Colm Keaveney (Galway East, Fianna Fail)
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99. To ask the Minister for Health his response to the criticisms of child and adolescent mental health services in the recent report by the Ombudsman for Children entitled A Meta-Analysis of Repetitive Root Cause Issues Regarding the Provision of Services for Children in Care; and if he will make a statement on the matter. [15122/14]

Colm Keaveney (Galway East, Fianna Fail)
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The object of this question is to elicit a response from the Minister to the several criticisms and observations made by the Ombudsman for Children in a recent report, A Meta-Analysis of Repetitive Root Cause Issues Regarding the Provision of Services for Children in Care. Will the Minister respond to the observations made by the Ombudsman for Children in section 4.6 regarding concerns with respect to the inter-professionalism and multi-agency collaboration with the Child and Family Agency?

James Reilly (Dublin North, Fine Gael)
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I note the report referred to by the Deputy which was published recently by the Office of the Ombudsman for Children. A significant part of the report refers to services provided by the Child and Family Agency, and my colleague, the Minister for Children and Youth Affairs, has recently responded to the issues raised in the report. As a number of the report's recommendations relate to the HSE child and adolescent mental health services, CAMHS, and the need for improved inter-agency co-operation with the Child and Family Agency, I have asked the executive to consider these and determine the steps necessary to address the issues identified.

The HSE child and adolescent mental health services are benefiting significantly from the funding provided by the Government for mental health services, which amounts to €766 million in 2014, including additional funding of €20 million this year, as part of total additional funding of €90 million over the period 2012 to 2014, inclusive. By the end of 2014, up to 1,100 new posts will be put in place to strengthen community mental health teams for both adults and children, and develop other specialist mental health services.

A Vision for Changerecommended the establishment of 99 multi-disciplinary child and adolescent mental health teams to provide acute secondary mental health care in the community. There are now 61 CAMHS teams in place, compared to 54 in 2008. The additional funding in 2012-14 is being used in part to expand and enhance the skill mix of these teams. Approximately 230 new posts were allocated to CAMHS over 2012-13 and recruitment is well advanced. The increasing demands being placed on our child mental health services were reflected in the 14,000 or so referrals received by CAMHS teams in 2013. This was nearly 1,000 or 8% more than projected in the HSE national service plan last year. However, the target of 70% of referrals being seen within three months was maintained.

I accept that there are specific additional risks of developing mental illness associated with children who are within the care system and that a proportion of the children attending CAMHS services are in contact with, or in the care of, the social services. A comprehensive protocol is in place between the HSE and the Child and Family Agency to ensure that the needs of children in the care of the State have access to CAMHS services in the same way as any other child with a mental illness, prioritised on need.

Colm Keaveney (Galway East, Fianna Fail)
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I thank the Minister for his response. Can he confirm that there will no longer be a situation where a child in care has a social worker in one area while relying on child adolescent mental health services in another area? Will the child be guaranteed to have a seamless access to a service? Several serious communications issues were identified in that report, including a case where the child adolescent mental health services failed to monitor a child's health status for over seven months. Can the Minister categorically state today that this is being addressed? I welcome the fact that he has asked the HSE to consider the report. The report found that where a child had been initially assessed in one area, she had been refused an assessment in another area, even though she was under the care of the HSE. Has this practice stopped since the Minister referred this report to the HSE?

The final issue was the most serious and may have implications not just for those in care, but also for those presenting to CAMHS. The report stated that "CAMHS does not work with children with an intellectual disability, and disability services do not work with children with mild intellectual disability." When are we to expect a response from the HSE on that reference in the report?

James Reilly (Dublin North, Fine Gael)
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I anticipate that the response to the last issue will come fairly soon. I would like to apologise; this is the area of the Minister of State, Deputy Lynch, who is unavailable to us today due to a family bereavement. I am here in her stead. I remember that when I was on the benches across and we were discussing child care, it was about the terrible tragedy of so many deaths in care in the past. I am glad to see that that situation has greatly improved even though we still need to work on it.

We also continue to work on the admission of children to adult facilities, because nobody in this House thinks that is appropriate. New services are being put in place. In 2008, 25% of admissions of children to the HSE inpatient acute services were to age appropriate child and adolescent units. By 2013, this had increased to 68%, so clearly we have more road to go.

Colm Keaveney (Galway East, Fianna Fail)
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What actions will the Minister be taking with respect to the report, specifically on the issue of CAMHS? Will those who have the responsibility for children be committed to playing a full-time role in collaborating with the new agencies, especially in respect of the parenting of children in the care of the State? The report notes that the Child and Family Agency has been created, and we welcome that. However, there is a concern that the agency will not have the same reach in terms of its responsibility for services under the direct control of the HSE. The lack of control by the agency primarily relates to CAMHS. CAMHS does not come under the new Child and Family Agency, and neither does the public health nurse. However, we have a system with respect to the welfare of children in this country under a multidisciplinary, multi-agency environment and I have concerns, as has happened in the past, that children will fall through the cracks of the bureaucracy again.

James Reilly (Dublin North, Fine Gael)
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We all share the Deputy's concerns that children might fall through the cracks and we must guard against that when we have so many people involved in their care and well being. In September 2012, access protocols for CAMHS services were approved by the HSE, with effect from 1 January 2013.

The protocol reiterates the position of children accessing services in line with the Mental Health Commission's protocols, including children being referred for the first time to the mental health service from outside their geographic area. In effect, all children requiring secondary care mental health services are seen on the basis of clinical requirement. Children in care are provided with child and adolescent mental health services on the same basis as all other children in the population. A comprehensive protocol has been developed between the HSE and the Child and Family Agency to ensure the needs of children in the care of the State are met when it comes to accessing health services, including mental health services. This reinforces the position that child and adolescent mental health services are available to children in the care of the State in the same way as they are available to any other child with a mental illness. Basically, it is prioritised on the basis of need. This protocol is at an advanced stage of discussion pending agreement.