HSE audit finds South Kerry Camhs was an outlier

Dr Aoife O’Sullivan, a GP in Cork city centre, said waiting lists for Camhs are an obstacle for children seeking help which is directly linked to staff shortages

The Maskey Report last year revealed that hundreds of children received “risky” treatment from a doctor in the Child & Adolescent Mental Health Services (Camhs) in South Kerry.

An unpublished HSE audit of prescribing practices in child mental health services has not found evidence of over-prescribing of medication in any region other than South Kerry, the Minister of State at the Department of Health has confirmed.

The audit commenced in July last year on the back of the Maskey report which revealed that hundreds of children received “risky” treatment from a doctor in the Child & Adolescent Mental Health Services (Camhs) in South Kerry. Some 46 children suffered “significant harm”.

The audit has yet to be published but, speaking at the launch of a quick reference guide for GPs working with patients who have depression by the Irish College of General Practitioners (ICGP), Minister Mary Butler said that the issues appear to have been confined to South Kerry Camhs.

“We will have the audit from the HSE. The really good news, one piece that I’ll share with ye today, is that the over-prescribing that we saw in Kerry South, we haven’t seen it anywhere else,” she said.

“We haven’t seen that coming across anywhere else in the country. And that for me is massive.”

She said other issues remain including “in relation to teams, in relation to admin, in relation to working off the paper system".

“But in relation to any child being over-prescribed, that hasn’t come across and that is really really important.”

The HSE also announced a separate look-back review into Camhs in North Kerry and the results of this audit have yet to be released. 

Issues continue to face Camhs across the country, though, with under-staffing a major issue. In February, the HSE said none were fully-staffed, with levels ranging from 45% to 75% of target numbers.

Ms Butler said there are now 75 Camhs teams with one more to open shortly in Wexford.

“What I am thinking of at the moment is might you be better off, for example, having 50 fully-staffed teams and asking parents to travel that little bit longer, knowing that when you get to that particular team the supports will be there,” she said.

“We’re just throwing everything out there at the moment trying to decide.”

GP referrals

The minister said she hopes the new guide, launched by the ICGP, should help to improve patient outcomes and ensure they get the right care and access the right services. 

“I think this guide is really going to be great because sometimes there is not always clarity around where you should refer somebody onto, especially young children when they have mental health difficulties,” she said.

ICGP research shows that among 29m annual GP consultations, one-in-five can include mental health issues. Some 90% of mental health care is given by GPs.

Co-author of the guide, Dr Aoife O’ Sullivan said: “Rates of depression are very significant here in Ireland, in older as well as younger people with reported increases in mental health issues generally since the covid pandemic in 2020.”

She said the guide will help GPs quickly find information on screening, assessment and management of depression, and said “effective early intervention leads to better outcomes” for patients.

Dr O’Sullivan, a GP in Cork city centre, said waiting lists for Camhs are an obstacle for children seeking

help which is directly linked to staff shortages.

Access to online therapy is helpful for adults and over-16s, she said, but she said for under-16s this is more difficult to access.

“It depends where you are living, you could be down in Castletownbere which is two and half hours away from the city or you could be in the city, so even geographically your access to counselling is going to vary hugely,” she said.

Another issue is how GP referrals are assessed, she said. “In some areas, not in Cork and Kerry, they have this idea where you can refer in and the referral will be sent on to the most appropriate area (of care),” she said.

“So GPs in Cork and Kerry will be referring to Camhs, referring to counselling, to primary care and hoping one of them comes through for the family. Whereas if you could refer to one central location and they would say ‘this is suitable for counselling, this is suitable for Camhs, this is suitable for disability’ it probably would be a much more efficient system actually.” 

Dr O’Sullivan urged patients to talk to their GP about depression, suggesting booking a double appointment to allow time to discuss sensitive issues. Support around depression is also available through AWARE on 1800 80 48 48.