Brendan Griffin (Kerry, Fine Gael)
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I am grateful for being given the opportunity to discuss this matter and I thank the Minister of State, Deputy Butler, for being present. I had the opportunity to raise this matter on Questions on Promised Legislation last Thursday when I referred to the report on south Kerry CAMHS as devastating reading, which it is. At the time, I called for a full Garda investigation into the matter. I am hopeful that progress is being made in that regard. I also made the point that this failure in regard to south Kerry CAMHS has resulted in catastrophic outcomes for some children, which is at odds with the finding of the report, or certainly the wording of the finding of the report. I stand over those comments. I also called for the Government to make sure that every single child and family affected by the failures of CAMHS in south and indeed north Kerry, would immediately receive the care and support they need. I also called for this catastrophic failure for children in both south and north Kerry and throughout the country, never to happen again. We are yet to establish definitely throughout the country whether these failures are occurring, but certainly, anecdotal evidence in recent weeks is pointing to that unfortunate suggestion. That needs to be established immediately, and interventions need to happen without delay.

I will read into the record a brief snip from an email I received this week from a concerned parent. It states:

Dear Brendan, we request immediate support. The CAMHS south Kerry LBR report was sent to us on Wednesday last and we have been left entirely alone to process the findings. We need support. We need immediate access to a consultant child psychiatrist, and not anyone from within CAMHS Kerry. Our kids have ongoing needs and we are extremely dissatisfied with the level of so-called support they are receiving.

That was just this week. When we hear in the public domain that supports are being provided to families, that interventions are there, quite clearly this is not the only case but this is an example of the type of contact I am receiving this week, and I am sure other public representatives are also receiving. This needs to be addressed immediately. I call for an intensification of efforts to ensure that the children and families impacted by this gross failure in south and indeed north Kerry are addressed immediately and that the professional support that is quite clearly required by these families is provided. It is just not good enough that any family or child would feel alone, particularly at this time, after everything we have learned.

In the brief time I have left, I want to raise the issue of the recruitment process. Alarm bells surely must be ringing within the HSE in that this is another example of an appalling situation where the work of a professional medic has resulted in terrible outcomes for patients in Kerry. We know that in recent years we had the scandal in the radiology department in University Hospital Kerry. Around the same time we had the start of this particular failure in CAMHS. I ask the Minister of State, are the recruitment processes within the HSE being examined? It seems that the wrong people and totally inappropriate people are being appointed to these very responsible positions. This is another example of a gross failure. Is it going to be examined?

Mary Butler (Waterford, Fianna Fail)
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I thank Deputy Griffin for raising this important issue. I know that I have the support of everyone in the House in working to address the challenges throughout our mental health system, in particular those arising from the report on CAMHS in south Kerry. This is a priority for me and for the Government as a whole.

As Members know, the report by Dr. Seán Maskey was published last Wednesday. Dr. Maskey is an independent consultant psychiatrist working out of Maudsley Hospital in London. I wish to put on the record of the House that the report was completely independent. Not one word was changed or redacted. Sometimes in the HSE reports are not published, sometimes reports are redacted. I welcome the fact that the full report was presented. The HSE has considered the report, acknowledged the systemic failures that occurred over a sustained period and accepted the recommendations put forward. There were many contributory factors which led to this catalogue of failures, including an absence of clinical oversight and appropriate governance and management structures. Work is under way to implement the full suite of recommendations as a matter of priority. Deputy Griffin will be aware that there are 35 recommendations in the report - including an assessment of a reconfiguration of the service - six of which have already been implemented. Implementation of a further 13 has commenced. Implementation of the others has yet to commence.

The HSE has met with 198 of the 240 young people affected and their families to discuss the deficits in their care and to provide them with key information and referral to any necessary services and supports. I note what Deputy Griffin read into the record. I spoke to Michael Fitzgerald, the chief officer, again last Friday and informed him that we must put in place all the supports these young people need, such as talk therapies, cognitive behaviour therapies and so forth. Mr. Fitzgerald indicated that he will revert to me this week. What must be put in place includes, as I said, counselling supports and appropriate services from within the area of child and adult mental health.

