Mick Wallace (Wexford, Independent) | Oireachtas source

It is nearly a year since Dr. Kieran Moore resigned from his position as consultant child psychiatrist in CAMHS in Wexford and there is still no replacement. He specifically cited the working conditions in the CAMHS facility at Slaney House, Wexford, as reason for his resignation. We understood in September that the new CAMHS facility at Arden House would be open in a matter of weeks. In response to a parliamentary question I submitted in November, after no sign of the facility opening, I was told that the new facility at Arden House would be opening in the first quarter of 2019. We now hear that the work required for the new facility at Arden House has only recently gone to tender and that the facility will not be open now until July. I am unsure how we expect to attract consultant child psychiatrist to replace Dr. Moore if we have not improved the working conditions that he cited as the reason for his own resignation.

Approximately half the positions on CAMHS teams nationally have been vacant for a number of years. The staffing levels in CAMHS Wexford, north and south, in 2017 were 48% and 42%, respectively, of the recommended staffing levels in A Vision for Change. Consistently throughout 2018, almost 3,000 children and adolescents were waiting for a CAMHS appointment. The children and young people on that waiting list are waiting for a first appointment, which is their initial assessment, and not for actual treatment. They will then have to endure a protracted waiting period.

The problems with CAMHS need to be seen in context. The pressure on CAMHS is compounded as a direct result of the lack of adequate alternatives. CAMHS has become, as the national director of mental health services in the HSE said, a catchall service. This is a crucial point. CAMHS is a specialist service for the most severe mental health cases but is being swamped by inappropriate referrals because the options in terms of referrals from GPs for children and adolescents who present with mental health problems are so limited and narrow in scope. The waiting list for primary care child psychology services in Wexford are over three years long at the moment.

The over-medicalisation of mental health services is also a massive problem. Public psychotherapy and counselling services for children and adolescents are limited. Places like the Ferns Youth Diocesan Centre in Wexford are doing very good work but there are not enough of these counselling hours available. There are private practices but not everybody can afford them.

A Vision for Change states that the consensus among users and service providers was that psychological therapies should be regarded as a fundamental component of basic mental health services rather than being viewed as additional options that are not consistent consistently available. This is one of the main messages of A Vision for Change consultations, that people want alternatives to medical medication, including access to counselling and psychotherapy. A Vision for Change states that all individuals should have access to a comprehensive range of interventions in primary care for disorders that do not require special specialist mental health services.

There is, as far as I can see, a very broad consensus among almost all mental health service stakeholders that the lack of accessible counselling services is a massive problem and that it is at the heart of much that is wrong with our mental health services. This is one of the strongest messages expressed in the interim and final reports of the Joint Committee on the Future of Mental Health Care. A related issue also highlighted in the committee's reports was that there was an over-reliance on medication as a response to preventing mental health ill-health issues in the absence of alternatives in primary and community care levels.

The Irish College of General Practitioners and the Mental Health Reform Coalition have repeatedly referred to what they see as an over-dependence on medication in our mental health services. The Ombudsman for Children told the Oireachtas committee that children themselves have identified a rush to medicate them in their treatment. I find this an incredible statement. If so many people who work in the mental health services are crying out for talk therapy supports, if this need is so clearly laid out in A Vision for Change and if the national director of mental health services is making similar noises when speaking of the pressure on CAMHS, then why has so little progress been made to make these changes? Perhaps the Minister of State might address this point. It does not seem to be an ideological based position based on the evidence of the of the various groups I just mentioned. Will the regulation of psychotherapy help? Maybe it will. I know many psychotherapists are concerned about how their skills have been ignored so much to date. They are very wary of the proposed tele-counselling model. Tele-psychiatry may be a work around because of the global shortage of consultant psychiatrist but tele-counselling, according to many counsellors, fundamentally misunderstands the nature of counselling and psychotherapy.

While people are crying out for talk therapies, psychotherapists and counsellors are being routinely exploited by the Government's policy of indirectly funding psychotherapists and counsellors via the voluntary and charitable sector. These charities, often funded by Tusla, for example, routinely advertise and recruit qualified accredited and pre-accredited psychotherapists on a voluntary basis and expect them to work for nothing. I can give many examples of this and a number of psychotherapists and counsellors raised this issue with me recently. We have created culture in which psychotherapists are sometimes expected to work for nothing. This is a misdirection of public funds and it only serves to lower the standard of available counselling.

There are at least 5,700 accredited psychotherapists registered with the two main accrediting bodies in Ireland. They will have at least a level 8 honours degree in psychotherapy and counselling. They are experienced, skilled and eager to work but do not fit the HSE's qualification requirements for the grade of counsellor. We have a farcical situation where if someone presents with suicidal ideation, he or she is routinely referred by the HSE to the services of Pieta House, for example. I spoke to psychotherapist this week who works with Pieta House. She regularly counsels such clients who are referred from the HSE, yet she herself does not fit the criteria to work in the HSE itself. Even more bizarre, she is a supervisor of psychotherapy and counselling and supervises therapists who work for the HSE. We need to re-examine the qualification criteria for the grade of counsellor within the HSE to remedy this farcical situation. If we can create the grade of assistant psychologist, we can certainly look again at the counsellor or therapist grade.

I urge the Minister of State to increase investment in talk therapies. The mental health services spend roughly €400 million per year on drugs while some €10 million is spent on counselling. The Minister of State may correct those figures but if they are even close to correct, I am sure he would agree this kind of spending is disproportionate and needs to be addressed.

I am not blaming the Minister of State for all the problems we face in this area and I believe he is genuinely interested in making things better. I listened to his speech, in particular where he said we are perhaps too eager to give out about the HSE and what it is and is not doing. He will have to forgive us, given there are so many problems. Surely he would agree we need to move faster to get to a place where we use more psychotherapy, although I know that is not easy. I know there is an effort to try to regularise the industry in a way that has not been done before, although it has been talked about for over 20 years in these buildings. There has to be an urgency about it but I do not see that. Nonetheless, I am not blaming the Minister of State for that and I am sure he is up against serious obstacles in trying to make it happen.

Only this week, three psychotherapists came to see me to highlight some of the issues I have raised. They are very conscious that, in this House, we change things around and we make things happen in lots of different areas, but it is very disappointing that we have not got to where we want to go in terms of making better use of all the psychotherapists in Ireland, who would make themselves available and who are interested in working. As the Minister of State knows well, there are far more of them than there are psychologists and they are far more available. We need some joined-up thinking. It will mean a massive improvement in this whole area when we get to that point.

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