Mary Butler (Waterford, Fianna Fail) | Oireachtas source

I am pleased to join the Leas-Chathaoirleach and members of the committee and to contribute to this important debate on services and supports provided by the State for autistic people. I thank the committee for bringing this matter to the attention of the Seanad. I particularly welcome the opportunity to discuss access to mental health services and congratulate the committee on all the work it has done to put a focus on autistic people.

The Government remains committed to the development of all aspects of mental health services nationally, including for those with a diagnosis of autism. The Government acknowledges the needs of people presenting with autism. Mental health difficulties can be complex and access to services has posed challenges. Both I and the Department of Health are actively working to improve access, signpost resources and use policy and legislative changes to drive improvement. The commitment to improving access to mental health services can be seen through increased funding provided by the Government to mental health. The total allocation for mental health services in 2023 is over €1.2 billion, which is nearly 20% higher than when this Government came into power. This funding allows for a continued focus on improving services and reducing waiting lists for both CAMHS and primary care psychology.

While I remain committed to mental health service improvement, my colleague, the Minister of State with responsibility for disability, Deputy Rabbitte, has brought the same drive and conviction to autism, and she announced the Government’s intention to develop an autism innovation strategy in 2021 to advance the programme for Government commitment to national action on autism. The strategy is in progress. There was an initial public consultation in April 2022 that sought views on the main challenges and barriers facing autistic people in Ireland. Importantly, it provided suggested actions for a future strategy. Work on this continues and a report analysing the feedback from this public consultation was published this April to mark Autism Awareness Month 2023. In addition, in late 2022, following an application process, the Department of Children, Equality, Disability, Integration and Youth also appointed the autism innovation oversight and advisory group. It is intended that, in collaboration with that group, a further public consultation will be convened later in the year before the strategy is finalised. It is the ambition of the Minister of State, Deputy Rabbitte, and the Government, that the strategy will provide the building blocks for Ireland to become a more autism-inclusive country. Equally, the programme for Government contains a commitment to improving all aspects of mental health in line with Sharing the Vision, the national mental health policy, and Connecting for Life, Ireland’s national strategy to reduce the incidence of suicide.

On mental health services for children and adults with autism, recommendation 20 of Sharing the Vision highlights the need for further development of early intervention and assessment services in the primary care sector for children with attention deficit hyperactivity disorder, ADHD, and autism to include comprehensive multidisciplinary and paediatric assessment and mental health consultation with the relevant community mental health team, CMHT, where necessary. This policy recommendation has been developed specifically to ensure services are aligned so children and their families can access the most appropriate care and supports from the correct care providers as soon as possible. The implementation of this recommendation is in process. Phase 1 of the piloting of an autism assessment and intervention protocol is complete. This programme requires integration across all services, including mental health, and work is underway to develop a pathway to address recommendations arising from phase 1 and to ensure the next two pilot sites, which will be CHOs 4 and 7, will commence. It will then be rolled out incrementally across all rest of the CHOs.

Assessment for those with autism spectrum disorder, ASD, is carried out by a multidisciplinary team that includes a speech and language therapist, an occupational therapist, a psychiatrist, a psychologist, a social worker and a paediatrician. Most clinical needs of children with a primary diagnosis of an ASD are normally best met in services such as HSE primary care or children’s disability network teams, CDNTs. The National Policy on Access to Services for Children & Young People with Disability & Developmental Delay was adopted nationally at the end of 2021. Children with complex or specialist needs requiring multidisciplinary or unidisciplinary support will be seen in primary care, where appropriate. Under the progressing disability services programme, children’s disability services have transitioned from early intervention teams and school-age teams to 0-18 CDNTs. Services are based on needs rather than diagnosis to optimise access.

HSE children’s disability services received funding for 190 posts in budget 2022. Budget 2023 provided for a further 136 posts to provide services in 104 special schools for children with complex needs. The overall funding in recent years provides for over 600 whole-time equivalent, WTE, posts. As with many other care groups, recruitment for disability network teams remains a challenge. The 2022 CDNT staff census notes an average vacancy rate of 34% across CHOs. This equates to approximately 700 WTEs. My colleague, the Minister of State, Deputy Rabbitte, in collaboration with the Department of Children, Equality, Disability, Integration and Youth and the HSE, continues to work collaborative to fully resource CDNTs to maximise capacity.

On access to mental health services for autistic people, it is important to note that mental health services are available to all children in this country regardless of whether they have a diagnosis of an ASD or any other condition. Where a child or adolescent presents with a moderate to severe mental health disorder and autism, it is the role of CAMHS to provide appropriate multidisciplinary mental health assessment and treatment for the mental disorder. This may involve joint working or shared care with other agencies. Access to CAMHS for children with ASD is specified in the CAMHS clinical operational guideline, COG, which was published in 2019 and sets out the core functions and remit of CAMHS. These guidelines are due for renewal this year. As such, any child with a moderate to severe mental health need, who also has a diagnosis of autism, can access CAMHS. However, CAMHS is not suitable for any child or adolescent where their mental health difficulties are milder. Nor is CAMHS suitable for children in need of interventions specifically regarding learning difficulties, social issues, behavioural challenges or mild to moderate mental health problems. This remains the case whether or not a child has a diagnosis of autism. Those who have a diagnosis of autism in conjunction with intellectual disability, but who do not meet the criteria for CAMHS will have their needs best met through HSE primary care and the children’s disability network teams.

The work of the Department of Health, the Department of Children, Equality, Disability, Integration, and Youth, and their agencies, is very much focused on ensuring that the needs of children and their families are met by the best services, in the correct locations and in a timely fashion. Our common goal is to improve access to care and crucial supports that are often so urgently needed for these children, who often have complicated care needs. Early assessment, early intervention and appropriate care remain central objectives. For example, the HSE is delivering targeted waiting list initiatives in both CAMHS and primary care child psychology by focusing on areas experiencing particular challenges in meeting service demand.

In the area of disability services, the HSE continues to drive a number of initiatives to reduce waiting times for children and families. These include sourcing therapy assessments and interventions externally via private service providers and the use of private providers enhancing CDNT capacity to support increased therapy interventions.

I take this opportunity to reiterate that the Government, the Department of Health, the HSE and all advocates in the sector share the committee's vision of continuous cross-sectoral service improvement for autism. I look forward to today’s discussion and to us working together to focus on the important themes on the agenda.