The HSE apologised to each individual at the meetings to which I refer in person and, subsequently, in writing last Wednesday for any harm caused. As part of the recommendations a full nationwide audit will be conducted of compliance within CAMHS operational guidelines by all CAMHS teams. I have also directed that there be an independently led prescribing audit in each of the CAMHS teams. This will cover community and inpatient teams. There will be a further independent audit of case files in north Kerry because we know that the relevant non-consultant hospital doctor worked in north Kerry for a time. In addition, the HSE will commission qualitative research to identify the experiences of children, young people and their families using CAMHS nationwide. It is important that we hear from service users all over the country, not only in Kerry, availing of all the supports from the 73 CAMHS teams. I have directed that this three-stranded approach be subject to independent oversight.

In addition, the Government has committed to a non-adversarial scheme for compensation for the children and their families affected by the matters that are the subject of the report. I will ensure that the details of such a scheme are confirmed without delay.

On a separate front, An Garda Síochána in Kerry is in receipt of the detailed and extensive final report, which will now be considered to see if there are grounds to commence a criminal investigation. Although it is not appropriate to comment on human resources or industrial relations matters relating to any individual, the chief executive officer of the HSE has stated that disciplinary action will be taken if appropriate.

I acknowledge that there are significant challenges in our mental health services. The south Kerry CAMHS report is invaluable in addressing these. The Deputy is quite right in speaking about recruitment. There are 85 consultant psychiatrist posts funded for CAMHS and there are currently 79 such consultant psychiatrists in place. There is a vacancy in six roles and Kerry is one of those. The challenges are very stark when it comes to recruitment and it can take up to nine or ten months to fill a post. On many occasions, the person is successful in attaining a post but we cannot get the other post backfilled, which can also cause significant delays.

Brendan Griffin (Kerry, Fine Gael)
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I thank the Minister of State for her reply. I acknowledge, in particular, her reference to the non-adversarial process for trying to address the matter and support some of the families. That is absolutely crucial. There must be a review of recruitment. I have put in a very detailed parliamentary question this week on the matter but there must be a review of what background checks were made. Is this something that will happen again or can we be sure it will never happen again? There must have been a failure somewhere in that recruitment process if certain individuals are getting into the positions and failing so clearly. There are other factors but the recruitment process must be looked at. Too many alarm bells have rung without a review happening in that regard. Confidence in the system has gone and that is why exceptional measures in the context of intervention are required. The support from within CAMHS is not good enough for people who have been so badly let down by this. For the children who have been so badly neglected, it is crucial that this be rectified immediately.

In the very brief time I have left, I will raise a very tragic case that came to my attention last September. When I brought it to the attention of the HSE, an immediate review was undertaken. I refer to the case of a child who attended Kerry CAMHS with their mother but who was turned away. Two weeks later, the child took their own life. Five months have passed since the review was initiated and the family has not got a conclusion. These people deserve answers. We speak about catastrophic impacts on children but this family has lost a child. It has been five months since I brought this matter to the attention of the HSE. I was guaranteed a review would happen. We need this to be concluded now for the family to give these people some answers.

Mary Butler (Waterford, Fianna Fail)
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I would rather not comment on that individual case but I will check it out for the Deputy and see what is the position of the review of that young child's case. I offer my sincere condolences to the family. I can only imagine what it has been like for them in the intervening five months of waiting.

The Deputy is quite right that we need confidence in CAMHS both in Kerry and all over the country. That is why I took a three-pronged approach in the audit. The first audit relates to compliance and the standard operating procedures but we will look at everything, including configuration of teams. Last week and this week, I heard across the floor of the Dáil how some children are finding it difficult to access supports, depending on geographical location. They are falling between two stools. We are going to look at that again. As I said, we are also going to speak with service users - children and young people - and that will be academic research done completely independently of the HSE. The third element is the important prescribing audit.

The Deputy has raised a very valid point. It is something I have raised previously with the Minister, Deputy Donnelly. It is very frustrating as a Minister of State to receive a budget but we find it very hard to recruit people. We successfully recruited 53 staff to clinical positions in CAMHS last year throughout the country. There is significant investment in CAMHS again. It is very frustrating when it takes that length of time. We can be up to eight, ten or even 12 months filling some posts. For example, it took a year and a half to get a consultant psychologist into Wexford. We have challenges in Donegal with dieticians. A decision was taken by the HSE in 2016 when the choice was to leave the post vacant or put in a non-consultant hospital doctor without the experience but with oversight. Unfortunately, the process fell down because the oversight was not available.