Colm Burke (Cork North Central, Fine Gael)
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I thank the Minister of State for the debate last night. I raised this matter during that debate and I want to tie down the particular issue of why there is not in place in the Irish mental health service a regular peer review of psychiatrists and the manner in which they are managing their patients and the prescribing of medication. When a patient is in a hospital setting, there is a team of nurses and doctors in place and there is a whole system where, if a patient is detained for a period of time, there is a full hearing on both sides of the argument as to whether that patient's care in the psychiatric hospital continues. However, for outpatient care, it appears there is a glitch in the system in that there is no peer review. This is my main concern.

I have been speaking to people involved in clinical psychology and to counsellors. All of the accredited counsellors have supervisors so there is a gatekeeper who assists them to make sure the advice and assistance they are giving is in the best interests of their patients and they can continue to improve and learn from that supervisor and gatekeeper. However, that does not appear to happen within the outpatient facility for those requiring care for psychiatric difficulties, whether in regard to depression or anxiety. I ask that a proper structure is put in place to deal with this issue.

As has been very much highlighted in recent days with the review carried out in Kerry, in the South/South West Hospital Group area of the HSE, more than 200 children were adversely affected because the checks and balances were not in place. I do not believe we can continue with the system as structured at present without having some change and ensuring there is that review. I ask the Minister of State to ensure the necessary changes in that area are made.

Mary Butler (Waterford, Fianna Fail)
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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.

Colm Burke (Cork North Central, Fine Gael)
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One of the recommendations in the report published by Dr. Sean Maskey was that agreements should be developed with GPs to share the treatment of children with attention deficit hyperactivity disorder, ADHD, and pharmacists might help if that were to cause difficulties for GPs with regard to medication. Another point in the report was that clear written guides for the use of antipsychotic medication should be developed. There are very good recommendations in the report. I want to know the timeline for the implementation of these, not just in Kerry but for the entire country. It is an extremely good and well-researched report and it contains very constructive proposals that need to be implemented at an early date.

Mary Butler (Waterford, Fianna Fail)
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The Deputy is correct. There are 35 recommendations in the report and six of those recommendations are already complete. If memory serves me, I said last night that 13 of them are being progressed and the rest have yet to commence. I will be keeping in close contact with the HSE to make sure these recommendations are in place.

One part of the review we are doing is in regard to the 72 CAMHS teams dealing with those children who are medicated. As we know, out of 1,000 of the case files in Kerry, 500 children were medicated and 500 were not. We are going to do an audit of those children throughout the country who are medicated to find whether this raises red flags. What we are also doing is looking at the standard operating procedures for all CAMHS teams that were introduced in 2015, with the guidance having been updated in 2019. We are also doing an audit to see that those checks and balances are in place.

The most important thing to do is to make sure that any parent who brings a child to CAMHS anywhere in the country has confidence in the service. I know Paul Reid, the chief executive of the HSE, said earlier today that it is working out the details of how these audits will be carried out. I am in close contact with the Department and the HSE. The audits will be done in a timely manner and it is important that they are independent. It is also important that standard operating procedures regarding all CAMHS teams are enforced.