Camhs in South Kerry 'an orchestra without a conductor', committee hears

HSE chief operating officer Anne O'Connor said  there wasn't a proper structure in South Kerry Camhs. Picture: Leon Farrell / Photocall Ireland

The lack of a full-time consultant psychiatrist in South Kerry Camhs meant it "all fell apart", with the HSE promising a new audit will uncover any issues that may have occurred in other parts of the country.

The joint committee on health and sub-committee on mental health heard the HSE reiterate its apology for what happened in Child and Adolescent Mental Health Services (Camhs) in South Kerry, and also stories about one teenage girl apparently turned away from Camhs and who later took her own life, and of another child who had been attending North Kerry Camhs, where she was allegedly over-medicated, something which changed only when she transferred to South Kerry.

The damning Maskey Report into the situation in South Kerry, where unreliable diagnoses and inappropriate prescriptions led to serious difficulties for hundreds of children, is now being acted on, HSE chiefs said, pledging to implement all of the report's recommendations.

However, members of the committee said there was an urgent need to review governance structures, with two committee members criticising the "confusing" nature of the structure that had been in place in South Kerry, as well as the broad outline given of monitoring and oversight of Camhs more generally.

The executive clinical director of Kerry Mental Health Services, Dr Maura Young, told the committee that the lack of a full-time consultant psychiatrist in South Kerry — with a level of supervisory cover provided by an overworked stand-in consultant — was like an orchestra without a conductor, "which is why this all fell apart".

"Action was taken but it wasn't enough to stop what was happening," she said, with the committee hearing the provision of weekly supervision for the doctor involved in the over-prescribing was "not availed of".

A full audit will now take place and the first scheduled meeting of the newly-formed National Oversight Group is to take place on Thursday. 

The group will then sign off on the standards against which the upcoming audits will be carried out, with the chief operations officer of the HSE, Anne O'Connor, saying this would start with a focus on children and young people with ADHD around the country, to see if they may have experienced any issues with prescribing of medication.

Ms O'Connor defended taking that route, arguing it was following the recommendations in the Maskey Report, with some committee members querying why the audits were not broader in scope.

Sinn Féin health spokesperson David Cullinane said it was "unacceptable" that the HSE delegation would not address concerns over the alleged marginalisation of the whistleblower in the South Kerry situation, Consultant psychiatrist Dr Ankur Sharma, adding he had been treated "very, very shabbily".

Social Democrats leader Róisín Shortall said the governance structure outlined by the HSE delegation to the committee was "exceptionally confusing" and added: "It seems everyone is responsible and no one is responsible."

"It seems like nobody is in charge."

That point was echoed by Neasa Hourigan of the Green Party, while David Ward of Sinn Féin raised the case of a teenage girl who, he said, had been over-prescribed medication when in North Kerry Camhs, and was taken off the medication by Dr Sharma when she moved to South Kerry Camhs, and yet who was not considered to have been one of the hundreds of children and young people most adversely affected by what happened in Camhs there.  

"She started losing her personality and losing her smile," he said.

Brendan Griffin TD of Fine Gael outlined a case he said he was aware of; a young person he said was turned away from CAMHS and who later took their own life.

Cork Kerry Community Healthcare chief officer Michael Fitzgerald said the case was the subject of a serious incident management review which was likely to take a number of months.

The committee heard there had been ongoing recruitment difficulties in South Kerry, with a locum long sought but only secured for a six-month period in 2020, and with two people who had initially accepted posts in the area then withdrawing their candidacy.

Ms O'Connor said: "What has happened down in Kerry has proved there wasn't a structure there."