Tuesday, 16 February 2010
Mental Health Services.
I thank the Ceann Comhairle for allowing me to raise this issue on the Adjournment. I welcome the Minister of State with responsibility for mental health and disability services, Deputy Moloney, to the House to reply. There is an urgent need to invest in services for child and adolescent psychiatry. It is not acceptable that more than 2,600 children and adolescents are on waiting lists for mental health services, with more than one quarter of those waiting more than one year to access those services. It is accepted that early intervention and treatment are crucial to full recovery from child and adolescent psychiatric difficulties. Children have a right to enjoy the highest possible standard of mental health. They have the right to enjoy a sense of well-being, control over their lives and the ability to realise their potential. Good health comes from having a balance between all aspects of life, social, physical, spiritual and emotional.
To vindicate the right to mental health, children need a supportive environment for themselves and their families, and appropriate support and services when they experience difficulties. However, the reality is that children's right to mental health is not being vindicated. For example, in a shocking violation of their human rights, children continue to be treated in adult inpatient units. They face unacceptably long waiting lists to access services and there is patchy service provision across the State. Official responses fail to meet basic needs and there is a lack of focus on early intervention and promotion that could prevent future problems. With no national directory of services, navigating the system can be a nightmare for children and their families. Insufficient supports are provided for Ireland's most vulnerable young people, namely, those in the care and youth justice systems. The mental health system fails to effectively link with education in the early years - the first point of contact for children outside of the family - which is a crucial missed opportunity.
Children's rights must be respected so that every child is able to reach his or her full potential. This is not a pipe-dream but a vision that should now become reality. The Government must support best practice and move towards the provision of mental health services for children from early childhood up to early adulthood. Today's children are tomorrow's workers, parents, teacher and leaders. We must invest now in their well-being; to do otherwise violates their rights and makes little economic sense.
New consultants appointed to deal with growing waiting lists in child and adolescent mental health services have only one third of the front-line staff required and often have no premises from which to work. Despite having the fourth highest rate of suicide in Europe among 15 to 24 year olds, the latest Health Service Executive figures indicate, as I referred to earlier, that more than 2,600 children and adolescents are on waiting lists for mental health services, with more than one quarter of these waiting more than year. Only 55 of the promised 99 community mental health teams have been delivered. Despite the appointment of additional consultants, a lack of resources means there are significant limits to what can be achieved. Unpublished details from a recent report show that managers of child and adolescent mental health services raised serious concerns about their inability to deliver comprehensive services because of pressure on staff.
The Government's framework for mental health provision, A Vision for Change, identified the deficiencies in existing child and adolescent psychiatry services. For instance, it acknowledges that child community mental health teams and services are well below the norms recommended by the working group on child and adolescent psychiatric services. The document also points to the inequitable variation in the distribution of child services throughout the State and acknowledges that dedicated adolescent mental services are virtually non-existent on a national basis. A Vision for Change asserts that paediatric liaison services are not available in the majority of major hospitals outside the three national children's hospitals in Dublin. It also accepts that mental health services for autism and autism spectrum disorders are not always accessible and that there are insufficient inpatient and day hospital facilities and no dedicated child and adolescent forensic teams. The Minister must fast-track the provision of these services without delay.
John Moloney (Minister of State, Department of Education and Science; Minister of State, Department of Health and Children; Minister of State, Department of Enterprise, Trade and Employment; Minister of State, Department of Justice, Equality and Law Reform; Laois-Offaly, Fianna Fail)
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I thank Deputy Neville for raising this important issue. I begin by reaffirming the Government's commitment to providing 100 beds for child and adolescent services during the term of A Vision for Change. The latter is a ten-year programme, launched in 2006, and, as such, it is a work in progress. I propose to outline to the House the progress to date in the area of child and adolescent psychiatric services.
A Vision for Change provides a framework for the development of mental health services and proposes the development of a comprehensive child and adolescent service for children up to the age of 18 years. Traditionally, adult mental health services were responsible for 16 to 17 year olds and admissions to approved centres in that age group were to adult facilities. The Mental Health Commission recently issued an addendum to the code of practice relating to the admission of children under the Mental Health Act 2001 which seeks to ensure that by 1 December 2011, no child under 18 years will be admitted to an adult psychiatric unit. We intend to meet that commitment.
As I said, A Vision for Change will be implemented over a period of seven to ten years and must therefore be viewed as a work in progress. As part of the process of implementation there is a need to expand the child and adolescent service to enable it to cater for 16 and 17 year olds. In this regard, the Health Service Executive has prioritised the development of child and adolescent services and there have been significant improvements in those services in recent years. For example, inpatient capacity has more than doubled since 2008 and we now have 30 dedicated child and adolescent beds- ten in Galway, 12 in Dublin and eight in Cork. I had the great pleasure last year of officially opening the new child and adolescent units at St, Stephen's Hospital, Cork and at St. Vincent's Hospital, Dublin. In addition, two-20 bed units are under construction at Bessboro, Cork and Merlin Park, Galway. It is anticipated that construction will be completed on both of these developments and the beds commissioned in 2010. Further beds will be provided in the context of the Health Service Executive's mental health capital programme. I hope to provide more specific details in this regard on 1 March.
Budget 2010 provided for a multi-annual programme of capital investment in high priority mental health projects consistent with A Vision for Change, to be funded from future disposals. In 2010, the Health Service Executive may proceed to dispose of surplus assets and reinvest an initial sum of €50 million in the mental health capital programme. Provision for continued funding of the programme will be made in the 2011 Estimates and subsequent years, in the light of the previous year's programme of asset sales. However, in providing more child and adolescent beds, I am conscious that we must take care to ensure our services do not become imbalanced in favour of inpatient treatment. The capital programme will therefore also provide for community facilities in terms of day hospitals and outpatient clinics. Only those children with the most severe disorders should be admitted as inpatients and, when admitted, the aim of the service must be to discharge the child back to his or her family and ongoing care in the community at the earliest possible date. The establishment of further multidisciplinary child and adolescent mental health teams is therefore a priority for the Health Service Executive. At present there are 55 teams in place throughout the country and a further eight are in development. The development of additional community-based services coupled with the provision of additional inpatient capacity represent significant progress in the provision of mental health services for children and adolescents.
The Health Service Executive launched the first annual report on child and adolescent mental health services last October. This report provides a comprehensive picture of the stage of development of Child and Adolescent Mental Health Services as well as providing important information on the young people presenting with mental health issues and how the nature of their condition changes with age. As this is the first report of its kind, many of the measures in the report do not have historic comparators and therefore it is too early to draw trends. However, the executive now has comprehensive information from which to monitor the mental health of children and adolescents, and this will inform the development of services that respond to their needs. The data will also enable the HSE to determine what is being delivered for existing resources, review resource distribution and, importantly, to develop minimum datasets, key performance indicators, standards and care pathways. Information is now to hand which indicates how the needs of children change as they mature and this will help to inform policy and service planning for the years ahead.
I thank Deputy Neville for raising this matter. I reaffirm the commitment that the target number of child and adolescent beds specified in A Vision for Change is 100. I hope we can deliver on that within the timeframe involved.