Friday 3 February 2023

that way madness lies

A family from The Midwest has been promised Lotto money - €31 million - to support one of their number who has cerebral palsy, hearing loss and other cognitive impairments. The family's lawyers allege that the tragedy occurred because 1) the mother's urinary tract infection UTI was neither identified nor treated 2) steroids were not administered at the appropriate time. As all these events happened nearly 20 years ago, it is difficult to mount any effective defense against the allegations.

TIL that untreated maternal UTI is indeed associated with cerebral palsy CP. One study from 25 years ago found that kids with CP were 5x more likely if the mother had a UTI than otherwise. Significantly, the top Google hit for the association flags up a firm of Michigan attorneys who specialize in getting cash for misfortunate sufferers from CP. Cochrane, the GoTo for authoritative medical evidence has nothing to say about the UTI/CP association but does recommend pre-term screening for maternal UTI because that intervention helps prevent preterm and low-weight births. Cochrane's assertion is that routine screening and treatment will reduce cases of pre-term birth from 5% to 3%; saving €60,000 each time. Someone needs to do the calculus for the cost of "routine screening" to set against 2% x €60,000 to see if that's an efficient use of health resources.

Cerebral palsy is a terrible thing: physiotherapy and other interventions - like respite care for the parents! - can make life easier and more fulfilling for all concerned but it all costs money. Mr Justice Coffey has decided that €31m is what it will take to cherish this citizen and her family while she's still with us. But here I choose to put €31m into context for the nation's young people. The annual budget for all Child and Adolescent Mental Health Services CAMHS appears to be on the order of €85million annually. The same source indicates that another €40million a year would bring CAMHS funding close to what civilized societies expect from the tax-dollars. 

And now we have a damning report: Mental Health Commission finds CAMHS is barely fit for purpose. Any organization needs an audit from time to time. But with CAMHS, the first pass audit turned up a quite disconcerting proportion of failings. You can't close such a Pandora's Box, once you've peeked inside - you have to keep digging because each deficit, failing or error is a beloved but troubled child not getting the help they need; and deserve at least as much as all the high-profile cerebral palsy cases which reach the courts. 

Trouble is, mental health is really not usually amenable to a quick fix. But if CAMHS is chronically under-funded, under-staffed and swept under the un-sexy carpet [and it is!] then the few Effectives left in the building don't have time to give any child the attention needed, let alone ALL the children who need it. One of the identified failings is giving anti-psychotic meds to children for longer than is clinically advisable because auditing a child's chart takes time and there are three more new kids on the books who have just tried to top themselves or are unable to face school or are in A&E again atfer self-harming physically or chemically. Hello! There are 20,000 "open" cases on the CAMHS books, the failure-to-serve rate from the pilot audit indicates that 4,000 [20%!] of these open cases have been badly served by the state.

Adversarial defense of claims against the HSE and its subsidiaries including CAMHS means that, in addition to the cash or credit awards to the plaintiff, the plainiff's lawyers and the HSE's lawyers get their cut. In a case which has dragged through the courts for years of billable hours, this is also going to be a seven-figure sum. 

Every million given to the lawyers is 15 person years of salary for mental health Effectives. Or one new CAMHS unit [Consultant Psychiatrist; Registrar; 2x Psychiatric Nurses; 2x Clinical Psychologists; Social Worker; Occupational Therapist; Speech & Language Therapist; Social Care Worker; 2x Grade IV clerks] servicing maybe 1,000 young troubled citizens a year.

And remember: one of the reasons that a CAMHS case is no longer open is because a coffin has closed. We've got to do better than this.

Note added in press: I was visiting m'pal Rissoles a tuthree days ago for the first time in yonks. One of his kids recently prevailed upon Daaaad to go with her to a local perf by Blindboy Boatclub of the Rubberbandits. In the questions from fans afterwards, a succession of youngsters stood up to say thanks for The Blindboy Podcast which had saved them from a sea of trouble. B.B. was flattered but understandably aghast: "WTFittyF" [I paraphrase at second hand] "there's something seriously amiss if my ramblings about mental health are more help that the serried ranks of services paid for by the state. Y'all, we'all should get onto our elected reps and let them know this is not good enough." Amen!

1 comment:

  1. Coincidentally our eldest was there too, or at least the Waterford gig 😀