Professor Joyce O'Connor:

I thank the committee for giving me the opportunity to attend today. I have a written submission but will not read it. I just want to make one proposal, which is on addressing excessive and unacceptable waiting lists. Before I make it, I must congratulate Senator Joan Freeman and her colleagues on putting a spotlight on the issue of mental health. It is very much needed. All the submissions have very clearly defined what the problems are. What comes across to me is the determination of Senator Freeman, the Minister, the HSE representatives and all the others who presented in positing the high priority of children. They have defined the issues very clearly. In the spirit of Mr. Gibson, I ask that the case study he gave on a particular child be used in drawing attention to the immediate priority of addressing waiting lists. Through Senator Freeman, I ask the Minister to establish, through his office, a national task force to address this issue as a matter of priority.

Waiting lists create enormous problems for parents.

Last week, I was very moved when I heard what parents had to say and the issues they addressed. We know that the longer young people and adolescents wait to be assessed, the greater their problems and the more difficulties are created for families.

The acting national director of mental health services, Mr. Jim Ryan, is here today. He could give leadership and organise a response. He could do exactly what Mr. Jim Gibson and the Ombudsman for Children, Dr. Muldoon, talked about and adopt a child centred approach and respond in an integrated and co-ordinated manner. How can it be done? A structure already exists because there are nine community health care organisations that lead in mental health. We should avail of all of the services that are available. Myriad services are available and not only ones that are statutory to the HSE. We also have the Jigsaw and Spun Out organisations in the voluntary sector. A whole range of services is available but I will not list them. There is also the independent sector of which the Dean Clinics are an example. The National Treatment Purchase Fund should be used to address this issue, if necessary. I ask that all of these resources are brought together in a way that will address the issues created by waiting lists.

I do not underestimate the funding, recruitment and staff retention issues as they have been well documented. They are issues for the future. They will not be solved immediately and will take a long time to be resolved. As Dr. Muldoon has said, there are cultural issues involved. We need to know how the services work and not just focus on additional resources. We also need to know the process of referral, triage, assessment and intervention.

It is important to note, and for Senator Freeman and her committee to see, that there is a suitable model available for review and possible modification. I hate to say it but the Gordan Lynch and Elma Hedderman study was conducted as long ago as 2006. It clearly showed that more streamlined triage practices can significantly speed up triage and assessment, and reduce waiting times from a year to just a few weeks. As suggested earlier, triage can be undertaken by nurse practitioners and other experienced members of a multidisciplinary team. As we know, mental health issues cover a wide span and triage is a very good way to address the issues quickly.

Other researchers called Aisling Ní Shiothcháin and Michael Byrne carried out a review on best practice and analysed waiting list management and initiatives in 2009. They have produced a 14-point plan on how to do so and they would say, as I would, that managing the waiting list is key. Waiting lists are unacceptable. Young people and their families are suffering on a daily basis and their situation can deteriorate. Early intervention could help alleviate the problem. We know that early intervention is important in so many areas, particularly young people's potential in their future lives.

I suggest that we address the problem in an immediate fashion. The Minister of State may be shocked to hear that this issue could be resolved by Christmas if we adopted a focused approach. I believe we can do it because there is a structure already in place, we have limited resources in the community, we have community care organisations that operate under the director of mental health services, we have evidence-based research in how to address the problem through referral, triage and interventions, and we have a 14-point plan. I sense here today, and having heard the submissions this morning and watched proceedings last week, that people want this issue to be resolved. We have the belief but in this case we need the focus, we need the use of evidence-based practice and we need good leadership. I think we should celebrate this and give a plan to the HSE to see how this can be done in the future in a cost-effective manner but, more importantly, in a way that addresses the needs of young children, adolescents and their families.