An independent report into North Kerry Child and Adolescent Mental Health Services (CAMHS) has found a risk for potential harm in 209 cases.
The report, commissioned by the Health Service Executive, determined that in 195 cases the risk was moderate, in two cases it was determined as major, while 12 cases were determined as minor risk.
No cases were determined as being of extreme harm.
In all, the review looked at 374 cases recorded as active on the CAMHS database on November 2022.
Among the issues identified were a high rate of prescribing anti-psychotic medicines, non-compliance with recommended physical health assessments and monitoring, and a low rate of individual or family psychotherapeutic intervention.
There was no evidence of any standard operating procedures.
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The review was commissioned by the HSE and conducted by consultant child and adolescent psychiatrist Dr Colette Halpin.
The review says that 79% of patients attending the generic service were prescribed psychotropic medication.
This compared with 39% in the HSE National Audit of Prescribing 2023.
The review says that polypharmacy, which is the prescription of two or more psychotropic medications simultaneously, was a concerning feature.
Two drugs - Risperidone, which is a neuroleptic medicine, and Guanfacine, which is an ADHD medication - were prescribed in the CAMHS Area B more than the national average.
These medications were found to be associated with side effects, in particular weight gain and sedation.
The Halpin Report says that Sodium Valproate, an anti-epileptic medication, was prescribed in 42% of cases to manage behaviour that challenges and sleep difficulties.
It points out that Sodium Valproate is not licensed to treat behavioural dysregulation or sleep difficulties in children with an intellectual disability and is not used in CAMHS nationally.
There was limited availability of individual psychotherapy or "talking therapies".
When psychotherapy was offered to patients, there were often very long waiting times for appointments.
The most common reason for potential harm was inadequate physical health assessment and monitoring.
Read More: 'It destroyed her' - mother of North Kerry CAMHS patient
A large number of cases reviewed were found to have gaps in essential cardiovascular monitoring required for the prescribed medication.
The review says that children with a moderate to profound intellectual disability and mental disorder had no access to non-medical interventions.
46% of children attending the services had a confirmed or suspected diagnosis of autism. Almost all these children were prescribed psychotropic medication.
The report also found that the resources on CAMHS Area B Team were significantly below what is recommended in national mental health policy - A Vision for Change 2006, and Sharing the Vision 2020.
It added that robust governance structures and adequate resources are needed to provide a comprehensive and safe service for all patients referred to CAMHS for treatment of mental disorder.
Patients frequently advised to self-refer to external services
The report acknowledges the lengthy wait time endured by parents, young people and their families for the outcome of this report.
The final report was submitted on 5 November last year.
It states the look back review team involved fully appreciate the patience and forbearance of parents and families.
It also recognises the time and effort families and young people took to participate in the open disclosure process which may have been difficult and distressing for them.
Meanwhile, the report also says that children and young people attending CAMHS during the review period were frequently advised to self-refer to Pieta House, Jigsaw and other external non-HSE community treatment services for a "therapeutic space".
It notes that the was no CAMHS specific service level agreement or governance arrangement for accessing therapies through these agencies in the HSE Regional Area at the time.
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Families of more than 300 children treated by the service have been sent copies of the review.
The report was sent to the families by registered post yesterday and is expected to be published by the HSE later today.
The review was commissioned after a random audit of 50 files in the North Kerry Child and Adolescent Mental Health Services found what the HSE described as "potential concerns" in the care of 16 children.
Most of the issues raised related to prescribing practices, but there were also "some clinical concerns" about the professional practice of a clinician.
The clinician is not currently practising medicine.
Publication of the review had been delayed because of the scale of what was uncovered.
An earlier, more extensive review, published in January 2022 which examined the care given to 1,300 children by CAMHS in South Kerry, found that 227 of them had been exposed to the risk of serious harm, while 46 children had suffered significant harm.
Early indications are that the findings of the review of services in North Kerry will be even more damning, with the HSE already issuing apologies to more than half of those whose files were examined.
HSE clinical lead says 'sorry' and that young people were 'failed' by services
Commenting on the publication of the final report of the North Kerry CAMHS Look Back Review, the HSE National Clinical Lead for Child and Youth Mental Health, Dr Amanda Burke said, "this report clearly outlines the ways in which many young people were failed by the mental health services that were provided to them".
"I would like to echo the apology provided to those young people and their families by Dr Andy Phillips, the HSE South West Regional Executive Officer," she said.
Dr Burke said the Look Back review's findings included high rates of prescribing of psychotropic medication in the absence of talk therapies, deficits in physical health assessment and monitoring of patients on medication, higher rates of polypharmacy than is considered standard practice, and parents not being adequately consulted or informed of the nature of medications being prescribed.
An independent prescribing audit commissioned by the HSE in 2023, conducted in response to the issues that emerged in Kerry, identified no similar concerns relating to prescribing practices in CAMH services anywhere outside of Kerry, she said.
Dr Burke added: "The HSE wants all children, young people and families to have equitable and timely access to high-quality mental health services. The action plan works towards redesigning and delivering integrated Child and Youth Mental Health services which are safe, easy to access and appropriate to individual needs.
"Key to this will be our roll out of the single point of access and the electronic health record for CAMHS later this year.
"Together we are improving the consistency and safety in how care is delivered, through improving accessibility and ensuring the involvement of children, young people and their families in the design, delivery and evaluation of mental health services."
The HSE said that later this year to improve services, it will be rolling out a single point of access and electronic health records for the CAMHS service.
It said it is improving the consistency and safety of how care is delivered.
HSE South West confirms intention to carry out clinical review of files
While the HSE South West said it can "confirm today our intention to carry out a clinical review of files of young people in Kerry who accessed North Kerry CAMHS services over a defined period prior to November 2022".
It added that this is for those "who have either a diagnosis of intellectual disability or who were prescribed antipsychotic medication or who received high dose psychotropic medication during their care and treatment with CAMHS".
The HSE also said it echoed the apology provided to the young people and their families by Dr Andy Philips, the HSE South West Regional Executive Officer.
Meanwhile, Minister for Mental Health, Mary Butler said it is her intention to extend to the families affected, the non-adversarial compensation scheme that is in place for families impacted by deficits in care in South Kerry.
She said she has spoken to the Attorney General in relation to this and the Department of Health will now progress it with the Attorney's Office and the State Claims Agency.
She also said she acknowledged the HSE's intentions to carry out a clinical review of files of young people who accessed North Kerry CAMHS services over a clinically defined period, who have either a diagnosis of intellectual disability, or who were prescribed antipsychotic medication, or who received high dose psychotropic medication during their care and treatment.
