A national audit of prescribing in Child and Adolescent Mental Health Services (CAMHS)

Abstract

Abstract Introduction Specialist Child and Adolescent Mental Health Services (CAMHS) provide essential support to the mental well-being of young people. Concerns regarding CAMHS delivery in Ireland have been brought to the fore since 2022 and the publication of the Maskey report; this report presented the findings from a review into the care delivered in one region of Ireland and highlighted risk of harm to children and young people due to deviation from clinical best practice.[1] Following the report’s publication, a national audit of CAMHS prescribing practice was requested by the Minister for Mental Health and Older People. Aim To conduct an audit of prescribing in CAMHS nationally and determine adherence to defined audit standards. Methods Every community CAMHS team in Ireland were requested to self-complete the audit on a random sample of 50 children under their care between 1st July 2021 and 31st December 2021, and prescribed medication during this period. An audit tool was developed by the audit team, based on issues identified in the Maskey report, and was sent electronically to each CAMHS team. The tool gathered data on demographics of children, disorders treated, medications prescribed, patient monitoring and communication. Adherence to six audit standards was evaluated. These standards were: i)involvement of a consultant in prescribing. ii)consent to medication by parent/guardian. iii)baseline physical assessment. iv)ongoing physical monitoring. v)communication with general practitioner. vi)follow-up review appointment arranged. The target for each standard was set at 95%. Data were analysed using the software STATA Version 17.0[2] Results The audit sample comprised 3528 children, representing 74 CAMHS teams nationally. More males were included in the sample (n=1955, 55.4%). The median age was 15 years, with a range of 4-17 years. -The majority of children (70.6%) were taking one medication, 24.2% were prescribed two medications and 4.6% were prescribed three medications. -54% of children were prescribed ADHD medications; 41.9% were prescribed an anti-depressant, 10.9% were prescribed an antipsychotic. -Most medications were prescribed within recommended dose ranges. -95% of prescribing was done under consultant supervision. -89% of children had consent to medication documented. -90% of children had baseline physical monitoring conducted prior to prescribing. -92% of children had ongoing physical monitoring conducted. -90% had documented communication with the child’s general practitioner. -98% of children had follow-up review appointments arranged. Conclusion This audit of 3528 children from 74 CAMHS teams is the first of its kind to highlight nationally the broad complexity in prescribing practices in CAMHS in Ireland. These data add to the limited literature on the nature of illnesses treated by CAMHS and the need for services. The work has several strengths and limitations; a key strength is that 100% compliance was achieved in terms of participation of community CAMHS teams, a limitation is that external validation of the data was not undertaken as it was not feasible in the timeframe available. Several recommendations, at national and community health organisation level, were derived from the results of this audit.