‘A scandal’ - CAMHS flaws in Kilkenny services revealed in report

“Severe” staff shortages, long wait times and under funding have been revealed in a Mental Health Commission report into child and adolescent mental health services in Kilkenny.

The damning report, published last week, also revealed that basic health checks are not always carried out before medication is prescribed to children and young people, and ongoing health checks for young people on medication, including anti-psychotics, are not always carried out.

Despite the highly skilled staff who ‘wanted to provide child and family-focused care and treatment’ underfunding meant they ‘were frustrated at the lack of resources to do so’, according to the Commission.

CAMHS, the HSE’s Child and Adolescent Mental Health Service, refers very specifically to services that provide specialist mental health treatment and care to young people up to 18 years of age, through a multidisciplinary team.

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Kilkenny is part of the HSE CHO5 area (Community Healthcare) with a number of other counties.
Among the findings by the Mental Health Commission were that CHO5 has severe staff shortages, long waiting lists, poor access to out of hours and inpatient care.

Unsettling facts in the report include the lack of health checks on children and adolescents before and during the use of medication.

For the purpose of this review, the Commission focused on three types of medication: ADHD, anti-psychotic and anti-depressant medication. In their sample, 37% of children/adolescents were on ADHD medication, 20% antipsychotic medication and 58% on antidepressant medication (some could be on more than one type of medication).

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For those prescribed antipsychotic medication, pre-prescription health checks including pulse, blood pressure, height and weight were not completed in more than 70% of cases.

Once medication is prescribed the number of patients monitored were: 60% for those on ADHD medication, 30% for those on antipsychotic medication and just over 60% for those on antidepressants.
Some children do not tolerate physical checks, the report notes.

Meanwhile, staffing in the Carlow/Kilkenny area is just 51% of the level recommended by the national health policy A Vision for Change (AVfC), launched 16 years ago.

The Commission points to underfunding as a main source of problems in the area. “CHO 5 has been underfunded for a number of years to provide a comprehensive CAMHS service. In 2017, it had the second lowest funding per capita across the CHOs and it remains well below the national average.”
CAMHS funding in the CHO5 area was €62.60 per head in 2022, while the national average was €85.30.

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Some of the other stark findings of the report include:
Risk training had taken place, but this was not mandatory. Some risks had been identified, such as lack of staff and poor facilities. A number of teams appeared confused about how they escalated local risk – whether they escalated to their line manager or the clinical lead, who was the consultant psychiatrist, or to both.

Transitioning young people at 18 was reported to be difficult across CHO5 and they were not always accepted by Adult Mental Health Services (AMHS). For example, a number of CAMHS teams stated that if Autism Spectrum Disorder (ASD) was part of diagnosis, or young person had ADHD, they not accepted by AMHS.

There were very few clinical audits carried out in CHO5. Teams were aware of the importance of regular clinical audits such as medication audits, but said that due to the poor staffing of teams, all time was spent on assessments and interventions with children and their families.
The full report can be read on the Mental Health Commission website: https://www.mhcirl.ie/