Bold claim: A formal review of North Kerry CAMHS uncovers genuine risks of harm in a significant number of cases, and the findings demand careful scrutiny and action. But here’s where it gets controversial: the report also raises questions about how mental health services are staffed, funded, and governed, and what that means for children and families relying on them.
Overview
An independent assessment of the North Kerry Child and Adolescent Mental Health Services (CAMHS) identified potential harm in 209 cases. The Health Service Executive (HSE) commissioned the review, which evaluated 374 cases that were recorded as active in November 2022. The risk levels were categorized as follows: 195 cases with moderate risk, 2 cases with major risk, and 12 cases with minor risk. No cases were deemed to involve extreme harm.
Key findings and context
- The report highlights several clinical and systemic concerns, including a high rate of antipsychotic prescriptions, gaps in recommended physical health assessments and monitoring, and a low rate of individual or family psychotherapeutic interventions.
- It notes an absence of standard operating procedures across the service.
- A striking figure in the document is that 79% of patients at the generic CAMHS service were prescribed psychotropic medications, compared with 39% in the HSE National Audit of Prescribing 2023.
- Polypharmacy—giving two or more psychotropic medications concurrently—was identified as a worrying feature.
- Two medications, Risperidone (an antipsychotic) and Guanfacine (used for ADHD), were prescribed in Area B at rates above the national average. These drugs are associated with side effects such as weight gain and sedation.
- Sodium Valproate, typically an anti-epileptic, was used in 42% of cases to manage challenging behaviour and sleep issues. The report notes that in children with intellectual disability, Sodium Valproate is not licensed to treat behavioural dysregulation or sleep problems and is not used in CAMHS nationally.
Therapies and access
- Access to non-medical or “talking” therapies was limited, with long waiting times for psychotherapy when offered.
- The most common root cause of potential harm related to inadequate physical health assessment and monitoring, including gaps in essential cardiovascular monitoring for prescribed medications.
- Children with moderate to profound intellectual disability and a mental disorder reportedly had little access to non-medical interventions.
- About 46% of children attending CAMHS had a confirmed or suspected autism diagnosis, and nearly all of these children were prescribed psychotropic medications.
Resources and governance
- The CAMHS Area B Team's resources were significantly below levels recommended in national policy frameworks, notably A Vision for Change (2006) and Sharing the Vision (2020).
- The report stresses the need for strong governance structures and adequate resources to deliver safe, comprehensive care for all referred patients.
- There were frequent recommendations for patients to self-refer to external services such as Pieta House or Jigsaw, due to limited internal capacity at the time. Importantly, the report notes there was no CAMHS-specific service level agreement or governance arrangement for accessing therapies through these external agencies in the HSE Regional Area during the period reviewed.
Impact on families and the service
- More than 300 families receiving CAMHS care were sent copies of the review by registered post. The final report was completed on 5 November of the previous year and released to families ahead of broader public reporting.
- The review followed a random audit of 50 files that flagged “potential concerns” in the care of 16 children, with most issues revolving around prescribing practices and some concerns about a clinician’s practice (the clinician in question is not currently practising medicine).
- Publication delays were attributed to the scale of findings.
Context and prior investigations
- A 2022 preliminary review of CAMHS in South Kerry, examining care for about 1,300 children, found that 227 had been exposed to the risk of serious harm and 46 had suffered significant harm. Early indications suggest the current North Kerry findings could be similarly troubling, and the HSE has already issued apologies to many of those whose files were examined.
What this means going forward
- The report underscores an urgent need to rebuild robust governance, expand and standardize access to non-medical therapies, and ensure consistent, guideline-concordant physical health monitoring for youths on psychotropic medications.
- It also prompts important questions about how best to balance rapid access to pharmacological treatment with safe, evidence-based non-pharmacological options, particularly for neurodevelopmental conditions and autism spectrum disorders.
Controversy and discussion prompts
- Should high rates of psychotropic prescribing and polypharmacy in CAMHS be interpreted as appropriate short-term management or a sign of systemic under-resourcing and limited therapy options?
- How far should external community services be used as substitutes for in-house CAMHS therapies, and what governance is needed to coordinate care safely across providers?
- Is it defensible to prescribe sodium valproate for behavioural or sleep issues in children with intellectual disability when national guidance cautions against it in these circumstances? What safeguards should be in place if such practices continue?
What would you like to see improved in CAMHS based on these findings? Do you think the balance between medication and therapy is currently appropriate, or should there be a stronger emphasis on non-pharmacological interventions? Share your thoughts in the comments.
