Watchdog exposes string of failings in children's mental health services
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The country's mental health watchdog has exposed a string of failings in the Child and Adolescent Mental Health Service, including 140 young people "lost" in the system in the Mid-West area.
The watchdog has also expressed fears that other children are without adequate follow-up services, including regarding their medication.
The interim report published by the Mental Health Commission found that a "very limited desktop review" had identified 140 'lost' cases in one area and added: "We identified another team that had open cases of children where there was no documented review for up to 2 years. This risk had not been identified by this Camhs service. Another team were attempting to identify an unknown number of cases that had been lost to follow-up following a change in staffing."
According to the MHC: "Those lost to follow-up included children on medication, with some reaching their 18th birthday with no discharge or transition to adult services planning or advice about medication. We heard from parents and young people of the efforts that they made to get a review appointment, a prescription renewal or advice about their child’s care while on medication."
On the 140 cases the HSE said Mid-West Community Healthcare commissioned a Healthcare Record Review in respect of one of its Camhs teams because it had a deficit of senior clinical capacity and that all identified children were then contacted and offered appropriate care "and no adverse impacts have been identified for any of the children involved".
According to the HSE: "We told the Commission of these 140 cases, of the process undertaken and of all the relevant actions taken in response to all matters identified by the Mid-West Camhs team. This is the historic issue referred to in the MHC report."
The HSE said concerned families can contact the HSELive phone line on 1800 700 700.
But the MHC report — conducted by Inspector of Mental Health Services, Dr Susan Finnerty, and based on a review of Camhs in five out of nine Community Healthcare Organisations — uncovered other serious concerns.
"There was evidence that some teams were not monitoring antipsychotic medication, in accordance with international standards (there are no national standards)," it said. "Consequently, some children were taking medication without appropriate blood tests and physical monitoring that is essential when on this medication."
Other issues highlighted in the report included staff shortages, children "deteriorating" on waiting lists and paper-based recording systems.
On risk escalation in some cases, it said: "This had frustrated some teams to the extent that they told us that they didn’t 'bother' to escalate risk anymore as there was no point."
And it said: "GPs told of frustrating attempts to get a child assessed and having to resort to sending a child to the Emergency Department in local hospitals to obtain a psychiatric assessment. Families and young people reported having to be referred on multiple occasions in order to get a service from CAMHS while being unable to get a timely service from other agencies.”
Dr Finnerty said she had issued an interim report, covering CHOs 3, 4, 5, 6, and 7 [this includes Limerick, Clare, Tipperary, Cork and Kerry as well as areas in the east of the country] due to the serious concerns identified so far. Five escalations of risk have been made to the HSE and the Commission recommended an immediate clinical review of all open cases in all Camhs Teams, with a particular focus on children who have been lost to follow-up, and physical health monitoring of those on medication, alongside immediate regulation of Camhs under the Mental Health Act.
Damien McCallion, HSE Chief Operations Officer, said improvements were already underway and targeted action had been taken. "In the case of all children where concerns have been raised by the MHC in their report, these have been managed directly by the service caring for them," he said.
Dr Siobhán Ní Bhríain, HSE National Clinical Director Integrated Care, said progress had been made but added: "We know that there continues to be gaps in the current service, including levels of access, adequate levels of staffing/infrastructure and lack of consistency in the quantity and quality of services provided."
The HSE is conducting its own audits of various elements of Camhs across the country, including prescribing practices, but the Chair of the Irish Association of Social Workers, Vivian Geiran, said the findings in the MHC interim report were deeply concerning.
"It is an example of systemic failure and there doesn't seem to be an appropriate or strong enough systemic response," he said.
"Where is the control, the management, the culture, the planning, the coordination?"
Mr Geiran asked if Camhs now needed "radical change", describing the current situation as "a ship drifting without any rudder or direction".
Dr Finnerty's review will continue in the other CHOs and John Farrelly, MHC Chief Executive, said the HSE had promised to act: "This review, we have been reassured, will include a focus on physical health monitoring of children who are on antipsychotic medication as we have recommended," he said.