CAMHS — Child and Adolescent Mental Health Services

The Report of the Expert Group on Mental Health Policy, 'A Vision for Change', was published in January 2006. It set out a 10-year framework for the development of mental health services in Ireland, recommending the development of community-based CAMHS teams, inpatient child-specific beds, and the closure of adult wards to children. It recommended 99 community CAMHS teams nationally. Implementation was incomplete: successive HSE progress reports documented persistent shortfalls in team numbers and inpatient capacity.

Amnesty International Ireland published a report in 2012 documenting systemic failures in child and adolescent mental health services, including long waiting lists, placement of children in adult psychiatric wards, and inadequate community teams. The report found that 'A Vision for Change' (2006) had not been implemented fully after six years and called for a statutory entitlement to mental health services. This report contributed to sustained political and public pressure on the HSE and Department of Health to accelerate CAMHS reform.

The independent Maskey Review, commissioned by the HSE and chaired by Dr Susan Maskey, examined the CAMHS South Kerry service and found that 46 children had been prescribed medication inappropriately. The review found failures in clinical governance, supervision and oversight. The HSE accepted the review's recommendations and apologised to the affected families. The review prompted the Mental Health Commission to commission a wider audit of CAMHS services nationally, which reported in 2022.

The Department of Health published 'Sharing the Vision: A Mental Health Policy for Everyone' in June 2020, replacing 'A Vision for Change' (2006). The policy set out a framework for the period 2020–2030, with CAMHS reform as a central theme. It committed to the further development of community CAMHS teams, the elimination of children from adult psychiatric wards, and improved access to early intervention services. A National Implementation Monitoring Committee was established to oversee delivery.

The Mental Health Commission published its report on CAMHS services in October 2022, following an audit of 32 CAMHS teams nationally. The report found that 257 open cases had been closed without any clinical treatment or contact. It found widespread deficiencies including lack of clinical governance, poor record-keeping, inadequate supervision, and high clinical risk. The report identified failures in 10 out of 11 specific quality dimensions assessed. The findings were described by the Mental Health Commission as 'deeply concerning'.

Following the publication of the Mental Health Commission CAMHS report, Taoiseach Micheál Martin issued a formal State apology in the Dáil in October 2022 to children and families affected by failures in CAMHS. This was a formal political acknowledgement of systemic failure in the child mental health system. Minister for Mental Health Mary Butler committed to a CAMHS Taskforce and an action plan to address the report's findings.

Budget 2023, announced in September 2022, included an additional €56m for mental health services including CAMHS, bringing total HSE mental health expenditure above €1.1bn annually. The additional funding was directed at new CAMHS teams, expanding community mental health supports, and addressing waiting lists. However, recruitment of specialist CAMHS staff — consultant child and adolescent psychiatrists, psychologists and nurses — continued to be constrained by national and international staff shortages.

The HSE established a CAMHS Taskforce in early 2023 to oversee implementation of the Mental Health Commission's 2022 recommendations. The Taskforce published an action plan setting out time-bound commitments to address clinical governance failures, improve record-keeping, reduce waiting lists, and ensure no child's case is closed without clinical contact. Implementation was monitored quarterly, with reports published on the HSE website.

Evidence given to the Oireachtas Joint Committee on Children in 2024 confirmed that CAMHS waiting lists nationally remained above 4,500 children. The HSE's own CAMHS waiting list data published quarterly showed persistent waiting lists in excess of four months for routine referrals in many CHO areas. Children in Community Healthcare Organisation (CHO) areas 1 (north-west) and 2 (north midlands) faced significantly longer waits than those in CHO 6 (Dublin South). The HSE committed to reducing waiting lists to within 12-week referral-to-treatment targets.

The HSE reported in early 2025 that additional CAMHS teams had been established in several CHO areas, with new consultant child and adolescent psychiatrist posts filled following targeted international recruitment campaigns. The Programme for Government 2025 committed to further CAMHS expansion and to achieving parity of access to mental health services across all CHO areas by 2027. Despite new team establishment, waiting lists in some areas remained above 12 weeks for routine referrals.

As of May 2026, CAMHS waiting lists remain above WHO-recommended referral-to-treatment targets in multiple Community Healthcare Organisation areas. The HSE CAMHS Taskforce continues to oversee implementation of the 2022 Mental Health Commission recommendations. The CAMHS Taskforce's quarterly reports indicate progress in clinical governance but persistent challenges in rural areas. No statutory entitlement to CAMHS services has been enacted.

