A non-adversarial compensation scheme for more than 200 CAMHS patients found to have been exposed to potential harm, following a review of the Child and Adult Mental Health Service in North Kerry, has been extended.
In addition, CAMHS patients in North Kerry who were not covered by the review and who have concerns about their diagnoses or treatment are to have their files reviewed, and will also be given access to the compensation scheme, if they were exposed to harm.
Last month, the HSE published a review into the CAMHS service in North Kerry which found that, of the 374 cases recorded as active in November, 2022, 209 had been exposed to a risk of potential harm - more than half the cases reviewed.
These patients will now be given access to a non-adversarial compensation scheme drawn up for patients who were found to have been harmed, following a similar review in South Kerry.
"I am pleased to confirm I have approved the extension of the existing non-adversarial scheme to provide for young people and families impacted by deficits in care in North Kerry," Minister with Responsibility for Mental Health Mary Butler said in a statement.
"The scheme for young people and families in South Kerry arising from the Maskey Report has worked well, and families have told me they appreciated the non-adversarial approach."
The North Kerry review 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.
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 being followed.
There are indications that the extension of the review, announced by Minister Mary Butler this afternoon, could lead to findings that approximately 300 more patients may have been exposed to potential harm.
The State Claims Agency will accept claims for compensation under the scheme from CAMHS patients in North Kerry from today.
The North Kerry review was commissioned by the HSE and conducted by consultant child and adolescent psychiatrist Dr Colette Halpin.
Psychotropic medication
The review found 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 North Kerry area 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 challenging behaviour 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.
The review found 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, it found.
The most common reason for potential harm was inadequate physical health assessment and monitoring.
A large number of cases reviewed were found to have gaps in essential cardiovascular monitoring required for the prescribed medication.
The review said 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 Halpin report also found that the resources within the CAMHS service in North Kerry 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.
Review commissioned after random audit
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.
The HSE also announced this afternoon that it is commissioning a comprehensive clinically-led further file review covering the period during which it had governance of CAMHS in North Kerry. This extends to all cases open to the service up to 21 November 2022.
North Kerry Lookback Review Report
"I welcome the further file review to be undertaken by HSE South West, and I am grateful to the team of professionals who have agreed to continue to support the process," Minister Butler said.
"The further review will clinically prioritise files where the potential for harm is deemed greatest in line with the findings of the North Kerry Lookback Review Report.
"This includes files of children with a diagnosis of mental health and intellectual disability, where children were prescribed neuroleptic (antipsychotic) medication, where children were receiving high dose psychotropic medication, and files where there is evidence of polypharmacy.
"Importantly, in extending the existing compensation scheme, I have also ensured that it covers any young people who may become eligible as the HSE undertakes its further file review. I wanted to guarantee that if a young person is identified as having suffered harm through the review of their file, they can apply to the scheme immediately."
"I will visit Kerry again in the coming weeks to meet with more families who have been in contact with me since the Report was published last month."
In its statement, HSE South West said that in order to ensure a timely review process based on clinical risk assessment, the further file review will be directed specifically on areas where the potential for harm is deemed greatest in the first instance. It said the outcome of the further file review will inform any future actions on behalf of the HSE.
The HSE said that, as identified by the North Kerry Lookback Review Report, the review will focus on:
- Children/Young people with a diagnosis of mental health and intellectual disability
- Children/Young people prescribed neuroleptic (antipsychotic) medication
- Children/Young people receiving high dose psychotropic medication
- Children/Young people where there is evidence of polypharmacy
It said a Serious Incident Management Team, which will include patient voice representation, will oversee the further file review and the independent clinicians who will undertake the process.
The HSE says it will contact young people and their families whose files have been prioritised for review. It says other individuals who fall outside the scope of the process and have concerns about their care can request for their file to be reviewed.
The Kerry CAMHS Information Line remains open on 1800 700 700 or 01 240 87 87 - Monday to Saturday.
