In the north Kerry Child and Adolescent Mental Health Service (Camhs), children were twice as likely to be prescribed medication than they were to receive talking therapies.
Concerns around overreliance on pharmacological intervention have long been flagged both in Ireland and internationally. But in north Kerry, these concerns have now been borne out in hard statistics upon publication of the review into the service.
Of the 374 children whose files were examined during the independent look-back review, published on Wednesday, 79 per cent were on psychotropic medication, while just under 38 per cent received individual psychotherapeutic interventions.
Of course, medication has a role in the treatment of mental ill health but its prescription and monitoring must abide by clinical regulations to ensure safe and effective use.
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What happened in north Kerry illustrates why regulations are important and why they must be followed. Families have spoken out about children who attended services seeking help with anxiety or depression but left appearing almost sedated, and a shell of their former selves.
What the review also shows is how people who are neurodivergent or have an intellectual disability (ID) were disproportionately affected by increased prescription practices in this service.
“Children with a moderate to profound intellectual disability and mental disorder had no access to non-medical interventions,” the report said.
“There was a greater risk of potential for harm among Camhs ID patients, as baseline physical health assessment and monitoring were virtually absent.”
Some 46 per cent of patients in the north Kerry service had a confirmed or suspected diagnosis of autism. Almost all of these children were on medication.
The report highlights the risk of polypharmacy – the prescription of two or more psychotropic medications at the same time – as a significant concern.
Among those with an ID, 94 per cent were found to be on more than two of these medications. In 3 per cent of these cases, children were on seven of these medications, while 46 per cent were on three types.
The types of drugs being prescribed were also a cause for concern among the review team. Some 80 per cent of children with an ID attending the Camhs unit were taking antipsychotic medication, compared to 10.9 per cent of children attending Camhs nationally.
In 20 per cent of children with a moderate to profound ID, antipsychotic drug Olanzapine was prescribed.
But, the report said, the drug was “not licensed for the treatment of behaviours that challenge in children with an ID, nor is it standard practice to prescribe for this purpose”.
Anti-epileptic drug sodium valproate, also known as Epilim, was prescribed in 42 per cent of ID patients.
“Sodium valproate is not licensed to treat behavioural dysregulation or sleep difficulties in children with an ID and is not used in Camhs nationally. Its efficacy is not supported in literature,” the report added.
The length of time some children were on some drugs was inconsistent with “clinical guidelines”.
Risperidone is an antipsychotic drug that is recommended only for short term use. The report highlights, however, that children were prescribed it for up to 94 months, or almost eight years.
The difficulties faced by families of children with disabilities have in accessing healthcare and support is a regular headline.
Oftentimes, those on the waiting list to be seen by Camhs teams nationally are those who have a dual diagnosis of mental health difficulties and autism, ADHD or ID.
But in the cases outlined in the north Kerry report, the services were accessed but they did not provide care in line with guidelines of standard practice.
It is important to remember, too, that this report looks at just 374 patients who were on the database in November 2022.
With affected families calling for a broader look back to when the clinician at the centre of the controversy began working in the service, it seems reasonable to wonder: just how many more children were placed at risk of potential harm?
