Pa Daly (Kerry, Sinn Fein)
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7. To ask the Minister for Health what reviews are currently taking place with respect to north Kerry child and adolescent mental health services, CAMHS; and how they differ from the announced national audit of cases. [17949/23]

Kathleen Funchion (Carlow-Kilkenny, Sinn Fein)
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I am taking this question on behalf of my colleague, Deputy Pa Daly. I ask the Minister of State at the Department of Health what reviews are currently taking place with respect to the north Kerry CAMHS and how they differ from the announced national audit of cases.

Mary Butler (Waterford, Fianna Fail)
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I was expecting the Deputy's colleague, Deputy Mark Ward, who is seated beside her, to take this question on behalf of Deputy Pa Daly.

Following the publication of the Maskey report, in order to gain assurance about the quality of the CAMHS service being provided in north Kerry, the HSE confirmed a planned sample file audit of 50 files in north Kerry CAMHS would take place. This was a random audit of files and represents approximately 10% of the caseload of the north Kerry CAMHS teams. I make that point to ensure there is no confusion and we all understand the situation that ensued in relation to south Kerry and the Maskey report. As a result of the Maskey report, concerns were raised that there may have been a crossover between north Kerry CAMHS and south Kerry CAMHS. That is why we are discussing this today. This audit was undertaken by a team of ten consultants from across the country, with oversight provided by the national clinical adviser and group lead for mental health.

On 21 January 2023, the local HSE received a final report from the team of CAMHS consultants who carried out this audit in north Kerry. The audit team raised potential concerns regarding the standard of care received by a small number of patients. The audit team recommended that a further review be carried out of all cases currently open to the service. Based on these concerns, HSE CHO 4 took immediate action by beginning the process of setting up a look-back review. I gave a commitment at the time that if any issues were raised in north Kerry, we would move to a look-back review. The HSE has advised the Department of Health that in preparation for the first phase of this north Kerry look-back review, the files of current cases are being profiled in order of urgency and risk.

Discussions with a proposed senior clinician to lead on the review are ongoing and the draft terms of reference have been developed. The review is separate from the audits arising from the Maskey report, more specifically the national prescribing audit, which focuses on prescription practices in CAMHS, and the national audit of compliance with the CAMHS operational guidelines.

Kathleen Funchion (Carlow-Kilkenny, Sinn Fein)
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As I said, I am asking this question on behalf of my party colleague. The results of the reviews that have so far taken place, whether by the HSE or the Mental Health Commission, are clear that serious lapses in standards of care took place, with devastating consequences for children and teenagers in Kerry and their families. At the time of the publication of the south Kerry look-back review, the Taoiseach admitted it was a serious matter, yet we have seen little progress on the urgent restructuring that is needed within mental health services in Kerry. The status of the north Kerry review, which the Minister of State touched on, is also unclear. Of what value is it for families in the context of the wider audit?

I understand Deputy Daly also asked separately how many families had come forward. Any information the Minister of State might have in that regard would be appreciated. In the immediate aftermath of the scandal breaking, families, children and young people were left without any support and with a local service they understood had let them down. The families feel as though the progress made leaves a lot to be desired.

Mary Butler (Waterford, Fianna Fail)
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I know the Deputy is asking this question on behalf of her party colleague but I do not agree the status is unclear. It is crystal clear. On 21 January 2023, the local HSE office received a final report from the team of CAMHS consultants who had carried out the audit. When concerns were raised by the audit team in respect of individual children, immediate contact was made with the families and clinical reviews and open disclosure meetings were facilitated as appropriate. Contact was also made with the families of the remaining 34 young people reviewed by the audit team advising that their files were part of the north Kerry CAMHS clinical audit and that the audit had found no evidence of harms. The audit looked at 50 files and 34 families were contacted, thankfully, to say there were no issues, while between 14 and 16 cases warranted a look-back.

Last week, I travelled to Ballincollig in Cork and met families of children who had been affected by the debacle in Kerry CAMHS. It is important to keep in touch with the families affected.

Kathleen Funchion (Carlow-Kilkenny, Sinn Fein)
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I thank the Minister of State. I will relay that information to Deputy Daly. Some of it might be new information, not least the reference to meetings she held last week. The Deputy made the point that the latest figures show 4,314 children are awaiting CAMHS appointments, 88% of them since the start of 2020. More than 600 of these children have been waiting for more than one year, with the majority in Cork and Kerry.

In general in respect of CAMHS, we need a properly staffed CAMHS team to address the waiting lists and ensure we will not face the same issues again. The crisis was fundamentally an issue of proper supervision and oversight, with a lack of adequate workforce planning at its heart. It is true of all CAMHS services that we want to see them work well, given we are talking about children and young people. What plan has been brought forward to resolve the issues and start the process of rebuilding trust with vulnerable children and service users? The Minister of State touched on some of this in her initial reply.

Mark Ward (Dublin Mid West, Sinn Fein)
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Since the Maskey report was published, the emphasis has been on Kerry, and rightly so, given the chronic mistreatment of children there. Deputy Funchion cited figures from February but they have increased again since March. I have figures to hand that show the national figures in CAMHS increased by a further 3% between February and March. A total of 4,434 children are waiting for a first appointment, while 682 have been waiting for more than a year. CHO 4, where the emphasis should have been, has the longest waiting list. When the Maskey report was published, 764 children were waiting for a first appointment, whereas that figure is now 888. Some 343 of these children in CHO 4 have been waiting for more than a year, amounting to 50% of the national total in that one CHO area.

I raised this issue yesterday with the Minister for Health at a meeting of the Joint Committee on Health and he indicated he would refer it to the Minister of State. If I am being realistic, I know I am not going to get that answer straightaway, so I will not put her on the spot, but I will ask her the same question I asked the Minister yesterday. What is being done to address this? The figures do not lie. The waiting lists are going up and up and CHO 4 seems to be an outlier in the context of these bad figures.

Mary Butler (Waterford, Fianna Fail)
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I thank both Deputies for their questions. As I was going to say in response to Deputy Funchion, we are all very aware of the challenges we have in CAMHS throughout the country and of the fact waiting lists are going in only one direction, which the Minister and I are very unhappy about. We speak about it constantly.

One thing Deputy Ward did not mention is that there were 33% more referrals to CAMHS in the past two years than ever before, and the teams saw 21% more children than ever before. The number of referrals coming in is unprecedented-----

Mark Ward (Dublin Mid West, Sinn Fein)
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If they got the appropriate primary care, they would not need them.

Mary Butler (Waterford, Fianna Fail)
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If I can answer, 225,000 appointments were given to children in the care of CAMHS last year. Ninety-one people were added to mental health staffing between December 2021 and December 2022. It is not that we are not acting.

To drive CAMHS reform, I am holding a series of roundtable discussions with key CAMHS stakeholders. The first meeting, to be held this afternoon, will involve the College of Psychiatrists of Ireland, the HSE and the Department. In the next two weeks, there will be further meetings with NGOs relating to psychology and mental health reform - across the board - to see how we can address this issue. I am very concerned about the waiting lists.