More than 100 mentally ill children, including some on medication, were left for up to two years without care by the Child and Adolescent Mental Health Service (Camhs), a report published on Monday finds.
In an interim report, the Mental Health Commission identifies serious risk to the safety and wellbeing of children accessing Camhs, including 140 “with open cases [who had] been lost to follow-up”. While not identified in the report, the 140 open cases are known to be in the community health area (CHO) which covers Clare, Limerick and north Tipperary.
“These young people were in need of an appointment... but had not been contacted,” notes the report. “[They] included children on medication, with some reaching their 18th birthday with no discharge or transition to adult services.”
The report finds poor monitoring of medication; children waiting days in emergency departments for psychiatric care; children left unreviewed on antipsychotic medication for years; exhausted, overwhelmed and inadequately supervised staff; psychiatrists not trained to work with children; poor risk management; poor clinical governance; and chaotic, paper-based record-keeping.
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Led by the chief inspector of mental health services, Dr Susan Finnerty, the review comes in the aftermath of the Dr Sean Maskey review of south Kerry Camhs, published last year, which found serious shortcomings in the care of 240 children.
Dr Finnerty’s examination of the service across the State’s nine CHOs is ongoing, with a final report due in late 2023. The commission said it moved to publish its interim report, “because of the serious concerns and consequent risks for some patients that we have found” in four areas.
Difficulties filling psychiatrist posts meant some areas had “resorted to tele-psychiatry”. In one team, covering Kerry and Cork, a consultant psychiatrist covers 23½ hours a week by tele-psychiatry from the Middle East. In another team, the consultant worked part-time, and there was no consultant to cover their work while they were absent.
“This resulted in seriously ill children waiting until that consultant was back on duty, with other team members trying to ‘hold’ the child safely until the consultant returned.”
In another case a child “waited four days in [an emergency department] until they could be assessed by a consultant psychiatrist”.
The commission noted that referrals to Camhs had increased in the past two years and the “severity and complexity” of cases had also risen. “Between 2020 and 2021, referrals... increased by 33 per cent, while the number of new cases seen has increased by 21 per cent in that same period,” it said.
In a statement, the Health Service Executive (HSE) said it had identified the open cases referenced by the commission.
It said “all identified children and young people/guardians were contacted” and all had “received appropriate care, including face-to-face appointments, telehealth appointments, clinical reviews, and discharge and referral to other services, as necessary”. None experienced “adverse impacts”, said a spokeswoman.
HSE chief operations officer Damien McCallion said a “major improvement process” was under way at Camhs which would be driven by “a senior clinical/operational team”.
“The HSE engaged with [Dr Finnerty]... and where specific concerns were identified, we immediately put in place targeted action plans to address them. In the case of all children where concerns have been raised... these have been managed directly by the service caring for them.”
Anyone who has a concern about a child currently engaged with Camhs can call 1800 700 700 for support and advice.
