Mary Butler (Waterford, Fianna Fail) | Oireachtas source

I thank the Deputy for raising this issue, which is timely and very important. The Deputy asks about peer review for psychiatrists in the context of prescribing medicines to people using mental health services and, no doubt, like me, he is thinking of the publication yesterday of the report into the independent review of care provided in the child and adolescent mental health services, CAMHS, in Kerry. I could go into the report but we spoke about it last night and the Deputy is acutely aware of the devastating impact it had on the children, young people and families affected. The report clearly identifies a catalogue of failings at multiple levels within the system. This is clearly evidenced by the lack of clinical oversight, to which the Deputy alluded, including the absence of a clinical lead and a CAMHS consultant. There was no system used to check the prescribing of medication or the quality of service by the doctor's supervisors. There were also concerns raised regarding governance and oversight of the team by line management and the effectiveness of the CAMHS oversight group.

These failings are central to the issue raised by the Deputy about peer review. The Medical Council of Ireland maintains the specialist register for psychiatrists, who must comply with requirements, including training, to remain on the register. This includes peer review, which is a training issue and is part of the registration process for psychiatrists.

In the context of the report into care provided in south Kerry CAMHS, all of the recommendations, including those related to clinical oversight, will be implemented as a matter of priority, with many already under way. The recommendations made include 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 to include a random selection of files, proportional to the medical caseload, from a continuous six-month predefined time period in 2021. A further audit of case files in north Kerry will also be carried out.

There are 35 recommendations in total in the report which cover other areas such as staff training, clinical oversight, recruitment, care planning and involvement of children and families in governance structures, among others. We all acknowledge that fundamental reforms are needed in many areas of mental health service delivery, not least in child and adolescent services. This report has brought them into sharp relief. We need to take one step further. At the moment, two drafters have been appointed by the Attorney General to start drafting the mental health Bill to amend the Act that was introduced in 2001. That Bill is currently undergoing pre-legislative scrutiny in the Joint Sub-Committee on Mental Health. I believe this is a real opportunity to make sure those checks and balances are put in place and underpinned by legislation.

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