Dáil debates
Wednesday, 24 January 2024
Saincheisteanna Tráthúla - Topical Issue Debate
Mental Health Services
9:10 am
Pa Daly (Kerry, Sinn Fein)
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The Minister of State is familiar with the CAMHS disaster that occurred between 2016 and 2021. That is the identified period for which there was overprescription of medication and inappropriate care. Children experienced massive weight gain. Risperidone was nearly universally applied and prescribed for children. Lives were ruined. Following the identification of some of the issues involved, the Maskey report was established. Following Maskey, a redress scheme was put in place to deal with children who were under the care of a particular doctor. However, the scheme is quite limited in that it deals with patients who were treated in south Kerry between 1 July 2016 and 19 April 2021.
There is a fundamental unfairness in who is allowed into the scheme and who is excluded from it. The Minister of State probably has the exact figures, but there are an awful lot of children and parents who have received apologies for the treatment, or lack thereof, in its care in the Kerry region. Anybody who was treated in north Kerry who had the exact same difficulties as people who have been identified by Maskey are not included in this scheme and cannot access it. In addition, some patients in south Kerry whose treatment may have commenced prior to 1 July 2016 are also excluded from the scheme.
What are the benefits of the scheme? One can avoid a lengthy and expensive civil litigation route. One is provided with €10,000 upfront in order to pay for medical reports that can often cost up to €3,500. It is only fair that the scheme be extended to all patients or former patients who have received the letters of apology so that they can avoid having to pay large sums of money, because it is an obstacle to justice for those people who the HSE has written to and apologised that their treatment was lacking and did not match the required standard of care that these people deserve.
It has been a long road for them. Following Maskey, they were waiting a long time for various audits and other procedures to be established. They feel they have been strung along a bit. If any cohort of patients in this country now deserves a break and quick access to justice, it is them. Where apologies have already been received and when, in effect, there has been an admission of liability, why not save the State some money while providing easier access to justice for these people by extending the scheme so they can be included in it?
Mary Butler (Waterford, Fianna Fail)
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I thank the Deputy for raising this important issue. The independent report of the lookback review into child and adolescent mental health services, CAMHS, in south Kerry was published on 26 January 2022. This examined the files of everyone who received care from south Kerry CAMHS between 1 July 2016 and 19 April 2021, which is a five-year span.
Almost 1,500 children and young people were identified by Maskey as falling within the relevant time periods and requiring further review. No extreme or catastrophic harm occurred in 1,332 cases considered between July 2016 and April 2021. However, 240 young people did not receive the standard of care they should have received from CAMHS. Some 46 children, as the Deputy knows, had significant harm caused to them, and that number is subject to change.
In April 2022, the Government announced a non-adversarial compensation scheme, of which the "non-adverserial" piece is very important. As the Deputy knows, we turned this around in 11 weeks. I felt it was important that it be done quickly due to the level of the situation, the fact that so many children were harmed and the upset and distress it caused. We put in place a scheme to provide full compensation and clinical supports, if required, to those who suffered harm or injury as identified under the Maskey report. This also included, as agreed under the scheme, provision for some upfront payments to meet certain costs initially incurred by those eligible.
To qualify to receive compensation, patients must have suffered harm or injury while attending Kerry CAMHS from 1 July 2016 to 19 April 2021, be identified as being affected by the events outlined in the Maskey report and have been notified by CAMHS. Anyone who does not meet these criteria is free to pursue a case separately with the HSE.
It is important that the Maskey report notes there is no definitive number of people who suffered harm. Therefore, further evidence of levels of harm may be found and therefore the number of people eligible for the scheme may change.
That is the really important piece. In December 2022, the HSE confirmed that a file identification process in north Kerry was complete. The process involved the examination of files where the NCHD1, that is the person we had in south Kerry, was involved in care at any level. The outcome of this review was that an additional 25 children have suffered an adverse outcome. As the incidents involved NCHD1 and as these cases were identified as a continuation of the Maskey investigation into Kerry CAMHS, these additional cases fulfilled the criteria of the compensation scheme.
