Ms Anne O'Connor:

Good morning Chairman and members. I thank them for the invitation to meet the Joint Committee on Health and the Joint Sub-Committee on Mental Health to discuss the governance and clinical oversight of child and adolescent mental health services, CAMHS, in Kerry. I am joined by my colleagues, Mr. Michael Fitzgerald, chief officer for the Cork Kerry community healthcare organisation; Mr. Jim Ryan, head of mental health operations; Dr. Maura Young, executive clinical director for Kerry mental health services; and Dr. Amanda Burke, child and adolescent consultant psychiatrist and executive clinical director for Galway Roscommon mental health services.

The report on the Look-Back Review into Child and Adolescent Mental Health Services in south Kerry, also referred to as the Maskey report, was published on 26 January 2022. The look-back review was formally commissioned by the chief officer for the Cork Kerry community healthcare organisation, CHO, in April 2021, following an audit of case files in south Kerry CAMHS after concerns were raised about the clinical practice of a non-consultant hospital doctor, NCHD. The purpose of the look-back review was to consider potential issues relating to the clinical practice of the NCHD with regard to prescribing, care planning, diagnostics and clinical supervision in south Kerry CAMHS. In line with our procedures for dealing with serious incidents, this review was conducted in accordance with the HSE incident management framework 2020 and the HSE look-back review process guideline 2015. The review team was led by Dr. Seán Maskey, CAMHS consultant with the Maudsley Hospital in London. Dr. Maskey and his team reviewed clinical records of close to 1,500 children and young people who had attended south Kerry CAMHS between 1 July 2016 and 19 April 2021. A helpline was established in April 2021 to provide advice and support to families affected by the look-back review and it remains open. Through this helpline, families can access information, free counselling support and schedule appointments with clinical support teams.

The Maskey report identified a number of deficits in respect of governance, supervision and oversight, clinical practice and administrative processes within the south Kerry CAMHS team. These deficits are deeply regrettable and were contributing factors to the substandard care received by the 240 children, young people and their families. On behalf of the HSE, I wish to reiterate our sincere apologies to all those who have experienced deficits in the services they have received. Our aim at all times is to provide these children, young people and their families with safe and effective services and with every possible support and reassurance.

Cork Kerry CHO has taken immediate action to ensure appropriate governance, clinical leadership and supervision within south Kerry CAMHS. The objective remains to secure a permanent consultant psychiatrist and, in the interim, measures have been put in place to ensure clinical governance and leadership. A consultant psychiatrist is on site two days per week with additional support provided remotely three days per week. In line with recommendations in the Maskey report concerning telemedicine, a consultant psychiatrist will provide three evening clinics per week remotely from Dublin, while a pilot involving a consultant registered with the Irish Medical Council, based outside of the EU, is also under way.

The HSE has taken a range of actions to address the findings of the Maskey report and we are committed to ensuring full implementation of its 35 recommendations. Together with the chief clinical officer, I will chair a national oversight group to oversee, monitor and report on our implementation of the Maskey report. This oversight group will have a strong service user focus. It will operate in a fully transparent manner and progress reports will be publicly available.

Cork Kerry CHO has already identified supports for children and young people affected in south Kerry CAMHS and, in addition, is standing up a dedicated clinical liaison support team, which will provide key worker and case manager services to children and young people affected. This team will consult with families to determine how to best meet identified needs, taking into consideration the full range of health services, including specialist mental health services. The clinical liaison support team will also identify other appropriate services in the community, as well as services available from private service providers that can support the children, young people and their families.

While the scope of the look back review is confined to practices in south Kerry CAMHS, I appreciate that the Maskey report can give rise to concern among children, young people and families who avail of services provided by CAMHS teams in other parts of the country. In order to provide assurance to families who need our services, the HSE’s national oversight group will be commissioning an independently chaired review of medication practice across all CAMHS teams. The national oversight group will also commission an audit of compliance with operational guidelines as well as a qualitative study of how those who use, work in and refer to CAMHS experience those services. Information from the planned national audits will guide our continued efforts to enhance youth mental health services.

There has been a significant investment in CAMHS over a number of years to meet increased demand and to improve services for children and young people with mental health difficulties. Within the past six years, €22.6 million of development funding has been directed to enhance CAMHS. Since 2013, an additional 18 CAMHS teams have been established and close to 300 additional whole-time equivalent posts added to our workforce. There are currently 73 multidisciplinary CAMHS teams in place providing important assessment and treatment services. Alongside these targeted enhancements of capacity in our CAMHS teams, we have invested in telehealth, eating disorder teams and inpatient care.

Importantly, we have also invested in services such as Jigsaw and primary care psychology for children and young people with mild to moderate mental health difficulties who do not need to access the specialist mental health services that CAMHS provide. The improvement of youth mental health services will continue to be a key priority for the HSE as we continue to implement the recommendations set out in Sharing the Vision - A Mental Health Policy for Everyone.

I once again take the opportunity to apologise on behalf of the HSE to the children, young people and families whose care, as outlined in the Maskey report, did not meet the standards it should have.