Jimmy Deenihan (Kerry North, Fine Gael)
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Last week's "Prime Time Investigates" television programme starkly revealed the human suffering of those children and parents who have been abandoned by Ireland's under-resourced psychiatric services. Child and adolescent psychiatric services account for only 5% to 10% of spending on mental health services, while serving 22.68% of the population. This underinvestment has resulted, as Members saw last week, in child and adolescent services which are sporadic or non-existent.

The Kerry Child and Adolescent Mental Health Service is based in Greenview Clinic and is run by the Brothers of Charity. The clinic deals with children who experience severe and complex behavioural difficulties such as ADHD. At present, the waiting period for assessment at Greenview Clinic depends on the category in which one is considered to be — general, priority 2, which is semi-urgent, or urgent. There are 11 children currently in the general category, with a waiting period of 56 months — four years and eight months. There are 109 individuals on the priority 2 list, with a waiting period of 22 months, and there are 83 individuals on the urgent list, with a 16-month waiting time.

Figures obtained from the Health Service Executive under the Freedom of Information Act reveal that, nationally, over 3,000 children under the age of 16 are on waiting lists to get an assessment. The length of the waiting time depends on where one lives. In Dublin, the waiting time is two years, while it is three years in Mayo and, in many cases, over four years in Kerry.

According to an unpublished Health Service Executive report on child mental health teams, in September of this year there were only nine psychiatric nurses in the HSE, south, area, when really there should be 24. In a survey of teachers from over 200 schools, many of which were in Kerry, conducted by "Prime Time" and the Irish National Teachers' Association, over three quarters stated that their teaching had been compromised by a pupil with a mental health problem.

Mental health services for children in Kerry are under-resourced, understaffed, fragmented and inaccessible in many cases. Planning nationally has been haphazard and there are only two public units for adolescents in Ireland. Two, three or four year waiting times are devastating for children, who deteriorate enormously in that period without diagnosis or treatment.

Spending on mental health has halved in the 18 years from 1988 to 2006 and Ireland now has the fifth highest youth suicide rate in Europe. Many of these illnesses, including ADHD, are eminently treatable but for this to happen, early diagnosis is crucial and must be followed up with the administration of the relevant medication and training strategies and facility provision for the child and the parents involved.

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 psychiatric services through multidisciplinary teams.

Mental illness can affect any one of us at any time. It is estimated that one in four of us suffers with a mental illness, but the Government does not seem to recognise this area. Since 1997, the proportion of the total health budget spent in this area has dropped from 11% to under 7%. Mental health has been neglected for too long.

This neglect is manifesting itself now in County Kerry. People were amazed by the "Prime Time" report on the services for young people in County Kerry. I appeal to the Minister of State, Deputy Tim O'Malley, as a Deputy from a neighbouring county, to take on board the challenge faced at this time by the people who are involved in the services in County Kerry. There is a major difficulty in Kerry. I do not want to exaggerate for the sake of effect, but I appeal to the Minister of State to look to the HSE to draw up a special report based on what an independent "Prime Time" reporter discovered in County Kerry. I trust that he will take on board the points I have made. The issue is too important to ignore and to fail to follow it up with positive initiatives.

Tim O'Malley (Limerick East, Progressive Democrats)
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I thank Deputy Deenihan for raising this matter. I assure the House that work is continuing towards ensuring that appropriate psychological assessment of children with mental health problems takes place without delay.

Operational responsibility for the management and delivery of health and personal social services is assigned to the Health Service Executive, HSE, under the Health Act 2004. I am of the view that waiting lists must be constantly kept under review to ensure that children and adolescents are referred to and seen by an appropriate professional as soon as possible and that urgent cases are prioritised for immediate assessment.

An exercise is under way in the HSE to assess what needs to change in particular areas, including Kerry, to reduce waiting times. Dramatic improvements in waiting times can be, and have been, achieved. For example, the child mental health services in Kildare succeeded in greatly reducing their waiting times following the appointment of an advanced nurse practitioner who worked in close collaboration with the local multidisciplinary team to improve service access.

This is the type of service improvement I want to see achieved elsewhere in the country. It has been done practically, effectively and cost effectively. I have asked the HSE today to learn from this experience and apply it to reduce waiting times and improve access to child and adolescent services nationally, starting with those areas where access problems and delays are occurring.

My Department has been informed by HSE, south, that the Greenview Clinic, Kerry Child and Adolescent Mental Health Services run by the Brothers of Charity, provides a community outpatient multidisciplinary mental health service to children and adolescents in County Kerry on behalf of the HSE. All clinical cases referred to the service are prioritised based on clinical severity and complexity. Emergency cases, such as children who have self-harmed or are at risk of doing so, are seen immediately and are not placed on a waiting list.

Improving awareness and detection rates of mental health problems in young people is an important Government priority. The HSE has developed an on-line training programme for GPs with a comprehensive module on child and adolescent mental health needs. This is an important development and builds on expertise and knowledge within our services.

The HSE child and adolescent mental health services work closely with colleagues in the education sector and accept referrals from schools and the National Educational Psychological Service, NEPS. The HSE is also actively working with a number of voluntary and community agencies to provide added protection for children with mental health difficulties. Examples include Dublin East Treatment and Early Care Team, DETECT, in south Dublin, Ireland's first pilot project for early intervention in psychosis assessment, as well as the national roll-out of applied suicide intervention skills training, ASSIST, with a particular emphasis on personnel who work with young people.

The national mental health policy, A Vision for Change, sets out the model of child and adolescent mental health service that needs to be provided and resourced into the future. A Vision for Change acknowledges gaps in the current provision of child and adolescent services and makes several recommendations for the further improvement of these services. Recommendations include early intervention and health promotion programmes, primary and community care services, specialist mental health services for the treatment of complex disorders and the provision of additional child community mental health teams. The Government has already commenced implementation of this strategy and provided €26.2 million in funding in 2006 for this purpose. A further €25 million has been made available in 2007.

The HSE currently has 45 child and adolescent mental health teams. Eight additional consultant-led child and adolescent psychiatric teams per year will be established nationally for the next four years to enhance community and inpatient services. This year, an additional €3.25 million was allocated for the enhancement of child and adolescent services, including the development of eight new teams. A further €7.95 million is being provided for 2007 to significantly improve both community and hospital based services and facilitate the provision of early intervention services. The additional funding will enhance the multidisciplinary composition of existing child and adolescent mental health teams and provide for the development of a further eight new teams in 2007. Additional beds for the treatment of children and adolescents are to be made available shortly pending the construction of four new dedicated 20-bed child and adolescent units in Dublin, Cork, Limerick and Galway.

It is important to note that HSE mental health services are now funded on a population based model which takes account of population size and profile, including factors such as social deprivation. Services are being planned and resourced from a national perspective. From March 2007, the HSE will have more detailed information on the age profile of our population with the further analysis of the 2006 census data. This will allow the executive to target resources to areas of greatest need and to ensure the most appropriate services are available to young people throughout the country. In addition, recognising the link between social deprivation and mental illness, the HSE this year used a deprivation index to direct additional resources to areas of greatest need.

I assure the Deputy that the Government is fully committed to decreasing the waiting times for psychological assessment for children with mental health problems in Kerry and across the country.