CAMHS scandal: The bigger questions we are avoiding

A damning review is published.
A family speaks publicly.
A legal case emerges.

As is happening this week given the North Kerry Child and Adolescent Mental Health Services (CAMHS) review publication, we tend to hear about problems in our mental health services only when something goes badly wrong. For a brief moment in the news cycle, the problems pierce public consciousness and causes outrage. Prescribing practices and polypharmacy are questioned. Adverse effects and the limitations of the medical model are acknowledged.  Apologies are made. Plans for reform are drafted.

Then attention moves on.

But what if the issues that surface in these moments are not exceptional at all?

What if heavy reliance on medication, multiple concurrent prescriptions, limited access to talk therapy, and under-recognised adverse reactions are not failures of the system, but features of how it is designed?

Structural issues

CAMHS is consultant-led. Psychiatrists sit at the top of the service hierarchy. Their primary functions are to diagnose, prescribe, determine risk and monitor medication. Other disciplines — psychology, social work, occupational therapy, nursing — contribute, but within a structure overseen by medical authority.

This structure matters.

When psychiatry is the dominant organising force, pharmacological treatment inevitably remains central. That is not accidental; it is a design feature of the current system. And arguably, little will change until that structure changes.

Questions about this concentration of power have been raised by service users, human rights advocates, and international bodies. Even the Psychological Society of Ireland has publicly argued that psychiatry should not be in sole charge of youth mental health services, calling for shared governance and genuinely multidisciplinary leadership. The principle behind that position is simple: complex emotional distress in young people cannot be adequately addressed through a medication-centred lens. Yet in practice, medication remains the primary intervention.

Polypharmacy and the normalisation of risk

Once medication enters the picture, complexity can escalate quickly.

An antidepressant is prescribed and perhaps agitation follows; an antipsychotic is added. Sleep is disrupted; sedation is introduced. Concentration problems emerge; further medication is considered. Two, three, sometimes more psychotropic drugs become routine.

These were precisely the kinds of issues highlighted in the Kerry CAMHS review.

Each step may be defensible in isolation but together, they create a pharmacological web that is difficult to disentangle and increasingly risky, particularly in developing brains.

These risks are not speculative. They are acknowledged in guidelines, regulatory warnings, and academic literature. Psychiatrists such as Dr Pat Bracken, Prof Joanna Moncrieff and Prof Peter C. Gøtzsche, to name a few,  have long warned about these issues. In particular, Prof Moncrieff has argued that psychiatric drugs create altered mental states rather than correcting known biological abnormalities, and that withdrawal and long-term effects are often under-acknowledged.

Antipsychotics are associated with metabolic syndrome, cardiac risks, sedation, emotional blunting and movement disorders. Antidepressants can provoke agitation and increase suicidal ideation in some young people, particularly early in treatment. Withdrawal syndromes — often mistaken for relapse — are increasingly recognised across psychiatric drug classes.

Allowing these practices to continue without serious structural reform becomes more than a design problem. It becomes a question of leadership, vision and willingness to confront what the research has long made clear.

Informed consent

If the risks of these drugs are widely known in academic literature, are families being meaningfully informed?

Parents are told medication may help but informed consent requires more than listing side effects. It requires transparent discussion of benefit magnitude, long-term unknowns, and reasonable alternatives.

This is not simply a clinical issue but a legal and ethical one. 

Human rights law requires systems that protect vulnerable people from serious harm. Under Article 3 of the European Convention on Human Rights, the State has a positive obligation to have in place effective regulatory and oversight systems to protect individuals — particularly vulnerable people such as children— from inhuman or degrading treatment within public services. 

When the risks associated with powerful psychiatric medications are well documented, the question becomes whether oversight, monitoring and informed consent mechanisms are robust enough to meet that obligation?

Uncomfortable truths

This brings us to the most uncomfortable issue.

Psychiatric drugs are often justified on the basis that they correct underlying biological dysfunction. Yet after decades of research, no specific biological abnormality has been reliably identified for conditions such as depression or bipolar disorder (or any other psychiatric diagnosis) in the way insulin deficiency defines diabetes.

This does not mean distress is unreal. It means the mechanism of pharmacological intervention when someone presents with distress remains uncertain. So, if a drug is not correcting a known pathology, what justifies medium- to long-term use — especially in children?

In most areas of medicine, the more invasive the intervention, the stronger the evidence required. Psychiatric drugs are biologically powerful. They alter neurotransmission- the fundamental process by which neurons communicate – metabolism, and sometimes brain structure. If we are not certain what they are ‘correcting,’ and their risks are substantial, then transparency, caution and proportionality surely are not optional.

Beyond crisis-driven reform

This week’s report into CAMHS services in Kerry has reignited the mental health debate once again, but if we only interrogate the system when crisis erupts, we will continue to miss what is happening every day.

The more pervasive harm is quieter: young people living with long-term sedation, emotional blunting and diminished autonomy. Some will age into adult services, carrying diagnoses and prescriptions that become increasingly harder to unwind. This is where issues become entrenched and long term illnesses, rather than something that, if treated differently, could just have been an episode of unwellness, for whatever the reason may be.

This is not about demonising psychiatry or denying that medication can help some young people in acute distress. It is about recognising that when a system is built around prescribing medication, reform cannot mean simply adding more psychiatrists, as this merely scales the same model.

Real reform must mean redistributing power: genuine shared governance, access to therapy, access to medication free approaches, such as Open Dialogue as well as transparent and careful de-prescribing. What’s also required is a good dose of humility and honesty about what psychiatric drugs can and cannot do. This is the very least our young people and their families deserve.

Because the central questions are no longer avoidable: If we are not certain what these drugs are doing to young people’s brains and bodies, how have they become a default response to childhood distress? And to the wider CAMHS structural issue – how can a medically orientated system deal with complex human emotions such as sadness, distress, anger, and low self esteem? By its fundamental design, it cannot.