Children’s mental health ‘could worsen until 2030’ due to staffing shortages, experts say – The Irish Times

Severe deficiencies in child and adolescent mental health care (CAMHS) will persist through 2030 and even worsen as the shortage of psychiatrists becomes more acute, those working in the system warn.

Child psychiatrist Fiona McNicholas, who works at Camhs and Crumlin Children’s Hospital, said Camhs needed major overhaul to make it an attractive place to work for child psychiatry graduates.

“We know about the [650] psychiatrists currently available, more than half will retire or leave in the next ten years.”

College figures indicate that only 167 psychiatrists will graduate between now and 2030, but an additional 400-500 psychiatrists will be needed to replace those leaving and meet increased demand.

In an interim report on Camhs published Monday, the Mental Health Commission (MHC) identified serious risks to the “safety and well-being of children” using the service, including poor medication monitoring, understaffing, overworked and unsupervised staff, lack of care planning , inconsistent care, poor risk management and chaotic paper-based administration.

It found a lack of staff with a high turnover rate, a lack of capacity to provide needs-based therapeutic programs, a lack of clinical governance and long waiting lists.

Emphasis was placed on “difficulties in recruiting and retaining Camhs consultant psychiatrists”, which led some Camhs teams to “recourse to telepsychiatry”. In south Kerry Camhs, a consultant psychiatrist provides 23½ hours of online coverage from the Middle East.

In the Midwest, 140 children were “lost”—ie left without follow-up—while children in other areas were on antipsychotic medication for up to two years without monitoring.

The MHC found “with some teams [there was] appeal to psychiatrists who are not registered as specialist Camhs consultants”.

Frontline health service workers echoed the committee’s findings. The Irish College of General Practitioners expressed members’ “deep frustration at the high number of Camhs referrals and long waiting lists for essential mental health services for children”.

The Irish Hospital Consultants Association (IHCA) said 23 psychiatry consultant posts were “not filled by doctors on the register of specialists”.

The IHCA said this was “a serious indictment of government policy and a sad reflection of the current working environment where consultants no longer want to work in unsustainable conditions”.

The report “didn’t tell us anything we didn’t already know,” said Prof. McNicholas. “But maybe for the first time [the HSE] starts listening.

“There needs to be a whole system change with the HSE looking at the planning, management, governance of Camhs… It takes a mental health leader who works at a senior level. If they made the service better, with at least a good IT infrastructure, then Camhs would be more attractive.”

Unless the significant gap between the projected need for psychiatrists and the number of college graduates is bridged, she said the situation in Camhs “is going to get worse, yes”. She added: “It’s terrible.”

Roisin Clarke, interim director of Mental Health Reform — a coalition of more than 80 organizations working in the field of mental health support and advocacy — echoed a call in the report for “different models of Camhs provision,” given the difficulties in recruiting psychiatrists.

The report says: “It is unlikely that staff recruitment will improve in the medium term as this is both a national and an international problem. The current situation is not sustainable. Repeatedly stating that ‘there is a recruitment problem and we can’t get staff’ does not solve the problem and other models of delivering mental health care for children should now be considered.’

It describes the Camhs approach as “obsolete” which “relies heavily on a model of care in which the counseling psychiatrist is responsible for all children accepted for treatment”, adding that “other professions in the multidisciplinary team are negated and the attractiveness of advisor Camhs can reduce posts to potential international recruits. It is also unsustainable with the current medical workforce.”

An HSE spokeswoman said it was “expected” that the posts of director of mental health and a head of mental health for children would be announced in the next two weeks.

Children’s mental health ‘could worsen until 2030’ due to staffing shortages, experts say – The Irish Times

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