Outreach service commenced in South Louth, to enhance engagement in the community and to help build social skills.
4. ADHD clinics in all teams in Louth Meath.

Quality improvements
Finally, a number of quality improvements specific to the Louth/Meath area were also identified, with the report noting that:

“Occupational therapy managers working in mental health and primary care across CHO 8 are working collaboratively to discuss shared learning between care groups, pathways and address recruitment difficulties.

“Terms of reference have been developed and a shared learning morning has been arranged for Louth Meath CAMHS occupational therapists (OTs), primary care, and CDNT staff (June 2023).”

It also identified a further quality improvement as Louth Meath MHS has been chosen as a pilot site for the CAMHS Hub national programme.

The CAMHS Hub will have four clinical and one admin staff and will provide short term assessment and intervention to young people experiencing acute mental health crisis, with referrals coming from CAMHS community teams.

In a statement, Midlands Louth Meath Community Health Organisation said:

“The Mental Health Services in Louth and Meath welcome the publication of the Mental Health Commission (MHC) individual CHO reports on the Child and Adolescent Mental Health Services (CAMHS).

“There continues to be growing demand for the services provided by HSE CAMHS who now have nearly 20,000 cases nationally and see 225,000 appointments annually, and CHO teams have worked closely with the Mental Health Commission over the last year to develop and implement improvement plans for this critical service.

“While we fully accept the challenges and issues identified in our local CHO report, it is important to note that the hard work and dedication of the many staff working in this service is acknowledged and recognised by the MHC.

“All those who work in CAMHS in Louth Meath Mental Health Services are committed to improving the care provided and making our services more responsive to the needs of children and young people.

“We know there are key areas where we need to improve the services provided.

“We acknowledge the concerns raised by the MHC, including the gaps and challenges in staffing, deficits in infrastructure and issues relating to service delivery.

“We apologise to any young person or their family who has had a poor experience of our service and we want to assure them of our commitment to continue to develop our child and adolescent mental health services.

“While there has been significant increased investment in CAMHS and youth mental health service over the last 10 years, we know improvements still need to be made.

“The HSE is currently progressing a new HSE Child and Youth Mental Health Service improvement programme.

“This involves the establishment of a new national office for Child and Youth Mental Health to lead out on this programme and to provide leadership, oversight and enhanced governance to services.

“The HSE has also recently appointed a National Lead and a National Clinical Lead (CAMHS Psychiatrist) for Child and Youth Mental Health to lead this office and the service improvement programme.

“Louth Meath mental health services is committed to working with the new national office for Child and Youth Mental Health to deliver this improvement programme locally.

“As the HSE moves toward our new organisational structures and approaches to working (Health Regions) we will strengthen the integration between CAMHS and other services, including Primary Care, Disability, Acute Hospitals, Social Inclusion – in the clear understanding that the needs of our children may need to be met across a number of our services."