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Lack of follow-up care in CAMHS as the Mental Health Commission’s report published
Coleman Legal LLP
Jan 26, 2023

The Mental Health Commission published a report this weekend highlighting serious shortfalls in the care provided nationwide by the Child and Adolescent Mental Health System (CAMHS).

This report comes a year after the publication of the Maskey Report – which found that doctors working within South Kerry CAMHS had provided inadequate care to 227 service users over the five-year period from 2016-2021.

Furthermore, Dr. Markey’s report further found that 46 of these children had suffered significant harm.

Findings reported that issues with unreliable diagnoses, inappropriate prescriptions, poor monitoring of treatment, and potential adverse effects were of the most concern.

The recent Mental Health Commission’s report has found that there are similar concerns related to CAMHS nationwide, showing that the issues did not just exist in the Kerry community services.

The MHC report found that there are “serious concerns and consequent risks for some patients” in four out of the five Community Health Organisations investigated so far.

These serious concerns relate to a number of deficits, including staffing problems, long waitlists, failure of service workers to manage risk, a lack of emergency and out-of-hours services, patients getting “lost” in the system, and a lack of a standardised service nationwide.

The doctor heading the report has called for the HSE to carry out a clinical review immediately of all open CAMHS cases.

The HSE has released a statement promising to carry out follow-ups with any families affected by the findings of the report.

The statement read: “We will arrange further clinical follow-up for any child where that may be required from this review and will make direct contact with parents or guardians as necessary.”

The report found that staffing issues were one of the biggest concerns, with many CAMHS teams being severely understaffed leading to the staff they do have working more than their contracted hours.

Many of these workers became frustrated at the service after they experienced burn out due to be overworked and understaffed.

In relation to other staffing issues, the lack of governance in many Community Health Organisations is of key concern.

This has led to children being misdiagnosed and prescribed anti-psychotic medication without being adequately monitored along the course of prescription.

There are international standards that must legally be followed by doctors when prescribing any medications, these include the obligation to take routine blood tests, measure blood pressure and other physical monitoring.

The MHC’s report has shown that CAMHS doctors did not adequately carry out these practices. this has been of great concern to the MHC as for many of the medications prescribed by CAMHS, it is essential that those tests are carried out regularly.

Further issues relate to patients being “lost in the system”, whereby children and adolescents who have tried to access services offered by CAMHS faced issues with follow-up care.

It was reported that in some cases, children were not seen for a  review for up to two years since their last appointment.

This was commonly the case where patients had reached the age of eighteen and no discharge or transition to adult services plans were put in place.

The report also found that in one team alone (HSE Mid West Community Healthcare), there were 140 “lost” cases.

The HSE have responded to this finding, saying that these cases have since been flagged and followed up by the team and were never “lost.”

A spokesperson for the HSE stated: “All children on the caseload of this team have now received the required follow-up care, and no adverse impacts have been identified for any of the children involved.”

Parents of service users have said that the long wait times experienced by many service users has led to deteriorating mental health conditions in their children.

The doctor leading the investigation by the Mental Health Commission has said there might be clear examples of UN Convention on the Rights of the Child violations, that CAMHS will need a full clinical review as soon as possible to ensure all children and young adults in Ireland enjoy their right to the highest attainable standard of physical and mental health as per the UNCRC.

We fully expect that several families will receive correspondence concerning HSE in the coming weeks after the full publication of the MHC report. Families may be invited in for a reassessment or offered an apology in relation to previous treatment received.

Coleman Legal LLP has an experienced team dealing with over 300 clients who were under the care of CAMHS. Please feel free to contact our office if you have any concerns regarding the care you or your family has received while attending CAMHS nationwide.

Keith Rolls Partner Coleman Legal LLP

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