Separately, an audit of 50 sample files in north Kerry has also taken place to provide assurances around CAMHS in north Kerry. This was a broader random audit of CAMHS beyond the scope of the NCHD1 files originally identified. This file audit was not referenced within the original Maskey report and therefore sits outside the State compensation scheme arising from the Maskey report. The audit highlighted 16 cases of concern including some relating to prescribing practices and some clinical concerns about the professional practice of a clinician. Where concerns were raised by the audit team immediate contact was made with the families. The HSE took immediate action on the result of the files audit by setting up a look-back review similar to what happened in south Kerry to examine the files of anyone currently under the care of north Kerry CAMHS. A senior clinician, supported by a team of CAMHS consultants, has been appointed to lead this review which commenced in June 2023 and will be completed in due course. I will come back then.
9:20 am
Pa Daly (Kerry, Sinn Fein)
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I thank the Minister of State for the reply. I accept it was acknowledged that 240 people did not receive an adequate standard of care. The problem is that anyone who does not meet these criteria, as the Minister of State said in the reply, is free to pursue a case separately with the HSE.
An example of what we are dealing with in north Kerry in particular is the case of one young fellow who was a talented footballer, who had a social anxiety that was the most serious, was prescribed with Risperidone. He put on four or five stone. He was a talented footballer but he hardly leaves his room now. His life has been ruined. He is in his late 20s. He has lost contact with all of his peers. That is a case which is not included as part of the scheme. It is hard to understand why it cannot be.
I know there was a small audit of 50 sample files. I was arguing that there should be a full review of all files. Some 16 out of 50 cases of concern have been identified but not all of those are included in the scheme. Why not save the State some money and expand the scheme and allow these people who have been wronged by the State - the State has been seriously negligent in their treatment - quicker access to justice? This is coming from the patients. It also comes from their legal representatives who feel that it would be much easier where an apology is issued and an admission of liability has been made, to get them into the scheme as soon as possible. These people are still dealing with the lasting physical effects of the treatment. It is an ongoing problem and they just do not need the extra hassle of a long civil litigation process.
Mary Butler (Waterford, Fianna Fail)
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I accept everything Deputy Daly has said. He said it in good faith. People, families, children and young people have been through enough. This is not to say that the scheme in question is limited. The current situation where people from south Kerry were allowed into scheme occurred because we did a random sample audit of 50 files, then we did a complete look back over that five year period. That look back is now happening in north Kerry. As soon as we have the results from north Kerry, I expect more children to be eligible for the scheme.
Importantly, I also point out that as evidenced by the additional eligible children in north Kerry who have already been accepted into the scheme, any further appropriate cases in Kerry recommended by the HSE will be given full consideration by the State Claims Agency. Aside from the inclusion of such individual eligible cases it is not intended there will be any fundamental change to the compensation scheme introduced by the Government relating to the Maskey report, that is, the terms of reference of it. However, when we get the results of the north Kerry full look back currently being conducted I expect that more people will be eligible for the scheme.
In regard to the scheme, the latest information available to me is that 176 applications to the scheme have taken place with initial payments made. In regard to settlements, 23 mediations have taken place to date, of which 18 have been successfully resolved and others are ongoing. The Department, in conjunction with the HSE, continues to closely monitor developments in relation to CAMHS in north Kerry including any evolving issues in relation to the State Claims Agency compensation scheme.
As I already indicated, it is open to anyone to take a case privately but as the Deputy said, it is a non-adversarial scheme. It is good that so many people have decided to take up the scheme without going through that adversarial process. The scheme is not closed and we have to await the outcome of north Kerry.
Pa Daly (Kerry, Sinn Fein)
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When will that look back be finished?
Mary Butler (Waterford, Fianna Fail)
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It is currently under way. I hope to have it at the end of the first quarter of this year.