Mr. Bernard Gloster:

I apologise for the rescheduling that had to happen because of my diary. I want to recognise that with committee members and thank them for the welcome back. There are times when I wish I was back here all the time. I always found this to be a very supportive committee and one in which constructive work is done.

I am conscious that this is my first committee appearance since the incidents in Dublin two weeks ago. I take this opportunity, as this is the children's committee, to express my support for and indeed my good wishes to the families of the children who were caught up in that incident. I have obviously been closely connected to it because of our involvement. I express our good wishes to everybody who was affected by those incidents.

I thank the committee for the invitation to meet today to discuss access to CAMHS for individuals with dual diagnosis. I am joined by my colleagues Ms Mellany McLoone, chief officer of CHO Dublin north city and county and Dr. Amanda Burke, executive clinical director for mental health in the CHO 2 area up until recently. She is a consultant child psychiatrist on the specialist register and has just taken the first new national role of a dedicated national clinical lead for child and adolescent mental health services. I am grateful to her for taking that role and for the experience she brings to it. She will assist the committee this evening in some of its deliberation. I am also supported by Mr. Ray Mitchell and Ms Sara Maxwell from my office.

The range of services and supports for children and young people is extensive and is provided in acute and community settings. The HSE also works with and funds a number of providers in the voluntary sector to support the provision of services to children and young people. There has been an increased demand for mental health and disability services over a number of years, which has led to challenges for access including waiting times and sometimes disjointed pathways. It is of concern to me that at times, our patients and their families face challenges in accessing our CAMHS and our disability services and the following is indicative of our approach to attempting to resolve some of those challenges. The HSE has prioritised targeted service improvements to streamline referrals and to ensure patients get the right service at the right time. These include the national policy on access to services for children and young people with disability and developmental delay, which is designed to ensure that children are directed to the appropriate service based on the complexity of their presenting need; joint working protocols between HSE primary care, disability services and CAMHS to make the referral process between services as easy as possible for families and clinicians to navigate; and the child and adolescent mental health services operational guideline, which was published in June 2019 and highlights the importance of joint working or shared care with other agencies, including HSE primary care, children's disability network teams, CDNTs, and other agencies supporting children and adolescents such as Tusla, the Garda and the education services. In addition, the model of service for CAMHS-ID provides a framework for the development of specialist mental health services for children and adolescents with an intellectual disability, so that they can access services in the same way as their peers.

The final report into CAMHS was published by the Mental Health Commission in July this year and the findings have been accepted in full by me and by the HSE. Together with the Maskey report and the findings from HSE-commissioned audits on prescribing practices, adherence to the CAMHS operational guidelines and service user experiences, these findings are directly contributing to the HSE’s programme of work to improve services. Some of those improvements include piloting a standard autism assessment approach and protocol for use across all parts of the health service; piloting a central referral mechanism within CHOs for all specialist community paediatric services in the area. This will provide a single point of access, a more integrated service user journey and help to eliminate the practice of multiple, parallel referrals to different services; implementing a child and youth mental health improvement programme led by a dedicated national office with Dr. Burke and a dedicated assistant national director leading that service and separating it from our adult mental health services. This arose from the Mental Health Commission’s review of CAMHS, and our own internal audit of prescribing practices.

The model of care for dual diagnosis, namely, coexisting mental health and addiction, was launched jointly by the Minister of State, Deputy Butler, and the Minister of State, Deputy Naughton, in May 2023. This model of care outlines specialist services to support individuals with a dual diagnosis including specialist services for adolescents aged between ten and 17 years. The roadmap for service improvement for disability services for children and young people was launched by the Government and the HSE in October 2023 and aims to ensure children are referred to the most appropriate service; reduce the waiting time for children and improve outcomes; optimise use of voluntary and private disability service providers for assessments and interventions; improve the HSE’s legislative compliance for assessment of need, AON; and improve staff retention in CDNTs by being good places to work. Many of the 60 actions contained in this roadmap are already being progressed.

Assessment of need compliance continues to be a challenge, which remains a concern for me.

Some 7,612 applications for assessment of need were received in the most recent four quarters, the highest number of applications received in any 12-month period since Part 2 of the Act was commenced as far back as June 2007. A revised assessment of need standard operating procedure incorporating guidance on completion of clinical assessment was issued in July. The HSE continues to explore all options, including additional procurement from the private sector. Assessment of need administrative and assessment hubs are now in place to streamline assessment of need processes. It is important to note that children do not require an assessment of need to access a children's disability network team or primary care service.

A number of service improvements are being introduced to improve access to services for people with autism. A programme board with representation from persons with lived experience of autism is leading out on agreed priorities, including a programme of awareness raising to provide better information for autistic people and their families to improve access to services and support, for a better understanding of autism and to provide guidance to clinicians and service providers. It also aims to build professional capacity and competence among key professionals working with people who experience autism, including piloting the implementation of a tiered model of assessment. In addition to the measures outlined above, it is my intention to see the HSE, at all levels, increase and enhance our joint working with other sectors with responsibility for the well-being of our young people, including education, youth services and Tusla. I wish to place on the record of this committee that I recognise that our services are not anywhere near up to the par we want them to be. Substantial plans are in place to get there but it is complex and difficult. For some time to come, I envisage that we will continue to see young people experiencing challenges in our services.