Pa Daly (Kerry, Sinn Fein)
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The sample audit for north Kerry child and adolescent mental health services, CAMHS, is due either this week or next week. In my view, the HSE must expand the sample audit to a full review of all files in north Kerry, going back 15 years, as a matter of urgency. As the Minister of State knows, the Maskey report found that significant harm was caused to 46 children in south Kerry and that a further 240 were placed at risk of serious harm. Since that report was published, I have spoken to social workers, parents, patients and former patients. I spoke to a social worker who expressed concern about the supervision of children when there was no consultant psychiatric cover. The social worker told me that requests were made for a review of children who attended CAMHS from 2005 to 2015, when a consultant psychiatrist was eventually appointed. The concerns that she raised at that time were not addressed. The social worker told me that many children were placed on strong psychotropic medication, with poor follow-up. That was not even in Kerry but in another county.

Some parents may even be unaware that their children were under the care of CAMHS because it happened prior to the HSE taking over in 2014. I spoke to the parents of a child in the north Kerry area who is now in his mid-20s. He was a promising sports player but does not leave the house now. He suffered huge weight gain. His life has been destroyed. He was later told by another doctor that there was really not much wrong with him that justified that treatment and overmedication. Parents who were desperate to get help for their children trusted doctors but were let down. Their agony must not be prolonged by any more indecision and delays.

The Minister of State called for a full review but that has not happened. I am repeating the call for a full review. On the heels of the Maskey report, we were told that there are reports that the medical practitioner at the centre of south Kerry CAMHS may have been assigned to north Kerry CAMHS patients. That was reported by RTÉ. The sample audit of the north Kerry CAMHS patients was announced eight months ago. The scope was limited to a sample of 10% of current patients or about 50 cases. That sample audit was not enough then, as we said then and are saying again now. The history of overmedication, no supervision, poor governance and lack of clinical oversight predates the HSE taking over in 2014. I hear that complaints were made by social workers about poor follow-up in the Cork area from 2010 to 2012. I also am concerned that south Kerry families are being let down. They are not receiving therapies that they were promised and some therapies that were received were only online. Despite requests from me to the Minister for Health and the HSE to extend the sample audit to a full review of all north Kerry CAMHS patients over the past 15 years, the HSE has rigidly adhered to the sample audit.

I repeat my call to the Minister of State. The consequences for children, many of whom are now adults, are far too serious for anything other than a full review.

Mary Butler (Waterford, Fianna Fail)
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I thank the Deputy for raising this important issue. I am aware of the issues raised last week in the RTÉ "Drivetime" programme. The health and safety of children in CAMHS should remain the concern of us all. 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.

Those recommendations cover a broad range of areas, such as the re-establishment of trust in CAMHS, governance of the service, delivery of clinical services, improved clinical practice and the use of information and communications technology to support the delivery of services. The Government and the HSE are committed to implementing the recommendations as quickly as possible. At the moment 16 of the 35 recommendations are in place.

Deputy Daly said to me that a full review is not under way. Actually, it is, as a full review of all 73 CAMHS teams across the country is under way.

To provide assurance to those who use CAMHS, I requested the HSE to commission national audits in respect of prescribing practice, compliance with the HSE CAMHS operational guidelines and research on service users' and key stakeholders' experiences of CAMHS. Those are three independent audits. Independently chaired by Dr. Colette Halpin, the audit of prescribing practice in CAMHS is undertaken by an expert team, which is administratively supported by the HSE national centre for clinical audit and community operations. Following an initial pilot phase, the full national audit commenced in July. Data analysis has now commenced, with findings to be summarised in a final report prepared by the expert team.

This all came about, as Deputy Daly will know, because of the situation in south Kerry CAMHS. The HSE is conducting three individual audits. Also, and this is important, I requested that the Mental Health Commission, which is independent of both me and the HSE, undertake a review of all 73 CAMHS teams across the country. When both report I will have two parallel reports, which I think will give me great data I never had previously.

