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Calls for “urgent national response” as “serious concerns” raised over HSE treatment of minors

An interim report by the Inspector of Mental Health Services, Dr. Susan Finnerty, has revealed a variety of ‘serious concerns’ over the manner of childhood and adolescent mental health care provided by the HSE. 

The interim report into the ​​Child and Adolescent Mental Health Services (CAMHS) revealed that a significant number of patients seeking access to services were “lost”, with some patients being given “no discharge or transition to adult services, planning, or advice about medication.” on turning 18.  

CAMHS is responsible for the treatment of issues related to mental health in children up to the age of 18 such as depression, problems with food and eating, self-harm, attention deficit hyperactivity disorder (ADHD), psychosis, bipolar disorder, schizophrenia, anxiety, and others. 

Dr. Finnerty said that failings were such that in her opinion Article 24 of the European Convention on the Rights of Child as it applies to mental health may have “been breached for many children with mental illness.”

Among the failings listed in the damning report were: long waiting lists, lack of capacity to provide appropriate therapeutic interventions, lack of emergency CAMHS and out of hours services, absence of monitoring for children on medication, and the issue of so-called “lost” cases where 140 children who had open cases had been lost to follow-up. 

This, Finnerty said “ all point to a possible breach of Article 24”. 

Within the bounds of the Community Healthcare Organisation (CHO) alone, there were 140 “lost” cases where children and adolescents seeking mental health services did not receive appointments for up to two years. 

Dr. Finnerty states she could not understate the “distress and frustration” expressed by the families of those seeking care who flagged issues including, “long waiting lists, the refusal of the referral of their child to CAMHS, long waiting lists for primary care or CDNTs, the re-referrals to CAMHS” and a “lack of service for their child with ADHD if they do not consent to medication.” 

One family said they were “spending €90 a week to see a private occupational therapist and driving a round trip of 3 hours to do so”. 

Parents also ​​expressed concern about how their children “deteriorated” while waiting for an assessment during what Finnerty described as the “​​small window of opportunity” to treat mental health issues in childhood in such a way that ongoing issues into adulthood could be best avoided. 

“Serious concerns” were flagged regarding “clinical governance” whereby due to a lack of consultant psychiatrist cover there was “reliance on psychiatrists not registered as specialist” in the treatment of vulnerable patients. 

One child was left waiting for four days in the Emergency Department “until they could be assessed by a consultant psychiatrist”, the report says. 

A “lack of acceptable monitoring of medication” also caused concern as a significant number of children who were on medications which required monitoring were “lost”. 

Certain teams were found to be failing to adequately monitor children on medication in accordance with international guidelines. 

 In a number of instances patients taking antipsychotic drugs, which Finnerty said can have “safety repercussions”, were not properly monitored and in some cases “prescriptions were renewed without a documented review of the patient for up to 2 years”.

Possible side effects of antipsychotic medication are said to include “sleepiness, dulled feelings, slowed thinking, serious weight gain, increased blood pressure, galactorrhoea (production of breast milk) and distress.” 

The report also states that three CHO CAMHS reviewed had “not implemented many of the recommendations of the CAMHS Standard Operating Procedure 2015 or the subsequent CAMHS Operational Guideline 2019”. 

 It continues that care plans were “either absent or poor in many teams” and that there were “no practice managers and in general”. 

Teams were found to be “operating at about 50% of their recommended administrative staff” with the report highlighting issues related to staff being overburdened and “burnout”.

Lack of staffing also contributed to a negative impact on the amount of clinical time as clinicians were caught up in attempts to cover “administrative and clerical duties”. 

Patient files were found to be kept in improper conditions with​​ ‘paper based clinical files found to be “frequently disordered, with little logic to the filing of documents within them.”

This, the report says, led to confusion over patient progress and oversight.

Dr. Finnerty called for an “urgent national response” to the situation saying it could not wait for the publication of the final report which is to be issued this year.

 

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