The State is facing a slew of lawsuits following revelations of significant harm done to vulnerable young patients in the care of the Child and Adolescent Mental Health Service (Camhs) in Kerry.
A new report documents a litany of failings at the service, with 46 children suffering due to unreliable diagnoses and inappropriate prescriptions.
But concerns have also been raised that that report is not comprehensive because some patient files were missing.
Solicitor Keith Rolls said he is pursuing legal cases for almost 100 people.
He said that some 1,100 letters were sent to families saying that their children had experienced no harm at the service, but Mr Rolls has been advised by parents who received these letters that the medical files were missing, so the HSE could not accurately conclude that no harm was done.
Lucy, whose name has been changed to protect her son's anonymity, is one of the many parents who plans to pursue a case against the HSE.
Her son was first referred to the service aged eight with suicidal ideation where he saw Dr David Kromer, whose diagnoses and treatment of patients is understood to have sparked the HSE’s review into Camhs care in the area.
Her son, who has ADHD, was quickly prescribed two stimulants, the anti-psychotic drug risperidone and melatonin.
“I thought we were coming for therapies to help — like talk therapies. But all we got was medication," Lucy said.
“And when I questioned that, he said ‘if he had diabetes wouldn’t you give him insulin?’
"But the medication never worked. If anything, it just made him more anxious and withdrawn.
“Then he attempted suicide. I called Camhs but no one called me back."
On his second suicide attempt, she said that Camhs did see her son but advised her to get him counseling privately and remove all sharp objects from their home.
She said her son changed unrecognisably in a very short time on heavy medication.
“Risperidone impacts a young person’s hormones. My son developed breasts. He used to be very happy-go-lucky but had become hugely anxious. He’d hold a butterknife to his head and cut his fingers with knives.
“I took him off the medications at the start of the pandemic," Lucy said.
She said that while the publication of the report is “a small step forward”, apologies from the HSE ring hollow because the services are still not there to help her child and thousands of others.
“Talk therapy should be the first thing that is offered. We’ve had apologies but the services are still not there to help these children."
A father whose two children were allegedly prescribed inappropriate medication in North Kerry Camhs, said that he has been “extremely upset and angry” following the report's publication.
“I keep having flashbacks of giving my child that medication," he said.
“I want justice now. I am definitely not letting this go. They have to be held responsible for what they did.
The Children’s Ombudsman Niall Muldoon has expressed “absolute shock and horror” at the report into children’s mental health services in Kerry.
“CAMHS has been notoriously bad for taking people in to meet them”, he told Newstalk Breakfast. There were waiting lists of up to two years sometimes for children "who really need these services.
“These families were so let down. There must be a fear there about going into any CAMHS service which is going to do a huge disservice for children and young people.
“There's a real sense of shame and lack of trust in regard to that. On a national scale what it shows that we've got to take a look at our individual CAMHS services.
"There are 72 around the country, there should be over 100, so obviously we're severely understaffed and under-resourced, we've also underinvested in mental health for children.” Mr Muldoon added that he had been struck by the lack of governance and support for the service and that individuals had not been held to account.
“There was no case management, there was no data protection, there was no shared clinical diaries so it really seemed like a free for all as regards individuals taking the rules and ignoring the rules.”
Taoiseach Micheál Martin said the review's findings were "very, very serious" and called for a full audit of Camhs services nationwide.
"What happened is unacceptable. The first principle of medicine is to do no harm. Children were harmed here by a complete failure of clinical performance and oversight and by the entire management of the service," he said.
The HSE said it was "absolutely committed" to implementing the 35 recommendations in the report, but said that it would be “unfair” to single out any individuals.
"We can say that we have passed all relevant information to the Medical Council and to An Garda Síochána," a statement said.
In late 2021, there were 2,384 children waiting to be seen by Camhs services, according to the HSE.
Within this, 170 children were waiting for longer than one year.
Mental Health Reform pointed to increasing referrals as a key issue with a 40% jump between 2011 and 2019.
Access to Camhs doctors out of hours for emergencies varies considerably across the country, Mental Health Reform has found.
More than two in five Camhs roles — including 513 consultants' posts — were unfilled in 2019, according to figures released to TD Louise O’Reilly.
Kerry health services tried for six years to recruit a consultant and it took 18 months to fill a similar role in Wexford with other rural areas facing similar challenges according to Minister Mary Butler.
Waiting lists in Cork city and county increased by 23% in recent months, TD Padraig O’Sullivan told the Dáil this week.
The mental health budget for 2021 represented 5.1% of the HSE budget but the Sláintecare reform programme recommends ring-fencing 10%.
- If you are affected by any of the issues raised in this article, please click here for a list of support services.