Address by Ombudsman for Children, Dr. Niall Muldoon, at the Children’s Mental Health Coalition launch of “Meeting the Mental Health support needs of Children and Adolescents” Report

Ladies and gentlemen I am delighted to welcome you all to the Ombudsman for Children’s Office and to host the launch of this report on behalf of the Children’s Mental Health Coalition. I would like to thank Dr. Shari McDaid for her invitation to launch this report.

This Office has been in existence for over 10 years and has received over 10,000 complaints in that time. We regularly receive complaints involving various elements of the Health Service from access to mobility aids to insufficient Speech and Language resources to a lack of systemic support for disabled children attending the free pre-school year. However, there is no doubt that dealing with issues and complaints around children and young people, who are struggling to get access to, or sufficient support from mental health services, can be, on a human level, extremely difficult for all of us here in the Office.

The report being presented today, “Meeting the Mental Health Support Needs of Children and Adolescents” clearly highlights the current gaps within the Mental Health Services available to children and young people of Ireland. The report quite rightly draws upon the aspirational targets of the Vision for Change document from 2006 and compares them to what is in place at this point in time.

A Vision for Change stated that “Service Users, carers and families should be given the opportunity to influence developments within Mental Health Services, based on their own experiences.” That is very much in keeping with Article 12 of the UN Convention on the Rights of the Child which states that all children and young people should have a say in the decisions that affect their lives – and there is no doubt that the decisions being made over the past 10 years in relation to Mental Health Services have radically affected many children’s’ lives.

While A Vision for Change is nearly ten years old the Government relied upon it when generating their strategy document Brighter Futures, Better Outcomes in 2014 which was signed up to by ALL Government Departments. In that document they focused on two areas of the health of children and young people which would most radically benefit from early intervention – Obesity and Mental Health. The Strategy states that the Government will “implement A Vision for Change as it relates to children and young people…to improve access to early intervention youth mental health services and co-ordination of service supports”

The work of the OCO has regularly brought us into contact with the Mental Health Services in relation to complaints we have received. We have examined many of the issues highlighted within today’s report, including interagency co-operation and the impact that has on how children can recover.

In 2013 the Ombudsman for Children’s Office generated a Meta-Analysis of cases representative of the 1,000 or so cases we had handled about Children in Care since 2004. One of the concerns we highlighted was exemplified by the case of a young person who was under the care of CAMHS in one area but once they moved to another area the new CAMHS would not take over the clinical responsibility and the old CAMHS would not travel to see the young person.

This, of course, was at a point when children in care and CAMHS were both under the banner of the HSE. Since then, as we know, CAMHS has been retained within the HSE while Children in Care are now the responsibility of the Child and Family Agency. The key issue from the OCO’s point of view is the importance of a Public Body being guided by the best interest of the child and it is very clear to see how that is NOT being achieved in such a situation. The previously mentioned Better Outcomes, Brighter Futures Strategy said that “the State and its partners will work better together and plan service provision in a way that is child centred and benefits from interagency and multidisciplinary working”. I would hope that this becomes more readily the case soon than has been the case up to now.

As a psychologist I am acutely aware of the importance of appropriate early intervention with Children and Young People for issues around their mental wellbeing. I have seen the massive impact such interventions, when delivered in a consistent manner within an appropriate environment can have on the lives of those children and young people.  I have always been inspired by the power of the human spirit to flourish and heal, from even the greatest traumas, once they are supported in the right way. This is even more amazing to behold when it is a child or young person who begins to blossom and emerge from a deep darkness caused by some upset in their mental health.

In December 2007, my predecessor, Ms. Emily Logan was critical of the continuing use of adult psychiatric wards for the treatment of children and in 2011 the Mental Health Commission Code of Practice stated that such practice should be phased out by December of that year. While we as a society have come a long way from the dark days when we put all of our “problem people” into institutions and built the walls high enough so that the rest of us didn’t have to see them – the “out of sight and out of mind” philosophy!!! We really need to take stock, as a community, when we still allow over 90 of our most vulnerable children and young people to be “cared for” (and I use that phrase advisedly) within Adult Psychiatric wards each year – and their average length of stay is 4 weeks, which is not an insubstantial period of time. These are wards where violence, tension and threat are not uncommon and, I would suggest, that such an environment is upsetting for an adult but one can only imagine how it must leave a child or adolescent feeling when they are already struggling with negative feelings about themselves.

I tried to put myself in their shoes and to consider what they might be thinking in such a scenario and some of those thoughts may include these:

1. I must be as ill as these people for me to be put in here
2. Is this how I will end up?
3. Why Me? Why did they not put me in an adolescent ward?
4. I can’t get better stuck in here
5. If I have to be “specialed” I must be worse than I thought
6. Why can’t I get therapy or get my education while I am in here?

I very much welcome the recommendation within this report which seeks to “Enhance mental health promotion to increase protective factors and decrease risk factors for developing mental health difficulties”. This move to work “upstream” is probably our best way of reducing the pain and suffering of mental health illness in the highest number of people. If we can bring the conversation and the understanding to the widest possible audience then we are likely to generate early intervention more often and thus reduce the negative impact of long term illness.

In conclusion I think of the words of Maya Angelou and how she so eloquently re-wrote the concept of actions speaking louder than words –

 “I learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel”.

The way our children and young people feel within an Adult psychiatric unit and, when they leave it, will stay with them forever – we need to ensure that such a burden should no longer be placed on those young people.

As Ombudsman for Children I head an Independent Human Rights Institution, with responsibility for monitoring and promoting human rights, and therefore I see this report as a vital aid in understanding the gaps within the services available for this particularly vulnerable group of children and young people. I commend all the members of the Coalition for bringing this to fruition and I am pleased to officially launch this report and I look forward to the progress that will undoubtedly flow from it.

• 26 March 2015
• Type: Speech
• Topic: Mental Health