Mary Butler (Waterford, Fianna Fail) | Oireachtas source

I thank Deputies for the opportunity to speak to the House about the important topic of youth mental health. It is particularly timely and pertinent given the publication today of the independent report on the review of care provided in the child and adolescent mental health service, CAMHS, in south Kerry. The report sets out a catalogue of failures across multiple levels of the system in the care provided to young people accessing CAMHS in Kerry. I am sure Members of the House will be with me when I say my thoughts are with the families and children affected by this report. To learn of the systemic failings in their care is absolutely devastating.

The HSE has met 198 young people who have been affected, and their families, to discuss the deficits in the care they received and to provide them with key information and referral to any necessary services and supports. This includes counselling supports and appropriate services from within child and adult mental health services. The HSE apologised to each individual at these meetings, and subsequently in writing, for any harm caused.

It is important to acknowledge the significant and wide-ranging impact on the children and young people affected. There were 227 children identified where the diagnosis or treatment given to them by a junior doctor or non-consultant hospital doctor, NCHD, exposed them to risk of one of more of following: sedation; emotional and cognitive blunting; growth disturbance and serious weight changes; metabolic and endocrine disturbance; and psychological distress.

The report clearly identifies that the medicalisation of ordinary emotional responses in children and their suppression by medication risks delaying or damaging the development of emotional self-regulation skills which normally happens as children mature. Thirteen other children were found to have been unnecessarily exposed to a risk of harm under the care of other doctors in the service. Very importantly, there was clear evidence of significant harm caused to 46 children in the files that were reviewed. This included the production of breast milk, considerable weight gain, sedation during the day and elevated blood pressure. This figure of 46 will change as new information becomes available from meetings with the children, young people and families affected.

The look-back review team also examined 34 files in north Kerry CAMHS where there was an indication the named junior doctor was involved in their care. There were concerns raised in regard to 20 children and young people in that service. The HSE has offered an apology to them and their families, and there is a process in place for any ongoing intervention that might be required. The HSE undertook the investigation using its incident management framework and is liaising with other bodies, including Tusla, An Garda Síochána and the Irish Medical Council, as appropriate and as required.

Overall, the report has made findings about failings in the care and clinical oversight provided to numerous children and young people and has made recommendations to improve that care.

These failings occurred at multiple levels of the system and over a protracted period.

The key factors that contributed to these failings are extensive and include, among others, the absence of a clinical lead and CAMHS consultant from 2016 for the CAMHS team. Another CAMHS consultant agreed to cover this vacant post until it was filled on the expectation it would be on a short-term basis. The potential risks involved with this arrangement were not effectively managed and there was no regular, effective oversight of the NCHD's work through formal supervision and frequent joint working with a senior doctor.

While concerns about the NCHD were first reported in 2018, no proof was found that these concerns were addressed after being reported. The most worrying part of it is that those extra two years could have been prevented. In 2019, concerns about prescribing medication were clearly identified. However, the supervisor at the time advised changes but did not insist that these be implemented. When a new senior medical manager started in the service in 2020, concerns were not raised in respect of the NCHD's practices. The report outlines a number of areas where the supervision of the NCHD failed and where effective action was not taken; where concerns were apparent; and where the opportunity to change the doctor's practice was not taken effectively.

Other contributory factors included that there was no system used by the doctor's supervisors to check the prescribing of medications or the quality of service; a lack of adherence to the national CAMHS operating procedure 2015 or the CAMHS operational guideline 2019; referral acceptance levels, including the high level of cases that were managed by the NCHD; the team not maintaining an electronic diary process to co-ordinate their work; and poor case record management processes. There are also concerns regarding governance and oversight of the team by line management and the effectiveness of the CAMHS oversight group.

The HSE acknowledges the extent of the failures that have occurred. It has considered the report locally and nationally and has accepted the recommendations. Work is under way to implement the full suite of recommendations as a matter of priority. Among the recommendations made are an assessment of a reconfiguration of the service and a full nationwide audit of compliance with existing CAMHS operational guidelines by all CAMHS teams. Furthermore, a prescribing audit will be conducted in each of the 72 CAMHS teams nationally. A further audit of case files in north Kerry will also be carried out.

