Dr. Louise Higgins:

On behalf of the Psychological Society of Ireland, I thank the Chairperson and members for the opportunity to address the committee. The PSI is the learned and professional body for psychology in the Republic of Ireland.

In 2022, the PSI published an updated version of the Professional Practice Guidelines for the Assessment, Formulation and Diagnosis of Autism in Children and Adolescents. These guidelines were developed to help facilitate a high level of professional practice for psychologists. However, one of the biggest challenges faced by families is accessing a timely assessment for their child, with many often waiting years. Those accessing an assessment through the assessment of need, AON, as set out under the Disability Act 2005, have significant and lengthy delays despite a legal requirement to begin the AON within three months of receiving an application. The High Court ruling last March, which found the HSE’s preliminary team assessment, PTA, method of dealing with AON applications was unlawful, has resulted in a situation where many of the approximately 10,000 PTAs completed need to be redone, specifically those requiring an autism assessment.

PTAs were introduced by the HSE in 2020, despite PSI and other health and social care profession, HSCP, representative bodies clearly stating this was not in the best interests of children.

PSI welcomed the Report on Assessments of Need for Children published recently by the Joint Committee on Children, Equality, Disability, Integration and Youth. PSI agrees with the committee's recommendation 4, which states: "There needs to be an acknowledgment of the levels of resourcing required at all levels politically and within the HSE, in order to address the crisis in the disability sector". While PSI welcomes the development of autism diagnostic pathways by the HSE, we and other HSCP representative bodies have not yet been consulted. We are eager to ensure the mistakes in the implementation of the AON PTAs are not replicated.

Accessing intervention and supports is a further challenge for families. Research in recent years continually highlights the level of unmet service need for autistic children, with many families waiting years for supports. As of March 2022, none of the 91 children's disability network teams, CDNTs, was fully staffed, with an average vacancy rate of approximately 25% across teams and some teams being staffed only to around 50%. The consequences for autistic children and their families of unmet service needs are significant. Failing to provide timely services and services at an early stage increases the costs at a later stage and has a negative impact for the individual, families and society.

Autistic people experience significantly higher rates of co-occurring mental health difficulties. However, the reality is that many autistic children and adolescents have difficulties accessing mental health services. In addition, there is often regional variation in the implementation of any shared care for autistic children and young people who require services from more than one service provider. The recent interim report of the Mental Health Commission on the independent review of the provision of child and adolescent mental health services, CAMHS, highlighted major failings. This undoubtedly impacts on autistic young people accessing CAMHS.

It is now recognised that autism is a lifelong neurodevelopmental condition. Currently, however, autistic adults in Ireland can only access an autism diagnosis privately. Furthermore, services for autistic adults are minimal. A clear pathway is required for the diagnostic assessment of adults presenting with autism and the provision of post-diagnostic support for them. PSI has established a working group to develop guidelines for the assessment of autism in adults.

As stated in the committee's Report on Assessments of Need for Children, "failures within disability services over the last number of years have caused immeasurable harm to children, parents and therapists". Given the years of under-resourcing of disability services, it is imperative that members of the autistic community get the support they need in a timely way. To this effect, PSI makes a number of recommendations. The number of training places on all professional psychology training courses should be increased to ensure the recruitment and retention of adequate professional psychologists to address the high level of service need and current vacancies. To improve recruitment and retention, there should be immediate funding for all trainee psychologists. There should be a clear timeline for the implementation of the Government's disability capacity review to 2032 to future-proof and resource disability services and the AON process adequately. There should be changes to the current recruitment practices for psychologists, including the HSE national panel system for recruiting, to tackle the recruitment crisis and staff retention issues. We recommend efforts to retain existing staff in post by creating the possibility to promote those eligible to senior positions following a competency-based review. At present, this is not possible within services and is managed through the national panel system. This results in a loss of experienced clinicians from the disability sector to other sectors. We also recommend the creation of an agreed lifespan pathway within the public system for assessment and post-diagnostic supports.

Further recommendations regarding policy and reducing barriers for the autistic community are outlined in the PSI's detailed written submission.

I thank the committee for its time and I am happy to take any questions on the opening statement.