What does it take to improve children’s mental health services in Ireland?

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Opinion: Reform of current services is urgently needed, especially regarding accountability, advocacy and complaints procedures

The gaps identified in the South Kerry CAMHS review published last week highlight the insufficient mental health services and supports available for children and young people in Ireland. These failures are part of a broader picture of ignoring the voices of children, young people and their families, insufficient resources, poor governance and inadequate mental health legislation.

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From RTÉ Radio 1’s Today With Claire Byrne, Barry Lenihan reports on the problems with mental health services for children and young people in South Kerry

Last July, the government published the Heads of a Bill, which details proposed changes to the Mental Health Act 2001. Although many ongoing reforms are welcome in strengthening the rights of children, adolescents and adults, gaps will remain that put people at risk.

Problems have been identified in the provision of child and adolescent mental health services for many years. In 2016, the UN Committee on the Rights of the Child criticized the lack of comprehensive legislation on children’s consent and refusal to medical treatment in Ireland. Specifically, provisions governing the admission and treatment of children have been criticized for failing to protect their fundamental rights. Ireland was recommended to take steps to improve the capacity and quality of its mental health services.

It is clear that the provisions of the Children and Young Persons Act 2001 are wholly insufficient to guarantee their rights. We know this because many reviews and reports have pointed this out for many years. The proposed new bill contains significant changes that, if implemented, should significantly improve the law. Yet proposals in key areas are inadequate, fail to protect the human rights of children and young people, and miss the opportunity to strengthen governance and accountability.

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From RTÉ Radio 1’s Morning Ireland, John Farrelly from the Mental Health Commission on what happened to child and adolescent mental health services in South Kerry.

Why independent advocacy is important

The UN Committee on the Rights of the Child has criticized the lack of child-focused education and information services accessible to children and young people in Ireland. Advocacy is essential as children and young people using services or who are detained under the 2001 Act are in a particularly vulnerable situation.

The bill leaders recognize the need for advocacy and provide a definition of an attorney and recognize the right to hire an attorney on their own or with their family. Contrary to this, it does not provide advocacy services. The availability of a professional, independent and adequately resourced advocacy service would ensure that the voices of children and young people are heard and included in decision-making about their health. This is required by international human rights law and should be included in amending legislation.

Handle direct complaints

Another shortcoming of the legislative reform proposals is the absence of provisions allowing complaints to be lodged directly against mental health services. Unfortunately, the 2001 Act does not provide for an independent direct complaints mechanism dedicated to mental health services.

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From RTÉ Radio 1’s Drivetime, RTÉ journalist Barry Lenihan, Minister for Mental Health and Elderly Mary Butler TD, Keith Rolls from Coleman Legal and ‘Kate’ the parent of a child from mental health services for children and young people from South Kerry Tomber

In the absence of a specific complaints mechanism, people using mental health should complain to the internal HSE complaints mechanism. If they are not satisfied with the outcome of their complaint, the matter can then be referred to the Ombudsman. People who use mental health services have pointed to the ineffectiveness of these processes.

Non-ratification

Ireland signed the UN Convention on the Rights of Persons with Disabilities in 2007 and finally ratified it in 2018, but unfortunately delayed ratifying the Optional Protocol to the Convention. The Protocol essentially provides for two procedures to enhance compliance with the Convention: the individual communications/complaints procedure and the inquiry procedure.

The lack of ratification means that Ireland is an outlier among EU member states (along with the Netherlands and Poland) with respect to non-ratification. This undermines Ireland’s commitment to implementing and realizing the rights contained in the UN Convention on Disability.

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From RTÉ Radio 1’s Morning Ireland, Mental Health Services Inspector Dr Susan Finnerty says more needs to be done to help people with serious mental health issues

Furthermore, this non-ratification of the Protocol also means that children and young people are denied access to the mechanism to lodge individual complaints directly with the United Nations Committee on Persons with Disabilities (the body responsible for monitoring compliance of Ireland). As a result, an essential layer of accountability is missing.

The 2001 reform law should provide an independent direct complaints mechanism for mental health services. The Inspector of Mental Health Services could be given the responsibility and statutory powers to receive, investigate and adjudicate on individual complaints relating to mental health services and consideration should also be given to the establishment of an ombudsman of the Mental Health.

What to do next

On the whole, the provisions contained in the heads of the bill with regard to children and young persons are welcome. In particular, the part of the Bill dealing exclusively with the admission of children to licensed hospitals under the Act will be a significant improvement when implemented. This should address the disjointed approach and make the legislation more accessible to children and young people subject to the legislation, their families, mental health professionals and other stakeholders.

However, there are several areas where children’s rights can be strengthened in amending legislation. The Mental Health Commission concisely summarized the South Kerry CAMHS review as a “catastrophic failure of oversight, supervision and accountability”. The provision of an independent advocacy service and the establishment of a direct complaints mechanism are key elements in meeting international human rights obligations and ensuring adequate governance and accountability within health services mental.

For an in-depth discussion of some of these issues, you can read this report co-authored with Dr. Fiona Morrissey for mental health reform.


The views expressed here are those of the author and do not represent or reflect the views of RTÉ


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