Dáil Éireann Debate, Thursday - 8 December 2022
5. Deputy Mark Ward asked the Minister for Health the terms of reference and timeframe for the Mental Health Commission review into child and adolescent mental health services, CAMHS; if he will outline the concerns raised by the Mental Health Commission with the HSE and the nature of those concerns; if he will outline the HSE's response to those concerns; and if he will make a statement on the matter. [61489/22]
Amharc ar fhreagraThe Mental Health Commission is carrying out a review of CAMHS after major concerns were raised in the Maskey report on children who were subjected to significant harm in south Kerry. Could the Minister outline what concerns have been raised by the commission in the review?
When were they raised with the HSE? What was the nature of these concerns and what was the Government's response to them?
I thank Deputy Ward for his question. The Deputy will be aware that the Mental Health Commission is an independent statutory body established under the Mental Health Act 2001. The commission’s principal functions are to promote, encourage and foster the establishment and maintenance of high standards and good practices in the delivery of mental health services and to take all reasonable steps to protect the interests of persons detained in approved centres under the Act.
As the Mental Health Commission is an independent body, and in light of the fact that the commission has not completed its final review, the specific issues raised by the Deputy are, in the first instance, a matter for detailed consideration by the Mental Health Commission and the Health Service Executive. Any actions arising by the commission will, in the first instance, be raised by the Mental Health Commission with the HSE.
I understand the commission has completed a review of the child and adolescent mental health services, CAMHS, in five community health organisations, CHOs, with four to be completed, and one of those four has already commenced. As is normally the case with relevant Mental Health Commission inspections and reports, any commission concerns brought to the attention of the HSE are addressed directly by the executive.
I met with the Mental Health Commission in the past month and it told me it had raised concerns with the HSE in relation to matters that had been raised during the audit of the five CHOs. I look forward to receiving the reports from the Mental Health Commission when they are completed and formally submitted to me. To date, I have not received anything in writing.
The Deputy will be aware that the independent report of the review of care provided by south Kerry CAMHS, the Maskey report, made findings regarding significant failures across multiple levels of the system. This has led to an independent audit by the HSE and a subsequent review by the Mental Health Commission.
I am extremely troubled to find out that the concerns escalated by the Mental Health Commission to the HSE have not been conveyed to the Minister of State. This is extremely worrying. We are having these reviews because 240 children were placed at risk of significant harm and 46 children and young people experienced significant harm, including weight gain, sedation, elevated blood pressure and the production of breast milk. It is worrying and troublesome that the Minister of State with responsibility for mental health has not been given the information the Mental Health Commission provided to the HSE. The word "escalated" sounds worrying. The Mental Health Commission escalated this to the HSE but the HSE has not escalated this to the Minister of State. Will the Minister of State look into this to find out why she has not been given this information?
To be fair, when the initial report from Dr. Seán Maskey was presented to me I acted quickly and promptly. I initiated an independent audit by the HSE of three particular areas, namely, prescribing, standard operation procedures and the interaction of parents and families with CAMHS. The Mental Health Commission also agreed to conduct a full review of all nine CHOs. The standard operating procedure is that the Mental Health Commission must, in the first instance, raise any issues with the HSE, which is providing the services. I look forward to receiving these reports because I believe we will get data we have never had previously. We will able to look at all 73 CAMHS teams to see what has to be changed to ensure children are safe in these services.
I acknowledge the Minister of State's response to the Maskey report and how quickly she acted. I also acknowledge that three reviews are being done by the HSE and one by the Mental Health Commission. It is very welcome to have these reviews done. We must remember, however, that before these additional concerns were escalated, there were red flags all over CAMHS. The Linn Dara CAMHS service was supposed to reopen in September and that still has not happened. Inpatient capacity is lower now than it was when the Government took office. Some 4,000 children are waiting on appointments with CAMHS, a 32% increase on the figure for 2021. There are also thousands of children who, despite being referred into CAMHS by a medical practitioner, are deemed ineligible for referral. I hope those children are part of these reviews. A consultant psychiatrist has still to be hired in south Kerry where children are receiving consultations from a doctor in the United Arab Emirates. Children are still facing a cliff edge when they reach the age of 18 and are moved into adult mental health services, despite the recommendation in Sláintecare and A Vision for Change that the age be extended to 25.
I am extremely worried that the Minister of State has not received the reports from the HSE on the concerns that have been escalated by the Mental Health Commission. Is there anything the Minister of State can do to get those reports out? Other people have contacted about this matter. Parents are extremely worried about what is going on in CAMHS.
The HSE acts when it is contacted by the Mental Health Commission. Any safeguarding issues or concerns raised are dealt with promptly and appropriately by the HSE and the relevant CAMHS teams. At the same time, we must remember that thousands of children are receiving the support of CAMHS multidisciplinary teams on a daily basis. They receive good supports. I must try to build confidence in the service.
On the Maskey report, the Deputy is right. Unfortunately, the post in Kerry south has been funded since 2014 but the service has not been able to secure a consultant psychiatrist. One of the key recommendations of the Maskey report is that services look to outside sources to try to provide supports. This is the reason services are being delivered online to children and young people in Kerry south. The initial consultation is done by a consultant psychiatrist, not online. Following the initial consultation and assessment, supports are then provided online as part of the person's care.
