Mr. Mark Smyth:

On behalf of the Psychological Society of Ireland, PSI, I thank members for the opportunity to address the committee. One in three young people in Ireland is at risk of experiencing a mental disorder by the age of 13. This also coincides with when children make the often challenging transition from primary to secondary education and when their bodies are undergoing significant physiological and emotional changes.

Sharing the Vision recommends a stepped approach to care that would focus on promotion, prevention, early intervention, recovery and participation. Over time, this should reduce the need for more expensive acute and crisis response services. In this context, strategic investment in primary care services should be viewed as an investment rather than a cost. However, the current reality is that, as of August 2022, over 11,000 children were waiting for access to community primary care psychology services, with almost 4,000 children waiting more than a year for an appointment. That is 4,000 young lives prevented from accessing the supports that would see their difficulties reduced and overcome by spending over a year waiting for those supports. The additional investment in primary care psychology and mental health as part of the 2022 waiting list action plan was welcomed but there are not enough psychologists trained or available for sustained meaningful reductions in waiting lists.

The National Educational Psychological Service supports the personal, social and educational development of children in schools. This can be complex work that requires psychologists to become deeply involved in building trusting relationships with school communities. PSI welcomes the announcement in budget 2023 that NEPS will receive funding for an additional 54 psychologists to provide services to special schools and special classes. While this is a positive development, there will continue to be shortages of NEPS psychologists in schools due to there being no provision for cover for maternity leave. In a predominantly female-dominated profession, the impact of a lack of cover for maternity leave places additional unnecessary strains on psychological services to schools. In addition, inexplicably, the situation continues that trainee educational psychologists are expected to train for free for three years and pay thousands in fees each year. This is a direct impediment to attracting candidates to the profession as it is in direct contrast to other psychology professional training courses.

In contrast to the successful roll-out of the assistant psychologist, AP, grade in primary care psychology services, there is no current provision for employment of APs within NEPS. Employing APs could enhance NEPS service provision by freeing up qualified educational psychologists to complete the more complex work that they have been trained to do.

A clear causal line can be established between the oversubscribed specialist CAMHS and the failure to resource primary care psychology services to the extent required in providing evidence-based early intervention for children with mild to moderate mental health difficulties in school settings and in the community. Mental health support to staff, students and other members of the education community can help to reduce the frequency, length and impact of mental health difficulties that young people experience.

The successful adaptation and implementation of increased psychological supports within schools is constrained by several factors, with one factor predominating. Ireland does not have enough places on professional training programmes to meet current or future demands. Even if significant additional Government funding was to be provided to increase the numbers of psychologists in primary care psychology and NEPS posts, the reality is that we are not training enough psychologists to fill those posts.

The HSE report of the national psychological project team estimated a need for an additional 322 psychologists in mental health services alone. Each year, approximately 100 psychologists enter professional training programmes.

The key to the delivery of high-quality psychological services at primary care level, including in our schools, is the sufficient availability of skilled and trained personnel. There are significant shortfalls in the provision of psychological services due to inadequate staffing levels, which result in long waiting lists and significant difficulties in the recruitment and retention of trained staff.

One of the critical factors is the insufficient number of funded postgraduate training programmes. In 2000, the Department of Health, under the leadership of the then Minister for Health, the Taoiseach, Deputy Martin, responded swiftly to the requirement for the provision of extra training places by approving funding for a total of 30 additional trainee posts each year for three years. The PSI calls on the Government and the Taoiseach to show in budget 2023 the quality of leadership shown in 2000 and respond just as swiftly in 2023 to provide multi-annual funding to address the significant gaps in our psychological workforce. The PSI continues to call on the Government to fund an additional 50 trainee psychologist posts across the professional doctoral programme each year for a five-year period, which will necessitate an additional €2.45 million in funding per year or €12.25 million for the five years.

In psychology, there is the principle of Occam's razor. This posits that the simplest explanation is often the most correct. On why we have wholly unacceptable waiting lists for children and young people, the answer is that we have failed to train enough professional psychologists to meet previously predicted demand and this crisis in access will remain until additional funding for trainee place are provided.