Calls for consultant-led services and more managers in CAMHS

Child and adolescent mental health service (CAMHS) teams should be led by consultants with clinical managers coordinating care as part of major reforms of the current system, the College of Psychiatrists has recommended.

In response to controversies around the current CAMHS system, which has been dogged by long waiting times and suboptimal care, the College has today published new proposals for overhauling the service.

“The recommendations proposed outline radical new governance and management structures, and they will lay solid foundations for the development of a world-class mental health service of which we can all be proud,” said College president Dr Lorcan Martin.

Among the recommendations they propose include that each CAMHS team is led by a consultant child and adolescent psychiatrist.

Each team would also have a clinical service manager. This new role would lead team co-ordination, service audit and performance review.

The College adds that a nationwide network of CAMHS clinical directors is needed to fulfil clinical and managerial roles for teams, support regional development of services, and establish two-way links with national management teams.

They stress that both the clinical director and a clinical service manager representative must have membership of the Regional Area Mental Health Management Team to represent CAMHS.

“CAMHS in Ireland has been beset by chronic underfunding and under-resourcing,” said Dr Patricia Byrne, who is chair of the College’s faculty of child and adolescent psychiatry.

“There have been failures to provide fit for purpose governance systems to facilitate CAMHS development in line with the government’s mental health policies (‘A Vision for Change’ and ‘Sharing the Vision’).”

“The Mental Health Commission reports identified national deficits in team staffing, lack of minimal required resources to facilitate service delivery, failure to implement national policy objectives for comprehensive CAMHS provision, and failures at a national HSE level to respond to risks escalated through the HSE systems.

“This has led to variable and, at times, a sub-optimal service for children and adolescents who suffer from severe mental illness. Sadly, this has resulted in negative impacts in service experiences for young people and families who require our services, and for the front-line staff trying to deliver care. As such, a major reform of the service is of critical and unparalleled importance to the wellbeing of those patients and their loved ones.”

The proposals, which were developed by a special working group formed to examine the challenges faced by current services, also call for all CAMHS staff to receive specialist training to ensure optimal standards of care.

All members of the CAMHS multidisciplinary team must have clearly defined roles and be clinically accountable to the specialist consultant psychiatrist as the clinical lead, the proposal document states.

Dr Byrne added: “As a developed nation with a healthy budget surplus, it is unconscionable in 2025 that Ireland cannot adequately treat our very vulnerable young people who need help so badly. Mental health problems in childhood and adolescent are associated with detrimental impacts on developmental outcomes in young adulthood.  Patients, their families, and the doctors and other healthcare staff who work within CAMHS deserve so much better.”

The policy document ‘A Model of Governance and Management Structures for Child and Adolescent Mental Health Services in Ireland’, has been published today. The College has called on the Government to act urgently to implement the recommendations contained in the proposal.