Child and Adolescent Mental Health Services (CAMHS) Report in South Kerry prompts “full audit nationwide”

On Wednesday 26^th January, the Health Service Executive published a report into the care of over 1,300 children who attended the South Kerry Child and Adolescent Mental Health Services (CAMHS).

Taoiseach Micheál Martin has described a review into mental health services in south Kerry as shocking, very serious and unacceptable.

The report was originally commissioned by the Health Service Executive (HSE) following concerns raised about the treatment of a number of children and adolescents attending the facilities. The report was prepared by a team led by Dr Sean Maskey, Consultant Child & Adolescent Psychiatrist.

The report found that no extreme or catastrophic harm had occurred in the 1,332 considered. However, there were 227 children where the diagnosis and/or treatment exposed them to the risk of significant harm by way of one or more of the following: sedation, emotional and cognitive blunting, growth disturbance and serious weight changes, metabolic and endocrine disturbance, and psychological distress.

The report also found that 13 other children were found to have been unnecessarily exposed to a risk of harm under the care of other doctors in the service. 46 children were found to have suffered significant harm to include galactorrhoea, considerable weight gain, sedation during the day, and elevated blood pressure. The report went on to specify that the figure of 46 will change once new information becomes available following meetings with the families affected.

The report suggests that the diagnoses of ADHD, particularly for secondary-school children, was frequently made without adequate evaluation and/or without the required level of information in relation to their presentation in school from their teachers. Feedback from teachers was not requested as part of the management of treatment response for ADHD.

There was evidence of inconsistent and inadequate monitoring of adverse effects of medications on children and this included:

• Children started on stimulants did not routinely have a baseline pulse, blood pressure, height or weight measured and charted, to establish pre-treatment values
• Children started on antipsychotics did not routinely have a baseline blood test to establish pre-treatment values.
• There was no expectation of checking pulse and blood pressure seven days after starting stimulant or increasing the dose.
• Repeated height, weight, pulse and blood pressure measurements were erratic and not plotted on developmental charts.
• The patient’s GP was asked to do the blood tests in some but not all instances when children were started on antipsychotics. There were no results of this on file in the majority of cases. The tests were not routinely repeated at regular intervals.

Dr Maskey and his team made a total of 35 recommendations which cover areas such as re-establishing trust in the CAMHS service, governance, delivery of clinical services, improved clinical practice and the use of information and communication technology.

The government have announced that there will be an audit conducted into the compliance of each of the CAMHS teams nationally.

Following the publication of the report, the Health Service has issued an apology to the families involved.

About the Author: Avril Scally is Head of Medical Negligence at Lavelle Partners.