John Connolly (Galway West, Fianna Fail) | Oireachtas source

Like other Members of the House who spoke previously, I wish the Minister of State, Deputy Butler, well in her role and congratulate her on her reappointment. It is a difficult portfolio but the Minister of State will have the support of the House in all earnest efforts to try to improve services for patients in this area. I compliment the Business Committee on enabling this debate.

I am familiar with the case outlined by Deputy Tóibín, which was also outlined earlier by Deputy O'Hara, of the young man who presented at the accident and emergency department of University Hospital Galway last week. Unfortunately, he was in a position to leave the facility without receiving care and attention, and subsequently died by suicide. I offer my sympathies to the family of that young man. Resourcing front-line services for people who present with mental health difficulties at accident and emergency departments seems to be an ongoing issue. I agree with Deputy Tóibín. We seem to hear about these instances quite frequently. The challenge is that there does not appear to be a sufficient presence at accident and emergency departments of those who can intervene in a crisis situation. Of course, the challenge is that most of the staff in accident and emergency departments are busy and run off their feet. When these circumstances can result in what happened in Galway last week, it is something we need to look at carefully.

Another major infrastructural challenge is the absence of inpatient beds. The acute mental health facility in University Hospital Galway has 50 beds. The data highlights that the facility is consistently full, leading to my concern that it is difficult to get access to the facility. This must present a great dilemma to psychiatric teams in terms of the necessity of admission, and while there is a welcome emphasis on the provision of facilities within the community, we must ensure a sufficient number of acute beds. Ireland's psychiatric bed rate per 100,000 of population has declined from 78 in 2008 to 33 in 2019. The European Union average rate is 73 per 100,000, which we are some way below. We must be worried that the absence of acute beds is exacerbating problems within the community. That is something we should examine.

Many people have mentioned CAMHS. Despite attention deficit hyperactivity disorder, ADHD, referrals for assessment and intervention being the reason for the majority of referrals for CAMHS, children must often await assessment and the availability of interventions and therapies is limited. As was mentioned, 4,500 children are on the existing waiting list for CAMHS. It is likely that many of those patients were referred to CAMHS as a result concerns about ADHD and are seeking further intervention. The impact of not intervening at the earliest point is that there are difficulties and challenges later in life. I compliment the Minister of State because I know that in the past year, for the first time, a service for adult ADHD sufferers has been established in Galway, Mayo and Roscommon. That service is to begin this year and I hope it begins soon. Adults with ADHD cite increasing challenges in life that present as mental health difficulties. We need to provide care for adults. If we can enhance care in CAMHS for the children who present with ADHD, it will reduce the burden of the disorder as children move into adulthood.

As I said, ADHD is the commonest cause of a referral to CAMHS but there are only two CAMHS facilities in the country that provide specialist ADHD clinics. The current system means children with concerns who are referred for assessment for ADHD often must wait due to urgent cases being unavoidably prioritised. The Linn Dara CAMHS facility in Dublin, which I am sure the Minister of State and other Deputies are aware of, recognised in 2019 the urgent need for a standardised approach to the assessment and treatment of children with ADHD. That was the first HSE specialist service for the assessment and management of childhood ADHD. Over the past five years, its ADMiRE service has developed a structured, standardised and evidence-based clinical pathway for the assessment and management of ADHD. We should roll out that approach throughout the country to facilitate a greater service for those children and lead to better life outcomes for them. That would streamline referrals to CAMHS in a better manner. There would be a specific service for children with ADHD and an alternative service for children who present with other mental health issues, such as eating disorders and other such ailments.

It is a model we should look at expanding.

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