Vegetation growing through windows in 'unfit' Laois health unit for children and teens in Portlaoise

Mould, vegetation growing through windows and flaking plaster are conditions which led a health services watchdog to find that a centre for young people with mental health issues in Portlaoise is 'unfit for purpose'.

The Mental Health Commission made the assessment after visiting the Child and Adolescent Mental Health Services (CAHMS) in Laois which are located at the St Fintan's Health Campus on the Dublin Road.

Commission officials found stark differences between the two units on the campus in a report published on August 31 into the provision of CAMHS in the HSE's Community Healthcare Organisation (CHO) 8 which includes Laois and Offaly 

The main CAHMS unit was found to have good facilities with dedicated self-contained offices and consultation rooms located on the second floor. There was pivate waiting room contained within the facility readily available parking, disabled access via lift and assisted toilets.

Each clinician had their own office and facilities are not shared with any other services. 

The building is separate from one that houses the Laois / Offaly Young Adolescent Mental Health Service (YAMHS) but which is also in the St Fintan's Campus. It provides community based assessment and treatment for Young people between the ages of 16 to 18.

"The environment is unfit for purpose with plaster falling off the walls, torn lino on the stairs, vegetation growing in some windows, and rain coming through some windows There is mould growing on the walls of some rooms. The rooms are
not sound-proofed, and the waiting “room” is chairs in a corridor," found the commision.

The Commission also commented that the accommodation for the Laois/Offaly YAMHS Team is in a 190-year-old former
district asylum.

"This is not an appropriate location for children and young people," it said.

The report added that the the premises upgrade has been submitted to the National Estates Capital Steering Group for Capital Funding.

The shortcomings with the Portlaoise premises are reflective of the overall theme of a report that examined CHO 8 which consists of two mental health services: Louth/Meath and the Midlands Mental Health Services, which covers Laois, Offaly, Longford and Westmeath. 

The report found that per capita funding for young people under 18 for CAMHS in CHO 8 has remained the same despite the rise in population and the demand on CAMHS. The budget for CHO8 is €120 million but CAMHS Funding in 2022 was €13.2 million or (11% of overall budget).

It found that there were 110 children on waiting lists in Laois at the end of January but this reduced to 63 by March. There were 43 young adolescents waiting to be seen in January. This dropped to 32 in March in Laois.

There are just 10 staff attached to the Laois service. There of nine clinical staff and just one consultant psychiatrist.

The report found that there are areas of high deprivation across in Laois and across the CHO, which should influence the funding of the teams in these areas.

"However...there is insufficient staffing to meet A Vision for Change recommendations for CAMHS teams, let alone deal with high levels of deprivation where young people and their families have complex needs," it said.

The report found that CAHMS staff in the Midlands are highly skilled and offer a wide range of interventions. The Commssion highlighted other qualities and strengths but the challenges are significant.

These range from low numbers of team members in the face of increasing population and limited ability to recruit staff.

It is limited or no access to services for children and adolescents with autism and no dedicated CAMHS service for children and
adolescents with intellectual disability and moderate to severe mental illness.

There is no specialist eating disorder team.

It was found that difficulty in accessing CAMHS inpatient beds results in clinicians trying to manage children/young people who pose a serious
risk to themselves in the community.

It said there is no access to day hospitals or day programmes, which also results in clinicians holding risks at the community level.

The Commission spoke to young people and families most young people and their families praised individual staff members and felt that their needs had been met during. However, there were complaints about the length of waiting times. They spoke about moving from one waiting list to another, and of having to seek re-referrals from GPs to CAMHS 

There was confusion about the criteria for acceptance by CAMHS and immense worry about deterioration of their child’s mental health while on waiting lists.

The Commission found that the average age of young people accepted by CAMHS is 14 years old but the service sees children from six to 19 years olds.

An audit found that the average wait time from referral to assessment is three to four months. The Commission said a reasonable wait time from referral to assessment is three months or less.

It found that 64% of children/adolescents had a wait time from referral to assessment of three months or less.  Of children/adolescents that were waiting three months or less from referral to assessment, 91% waited approximately three months or less from assessment to treatment.

Just one Laois Offaly TD issued a statement in response to the findings. Independent TD Carol Nolan has described the latest report as a ‘deeply troubling but clear-eyed assessment of the road that needs to be travelled if children and families are to have access to the level of service provision that they need.’

“The Report from the MHC today has laid out a number of important recommendations that Government must take immediate steps to adopt,” said Deputy Nolan.

“The current situation is simply not sustainable either in terms of addressing increasing levels of need that families have, or in addressing the possibility of staff burn-out due to that increased level of demand. This is a point that I have been making for a number of years now.”

“Action must be taken, and the recommendations made today by the MHC must be brought into force. We should not allow a situation to develop where we are back here again in another year or two with no substantive improvements having been made,” concluded Deputy Nolan.