The Health Service Executive has apologised to children and young people who have not received the standard of care that they might expect from its Child and Adolescent Mental Health Services (CAMHS).
The Oireachtas Sub-Committee on Mental Health heard there are deficits in access and the quality and consistency of services due to inadequate Information systems and staffing problems.
HSE Chief Operations Officer Damian McCallion welcomed the publication of the Mental Health Commission's interim report on CAMHS last month.
The HSE said it had taken and would continue to take all concerns seriously to ensure they are addressed.
CAMHS handles 22,000 referrals and 225,000 appointments a year, according to Mr McCallion, and the growth in demand and difficulty with staff retention have impacted on the service.
Between 2019 and 2022, referrals rose by 16% and appointments rose by 10%.
"As of the end of December 2022, there were 4,293 children and young people waiting to be seen," Mr McCallion said, a 21% rise on the year before.
He said the HSE "promptly and comprehensively" addressed the specific cases raised by the Mental Health Commission's review.
"There are no active relevant concerns in regard to those cases," he insisted, and urged parents or young people to contact the CAMHS team or HSE helpline if they have any concerns.
A review of the CAMHS service will finish in May, he said.
In 2022, "92.7% of all urgent cases were seen within three working days," Mr McCallion noted.
63% of all referrals were seen within 12 weeks.
From June to December of last year, 758 cases were taken off CAMHS waiting lists.
However, Mr McCallion accepted that some people "are waiting too long" to access services.
CAMHS gets €137m annual funding and helps 2% of young people and children.
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National Clinical Adviser and Group Lead for Mental Health, Dr Amir Niazi, revealed that despite advertising several times the HSE has been unable to fill the post of clinical consultant to the CAMHS team in Kerry.
"We know the reasons why that post is not very popular," he said.
Jim Ryan, Head of Mental Health Operations, said the HSE had been engaging with the Mental Health Commission ahead of publication of its review, and continues to do so.
The four areas - of the five reviewed - in which concerns were raised "have been addressed comprehensively," he told Fine Gael Senator Martin Conway.
In three of the remaining four areas, the review has been completed or is nearing completion, "and to date we haven't had any issues raised with us," Mr Ryan said.
The review of the final area "is actually starting today," he added.
Mr McCallion said that when the review identified issues with specific cases, the HSE was alerted immediately.
There are 789 whole-time equivalent posts in CAMHS, whereas the target is 1,200, he said.
Staffing levels on individual teams range from 45% to 75% of the target, Mr McCallion added.
Dr Niazi said that an audit of prescribing among the 21,000 children using CAMHS shows that "around 8,000 are on medication".
The audit sampled 3,500 of those on medication and found that "almost 70% of those children were on one medication" while almost a quarter - 23% - were on two medications, 4.6% were on three medications, and 0.5% were on four or more medications.
He acknowledged there were cases of over-prescribing but said that this happens with complex diagnoses.
"We are on par with international prescribing practice," he insisted.
Mr McCallion said that there were 55 CAMHS beds in operation with 31 occupied last week.
There were a further "two or three" people on waiting lists.
He noted that last year the HSE had appeared before the committee to tell it of a temporary closure of beds at the Linn Dara facility.
Despite plans to reopen last September, the unit is still operating only 13 out of 24 beds because of a lack of staff, he said.
