Catherine Connolly (Galway West, Independent) | Oireachtas source

I thank Sinn Féin and Deputy Ward in particular for tabling the motion. The motion is practical and includes two of the recommendations in Dr. Susan Finnerty's report. It calls for the Government to accept there has to be a clinical review, and that there will be a timeline for it and when it will be completed. The second recommendation is equally important: the immediate regulation of CAMHS under the Mental Health Act. Dr. Finnerty's report has pointed out that the Mental Health Commission has "no legal power to enforce any action." The commission continues to monitor the actions taken on foot of these escalations, which I will come back to, but it has no legal power to enforce any action. That is a damning indictment.

We are here again, just over a year since Dr. Maskey's report in January 2022, which followed on from the actions of a brave whistleblower. I hope the Ministers of State can correct me, but my understanding is this doctor, Dr. Sharma, who was courageous, has been treated badly. He was sidelined and obliged to leave the country. I ask the Ministers of State to correct me if I am wrong. Is he working in Ireland? If they tell me quietly, I do not mind. My understanding is this man has suffered as a result of his courage. If that is what has happened, it is an indictment of our system. If the Ministers of State tell me I am wrong about that, I will be the first to acknowledge it.

As I said, this interim report come after the Maskey review of south Kerry CAMHS in January 2022. I should declare a particular interest. In a different life, I worked as a clinical psychologist in a community care setting for many years on three-monthly contracts. When I got a permanent, pensionable job I refused to take it because it was advertised as a community care psychologist, which was brilliant. This was in the bad 1980s but the system sought to put us back under what was called at the time child guidance, which was a retrograde step that became this entity that has proven so unsuited to the job. Children with mental health issues of a nature that determines they must go to a facility like this should not be the norm. All our effort should go into prevention and education support, which was the model in the bad 1980s, when people could walk into the health centre in Ballinasloe and theoretically get a service. We have gone backwards.

Not alone have we gone backwards, we have endangered our children. This is according to Dr. Susan Finnerty, who felt obliged to produce an interim report, although she has not completed her review of all nine CHO areas. Her concern was such that she decided to issue an interim report "because of the serious concerns and consequent risks for some patients [she is talking about children] that we have found across ... 4 out of 5 [areas]". These concerns include the risks to safety and well-being of children receiving - or not receiving - mental health services, or receiving services they should not be receiving, such as medication that is unmonitored, the management of that risk and the lack of clinical governance. Dr. Finnerty goes on to outline all of that. She states that so far, in this review, the Mental Health Commission has "made five escalations of risk to the HSE", and further up to the Department, as regards risk.

Quite startlingly, Dr. Finnerty states: "There were no risks pertaining to CAMHS documented within the HSE Corporate Risk Register and therefore no documented actions..." This might be seen to be in bad taste but three monkeys come to mind, where we see, hear or speak no evil. There is no risk so we will not have any action on it - that is clearly set out in the report. The symbolism of the three monkeys was not used by Dr. Finnerty, in fairness to her. The report goes on to state: "In some areas reviewed, risk management was poor, with lack of communication and lack of actions to mitigate ... a haphazard documenting of risks and minimalist generalised actions ... on the CHO ... register [and] All teams were significantly below the ... staffing levels". She pays tribute to the good work of staff on the ground but also highlights the serious problems, including large variation in services, families who are frustrated and upset, the inappropriate use of emergency departments in local hospitals, the failure to facilitate the free movement between primary care, which is non-existent, and these specialised services.

On medication, the report states, "There was evidence that some teams were not monitoring antipsychotic medication". There were no national standards but patients were not even being monitored in respect of international standards. There was no follow-up with appropriate blood tests and physical monitoring, which is essential. Children were lost to follow-up, which has been mentioned by many Deputies. The report states: "Of serious concern was that in some CAMHS teams children and young people with open cases, have been lost to follow-up." There were 140 lost cases in one team and a limited desk top review was carried out to identify these children and so on. Audits of clinical practice were rarely carried out. Four of the five CHO areas that were visited used paper trails and no electronic recording. According to the report, we appear to have breached, which is a very moderate comment, the rights of children as set out under the UN Convention on the Rights of the Child, which the State signed and ratified in 1992.

The report continues:

In the CHOs that we have reviewed to date [and that is only five out of nine], it appears that this right may have been breached for many children ... [I do not think there is any "may".] The long waiting lists, the lack of capacity to provide ... therapeutic interventions, the "lost" cases ... all point to a breach of Article 24.

Even the team on the ground that wanted to escalate risks said it was pointless because when it did so they went into a black hole and nothing happened.

There is absolutely no ring-fencing of funds for CAMHS.

Then we have a special position: the child rapporteur. It has been vacant since last July, I think. There was good news today; the Minister announced that there is a new rapporteur. Can the Ministers of State tell me why there has been no rapporteur since last July? The previous rapporteur, Professor O'Mahony, presented his annual report to the Government, pointed out that the delay in publishing these reports, after the Government gets them from him and generally, is totally unacceptable and pointed out the difficulties in attracting somebody to that post. Why was the Government not proactive? Maybe the Ministers of State can answer. I do not know.

I am not here to give out; I am here to express my outrage and upset, having read this report, that this could be happening now, on our watch, and at the failure to monitor medication. The question has to be asked: what was the role of GPs in this? Was the medication just renewed by them? The Ministers of State might elaborate on that. Each person has a responsibility, as does each Deputy, to do his or her best. Where was that with the GPs or whoever renewed the medication?

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