Seven child psychiatrists working ‘mix of full and part-time’ in Kerry

There are seven child psychiatrists working in Kerry, according to the Health Service Executive, equating to 3.7 full-time consultants in the region.

These consultants are working a mix of full-time and part-time hours, and the service is also relying on the use of remote appointments.

The chief executive of the HSE has apologised “unequivocally” to affected families after a report into Child and Adolescent Mental Health Services (CAMHS) in North Kerry found it was resourced significantly below what is recommended under national policy.

The review said the county should have a minimum of four full-resourced dedicated CAMHS teams, including four consultant child and adolescent psychiatrists and full multidisciplinary teams.

On Thursday morning, the HSE’s clinical lead for youth mental health Dr Amanda Burke said there was not currently any consultant working full-time on CAMHS in the county.

Dr Burke’s remarks sparked concern in the Dail, with Labour TD Marie Sherlock questioning how it could be the case that there was no full-time psychiatrist in the region.

Ms Sherlock said the review into services in Kerry painted a picture “akin to the wild west”.

The HSE later clarified there were seven consultant psychiatrists working in CAMHS in Co Kerry across two teams equating to 3.7 whole-time equivalents, working a mix of full-time and part-time both on-site and remotely.

It said that it has used telemedicine remote appointments amid significant recruitment challenges.

Mary Butler, Minister of State for Mental Health, was in Kerry to meet affected families on Thursday.

The 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.

The spokesperson for Ms Butler, who is the Minister of State responsible for mental health, added: “Efforts are continuing to recruit permanent consultant psychiatrists, however the availability of consultant psychiatrists continues to be a global challenge.”

Earlier, Dr Burke told RTE’s Morning Ireland: “Recruitment and retention continues to be a challenge and we are reaching out, both nationally and internationally, to get this.”

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.”

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.

In a statement on Thursday, HSE chief executive Bernard Gloster said it would continue a “significant programme of service improvement and investment” to ensure the recommendations are implemented.

“I am conscious that for the people of Kerry and indeed CAMHS service users across the country that their confidence has been eroded,” he said.

“While all of our improvements are good and welcome, there is no doubt but that our services in Kerry were so far below the acceptable standards as to cause risk of harm.

“That is unacceptable, it is not good enough and for that I am sincerely sorry.

“I have also clarified that the HSE has made a referral to the Medical Council in this case, and it is important that their assessment is allowed to progress.”