Dan Neville (Limerick West, Fine Gael)
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Question 4: To ask the Tánaiste and Minister for Health and Children her plans to increase the number of child and adolescent psychiatric inpatient beds; the number of such beds; and their location. [21373/06]

Tim O'Malley (Limerick East, Progressive Democrats)
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Most children with mental health problems are supported in the community. However, a small percentage of children and adolescents with mental health problems require inpatient treatment. Specialist public inpatient psychiatric services for children and adolescents are provided at Warrenstown House, Dublin and St. Anne's, Taylor's Hill, Galway, with capacity for the treatment of 20 inpatients.

A Vision for Change, the report of the working group on mental health policy, was published in January this year. The report addresses the future direction and delivery of all aspects of mental health services, including child and adolescent psychiatry. The Government has accepted the report and €25 million in additional funding has been provided this year for the further enhancement of mental health services. This brings the total funding for mental health services in 2006 to approximately €835 million.

A Vision for Change acknowledges the gaps in the current provision of child and adolescent mental health services and makes ten recommendations for the improvement of these services. In particular, the report recognises the need for additional child and adolescent inpatient beds. It recommends that urgent attention be given to the completion of four child and adolescent psychiatric inpatient units and that multidisciplinary teams should be provided for these units.

Project teams have been established by the HSE to develop four additional child and adolescent inpatient psychiatric units. The exact location of the units and the number of beds to be provided in each unit is being considered by the HSE. The recommendation is that there will be one in Limerick, Cork, Galway and Dublin. The approximate size of each unit will be 20 but there will be discrepancies in areas with larger populations. The aim is to ensure the units are located in the areas of greatest need and provide the most appropriate care setting for children and adolescents with mental health problems. Both the range of ages and the variety of disorders requiring inpatient treatment must be given careful consideration when planning child and adolescent inpatient services.

The mental health needs of children and adolescents are also being addressed by the appointment of additional child and adolescent psychiatrists, the enhancement of existing consultant-led multidisciplinary teams and the establishment of further teams. The number of child and adolescent psychiatrists' posts has increased considerably from 56 in 2005 to 70 in May 2006. Hopefully, this will have a knock-on effect in reducing waiting lists and the further provision for mental health services for children and adolescents.

Dan Neville (Limerick West, Fine Gael)
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The Minister of State has had a report for several years that claims the number of child inpatient beds needed is 148. With the rise in population, it has been calculated that the number now is 156. However he is proposing to establish only 80, 50% of the required beds. Some 16 and 17 year olds are inappropriately placed in adult psychiatric beds. How does he propose to tackle this problem? The Irish College of Psychiatrists has come out strongly on the need for proper care for this age group. Although the budget for psychiatric services has increased this year, will the Minister of State accept that since 1997 the percentage of the health budget allocated to the services has actually fallen from 11% to 7%? Is this not an indication of the Government's lack of attention to the development of the psychiatric services?

Will the Minister of State accept there is a deficit in the area of general psychiatric services? As a result there has been an increase in suicide. A vital approach to dealing with these issues is the provision of proper child and adolescent psychiatric services. Young children are not being treated for their difficulties. Due to the lack of resources, the service concentrates on the 12, 13 and 14 years old age groups. However, children in crisis at seven, eight and nine years of age are not being treated, leading to their difficulties becoming chronic.

In a recent reply to a parliamentary question on waiting lists for child and adolescent psychiatric services I was informed waiting periods are two years. This is inappropriate and unacceptable. Sexual abuse creates severe emotional problems for children and adolescents. Children abused by paedophiles have had to wait two years for counselling. Has the Minister of State any proposals to improve this situation?

Tim O'Malley (Limerick East, Progressive Democrats)
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Waiting two years for mental health services is unacceptable. That is why the Government and the HSE has increased child and adolescent psychiatrists by 20%. That should have a notable improvement in waiting lists. The Irish College of Psychiatrists argues there should be a full cohort of services for this age group. Opinion is divided on this. The working group did not accept that recommendation. It was of the view that all children up to 18 years of age should be treated by child and adolescent psychiatrists. Those over 18 years of age should be treated by the adult mental health services. Opinion is divided between psychiatrists, the HSE and the Department of Health and Children.

Dan Neville (Limerick West, Fine Gael)
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What is the opinion of the Minister of State?

Tim O'Malley (Limerick East, Progressive Democrats)
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In my opinion, children and adolescents should be treated up to the age of 18 years by the child and adolescent services. Otherwise, a situation could arise where an individual develops a psychiatric episode at the age of 14 years and is treated by one consultant up to the age of 16 years, then he or she would be treated by another consultant until 18 years and then transferred. This is not best practice and that is accepted by the expert group which examined the issue. I agree opinion is divided among psychiatrists.

The HSE and the Department of Health and Children are supporting the DETECT model of early diagnosis of psychosis. It is being rolled out in the Dublin area. It is proposed to roll out another model in a different environment, such as a rural area. I am considering this and seeking funding for it.

I am also consulting with general practitioners. The opinion of those in the medical profession such as general practitioners is that if the proper funding was given in the primary care area, there could be quicker diagnosis and treatment for young people with psychosis who need treatment. As I stated in my reply, the vast majority of people can be treated in the community. I am meeting a group of general practitioners soon to roll out a counselling and cognitive therapy service for people, especially young people, with requirements in this area. That is one of the recommendations of the expert group, that not all children or adults with psychosis should necessarily have to be referred directly to a psychiatrist and a multidisciplinary team. The feeling is that services need to be changed so people with psychosis and psychiatric problems should be sent directly to counselling or psychotherapists where the general practitioner is of that opinion.

Dan Neville (Limerick West, Fine Gael)
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Would the Minister of State accept that the number of psychotherapists is totally inadequate and that the Department and the HSE have not made any effort to increase the support systems to the psychiatric services?

In March 2005 the Minister of State announced the sale of lands to fund this properly. I understand, from his reply to a parliamentary question, that no movement whatsoever has been made on that. Not one piece of property has been identified which will go for sale. Recently, I asked for an inventory of properties that would be sold. Fourteen months after the announcement there is no inventory and no movement whatsoever.

Tim O'Malley (Limerick East, Progressive Democrats)
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My priority and that of the Government in the sale of any lands is based on the premise that first we must look after the clinical needs of any patients who are in these institutions. It is not simply a process of merely selling properties.

Dan Neville (Limerick West, Fine Gael)
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What of an inventory, so that we would know?

Tim O'Malley (Limerick East, Progressive Democrats)
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There is much work being done on it at present but the priority is to ensure the services are put in place in the community. That is being done at present.

Dan Neville (Limerick West, Fine Gael)
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It is not.

Tim O'Malley (Limerick East, Progressive Democrats)
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It is hidden work and is obviously not in the public arena.