Jersey's Child and Adolescent Mental Health Service (CAMHS) has been judged to be 'weak' in areas including how its governed, how data is collected and how risk and performance is managed.
A report by the Comptroller and Auditor General has identified where CAMHs is still failing and makes 32 recommendations.
The report calls for services to be governed and managed more robustly.
There is still no formal agreement (Memorandum of Understanding) between the Department for Health and Community Services and the Children, Young People, Educations and Skills Department on how CAMHS should be run .
The C&AG found that there was no common line of action between the two departments, which have joint responsibility for assuring 'the safe and high-quality delivery of services'.
Despite a caseload double that of the UK pre-pandemic, CAMHS is still understaffed, with more than a fifth of roles unfilled.
C&AG Lynn Pamment
Lynn Pamment has also found that - where children repeatedly miss appointments - not enough is done to make sure they are safe.
Current guidance is that a letter expressing concern is sent after the third missed session.
'... the guidance on how to manage situations where children and young people 'did not attend' their CAMHS appointment is not consistent with best practice and and is not sufficient to ensure children and young people are safe and that they receive appropriate services and care."
This report follows the announcement in February of this year of a major redesign of Child & Adolescent Mental Health Services.
Lynn Pamment says there are 'early signs' that new ways of managing referrals is cutting waiting time.
However, she has highlighted the lack of in-patient care and that timescales for introducing those services are 'not clear'.
She has made 32 recommendations to bring the service up to scratch, including finding areas which could delivered by, or in partnership with, community providers to help ease the caseload.
The report also wants to see a governing body appointed to oversee the service, as well as a central system to reduce the risk of errors being made.
16%-25% of youngsters seen by CAMHS are referred back. The C&AG says the service needs to get an understanding of why so many young people are coming back into its care and set out what actions it will take to reduce those numbers.
It also says clear policies should also be brought in that would look into how the patient felt about their discharge, if they'd met the goals they made at the beginning of their care and a plan of action on 'how to stay well.'
Lynn Pamment says the investment and the Children and Young People's Emotional Wellbeing and Mental Health Strategy announced by the government earlier this year has to be underpinned by her recommendations:
"Governance, data collection, risk and performance management for CAMHS has been weak. For the Strategy to lead to a step change in a service quality and range of provision it will need to be supported by stronger and more effective governance and other arrangements and more specific and detailed implementation plans."
Deputy Inna Gardiner
Children and Education Minister Deputy Inna Gardner, who previously heard and highlighted concerns about CAMHS in her former role in scrutiny, has welcomed the C&AG's report.
"These recommendations are also familiar to the CAMHS team, and the service has seen substantial improvements in the last year.
CAMHS has been able to improve the data it collects and recruit more people. The service now has 56 employees, up from 21 in mid-2021."
"The increase in staff has meant that waiting times for assessments, counselling and autism assessments have fallen."
The Minister says that she is working to ensure a 'Memorandum of Understanding' between the two departments is in place by the end of he year.
"The C&AG report offers us an opportunity to refocus our efforts and move forward to ensure all the recommendations are progressed.”