Sir, – The recent independent review of North Kerry Child and Adolescent Mental Health Services (Camhs), which found that more than half of the children assessed were at potential risk of harm, represents a deeply concerning moment for affected young people and their families.
Where care has fallen short, and where harm may have occurred, this must be acknowledged openly and addressed transparently. Against the backdrop of prior CAMHS reviews and prescribing practices nationally, such findings have understandably eroded public confidence in prescribing and warrant careful national reflection.
Medication in child and adolescent psychiatry should follow the Goldilocks principle: not too much, not too little, but just the right amount. The right drug must be prescribed for the right condition, with careful consideration given to the individual child’s age, intellectual level, physical, mental and developmental profile, and available support structures.
Prescribing must be evidence-based, with side effects and therapeutic benefits carefully monitored, and continued when benefits clearly outweigh any adverse effects.
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Psychopharmacology does not occur in a vacuum. It must form part of a multimodal treatment plan, in which psychological therapies, family supports, educational input and community resources are provided in parallel.
Responsibility for the pharmacological component rests with appropriately trained medical practitioners and nurse prescribers, while other members of the multidisciplinary team provide psychological and psychosocial interventions, ensuring safe, integrated and proportionate care within a broader therapeutic framework.
In the public service, responsibility for ensuring the availability and quality of this comprehensive care rests with the HSE. Children and parents must remain central to the process, working collaboratively with clinicians, with their values and preferences respectfully weighed alongside clinical evidence.
Close monitoring of individual cases and regular system-wide reviews are essential. All clinicians must remain responsive to emerging research and new evidence. Medications should be prescribed according to established protocols, where available, to minimise inappropriate or idiosyncratic use.
It is likely that the future of psychopharmacology will be shaped by advances in pharmaceutical research, neuroscience and genetics, enabling more bespoke, targeted, and occasionally combination medication based on symptom clusters and individual biological profiles rather than solely traditional diagnostic categories.
In the right hands, for the right person and in the right setting, with appropriate supports, clinical oversight and robust governance, psychopharmacology can be a vital and effective component of care for young people and their families, offering significant benefit and helping them to fulfil their potential and live full lives.
To withhold such effective treatment would be indefensible. However, its provision must be guided by strong clinical governance and delivered by appropriately trained clinicians who remain responsive to emerging evidence, ensuring safe, well-monitored, equitable and economically responsible care so that access is fair for all who stand to benefit. – Yours, etc,
Prof Fiona McNicholas,
Consultant Child & Adolescent Psychiatrist at Lucena CAMHS & CHI, Crumlin
Department Chair in Child & Adolescent Psychiatry in UCD.