As for the situation in north Kerry, I believe that the random sample audit works. The reason we know it works is that it worked in south Kerry. We did a random sample audit of 50 files. Dr. Maskey identified at that time that significant harm had been done to children and that other children were also affected. As a result of that, a full look-back was done. However, I have to wait for the results of the random sample audit files, whether it is north Kerry, Waterford, Galway or Dublin, to see the results. If then a full look-back is required, I will make sure that happens. I have to go by the procedures Dr. Maskey put in place because I know they work. They worked in south Kerry. Fifty sample files showed there were issues. We will have to await the results of this.

Furthermore, massive supports have been put in place. The HSE continues to engage with families locally, including the Kerry CAMHS family support group, on care and any other issues generally relating to the Maskey report. Those affected can contact the HSE, as the Deputy will know.

Furthermore, and I will come back to the Deputy in my supplementary response, I travelled to Tralee in August and launched the youth advocacy programme, YAP, for all users of CAMHS in south and north Kerry who want to advocate for themselves with the support of their parents. An independent advocacy group is in place to support all service users of CAMHS.

Pa Daly (Kerry, Sinn Fein)
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I thank the Minister of State for her reply. The only problem is that some of these families have been waiting 15 years since the misdiagnoses and the overprescribing of antipsychotic medication to their children. They are suffering internally in their family units and their children are still suffering as a result of what happened. The random sample, I believe, will lead only to a look-back. At least 25 families have come to my office to ask that they be included in the north Kerry review. Unless there is a huge proportion of people coming into my office, which is highly unlikely, a full review will be necessary. It was announced eight months ago. It was supposed to have been published within six months. That has not happened. It is supposed to be announced this week. That is the latest I have been told. I was told that about a week ago. It is not happening. The families are getting more frustrated and the status of patients who were treated pre-2016 is still up in the air. The south Kerry difficulties dealt with a specific period from 2016 onward, but the Minister of State and I know that the problems were there before the HSE took over the Brothers of Charity Services in 2014, going back 15 or 16 years. Some of those patients are now in their mid-20s and are still suffering, so they are getting increasingly frustrated by what they see as inaction. Their problems will continue. A full look back is inevitable, in my view, because this is continuing and because it is so serious.

I ask the Minister of State to look into this - I know that she has called for it herself already - and to push the HSE into doing what will inevitably have to be done.

Mary Butler (Waterford, Fianna Fail)
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I am satisfied with the measures now being taken by the HSE in respect of north Kerry CAMHS. When all this happened in February of this year, I moved very quickly to work with the HSE to put in place these three audits and the review through the Mental Health Commission. We cannot lose sight of that. There is a process in place. The process is set out under the terms of the audit being carried out by the HSE. What I requested at that stage across all 73 CAMHS teams was a sample random audit because I knew that it had worked in south Kerry. Fifty files were audited and they showed immediately that there were issues. Then Dr. Maskey performed a full look-back into, if my memory serves me right, about 1,250 files. We should also note that there were 500 files of children who were medicated where no harm was caused to them. It is important to say that.

I have to await the outcomes of these and the other audits on CAMHS nationally that are under way, including the review by the Mental Health Commission. This will help to inform any next steps necessary in respect of CAMHS in Kerry or elsewhere. I want to build back confidence in the CAMHS teams. We have 73 teams in operation at the moment. We will have a 74th team in Wexford very soon. It is important to state, however, that 2% of children who are referred through a GP or a primary care centre may need the support of CAMHS. A huge amount of really good, positive work is being done by multidisciplinary CAMHS teams the length and breadth of the country. It is really important that I try to support those teams to continue to do the really good work they have done, notwithstanding the issues we have. The focus for me, the Department and the HSE is to complete as quickly as possible the various audits now under way along with monitoring take-up of the compensation scheme. This will all help inform the next steps necessary. I will keep this under constant review.