Mary Butler (Waterford, Fianna Fail) | Oireachtas source

I thank the Minister for his contribution this evening and welcome all our NGO partners to the debate. I am very pleased to attend today with the Minister and I will also be in the Seanad next week.

The Government is fully committed to the delivery of high-quality, person-centred and recovery-oriented mental health services. The Mental Health Commission’s interim report on the independent review of the provision of CAMHS in the State by the Inspector of Mental Health Services looks at service delivery and administrative practices in five CHOs. The interim report, which focuses on five out of nine CHOs, is a timely contribution to the common objective of improving CAMHS overall, especially when it comes to quality and safety.

Following on from several meetings to discuss the Maskey report earlier in the year, I asked the Mental Health Commission to expand the remit of its annual thematic report to take cognisance of the Maskey report, which had been recently published. I was pleased to provide the necessary resources to the Mental Health Commission to enable this comprehensive review to take place running in parallel with the HSE national CAMHS audits. I look forward to the publication of the full report later this year and the relevant data supporting findings and I thank Dr. Susan Finnerty and her team for their work to date.

The Mental Health Commission plays a vital independent role in supporting and assisting in the development and improvement of mental health services. In highlighting areas where practices can and should be addressed, the interim report of the commission provides an opportunity to ensure that HSE services continue to be improved. At the outset, it is important to highlight that many of the findings in the interim report relate to specific operational issues within CAMHS teams that have been recognised and resolved by the HSE. However, young people and their families have the right to expect a service from CAMHS that is person-centred and meets their needs in a timely manner. Any single instance that falls short of the high standards that patients and their families should rightly expect is an area of concern. Like the Minister, I am acutely conscious of the 21,000 children and young people who receive supports from CAMHS. I am very conscious of the 770 people working in CAMHS who provide a very good service in the main. I was also very conscious when I spoke on radio this week on several occasions that the radio might be on in the waiting room and children and their parents might be listening to this debate. My job as Minister of State is to make sure we can put the correct procedures in place to make sure we can build confidence in CAMHS.

I am reassured from the ongoing and extensive engagement between my Department, the HSE and the commission regarding the findings of the interim report that care in individual cases has not been seriously compromised. Any areas of concern identified by the commission in carrying out its report were escalated immediately to the HSE for immediate action and resolution.

I understand the anxiety that patients and their families may have as a result of this interim report. Issues around open cases, medication reviews and governance of services are not to be taken lightly and I certainly do not take them lightly. It is of huge importance to me that parents are reassured that the services their children receive are safe and appropriate.

Last year, many young people and their families received excellent care and treatment within CAMHS teams, which have nearly 21,000 cases nationally and see 225,000 appointments annually. I again encourage anyone engaged with CAMHS to stay connected to his or her team. I have visited many CAMHS teams the length and breadth of the country in the past six months and was really struck by a young girl I met in Dundalk who came along with her mother. She had been in the care of CAMHS for four years, was almost 18 and was just exiting. She told me she had 96 appointments over four years. She had been seen every fortnight for four years. I was struck by her and how grateful she and her family were to the team for the help and support it gave her. There are many more. Notwithstanding that, we know there are many issues relating to not everyone receiving the service they should get.

As recommended by the commission, the HSE has confirmed to me that it is undertaking a review of open patient cases. This will initially consist of a review of all open cases where the patient has been prescribed medication by his or her CAMHS consultant or doctor and who has not been seen in the last six months by his or her CAMHS teams. This is the right thing to do. It is essential that these open cases are reviewed as a priority. I met with the HSE today and met with it yesterday with the Minister. We have had several meetings. This work will start immediately.

This review of open cases will provide crucial further assurances that these children and young people are receiving appropriate care that is reflective of their current and future health needs. Importantly, the review will include a focus on physical health monitoring for those who are on medication. As per the recommendation of the commission, these reviews will be based on NICE guidelines or similar relevant and clinically appropriate guidelines.

While this is an interim report with further work to be undertaken by the commission across the other four CHOs, the HSE has been proactive in ensuring that lessons learnt thus far have been disseminated throughout all CAMHS. On receipt of the draft report from the commission, the HSE national mental health office undertook engagement calls and meetings with all CHO management teams to share the observations and findings of the interim report.

All documentation in response to this report has also been shared with all CHOs, along with regular update meetings with heads of service and chief officers. In addition, lessons and recommendations from the Maskey report have also been shared with CHOs. At all times, the HSE has sought to ensure that it is proactively improving services based on the recommendations of reports and audits.

In the context of issues highlighted in the commission’s interim report, the new mental health Bill is at an advanced stage and will further underpin the rights of children accessing mental health services. It includes a number of reforms specific to children and young people such as the introduction of guiding principles; an overhauled approach to consent to admission and treatment for children and young people, including allowing young people aged 16 and 17 years to consent to mental health treatment on the same basis as physical health; and additional statutory safeguards such as the provision of information and care plans to all children and young people receiving inpatient treatment.

A new Part has been introduced to the Bill setting out the process of admission and consent to treatment for children, introducing capacity and consent for young people, and mirroring safeguards for adults under the Act for children, such as the right to information. The Bill will provide for the presumption of capacity for all young people aged 16 and 17 years to consent to mental health treatment. This will bring important parity between mental health and physical health on consent, as the Non-Fatal Offences Against the Person Act provides for people aged 16 and 17 years to consent to medical treatment.

