No consultant child psychiatrist working full-time in Kerry, HSE says

There is no full-time consultant child and adolescent psychiatrist working in Co Kerry, a senior HSE representative has said.

Reviews into Child and Adolescent Mental Health Services (CAMHS) in North and South Kerry have identified risks of potential for harm in how young people were treated.

The 2022 Maskey review into South Kerry CAMHS found the care of hundreds of young people did not meet standards it should have, including unreliable diagnoses, inappropriate prescriptions and poor monitoring of treatment.

That prompted a review into services in North Kerry, published on Wednesday, which found a risk of potential for harm in more than half of files it reviewed – citing similar concerns.

It found that resources for the CAMHS team were significantly below what is recommended in national mental health policy.

Dr Colette Halpin’s report said that Co Kerry should have a minimum of four full-resourced dedicated CAMHS teams, including four consultant Child and Adolescent Psychiatrists and full multidisciplinary teams.

However, the HSE’s clinical lead for youth mental health said on Thursday that there is not currently any consultant working full-time on CAMHS in the county.

Dr Amanda Burke told RTE’s Morning Ireland: “They don’t have them at the moment. Recruitment and retention continues to be a challenge and we are reaching out, both nationally and internationally, to get this.”

Asked how many consultants were working in the county, she said: “They have a number of consultants inputting.

“There are more than four consultants inputting but they are not full-time consultants and there are a number of arrangements in place.”

Pressed on how many consultants were working full time, she said: “There is no full-time consultant at this moment in time, as I understand.”

Dr Burke did not provide information on how many whole-time equivalents were working in the county and the HSE has been contacted for clarification.

She said there was “widespread acknowledgement” of workforce challenges in CAMHS both nationally and internationally, adding that it is a particular issue in rural areas.

“We have a plan to to remediate that but it’s something that takes consistent year-on-year funding and a clear recruitment strategy,” she added.

The North Kerry report investigated 374 files and found “a risk of potential for harm” in 55.8% of cases – with most being of “moderate/major” level.

Key findings from the report included a high rate of prescribing of psychotropic medication, failures in compliance with recommended physical health assessment and monitoring and a disproportionately low rate of individual or family/systemic psychotherapeutic interventions.

The report said this is inconsistent with standard practice in CAMHS nationally.

Seventy-nine percent of patients attending “generic” North Kerry CAMHS were prescribed psychotropic medication during the period of the review, well above the 39% national rate.

The prescription of two or more psychotropic medications at the same time was also noted as a concerning feature.

Inadequate physical health assessment was found to be the most common reason for potential for harm.

A large number of cases reviewed were found to have gaps in essential cardiovascular monitoring required for the prescribed medication.

Risperidone, a neuroleptic medication (anti-psychotic), and guanfacine (an ADHD medication) were prescribed more than the national average.

These medications were found to be associated with side effects, in particular weight gain and sedation.

The report also found limited availability of follow-up psychotherapy.

Mary Butler, the Minister of State with responsibility for mental health, is to meet with affected families this week.