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PNA General Secretary, Peter Hughes address the Joint Oireachtas Committee on Children and Youth Affairs on the issue of the crisis in CAMHS services

Thank you for your invitation to address the Joint Committee on Children and Youth affairs. As General Secretary of the Psychiatric Nurses Association, I would like to highlight my concerns in relation to the Child & Adolescent Mental Health Services (CAMHS).

The inadequacies and underinvestment in the current provision of CAMHS services is something that my union has consistently drawn attention to and I would hope that the interest by the Committee in this area will help in addressing the many gaps in CAMHS services that exist throughout the country.

In 2006 the Government Policy on Mental Health “ A Vision for Change ” was published outlining a 10-year plan for the provision of Mental Health Services. Chapter 10 of that widely welcomed strategy outlined the recommendations for Child & Adolescent Mental Health Services. Some of the key recommendations are as follows:

•  2 Multidisciplinary Teams per 100,000 population.

•  1 Liaison Multidisciplinary Team per 300,000 population.

•  1 Day Hospital per 300,000 population.

•  Urgent attention should be given to the completion of the planned four 20-bed units in Cork, Limerick, Galway and Dublin and Multidisciplinary Teams should be provided for these teams. This will result in 100 beds for CAMHS Nationally.

Most importantly the Vision for Change strategy included in it a provision for an evaluation after 5 years to assess the progress in the delivery of CAMHS services and whether it is meeting the needs of the population.

Eleven years on, we must question the commitment to the Vision for Change recommendations. The PNA in partnership with the Royal College of Surgeons Ireland (RCSI) published research last year in relation to the implementation of Vision for Change in the Adult Mental Health Services 10 years on. The results were stark and disappointing. Among the findings were:

•  60% of beds were closed yet only 30% of the recommended community services were put in place.

•  No 24-hour Crisis Intervention Services as recommended.

We are currently conducting research (phase 2) in partnership with RCSI in relation to the specialist elements of “ Vision for Change ” inclusive of CAMHS. Early indications suggest that there are:

•  37% of the recommended Multidisciplinary Teams operational as outlined in Vision for Change.

•  53% of the Liaison Services in operation.

•  52 beds operational out of the 100 recommended beds.

This research will be concluded by quarter four of this year.

The population of children nationally is expected to increase by 8530 between 2016 and 2017, which is consistent with the percentage growth annually over the last decade. This projection coupled with the expansion of the “Free GP

Scheme” will create an additional demand on the Child & Adolescent Services.

I also wish to make reference to the appalling situation of young homeless children currently living in hotels, guest houses and short-term accommodation. Not only does this situation increase the level of mental distress on those involved, but this transient situation complicates the follow up of the children as they are transferred from one CAMHS Service to another.

According to the Mental Health Division Operational Plan 2017:

•  There are 74 Multidisciplinary Teams Vision for Change recommended, 2 teams per 100,000 population which equates to 94 teams a shortfall of 20 teams.

•  There are 4 Day Hospitals nationally, Vision for Change recommended 1 for every 300,000 population which equates to 15 day hospitals a shortfall of 11 day hospitals.

•  There are 74 CAMHS beds nationally, Vision for Change recommended 100. However, only 52 of these nationally are operational due to staff shortages and particularly nursing shortages.

•  There are 20 beds in Cork but the Unit only has the capacity for a

maximum admission of 15 children due to nursing staff shortages.

•  St Joseph's Unit in Fairview has 12 beds but only 6 operational due to staff shortages (Nursing & Medical).

•  The Limerick Unit never materialised and the 20-bed unit in Galway is fully operational.

•  Linn Dara in Dublin a new purpose built 22 bed unit which only opened 18 months ago has in the last 2 weeks closed 11 beds due to Nursing Shortages. The Unit has only 50% of the nursing resource required. These 11 beds have been closed despite a list of 20 children awaiting admission.

We know all too well that the net result of these bed closures and under provision in CAMHS services are to further increase the unacceptable admission of children to Adult Mental Health Units.

We witnessed a stark example of this just last month with the admission of a 16year old to the Adult Mental Health Unit in Waterford. To add to the trauma experienced by this child we know that they had to spend the night sitting on a chair. To say - ten years after the publication of the Vision for Change strategy - that this is totally unacceptable is if anything an understatement.

Child and Adolescent Mental Health Services are in crisis and as outlined the provision of services is deteriorating rather that improving. The children and parents of our country are being let down by the non-implementation of policy and the lack of commitment or urgency in addressing the crisis.

And yet we know, and have known for 10 years, what needs to be done to address the crisis.

As a matter of urgency, the 100 beds as recommended need to be provided and staffed in order to provide quality therapeutic care and prevent further admissions of children to Adult Mental Health Units.

The number of Community Multidisciplinary Teams needs to be increased as recommended. They need to be fully staffed and expanded to provide out of hours Homebased Services.

The criteria for Clinical Nurse Specialists (CNS) is too stringent and needs to be adapted in the short term to facilitate an increase in applicant's. There are approximately 20 unfilled CNS posts nationally mostly due to insufficient applicants as the criteria is too strict.

The 15 day hospitals as recommended need to be provided.

Of course, the full implementation of these measures will only come if there is a substantial increase in the budget for mental health services which currently stands at 6.4% of the Health Budget.

Bizarrely, and probably only in Ireland, we have witnessed a situation where despite the growth in the demand for mental health services across the board there has been a steady reduction in the mental health budget as a percentage of the overall Health Budget. So ……………

In 1984 the Budget was 13% of the Health Budget.

In 1994 the Budget was 10% of the Health Budget.

In 2004 the Budget was 7.1% of the Health Budget.

As can be seen the commitment to Mental Health Services is diminishing each decade, yet the demand has never been greater. It is little wonder that the Taoiseach, Enda Kenny admitted in the Dail on May 23 rd last that mental health services have been neglected for over 30 years, and were, as he put it ‘the Cinderella of many Health Service Executive Votes and Department of Health Votes'.

Sadly, when we look at the mental health budget it is hard not to conclude that Vision for Change was used as a cost saving measure on the backs of those with Mental Health issues.

Too often we have seen the closure of beds with paltry investment in Community Services.

We are struggling to provide vital services while trying to manage a severe shortage of Psychiatric Nurses largely due to the fact that our highly skilled and committed nurses are being forced to leave the Irish health system for better pay, and terms & conditions in the Private Sector, UK, Australia and Canada, to name but a few of the market competitors.

And who can blame them when there is a consistent failure to realistically address the issues of pay and conditions for nurses – which at the end of the day is the only realistic solution that will stop the haemorrhaging of our nurses abroad and encourage those abroad to return.

I would like to the thank the Committee for the opportunity to briefly outline the extent of the ongoing crisis in Child and Adolescent Mental Health Services which we know is impacting severely on the children and parents of our country.

I can assure you that the PNA is determined to see the issues in CAMHS services addressed before they deteriorate even further, and we would welcome the Committee's support in achieving the provision of properly resourced and staffed CAMHS services that meet the needs of children, families and communities throughout the country.