The Government acknowledges that mental health services must constantly evolve and develop to ensure they are in line with international best practice and regulatory requirements. I note the recommendation from the commission regarding the need to regulate CAMHS. Regulations and standards play an important role in ensuring that healthcare services are safe, of high quality, and negate risk. Inpatient CAMHS are currently subject to the Mental Health Commission’s regulation, registration and inspection process, with annual inspections of each approved centre under the Mental Health Act 2001 (Approved Centres) Regulations 2006. As was set out in the published general scheme of the mental health Bill, the regulatory remit of the Mental Health Commission will expand to include all community residential services and all community services. Regulations will be drafted to set out the parameters of the commission’s regulation of these services following the enactment of the new mental health Bill.

Regulations must be drafted under relevant primary legislation, which in this case in the Mental Health Act. The new mental health Bill includes an overhauled approach to Part 5 of the Act which relates to regulation. As set out in the published general scheme, it will extend the commission's powers of regulation, registration and inspection to all community mental health services. The new Part 5 will provide a strong statutory basis to underpin the making of these regulations.

The significant and complex objective of drafting the new mental health Bill has been well under way for some time. I am pleased to say that the mental health Bill has been selected for priority drafting for the spring legislative session. Officials in my Department are working hard to progress the Bill with a view to the Bill being introduced as early as possible this year. The scale of extending the Mental Health Commission's regulatory remit to inspect all community residences and services will be sizeable and officials in my Department will continue to engage with the commission on both the drafting of these regulations and on the particulars of how the commission will take on the additional responsibilities. This, and any further recommendations for the Department arising from the commission’s independent review, will be considered on receipt of the Mental Health Commission's full report, which I understand will be completed by May of this year. Deputies will all be aware of the significant timeframes associated with finalising new primary legislation, and new regulations, and I know that I can rely on their support to expedite this as quickly as possible over this year, since this is important legislation.

An important new approach is that statutory entitlement to engage with an advocate will be included as one of the numerous proposed changes for the care and treatment of children in the Bill. This is grounded in a rights-based approach and belief that young people and their parents have the right to be listened to and consulted about their care, with meaningful participation and engagement that will assist their recovery.

In line with the current national policy, Sharing the Vision, HSE national mental health services is committed to further developing an advocacy service that will ensure service users are empowered to lead in their own care as is their human right. Advocacy services are currently available to all adult inpatient acute units provided by Peer Advocacy in Mental Health. While the need for independent advocacy services across CAMHS has always been present, the Maskey review has highlighted the need for independent advocacy services for both community and inpatient settings across the country. The youth advocacy programme, YAP, provides advice to young people and their families, and it plays a vital role in supporting them in their journey through CAMHS. I was pleased to launch this programme last August. It is operating in CAMHS in Galway, Linn Dara in Dublin and for CAMHS community services in Kerry. Further roll-out of this programme to the CAMHS units in Cork and north Dublin and to local community-based services is being progressed by the HSE.

The independent Maskey report of the review of care provided by south Kerry CAMHS made findings regarding significant failings across multiple levels of the system and made 35 recommendations to improve service delivery. These recommendations cover a broad range of areas such as re-establishing trust in CAMHS, governance of the service, delivery of clinical services, improved clinical practice and the use of information and communication technology to support the delivery of services. The Government and the HSE are committed to implementing the recommendations. The 35 recommendations have led to 63 actions, 19 of which, both national and local, have been implemented, with others under way.

Three specific audits are being carried out to provide assurance to those who use CAMHS. The HSE has commissioned independent national audits on prescribing practice, chaired by Dr. Colette Halpin, compliance with CAMHS operational guidelines, and research into service users' experiences of CAMHS. These audits will greatly help the potential for service improvement and expanding good practice. The information arising from the audits will be used to ensure that services meet the needs of patients and their families, and that services are provided to the highest of standards.

I turn to Kerry CAMHS and would like to outline developments. The consultant psychiatrist post at south Kerry CAMHS has been fully funded since 2016 but is unfortunately still vacant. The substantive consultant post has been advertised several times but is yet to be filled. Although extensive efforts to recruit to this post have been undertaken, the HSE does not envisage this post being filled in the short term due to a shortage of qualified personal applying in the area. Notwithstanding that, we have 80 consultant psychiatrists working across all 73 CAMHS teams. Extra clinical and administrative supports have been put in place at south Kerry CAMHS to support the team there.

As part of the implementation of the Maskey report and for completeness and good practice, a file identification exercise was initiated by the HSE in north Kerry to identify any remaining files where a doctor may have had an involvement, at any level. A screening exercise was carried out to establish what type of involvement the doctor had in each of these cases. From the screening process, a relatively small number of files was identified as requiring a full review. Dr. Maskey also undertook this review, which is now complete. The outcome of this review was that some children were identified as having an adverse outcome and some a minor event. The HSE commenced an open disclosure process on 14 December and offered to meet all the families involved. These cases fall within the same categories as the initial 240 identified by Dr. Maskey in the context of his original report.

I have fully supported the further reviews by the HSE into CAMHS in north Kerry. I am clearly concerned that 16 further cases have recently come to light in this area. I have been closely monitoring developments in this with the HSE and I am satisfied that appropriate action is being taken by the HSE. The HSE in CHO 4 will now establish a lookback review to focus on the files of young people currently under the care of the north Kerry team. The terms of the lookback review are being drawn up and the focus is on progressing this as quickly as possible.

In April last year, the Government approved a compensation scheme for individuals identified as affected by the Maskey report. This scheme is being administered by the State Claims Agency. Such a compensation scheme was called for by many mental health advocates, including families in south Kerry, and I was determined to drive this through to conclusion. I thank everyone who was here to listen to me and I will deal with other issues when I wrap up at the end.

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