The Irish Association of Social Workers Special Interest Group of Social Workers in Child and Adolescent Mental Health Services – express concern on the findings of the Halpin Report on Kerry CAMHS.
The Irish Association of Social Workers (IASW) are very concerned about the impact of the systemic failure on the wellbeing of the young people who attended Kerry Child and Adolescent Mental Health Services (CAMHS). We continue to advocate for appropriate and timely CAMHS intervention for all young people and families who need it nationally.
“The IASW CAMHS Social Workers have made it very clear that the current system needs to be fully resourced with both medical and Health and Social Care Professionals (HSCP) in order to fully meet the needs of children with mental health challenges” said Chief Operations Officer of the IASW Caroline Strong.
The Halpin report shares many similarities with the concerns raised in the Maskey report in 2022. The current report documented a high incidence of potential harm to children attending the service particularly in terms of prescribing practices. It highlights the ongoing need for clear oversight and governance structures to be in place in CAMHS services nationally.
As important are the need for clear policies and multi-disciplinary team (MDT) governance structures. All CAMHS teams must have an appropriately qualified clinical lead. Governance structures should also include representation from health and Social Care Professionals.
All CAMHS staff including Social Work should have their own discipline-specific line management structure in place in line with professional registration requirements. This must include professional supervision being in place for all clinicians and additional support and training available for all staff as required.
We welcome the authors recommendation that CAMHS teams nationally are fully resourced as is recommended in Vision for Change, with suitably trained staff who are supported to provide a range of evidence based psychotherapeutic interventions. The Maskey report made similar recommendations. While some progress has been made in service development there remains significant HSCP staffing gaps including for Social Work on many CAMHS teams nationally. The Halpin & Maskey reports found some children only received pharmacological intervention despite the strong evidence base for talk therapy and psychosocial support.
Many children present to CAMHS in distress due to challenging life experiences. As Social Workers we are concerned that there is a potential risk that children who only receive pharmacological intervention may not have the opportunity to develop a therapeutic relationship where they feel safe to share concerns including of a child protection or welfare nature.
The Halpin report references the ‘post code lottery’ that exists in terms of what CAMHS can provide in different parts of the country. The availability of fully staffed CAMHS teams is an issue nationally particularly in rural areas. The allocation of resources to CAMHS needs to consider the under 18 population size, the referral rate, as well as the area deprivation index.
The Halpin review team was made up solely of consultant Psychiatrists. We acknowledge that the focus of the review was predominantly on issues related to prescribing practices. However, the absence of other disciplines on the review team prevented broader consideration of the full impact on children and families not having access to a fully resourced CAMHS MDT.
We agree with the recommendation in respect of improved integration across services to ensure every young person who seeks support with mental health issues receives appropriate therapeutic input. It is hoped that the planned roll out of the single point of access system will allow children to be signposted to the right service at the earliest opportunity.
IASW welcome the recommendations in respect of electronic records, consent, record keeping and Individual Care Plans. All young people attending CAMHS should have a named keyworker in line with the CAMHS Operational Guidelines. However teams need sufficient staffing to allow keyworkers carry out the role in a safe, meaningful way for children, families and staff.
The IASW welcomes the recognition in the report on the particular vulnerabilities for young people attending CAMHS ID services. The gaps in availability of supports other than pharmacological are particularly a challenge in CAMHS ID services with some teams currently only having medical staff.
- We call on any further CAMHS reviews to include experienced CAMHS employees from all key disciplines including Social Work.
- We call for team coordinator roles to be fully resourced across all CAMHS teams as set out in the CAMHS operational guidance.
- We call for CAMHS nationally to be fully resourced in line with Vision for Change Policy to prevent further poor service provision.
- Further we call for service user involvement and consultation in any further reviews in line with the recommendations of the report.
