Richard Hogan: How is it that people can leave our health services more troubled than before? 

The government has given over a billion euro to the HSE for mental health services, but will it be spent where it's really needed? 

Richard Hogan: The recent controversy about a doctor who was prescribing the wrong medication, giving ‘risky treatment’ and without the right care for patients in Kerry was shocking but unfortunately not too surprising.

In medicine, as in psychotherapy or any of the science medicines, rule one is, "First do no harm". (Primum non-nocere). This is an incredibly significant starting point for any clinician because you are working with people who are coming to you for care and guidance. They are vulnerable because they view the clinician as an expert and are, for the most part, willing to do what is recommended in that session. 

I often work with families who are really struggling to manage the issue that is present in the family. And many of those families have been through the system, either with Camhs or Tusla. So, I have been hearing first-hand, for many years now, the lived experience of families with our national services. 

The recent controversy about a doctor who was prescribing the wrong medication, giving ‘risky treatment’ and without the right care for patients in Kerry was shocking but unfortunately not too surprising. It was in keeping with what I have heard far too many times in my work with families. 

I have heard the same story; too many different psychologists involved in the case, lack of consistency, a rush to judgment about the family, rapid prescribing of medication for teenagers against parents’ wishes, in many cases the issue they presented with was exacerbated by the intervention of the service. The voice of the family has been muted for too long. 

There is a feeling that this controversy, far from a singularity in a particular area, is a symptom of a far bigger problem. The hope is this controversy will provoke other families to speak out about their experiences and might possibly cause systemic change in our national mental health services. That is the hope.

The ‘fundamental review’ that An Taoiseach Micheál Martin has called for must answer the following question, how can families, at their most vulnerable and seeking help, come away from a service more troubled than they were before they engaged with that service? What is happening here? 

Like any profession, the vast majority of people working with Tusla and Camhs want to effect positive change for their clients. And I’m sure it has been very unpleasant for those dedicated staff members to face work over these recent weeks in the midst of such controversy. They deserve better. 

I have heard it from my own colleagues working with the HSE. Overworked, and burnt-out. The government has given over a billion euro in recent years to the HSE for mental health services, but what scrutiny is in place to ensure the money is spent appropriately? 

We should know where this money going, if it was allocated to the right places would there be such an issue with acquiring the right personnel, particularly in psychiatry? 

We need more transparency, so we can clearly see where all this money is going. We also need to hear from families. In any service at this level, a significant part of the checks and balance apparatus should include the families experience of the service and staff experience of working for the service. It seems to me, these services are really struggling to recruit the appropriately qualified personnel. 

In the Kerry case, there was a huge delay filling the vacant position of clinical lead for that area. This allowed a non-consultant hospital doctor to work with impunity and which, as the HSE report stated ‘culminated in unreliable diagnosis, inappropriate prescriptions and poor monitoring of treatment and potential adverse effects. 

These events exposed many children unnecessarily to the risk of significant harm. 

The thought that families and children, at their most vulnerable, are being put at ‘risk of significant harm’ by a service designed to help them, is a terrible indictment on our current mental health services in Ireland. 

And why so many families, I have met over the years, felt utterly let down by a service they engaged with.

In 2017 the mental health commission, in its annual report highlighted some of the major issues they found with Camhs. But the reality is it has no power to set standards or regulate services. That needs to change. We need an independent body overseeing the governance of health care in this country. 

We must make sure that those at the top have the skills, competency and acumen to understand how to rollout effective health care so that the services they provide are safe and of the highest quality. The implementation of a robust audit system needs to be developed so that a whistle-blower isn’t vilified for doing what management should have done – protecting children by overseeing standards of practice. 

The whole notion of whistle-blower needs to change too. For too long now the HSE has been plagued with poor management. We must look at how we appoint people to top positions, or we will keep reading about catastrophic failures like we did last week in South Kerry. 

The families of Ireland and their children deserve far better, and we can do better.