With respect to reconfiguration of the service, and with the hope of instilling some comfort to all that services will be delivered in line with best practice, all governance and organisation structures will be reviewed with a view to assessing reconfiguration of the service to address the systemic failings that have occurred.

People will understandably be concerned about CAMHS in their own communities. That is why it is important there will be a full audit nationwide of compliance with CAMHS operational guidelines by all CAMHS teams. In addition, I have asked the HSE to provide assurances regarding prescribing practices in all CAMHS teams nationally. A prescribing audit will be conducted in each of the 72 teams to include a random selection of files, proportional to the medical caseload, from a continuous six-month predefined period in 2021.

There are 35 recommendations in the report, which cover other areas such as, among others, staff training, clinical oversight, recruitment, care planning, and involvement of children and families in governance structures. Beyond the recommendations set out in the report, I will also be calling for the reinstatement of a HSE national director for mental health, in line with our programme for Government. I would appreciate support in doing this. I believe this post is essential in driving the fundamental reforms needed across our mental health system, not least in our child and youth mental health services.

An information line is open on 1800 742 800 from 8 a.m. to 8 p.m., seven days a week for anyone affected by the report. I would also encourage anyone of any age, wherever they are in the country, to reach out for help if they are affected by any of the issues raised in this report.

I can assure the House that I will be staying in close contact with the HSE on the implementation of the recommendations set out in the Maskey report.

We are all part of a family and we were all young once. Many of us have children and most of us have young relatives. Our children are the most important thing and to read of the systemic failings in their care is devastating. This is not just about the clinical decisions taken by one person but about how staff and teams manage themselves, are supervised and overseen in terms of their practices, and identify risks to ensure issues are picked up early and addressed.

More broadly, given the prevalence of mental health difficulties among children and young people living in Ireland, in addition to the mounting pressures experienced by our mental health services, the scale of the challenges we face is significant. In response to this, a range of actions are under way in the areas of policy, legislation and practice to enhance the experiences of children, young people and families using our mental health services and ultimately to improve their mental health outcomes.

Regarding national mental health policy, the national implementation and monitoring committee tasked with overseeing and driving implementation of Sharing the Vision has established a specialist group on child and youth mental health. The work of this group will be critical to ensuring the specific child and youth recommendations of the policy are fully realised in practice. This includes necessary improvements in the areas of out-of-hours supports, transitioning from child to adult mental health services, and greater collaboration between different sectors and agencies to ensure the individual needs of children and young people are fully met.

Connecting for Life, our national suicide reduction strategy has been extended to 2024. The strategy identifies priority groups, including young people, and provides a further opportunity to enhance child and youth mental health service provision in Ireland. More than 20 partners are involved in the implementation of the strategy including Tusla, the Department of Children, Equality, Disability, Integration and Youth, and the Department of Education. They each lead on or support a range of actions with the aim of reducing suicide, promoting mental health and well-being and enhancing services for our children and young people.

Significant strides have been made to update Ireland's mental health legislation, in line with international human rights standards, including the UN Convention on the Rights of the Child. Reform of the Mental Health Act in full will enhance the rights and protections of people accessing specialist mental health services, including children and young people.

The general scheme of a Bill to amend the Mental Health Act contains a new Part specifically dedicated to the care and treatment of children. The general scheme also provides for the extension of the Mental Health Commission's system of regulation, registration and inspection to all community mental health services, including those for children and adolescents. This provision is critical in enhancing the protections of people using our services.

The general scheme is currently subject to pre-legislative scrutiny by the Oireachtas Joint Sub-Committee on Mental Health, which commenced in November 2021. I thank the members of the committee for all the work they are doing. The Office of the Parliamentary Counsel commenced the drafting of the Bill itself the last week. I hope to introduce the Bill to the House as early as possible this year.

I take the opportunity today to highlight some of the recent developments in child and youth mental health service delivery. These initiatives seek to address the challenges we face across our system, including, for example, ongoing issues with increasing numbers of referrals, staff retention and difficulties with recruitment, with it taking on average nine to ten months to fill a post.

Budget 2022, which provided €1.149 billion for mental health, includes specific funding to continue the enhancement of CAMHS. More specifically, it will allow for the establishment of two new CAMHS tele-hubs and a dedicated €6 million to expand the capacity of community mental health teams nationally, with a particular emphasis on CAMHS.

