CAMHS National Audit

Independent review of the provision of CAMHS

Dr. Maskey’s report outlined severe deficits in the care given to many young people attending the service in South Kerry. 46 children were found to have suffered significant harm and a further 181 had been exposed to the risk of significant harm due to unreliable diagnoses, inappropriate prescriptions, poor monitoring of treatment and potential adverse effects.

Upon the publication of The Maskey Report, concerns were expressed as to whether similar concerns and risks existed in CAMHS in other parts of the country.

An Independent Review of the provision of Child and Adolescent Mental Health Services in the State was commenced by the Inspector of Mental Health Services. In January 2023, the Inspector, Dr. Susan Finnerty, published an interim report having completed her reviews in 5 out of the 9 Community Healthcare Organisations. Her decision to issue the report before all reviews had been completed was due to severe concerns and consequent risks for some patients that were found across 5 of the 9 Community Healthcare CAMHS reviewed.

Dr. Finnerty expressed concerns regarding the risk to safety and wellbeing of children receiving mental health services, the management of that risk and the lack of clinical governance. Many of the interim report findings compare directly with the awful experiences of children and families, as highlighted in the Maskey Report in South Kerry. The State needs to urgently fund the same resources that were made available in the South Kerry review. The damage being done to many children today, as we speak, may be irreversible.

Final Report

Report of the Independent Review of the provision of Child and Adolescent Mental Health Services (CAMHS) IN THE State by the Inspector of Mental Health Services.

The Mental Health Commission has today published the report of the Inspector of Mental Health Services on her Independent Review of the provision of Child and Adolescent Mental Health Services in the State.  This follows the Interim Report which had been published in January of this year.

The review looked at a sample of 10% of files opened by CAMHS since January 2021.  The report highlighted a catalogue of serious issues within CAMHS. There was a serious lack of governance in some areas.  There were also failures to manage risk.  Most CAMHS teams are seriously understaffed, some below 50% of what is required.

There are also huge variations in the number of children on waiting lists as well as the length of waiting lists in each Clinical Health Area (CHO). Young people consulted ats part of the review found the current position distressing and highlighted that services could only be accessed in a crisis.

One child was left in A&E for 4 days waiting to be seen by CAMHS.

The report also found that there was too much reliance on the Consultant Psychiatrist, a new model is required.  Some teams had no consultant psychiatrists which resulted in work being covered by locums.  This adversely affected continuity in care.

The report of the Inspector made 49 recommendations in total.

Speaking on RTE Radio One’s Drivetime, Keith Rolls, Partner at Coleman Legal LLP, told Barry Lenehan that the report did not go far enough. He highlighted that the issue of polypharmacy had not been addressed at all.

Only one paragraph of the 145 page report dealt with the mismanagement and failings in the prescription and monitoring of anti-psychotic medications. He was critical of the HSE’s conclusion that no harm had been done to any young people in circumstances where there had been no monitoring of antipsychotic medication in some teams in accordance with international standards.

Furthermore, one CAMHS team had 140 “lost” cases.  That the HSE could say that the litany of failures by CAMHS services nationwide had not caused any harm was unacceptable. He also criticised the recommendation of the Inspector of Mental Health Services that CAMHS be regulated by the Mental Health Commission stating that this was totally inappropriate.

Prescription and management of medication

There are no Irish guidelines in medication management for children and adolescents on antipsychotic medication.

The NICE (National Institute for Health and Care Excellence) Guidelines are accepted by consultant psychiatrists in CAMHS as an appropriate standard of care. These guidelines set out the monitoring required for antipsychotic medication.

Dr. Finnerty’s report found that some of the CAMHS teams, that were part of the National Audit, did not monitor to an acceptable standard. The report highlighted the safety repercussions for the children involved. Side effects of antipsychotic drugs include serious weight gain, increased blood pressure, sleepiness, dulled thoughts and galactorrhoea (production of breast milk).

The deficits in Medication Management are very similar to those identified in the Maskey Report. It is clear that a  comprehensive look-back of all Community Healthcare Organizations is urgently needed.

The Interim report – scratching the surface

Any outside off-island overview of CAMHS is to be welcomed. The Mental Health Commission went off-island to find international experts to review this awful situation. On behalf of our clients, we have also engaged an international team of experts to review the impact the acknowledged deficits in care have had on our clients.

One team alone had 140 children “lost to follow up” It is clear that this interim report is an urgent warning to those in charge, that the CAMHS system is in crisis, and any delay is further damaging lives.

The results of the interim report reflect an examination of only 10% of files across 45 of the 74 CAMHS teams nationally.

By their own admission, the Mental Health Commission has no power to enforce any action. In 2017, the Mental Health Commission in it’s Annual Report outlined a number of serious concerns in relation to CAMHS and Adult Mental Health Services.

Mental health commission annual report 2017

The Chairman in his foreword stated:

“Reform of the 2001 Act is now urgently needed and the Commission urges that the Department of Health takes heed of our commentary in this area to ensure the provision and regulation of a modern mental health service in Ireland. If this does not happen Ireland will continue to provide a level of unsafe and substandard services, which are not aligned to best practice and breach the fundamental rights of a vulnerable group of people who require such services.”

During 2017, a number of areas of significant non-compliance were identified by the Commission including medication practices, maintenance of records and staffing. The Commission also highlighted serious concerns in community CAMHS. The Inspector found that teams were inadequately staffed and noted a variation in waiting lists for CAMHS referrals and the provision of emergency cover.

The Commission had also developed templates that were widely circulated to be used as a useful “checklist” for services to self-assess. A template for Medication Management was one of those circulated. The Inspector’s report outlined that the Commission had met with the management teams of CAMHS in all nine Community Healthcare Organisations to obtain oversight of the State’s services.

Considering the Interim Report published by the Mental Health Commission in January 2023, and indeed the alarming findings of the Maskey Report in 2022, it is clear that the situation has deteriorated from the already unsatisfactory position that the Commission highlighted in 2017. Many young people attending, and who previously attended the services, have been failed.

Our team

At Coleman Legal LLP, we have a team of highly qualified solicitors and legal executives with extensive experience in medical misdiagnosis, mismanagement of medication, and deficits in care.

We are available to speak to the parents of the affected children in addition to patients who are now 18 years of age or older that may have been impacted by the misdiagnosis on the part of this HSE employee.

Coleman Legal LLP

Solicitors
84 Talbot Street, Dublin 1
D01 YX60
DX 112002

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