Aodhán Ó Ríordáin (Dublin North Central, Labour)
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I must apologise for my voice which has been affected by some dental work, but I will try to struggle through. I wish to raise the important issue of the new referral procedure for children in the north side of Dublin to the Mater child and adolescent mental health service. Mater CAMHS deals with the mental health needs of children aged from birth to 16 in Dublin North-Central. Sixteen and 17 year olds are also continuing to use the service. Dublin postcodes 1, 3 and parts of 7, 9, 11 and 6, Dublin North-West, Glasnevin and part of Cabra are also covered. The services provided are psychiatry, clinical psychology, social work, speech and language therapists, occupational therapists, administration, registrars in child psychiatry, trainees and students in all disciplines.

The referral process is for children from birth to 16 years with persistent mental health problems such as emotional, behavioural, developmental and other psychiatric disorders. It also concerns problems that impact on functioning at home, in school or in relationships that have not been resolved by primary care level intervention, including the National Educational Psychological Service. We are talking about deliberate self-harm, suicidal thinking, depression, mood disorder, complex and severe anxiety, attention deficit disorder, attention deficit hyperactivity disorder, significant emotional and behavioural difficulties, post-traumatic stress disorder, complex behavioural problems, conduct disorder, complex behavioural response, psychosis, eating disorders, obsessive compulsive disorder and complex developmental problems.

Local school principals dealing with these very vulnerable children in an acutely disadvantaged area, which is the team A area in Dublin North-Central, are being told they can only get referrals to use the Mater CAMHS service through their local general practitioner. Children in Dublin 2 or 4 can therefore be referred by their local school principal, but children in Dublin 1 and 3 have to go through their GP. This is completely unfair, unwarranted and unnecessary. We are asking school principals to bring a parent and child to their local GP before they can make an essential and sometimes immediate intervention to save a child's mental health or potentially save a child's life.

People working within the service are saying this is completely unworkable. Why is a child in Dublin 1 being treated differently from a child in Dublin 2 or 4? The referral process should be uniform throughout the system. Will the Minister ensure principals in the team A area for Mater CAMHS will continue to be allowed to refer vulnerable children to this most important service?

James Reilly (Dublin North, Fine Gael)
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I thank the Deputy for raising this issue for discussion today and giving me the opportunity to discuss it.

The Dublin north city and county child and adolescent mental health service, formally known as Mater CAMHS, has become part of the HSE from 1 January this year. Currently, referrals can be made to Dublin north city and county CAMHS from 13 different referral sources, which would not be consistent with national policy as advocated by A Vision for Change. The service is currently reviewing its existing clinical care pathway and referral criteria to bring it into line with A Vision for Change and the other mental health specialties. As part of this review it is developing a plan for the implementation for the standard referral pathway and referral criteria which, when implemented, will reflect A Vision for Change and national policy. This plan will be implemented in 2014. Some of the teams had reduced the number of referral sources in anticipation of the wider plan. However, the service can confirm that in advance of its referral criteria being brought in line with national policy, it will continue to consider all referrals, including those from schools.

Community child and adolescent mental health teams are the first line of specialist mental health services for those under 18 years of age, providing acute secondary mental health care. The assessment and intervention provided is determined by the severity and complexity of presenting cases. Nationally, there are a total of 61 child and adolescent mental health teams, comprising 56 community-based teams, two adolescent day hospital teams, and three hospital paediatric teams. All community CAMHS teams screen referrals received, with those deemed urgent seen as a priority and those regarded as routine placed on a waiting list. In the period 1 October 2012 to 30 September 2013, a total of just over 12,000 referrals were accepted by the HSE, representing a 21% increase when compared with the previous 12 months. This statistic alone highlights the challenges being faced in providing mental health services. Arising from the investment in mental health in 2012 and 2013, 232 new posts and €7.5 million were allocated to enhance CAMHS community team provision. Of these, 171 or approximately 75% had started in their posts by 31 January last.

The HSE will continue to prioritise investment in CAMHS services in line with A Vision for Change. The €20 million allocated to mental health for 2014 will allow between 250 and 280 more posts to be filled. As outlined in the national mental health division operational plan for 2014, a comprehensive workforce analysis will inform the best targeting of the 2014 investment. It is expected that a proportion of the new posts will be allocated to CAMHS to build on the 2012 and 2013 investments.

The detailed annual CAMHS reports will continue to report on the activity, access, timeliness and resources of these services. I wish to reiterate the Government's strong commitment to developing mental health services for children and adolescents nationally. I trust this clarifies the matter for the Deputy.

Aodhán Ó Ríordáin (Dublin North Central, Labour)
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I thank the Minister for his response. I note he said that "the service can confirm that in advance of its referral criteria being brought in line with national policy, it will continue to consider all referrals, including those from schools". The problem though is that the Mater CAMHS is telling local school principals something different. While people within the service are quietly telling principals that they think this is unworkable and they want the previous criteria to remain, the Minister's message and the message local principals are getting from Mater CAMHS are two very different things. I ask the Minister to ensure local schools dealing with these vulnerable children are aware they can still refer such children to the local Mater CAMHS and that the situation has not changed. Will the Minister also communicate that to the service itself? We do not want mixed messages to be coming from the Minister and the local Mater CAMHS.

According to a presentation for principals by that service, the HSE is recommending that referrals come through the local GP. Two very different messages are coming out here, so we need clarity. We are dealing with very vulnerable children in serious situations who will potentially need life-saving interventions.

We cannot play around with words in the circumstances. Principals and school communities need to know what protections they have and what line of responsibility they have. Mixed messages from CAMHS or the Department do not help. If the Minister could clarify the matter or ensure that it is clarified, it would be deeply appreciated.

James Reilly (Dublin North, Fine Gael)
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I thank the Deputy again for raising the matter. It provides an opportunity to communicate with service users as well as service providers. It is the responsibility of the Minister of State, Deputy Kathleen Lynch, who cannot be here due to a family bereavement. I apologise on her behalf and note that our thoughts and wishes are with her. I will discuss the matter with her. I have no doubt that she will be in a position to communicate a clear message to the services concerned. The question of whether it is more appropriate that referrals be carried out through certain pathways rather than in a broader sense is a matter for further discussion given the hugely increased pressure under which the service has come. That increase in pressure is evidenced by the statistics I have just set out to the Chamber.

The Government is committed to dealing with mental health issues and to ending the situation whereby children with serious mental health issues are admitted to adult facilities. We have reduced the incidence of that considerably. We are committed to ensuring that people are looked after in the community, which is the first line of defence. That is appropriate because it is where most needs can be met and it is far more convenient for parents and their children not to have to spend a great deal of time travelling to specialist clinics. It would be better to have local clinics accessed through local referral pathways.

I will certainly raise the Deputy's concerns with the Minister of State and we will clarify matters. The note from the Department is very clear that the current system of referral has not changed. I note from the document the Deputy read out the suggestion that it might be best done through the general practitioner. I do not have a difficulty with that but I accept equally that school teachers who are dealing with children on a daily basis are often skilled at detecting problems that might require further investigation. Such teachers should be facilitated for the sake of the child, which is what we are all interested in.