Kathleen Lynch (Cork North Central, Labour) | Oireachtas source

The additional funding for the Department of Health this year will ensure services are provided for people on a daily basis. As the Minister correctly pointed out at the end of his contribution, the majority of people who interact with the health service have a very good experience. That is because we have an incredibly well qualified and excellent workforce across the range of health services.

The areas for which I have responsibility are mental health, disabilities, older people and primary care, which are an integral part of the health service. The Minister referred to his commitment to maternity services. We are now reviewing the implementation of A Vision for Change in order to ensure we do not have the gaps which were there in the past. A Vision for Change will come to an end next year and we intend to ensure another plan is in place to continue on from where it finishes.

It will not be a completely new plan but it most definitely will build on what already is there. In this respect, we intend to take a serious look at a perinatal psychiatry service. It always strikes me that Ireland does not appear to have the same level of postnatal depression as do other countries, which cannot possibly be true. It simply is because we do not look for it here and the provision of that new service will ensure it will be possible to do so. As for the additional funding for mental health services in the coming year, substantial changes already have been made. It is a service in transition and that is changing dramatically from an institution-based service to a community one that sometimes uses an acute unit service when that is necessary. Next year, the priority will be on primary care and for the first time ever, the primary care and mental health services will be sitting at the same table. It always has astonished me that this had not been done previously but it will be done now. Moreover, we will ensure an expansion of the type of services we started to deliver last year in primary care. I refer to services such as counselling in primary care for the over 18s where people with mild to moderate depression who attend at their GP can be transferred directly into counselling without being obliged to first present to the acute service or the psychiatric services. This counselling service worked so well it ran out of money and the figures are quite incredible in this regard. Last year, there were more than 10,000 referrals and more than 31,000 sessions were delivered, albeit not all by people who work for the Health Service Executive, HSE, but by a range of counsellors within the community. Next year, we intend to expand that service and to ensure people under 18 equally have access to it. It should not always be the case that people who have difficulty with their emotional or psychological well-being automatically end up in the mental health services as there are other routes and we intend to ensure that such people can take them.

As for psychology in primary care, there is a shortage and an underdevelopment of psychology services across the country, which has resulted in reduced access to initial assessment. Better access will help to prevent the escalation of presentation to specialist services. At a human level, early diagnosis and intervention can lead to better mental health outcomes and a better quality of life and this is something to which all Members can commit. I am committed to developing a more fit-for-purpose primary care psychology service, which will be a stepped-care model integrated with the specialist service to enhance the service and reduce waiting times. I have asked the HSE to examine how counselling psychologists and clinical psychologists can contribute to developing the primary care psychology service. I have been concerned for some time that because the only psychologists mentioned in A Vision for Change are clinical psychologists, they appear to be the only people we are intent on employing, even though the HSE always has employed counselling psychologists and they work extraordinarily well. We seriously examined the waiting list for the child and adolescent mental health services, CAMHS, and discovered there were ways to reduce that list and lessen the amount of time people will spend on it. Sometimes it is not all about resources but thankfully, significant resources are available in respect of mental health.

As for speech and language therapies, the Government has committed an additional €8 million to provide therapeutic services for children. This will be targeted at young children with a disability to enable them to go to preschool. It also will address a more general need of those under 18 who need speech and language occupational therapy and psychotherapy. Speech and language therapy interventions can make the difference between a child integrating in social and educational settings and that child remaining isolated.

I always have maintained that one solution to overcrowded hospitals is within the community. While it is not the entire solution, it most definitely is part of it. I intend to continue to ensure that all departments with responsibility in the primary care setting come together, such as primary care in respect of mental health, as they must be at the same table. It is a service that must be delivered in primary care but by the mental health service. Moreover, when it comes to children and the National Educational Psychological Service, NEPS, again this sort of interaction and integration must happen. We have made incredible strides in ensuring that older people who need long-term care will have that more readily and I intend to ensure this continues as it is. The Government is making progress but people must accept the progress it is making is about changing a system fundamentally, which takes time.

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