Further investment will also be made in the national clinical mental health programmes this year, many of which are available to children and young people. One example is the national clinical programme on eating disorders, which has secured an additional €1.15 million in 2022 for the development of additional specialist eating disorder teams.

Funding for 2022 also includes €10 million for initiatives aimed at increasing mental health supports in response to the Covid-19 pandemic. This includes enhanced signposting and access to existing mental health services and supports; initiatives for children, young people and students; and additional psychosocial responses, recognising that people will require varying levels of support. The HSE is actively working on these initiatives to get them up and running as quickly as possible.

A further €10 million in once-off additional funding announced on budget day has been allocated to improve the experiences of individuals, including children and young people accessing specialist mental health services, in addition to community and voluntary mental supports. I was very conscious when allocating this funding that the service user would be front and centre.

Some €1.8 million of the €10 million fund is for vehicles and will support the transport needs of people using mental health services and promote their engagement within the community. This may include, for example, travel to and from medical and other personal appointments, employment and education programmes, day centres and social activities.

As part of the fund, €1 million will be distributed in partnership with Mental Health Ireland to support the work of smaller local voluntary groups providing vital mental health supports in communities nationwide. The fund will go live next Monday, 31 January, and I encourage any group with a proposal or project that meets the criteria to apply. A further €1 million of the overall €10 million is for MyMind to deliver approximately 16,000 counselling sessions, in over 15 languages, free of charge to people impacted negatively by the Covid-19 pandemic. Under 18-year-olds can access the sessions with parental supervision.

Other developments that seek to respond to the challenges and increasing pressures on our child and youth mental health system include significant advancements in the delivery of digital mental health supports, including the 50808 crisis text service; NGO online supports such as those provided by MyMind, SpunOut, SilverCloud, Turn2Me, Jigsaw and many more; and the national roll-out of digital cognitive behavioural therapy to address depression and anxiety in Ireland, enabling individuals, including young people, to access essential supports within 24 hours of referral. The commencement of two new Jigsaw services brings the total number of sites to 14 nationally and complements its digital services that are available nationwide. It now has 66% coverage of the whole country with regard to premises and 100% coverage in relation to online supports. There will be an investment of €6.85 million to progress the national clinical programme on eating disorders. Last year, I secured €3.94 million to complete the three existing teams, of which two are CAMHS teams, and three new teams which are nearing completion. Funding allocated in 2022 will provide an additional four specialist eating disorder teams, with one of these being dedicated for CAMHS.

In line with programme for Government commitments, there has been a year-on-year decrease in the number of child admissions to adult acute mental health units. In 2019, there were 50 such admissions, whereas in 2020 there were 27 such admissions. Latest data from the HSE for 2021 indicate that as of November, there were fewer than 27 admissions for last year. The vast majority of these admissions are among young people aged 17 and older, with some aged 16 years plus a number of months.

Last month, I announced a significant reduction of over 19% among children and young people under 18 waiting more than 12 months to be seen by primary care psychology services. This follows an allocation of €4 million that I secured last August to address such lists through targeted initiatives. I am fully committed to continuing to work with my colleagues in government to ensure the development of a sustainable primary care psychology service in the longer term. I am seeking funding to continue that roll-out. We were able to take 1,000 children off the list in a four-month period and if we could do that again, it would be very helpful. All the children who were taken off the list were waiting in excess of 12 months.

The HSE’s psychosocial framework, which was launched last year, will complement the changes needed to fundamentally reform our mental health system, as set out in Sharing the Vision, and in line with the current overhaul of our mental health legislation. This must also be supported by enhanced compliance with any existing or newly developed guidance to ensure consistency and standardisation in mental health service delivery.

In conclusion, I thank Deputies for participating in this debate, including those who are present in the Chamber. I am grateful for the opportunity to clarify how many of the concerns of Members of the House are being or will be addressed. There is no doubt that we all seek continued developments and improvements across our mental health system. I am fully committed to working with all Members to see this fundamental ambition realised. It is essential that all individuals, including our children and young people, accessing mental health services and supports receive a high-quality service, delivered in line with best practice, that is standardised in all parts of the country regardless of where people live. Finally, I thank mental health service staff and the community and voluntary sector for their immense work and ongoing dedication to supporting the mental health needs of people living in Ireland.

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