Warning over narrowing of HSE audit of child mental health services
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The HSE risk failing to uncover widespread malpractice in Child and Adolescent Mental Health Services because it has narrowed the scope of a national audit of the services.
That's according to the chair of the Mental Health Commission John Saunders who says he has serious misgivings about the audit which is supposed to gauge whether problems uncovered in the South Kerry CAMHS scandal are replicated elsewhere.
A review group led by London-based consultant child and adolescent psychiatrist, Dr Sean Maskey, found that, of 1,300 children who attended South Kerry CAMHS, there was clear evidence that 46 of them suffered significant harm. Its report also found that 227 children being treated by a junior doctor employed by the service had been exposed to the risk of significant harm through the doctor's diagnoses and treatment of them.
In correspondence released to the under a Freedom of Information request, John Saunders tells Minister for Mental Health Mary Butler that the HSE has narrowed the scope of the national audit too much and that it is therefore not following the recommendations of the Maskey report.
In particular, the HSE has said it will begin its audit by focussing on CAMHS cases involving young people with ADHD, before potentially broadening the scope of the audit later on.
But while the HSE said this was a recommendation of the Maskey Report - a position it also outlined before an Oireachtas Committee - Mr Saunders' strongly-worded letter of March 8 to Mary Butler argues the HSE should conduct a full audit.
"The Maskey Report does not limit or qualify this recommendation to ADHD," he wrote. "The MHC believes that if Dr Maskey had intended to do so, he would have clearly stated this.
"The HSE states in one of its letters to you that the audit of prescribing practice provides an important basis from which a robust national clinical audit can be developed leading to important improvements in the care of this vulnerable population.
An earlier letter to the Minister from Anne O'Connor, Chief Operations Officer with the HSE, sent on February 18, outlines the "risks involved in broadening the scope of audit", including that "the precipitous stopping of medication for any diagnosis is frequently associated with withdrawal symptoms that in and of themselves can result in very considerable harm.
"Therefore it is critical that the public messaging in relation to this audit emphasises that fact and advises strongly against the stopping of these medications against medical advice," she writes.
However, in the letter to the Minister, John Saunders wrote: "Where did the reference to the withdrawal of medication come from? It is a matter of clinical judgment to decide and record the basis of prescribing such medication and to carefully monitor same to ensure the safety and wellbeing of the child. Has the Minister been provided with a basis for this statement?"
The February 18 letter sent by Ms O'Connor also refers to the HSE engaging with the Office of the Attorney General and the States Claims Agency (SCA) "in the context of any redress scheme in this regard" adding: "The SCA stated in these discussions that they believe the proposal to widen the scope represents serious additional risk in terms of clarity of those encompassed by any scheme as well as financial exposure for the Clinical Indemnity Scheme."
To this, Mr Saunders said in his letter to the Minister: "The MHC also has significant concerns that the HSE appears to be relying on the limited scope of the compensation scheme for those impacted by the Maskey Report as a reason not to undertake an audit for the safety and benefit of children in the State."
In an email of February 28 from Dr Philip Dodd, from the Department of Health's Mental Health Unit, to Orla Keane of the Mental Health Commission, Mr Dodd said "as I understand it, the HSE are favouring the completion of an audit of prescribing practice focussing on ADHD, in the first instance, rather than including a range of conditions, as sought by Minister Butler."
Minister Butler said it had always been her preference for a full and expanded audit and that this has now been agreed between the HSE and the Department of Health “after several meetings and correspondence exchanged, as was my request from the start.”