Some of the youngsters sent abroad by the Government’s child protection agency were not first assessed or treated by mental healthcare services on the island, The Royal Gazette can reveal.The Government has always insisted that overseas treatment was to cater to “the needs of children who have exhausted the educational and therapeutic service options available in Bermuda”.But four out of 29 were not assessed or treated by mental healthcare services before they were sent abroad.All the children went to institutions in the United States, at an average annual cost to taxpayers of more than $180,000 each, as part of the Department of Child and Family Services’ psychoeducational programme.The DCFS said only 25 out of 29 children, or 86 per cent, sent abroad for the first time between 2015 and 2019 were assessed and/or treated by Child and Adolescent Services, at the Mid-Atlantic Wellness Institute, or by other Bermudian mental healthcare services.The statistics were revealed through a public access to information request from The Royal Gazette. The department said in a statement today: “All children sent abroad receive a local assessment. The professional assessment determines the specific needs required as part of the overall client treatment plan. In fact, overseas institutions do not accept clients from DCFS without an assessment and case file.”It added: “While all children receive assessments, not all clients require mental health assessments and/or services.“To reiterate, all children receive the appropriate assessments: 29 clients were assessed, 25 required mental health assessments and/or treatment, while four did not.”The department said: “The fact that 25 of the 29 cases received mental health assessments and/or services is further proof that each case plan is tailored to the specific needs of the child. “If upon assessment it is determined a child does not require mental health services, then to provide that course of treatment is not only unethical, it is in clear violation of professional standards. “During the time period referenced four clients presented issues that did not require mental health assessments or treatment and as such they received services designed for the presenting issues of each individual child.” The department released the total number of children from Bermuda who were at overseas institutions as part of the psychoeducational programme between April 1, 2015 and December 31, 2019, and how many of those had been sent abroad for the first time.There were:• 22 — eight of them new — in total between 2015 and 2016• 19 — six new — between 2016 and 2017• 21 — three new — between 2017 and 2018• 20 — ten new — between 2018 and 2019• 16 — two new — for the final nine months of 2019.The department was asked for the average annual cost of tuition per child sent abroad to a behavioural or treatment centre and the range of annual fees.The department said the information was already in the public domain through a notice in the Official Gazettein January, which listed contracts with the DCFS worth more than $50,000 a year.The notice listed 13 contracts, which ranged in value from $11,500 a month ($138,000 a year) for a “residential, educational, academic and therapeutic programme” in Utah to $36,225 a month ($434,700 a year) for a specialised programme that offered “medical, psychological and psychiatric services” in Massachusetts.It was not possible yesterday to confirm with the department that each contract involved an individual child. But the average annual cost of tuition per child amounted to $183,288 if they did. The annual average bill for taxpayers is close to $3.5 million as an average of 19 children are sent abroad every year.The department also released a list of 17 schools, all in the US, it has used since 2015. The Pati request asked for records to support a statement by the Ministry of Legal Affairs that DCFS workers visited children abroad every six months from their admission, and that Alfred Maybury, the department’s director, has a face-to-face visit with all children at least once a year. No records were released, but a list of dates of director and staff visits was provided, showing 70 trips by Mr Maybury and 73 trips by other staff between 2015 and 2019. The director visited Glen Mills, the reform school in Pennsylvania shut down last year for mistreatment and abuse of children, four times over the time frame. Other staff joined him on one of those visits and also made three separate visits. Mr Maybury visited West Ridge Academy in Utah, where Bermudian teenager Kirsta Simons died in November, seven times, including twice after her death. Staff joined him on three occasions and made four separate visits.The DCFS said it did not have statistics on children sent overseas who had ended up in jail after they returned to Bermuda, so could not release the information.• UPDATE: This article was amended to reiterate in the fourth paragraph — as was already stated in the first paragraph — that four youngsters were not assessed or treated by mental healthcare services before being sent abroad. Comments from a press release issued by the DCFS this afternoon have also been added. The headline has been edited to make clear the youngsters were sent abroad without mental health checks.