Dáil debates

Wednesday, 12 October 2005

Adjournment Debate.

Mental Health Services.

8:00 pm

Photo of Dan NevilleDan Neville (Limerick West, Fine Gael)
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I thank the Ceann Comhairle for the opportunity to raise the issue of A Better Future Now, a position statement on the psychiatric services for children and adolescents in Ireland, which was published in September by the Irish College of Psychiatrists. I congratulate the Irish College of Psychiatrists, especially its sub-group, Dr. Brendan Doody, Dr. Amanda Burke, Dr. Brenda Dowling, Dr. Finbarr O'Leary, Dr. Philip Tyndall and Dr. Sarah Buckley, for the excellent work they have done.

In excess of 200,000 children have a mental or behavioural problem at any one time. In excess of 100,000 will have a mild disorder, 80,000 will have a moderate to severe disorder and 20,000 will have a disabling disorder. According to the Irish College of Psychiatry, which drew its information from reports in the Minister's possession — this document is based on reports to the Minister — to effectively deal with this serious problem would require 236 inpatient psychiatric beds. Currently there are 20 beds in two units based in Galway and Dublin.

To effectively respond to the psychiatric needs of these children requires 150 consultant child and adolescent psychiatric posts. Currently there are 62 psychiatrists in this field of the profession. The lack of psychotherapists, family therapists, clinical psychologists, occupational therapists and other key staff seriously inhibits the internationally acknowledged best practice for the provision of child and adolescent psychiatry services through multidisciplinary teams.

There is currently no capacity in child and adolescent psychiatric services to provide for children in the 16 and 17 age group. There is an urgent need to establish a specialist outpatient team providing a regional service with an inpatient facility to specialise in eating disorders. The report points out that there is no dedicated facility for those suffering from eating disorders.

The World Health Organisation states: "The lack of attention to the mental health of children and adolescents may lead to mental disorders with lifelong consequences, undermines compliance with health regiments and reduces the capacity of societies to be safe and productive".

Given the level of mental illness in children, the provision of adequate and sufficient children's mental health services should be a priority. For children who require mental health interventions, services and supports are seriously out of step with need. There is limited availability of the appropriate range of services, including those in primary care, community care, inpatient services, day centres, rehabilitation services and outreach services to provide support in the home and school.

The frequent need for urgent responses to problems presented by adolescents leads services to deal disproportionately with adolescents at the expense of their work with young children, thereby preventing useful early intervention which has a secondary preventative value.

I am struck by the international comparisons of the ratio of the number of child and adolescent consultant psychiatrists to the child and adolescent population. Having some knowledge of the Finnish system and its pioneering work in the area of suicide prevention in the early 1990s, I note that Finland has a ratio of one child psychiatrist to 6,000 children. In Ireland, the figure is one psychiatrist to 16,150 children.

In 2003, 11,200 children and adults, mostly adolescents, presented at accident and emergency departments in our hospitals having attempted suicide. We do not know the true figures, however, and there is no information on those who were treated at general practitioner level or the many who, because of stigma, did not seek help. It was indicated to us yesterday that the figure is probably double the 11,500, approximately 20,000, as stated in the Joint Committee on Health and Children. Over 40% of suicides are preceded by a previous attempt. Suicide is nearly always related to mental and behavioural disorder and the availability of accessible mental health services is of vital importance in any suicide prevention programme.

The report outlines that the recommended service level for children up to the age of 18 years would require an extra annual expenditure of approximately €80 million and a capital investment of approximately €180 million. I draw the Minister's attention to the fact that the €180 million is similar to the amount spent on PPARS and the €80 million is similar to the amount spent on consultants for PPARS. What happened in that case would fund the total capital investment and the ongoing investment for one year. Since 1997, the proportion of the health budget has dropped substantially and we would like the Minister to address that in the budget.

Having closely worked with Amnesty International in drawing up its report, Mental Illness: The Neglected Quarter, I will conclude by quoting from the report. It states: "Amnesty International is concerned that Ireland does not comply with its international obligations in the treatment of children with or at risk of mental illness".

9:00 pm

Tim O'Malley (Limerick East, Progressive Democrats)
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I thank Deputy Neville for raising this matter on today's Adjournment.

As the Deputy is aware, in June 2000, a working group on child and adolescent psychiatry was established to make recommendations on the way child and adolescent psychiatric services should be developed in the short, medium and long-term to meet identified needs. The working group's first report considered the development of services for the management and treatment of attention deficit disorder and attention deficit hyperactivity disorder, ADD-ADHD. All aspects of the presentation, diagnosis, treatment and management of children suffering from ADD and ADHD were considered by the working group in the course of its deliberations.

In its report, published in March 2001, the different components of treatment required were set out and the importance of adequate linkages with other services, such as education services and the community health services, were emphasised.

The group recommended the enhancement and expansion of the overall child and adolescent psychiatric service as the most effective means of providing the required service for children with this condition. The working group found that the internationally acknowledged best practice for the provision of child and adolescent psychiatric services is through the multidisciplinary team.

The first report also recommended that a total of seven child and adolescent inpatient psychiatric units for children ranging from six to 16 years should be developed throughout the country. Project teams have been established to develop child and adolescent inpatient psychiatric units in Cork, Limerick, Galway and one in the Eastern Regional Health Authority area at St. Vincent's Hospital, Fairview. Approval was given earlier this year for the selection of project design teams for the units in Cork, Limerick and Galway. The second report of the working group, published in June 2003, contains proposals for the development of psychiatric services for people in the age group 16 to 18 years old. It recommends that, in the further development of the child and adolescent psychiatric service, priority should be given to the recruitment in each health board area of a consultant child and adolescent psychiatrist with a special interest in the psychiatric disorders of later adolescence.

The working group's report further recommends that arrangements should be made with the relevant adult services for the admission to acute psychiatric units of persons aged 16 to 18 years, under the care of the consultant child and adolescent psychiatrist with a special interest in the psychiatric disorders of later adolescence, where such a consultant is available. It also recommends that consideration be given to the development of specialist adolescent units particularly in the greater Dublin area.

The report emphasises the importance of co-operation and close liaison between child and adolescent mental health services and adult mental health services and suggests that the current arrangements, whereby the adult services provide a service to the population of their catchment area, including the 16 to 18 years age cohort, should continue on an interim basis, pending the development of the specialist service referred to earlier.

The development of child and adolescent psychiatric services has been a priority in recent years. Since 1997 additional revenue funding of more than €20 million has been provided to allow for the appointment of additional consultants in child and adolescent psychiatry for the enhancement of existing consultant-led multidisciplinary teams, and towards the establishment of further teams. This has resulted in the funding of a further 23 child and adolescent consultant psychiatrists. Nationally, there are now 56 such psychiatrists employed.

An expert group on mental health policy was established in 2003 to examine all aspects of our mental health services. This group consists of 18 highly experienced people serving in their personal capacity. The membership encompasses a wide range of knowledge and a balance of views on many issues affecting the performance and delivery of care in our mental health services.

The group requested submissions from interested organisations, individuals and the general public in October 2003 and received almost 150 submissions which it is considering. It has been decided also to undertake further consultation initiatives with various stakeholders, including users of the mental health services.

The group is examining the future direction and delivery of our child and adolescent psychiatric services and is taking into account the document to which Deputy Neville refers. The expert group is on target to complete its work later this year.