James Browne (Wexford, Fianna Fail) | Oireachtas source

If this was a once-off and from one person, we would not notice it but I have served on this committee and the Committee on the Future of Healthcare. Trade unions, voluntary groups, individuals, professional representative bodies and everybody else get their stuff in on time but with the HSE it is a common and consistent practice that a massive amount of information is dumped on us the night before. It drowns us in information. It is clearly a systemic policy and deliberate as it happens every time. I am not having a go at Ms Mannion but it is clearly a policy of the HSE. It happens at every committee at which it is to be represented.

It has been stated that recruitment is the single biggest challenge for mental health services but it is clearly also the biggest failing in mental health services, particularly for children. It is evident right down to basic services, where there is a lack of talk therapy and psychologists, as well as in the acute services such as CAMHS, access to accident and emergency departments, training and awareness of staff. It is a crisis and children are being irrevocably damaged to the point where some are losing their lives. We know this. General staffing levels are approximately at 75% of those recommended in A Vision for Change. The level is at approximately 56% of the recommendations for CAMHS, although it seems to go up and down a small bit, and it is similar for old-age psychiatry. Mental health and intellectual disability staffing is pretty much non-existent. There are consistency problems and there is gatekeeping going on. In some areas if somebody comes in with an autism diagnosis, they are not welcome and have to go somewhere else. Mental health and intellectual disability services are pretty much non-existent.

There are over 100 nurses on panels seeking jobs in CAMHS but they are not being given jobs because they are on general panels. We are consistently told they are seeking jobs where they are not needed, which is amazing. Apparently they will not go where the HSE say they are needed. I am not aware of too many places in mental health where there are too many staff. I would like an explanation again as to why there are so many nurses on panels waiting for jobs.

There is a serious shortage of psychiatrists but the College of Psychiatrists in Ireland sought a 10% increase in the number of training places this year. The HSE only approved a 5% increase. I would like an explanation as to why that is so. The college wants to train more psychiatrists and it has the people but the HSE is refusing to increase the number of places. We heard from Mr. Peter Hughes about the 34% retirement figure but I speak regularly with psychiatric nurses and many of them just want to get out. It is not that pay is not important - it is for everybody - but conditions are intolerable. There is a level of stress and one of the consistent issues that arise is the mental health of psychiatric nurses, psychiatrists and other staff working in the area. They are trying to do the impossible and they are consistently triaging. I am very familiar with Wexford and I know many of the families effectively being triaged. Psychiatrists and other staff in Wexford have my sympathy as it must be horrendous to have to look at families and children, constantly trying to triage and decide who is in the worst position.

It seems such a situation is becoming normalised, with acceptance of the genuine difficulties in recruitment. Mr. Hughes pointed out the number of unnecessary blocks being put in the way, which we saw with psychologists in particular. For a long time anybody not trained as a clinical psychologist was simply being blocked from going into mental health services. They may have been trained in other areas, such as counselling psychology, for example. Last year many ad hoc blockages were evident; for example, a person might have been fully qualified but had not done two weeks of training in a particular aspect. Such blocks were seen by people who wanted to enter the mental health area. Everybody is massively frustrated at this stage.

We must deal with this as an emergency. In Waterford and Wexford, by 1 August, as I understand it, there will be no practising psychiatrist. There are 3.6 full-time equivalents down there but one is on sick leave and the other 2.6 are leaving. The non-consultant hospital doctors, psychologists, occupational therapists and all the staff working under psychiatrists can no longer do their jobs effectively because there is nobody to oversee what they do. Will they be redeployed? If they are redeployed, what psychiatrist will come to the area? Speaking with consultants from outside the country looking at coming to Ireland, they say their lack of interest is not just about pay but the lack of an office, secretary or staff. They would spend their first year trying to recruit people.

That was probably as much a rant as anything else, but the frustration in this area is real. We experience the frustration daily in our offices when dealing with the families and trying to represent them to get the supports they need. There are other families effectively competing for the supports, in particular for their children, which is horrendous as well.