Minister wanted South Kerry Camhs audit to cover case files for all diagnoses, not just ADHD

The HSE told an Oireachtas committee that the audit would be limited to young people with an ADHD diagnosis, just days after Minister Mary Butler sought a broader investigation

Mary Butler, Minister of state for mental health, had written a letter to Anne O’Connor, HSE Chief Operations Officer on March 3 "that an audit of prescribing practices based on a random sample of case files to include any and all diagnoses, and not to be confined to ADHD, should be undertaken in line with my original request". File photo: Gary Ashe / RollingNews.ie

The Minister for Mental Health had requested the HSE broaden its audit of Child and Adolescent Mental Health Services (Camhs) before senior HSE personnel told an Oireachtas Committee it would be limited to young people with an ADHD diagnosis.

Anne O’Connor, HSE Chief Operations Officer and others appeared before the Oireachtas Committee on Health on March 2, outlining how the initial audit would be limited, arguing that this was in line with the recommendations of the Maskey Report into the scandal in South Kerry Camhs.

The Maskey review found that from July 1, 2016, to April 19, 2021, 240 children did not receive the correct treatment from a doctor and significant harm was caused to 46 of them. A State compensation scheme has been established. 

Last month the Irish Examiner revealed that the Mental Health Commission had written to Minister of State for Mental Health and Older People, Mary Butler, questioning the HSE's rationale before the committee. It later emerged the minister herself had requested a broader audit.

Correspondence released under FOI by the Department of Health now shows the minister had stressed the need for greater scope within the audit in a meeting just days beforehand.

In a letter to Ms O'Connor on March 3, Ms Butler referred to earlier correspondence and a meeting both had attended on March 2, alongside Minister for Health Stephen Donnelly, HSE CEO Paul Reid, and others.

"As you will recall at the meeting, the clear request from Minister Donnelly and myself was, notwithstanding the views and position of the HSE, that an audit of prescribing practices based on a random sample of case files to include any and all diagnoses, and not to be confined to ADHD should be undertaken in line with my original request," the minister wrote.

"Minister Donnelly and I acknowledge that this will take some preparatory work, however, I would be grateful for an outline of the plan within the next week, as was requested by Minister Donnelly before the close of the meeting."

Other correspondence released to the Irish Examiner - this time by the Mental Health Commission - showed the mental health watchdog questioning the reasons given by the HSE for the initial narrower scope of the national audit. Ms Butler then confirmed a full audit would be taking place, something officially confirmed by her Department days later.

Ms Butler said having requested an audit of prescribing practice and following intensive discussions with the HSE, an expert team, chaired by Dr Collette Halpin, has been established. The independent team, which also includes Dr Imelda Whyte and Dr Suzanne McCarthy and which is supported by the HSE National Centre for Clinical Audit, is expected to report back in the last quarter of this year.

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"Proposals for the audit of compliance with Camhs operational guidelines are being procured," the minister said.  "Once they are assessed, a successful provider will be chosen. They’ll be asked to complete the audit within six months of appointment.

"On the qualitative research into Camhs experiences, work is at an advanced stage. HSE is engaging with an academic partner and they are at an advanced stage. The research will require ethical approval. It’s expected that this work can be completed within six months of confirmation of approval."

The department said Camhs teams have, over the past number of weeks, actively engaged with and assisted Dr Susan Finnerty and the Mental Health Commission in conducting an independent review of Camhs provision, as announced by the Commission in February this year.