Many children experience anxiety and worry from time to time, and as a result, they may act out in disruptive ways. Children without a mental disorder may perform differently than children with a recognised mental problem, and children with the same diagnosed mental disease may have different strengths and limitations in their development, coping, and quality of life. Some of the common mental disorders in children are Depression, Generalised anxiety disorder, Post-traumatic stress disorder, Attention deficit hyperactivity disorder(ADHD), and Eating disorders. But the HSE audit decided to maintain a complete focus on ADHD in children and narrowed down its audit. The chair of the Mental Health Commission expressed reservations about an audit aimed at determining whether flaws discovered in the South Kerry Child and Adolescent Mental Health Services(CAMHS) affair are repeated elsewhere.The Health, Safety and Environment(HSE) have stated that it will begin its investigation by focusing on CAMHS cases involving young people with ADHD, with the possibility of widening the scope of the investigation later.
A study committee chaired by Dr Sean Maskey, a London-based consultant child and adolescent psychiatrist, reported that 46 of the 1,300 children who attended South Kerry CAMHS suffered a serious injury. It also discovered that 227 children treated by a junior doctor employed by the organisation were at risk of serious injury as a result of the doctor’s diagnosis and treatment. John Saunders tells Minister for Mental Health Mary Butler in a letter obtained through a Freedom of Information request that the HSE has reduced the scope of the national audit too much and is thus not implementing the Maskey report’s recommendations. The HSE has stated that it will begin its investigation by focusing on CAMHS cases involving young people with ADHD, with the possibility of expanding the scope of the investigation later. While the HSE stated that it was a recommendation of the Maskey Report – a position it also stated in front of an Oireachtas Committee – Mr Saunders’ strongly worded letter to Mary Butler on March 8 argues that the HSE should conduct a complete audit. He went on to say that the Maskey Report’s advice isn’t limited to ADHD. The Mental Health Counsellor(MHC) believes that if Dr. Maskey had planned to do so, he would have stated so clearly.
According to one of the HSE’s communications to you, the audit of prescribing practise could lead to a complete national clinical audit, leading to significant changes in the treatment of this vulnerable population. How can the HSE reconcile this claim with the fact that the audit was confined to ADHD cases? The MHC believes that the HSE’s attention on ADHD is insufficient and incomplete. Anne O’Connor, HSE Chief Operations Officer, wrote to the Minister on February 18 about the “risks involved in broadening the scope of the audit,” including that “the abrupt discontinuation of medication for any diagnosis is frequently associated with withdrawal symptoms that can result in very significant harm in and of themselves.” As a result, she says, it’s critical that the public messaging surrounding the audit emphasises this fact and strongly warns against stopping these prescriptions without first obtaining medical advice. John Saunders, on the other hand, wrote to the Minister: “What was the source of the remark to drug withdrawal? Choosing and documenting the grounds for prescribing such medication, as well as closely monitoring it to guarantee the child’s safety and well-being, is a matter of professional discretion. Is there any evidence to support the Minister’s claim?” Ms O’Connor’s February 18 letter also mentions the HSE meeting with the Attorney General’s Office and the States Claims Agency (SCA) “in the context of any redress scheme in this regard,” adding, “In these conversations, the SCA stated that “The proposal to widen the scope introduces a considerable additional risk iterms of defining who is covered by any plan and the Clinical Indemnity Scheme’s financial liability.”
The MHC is particularly concerned that the HSE is using the limited scope of the Maskey Report compensation programme as an excuse to avoid undertaking an audit for the safety and benefit of children in the state. In his letter to the Minister, Mr. Saunders said. “According to Dr. Philip Dodd of the Department of Health’s Mental Health Unit, the HSE prefers to complete an audit of prescribing practices focusing on ADHD in the first instance, rather than including a range of conditions, as examined by Minister Butler, in an email to Orla Keane of the Mental Health Commission on February 28. Minister Butler stated that a full and expanded audit had always been her preference and that the HSE and the Department of Health had now agreed on it “as a result of multiple meetings and exchanges of correspondence, as per my desire from the beginning.”
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