As of 2024, national CAMHS waiting lists exceeded 4,500 children referred but not yet seen by a specialist team. Children awaiting assessment or treatment for conditions including anxiety, depression, eating disorders and psychosis may experience clinical deterioration during waiting periods. The Mental Health Commission's 2022 report found 257 cases had been closed without any treatment contact, meaning those children received no service despite being on an active caseload.

Access to CAMHS varies substantially across the nine Community Healthcare Organisation areas. Children in CHO areas 1 (Donegal, Sligo, Leitrim, West Cavan), 2 (Cavan, Monaghan, Meath, Louth) and 7 (Kildare, West Wicklow, Dublin South, Dublin South East) face longer waiting times and lower staffing ratios per 100,000 children than CHO 6 (Dublin South City, Dún Laoghaire). The Maskey Review (2020) identified South Kerry as a case of particularly acute under-resourcing. Rural children and those in border counties experience systemically inferior access.

Ireland has one of the lowest ratios of consultant child and adolescent psychiatrists per 100,000 children in the EU. The College of Psychiatrists of Ireland has documented ongoing vacancies in consultant CAMHS posts, driven by competition with private practice, the UK NHS and Australian health services. High staff turnover disrupts therapeutic relationships and contributes to waiting list growth. The HSE's CAMHS Taskforce action plan identified staffing as the primary constraint on service expansion.

'A Vision for Change' (2006) set a target of allocating 8.24% of the overall health budget to mental health services. Despite Budget 2023's additional €56m, the mental health share of total health expenditure has remained below the recommended level. Ireland spends a lower proportion of its health budget on mental health services than most comparable EU member states. The underfunding has been documented by Amnesty International Ireland, the College of Psychiatrists, and the Mental Health Commission in successive reports.

Article 24 of the UNCRC obliges States Parties to recognise the right of children to the enjoyment of the highest attainable standard of health and to mental health care. Article 39 requires States to take measures to promote recovery and reintegration for children who have suffered neglect. Ireland ratified the UNCRC in 1992. The UN Committee on the Rights of the Child has specifically called on Ireland to increase resources for child mental health services in its periodic reviews of Ireland's compliance.

If breached: UN Committee on the Rights of the Child periodic review recommendations; domestic legal obligations under the Irish Human Rights and Equality Commission Act 2014.

The Mental Health Act 2001 and its amendment Acts establish the legal framework for mental health services in Ireland, including CAMHS. The Act requires that children admitted as involuntary patients be accommodated in approved centres appropriate to their age and needs. It established the Mental Health Commission to oversee standards. The Act obliges the HSE to provide adequate community-based mental health services. The Mental Health (Amendment) Act 2018 further strengthened child-specific protections.

If breached: Mental Health Commission regulatory action; inspections of approved centres; legal proceedings by or on behalf of affected patients.

The 2020 national mental health policy 'Sharing the Vision' sets out 100 actions for mental health service development over 2020–2030, including specific CAMHS commitments: development of additional community teams, elimination of children from adult psychiatric wards, and improved access to early intervention services. The National Implementation Monitoring Committee is required to publish annual progress reports on delivery of these commitments.

If breached: Oireachtas scrutiny; Mental Health Commission regulatory action; reputational consequences for HSE and Department of Health.

Parents of children whose cases had been closed by CAMHS without any clinical contact raised objections through advocacy groups and directly to the Mental Health Commission audit. The key objection was that children referred to CAMHS by GPs and schools were being placed on waiting lists and then, when teams reviewed caseloads, discharged without ever being seen by a clinician. Parents argued this left severely unwell children without any State support and placed them at clinical risk. The Mental Health Commission documented 257 such cases in its 2022 report.

Families of 46 children in CAMHS South Kerry raised objections, following the Maskey Review, that their children had been prescribed psychiatric medication by a clinician operating without adequate clinical governance or supervision. Families raised concerns about the process by which medication decisions were made, the lack of oversight, and the HSE's response time in investigating the matter. The HSE apologised and accepted the Maskey Review's findings.

Opposition TDs and advocacy organisations raised at the Oireachtas Joint Committee on Children that children in rural and border counties face waiting times significantly longer than those in Dublin and Cork, and that this geographic inequity amounts to a two-tier child mental health system. The objection was that additional CAMHS funding was disproportionately deployed in areas with established teams and infrastructure, widening rather than narrowing the urban-rural gap.