Seán Ó Fearghaíl (Kildare South, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I am grateful to the Leas-Cheann Comhairle for selecting this matter which is of concern to all Members. We are aware that the Mental Health Commission has published its 2013 report today and of the concerns expressed in it about the 91 admissions of children to adult mental health facilities during 2013. We all have experience of the impact on families and individual children of the requirement to seek such help. We are aware of the inordinate difficulties with which families must contend, first, in dealing with a child who has mental health problems and, second, in dealing with a system that is, regrettably, not always as sympathetic or proactive as one would wish. To find, in addition to all of these problems, that so many children were placed in completely inappropriate adult settings at a time when, it appears, there were vacancies in the appropriate settings is particularly concerning.

The report indicates that although in 2013 there was provision for a maximum of 48 beds, they were not filled at all times. People were told beds were unavailable because the child and adolescent community mental health, CAMH, service does not operate an emergency response service, particularly at weekends. While we support the Government's ambition to develop and deliver up to 108 beds by 2015, we must judge the service based on what is available today. All the indications are that even the limited number of 48 beds are not in use full time and not accessible by those who need them.

Dan Neville (Limerick, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I thank the Leas-Cheann Comhairle for allowing me to raise this issue which, unfortunately, we have been raising for over a decade and a half. During that period the professionals have expressed concern about the proper care of children in need of psychiatric in-patient care. Having children, some under ten years of age, in the same ward as people aged 30 to 90 years is deemed by all psychiatrists, psychotherapists and general mental health service staff to be totally unsuitable and detrimental to their recovery. We must be concerned about the high number of children being admitted to adult psychiatric units. In 2013 there were 91 admissions to adult units, involving 83 children.

A Vision for Change 2006 included the recommendations of the expert group that mental health inpatient services for children up to the age of 18 years be provided only in dedicated child and adolescent psychiatric inpatient units. The HSE has failed to meet the code of practice on the admission of children under the Mental Health Act 2001, as drawn up by the Mental Health Commission. The code of practice specified that from July 2009 no child under the age of 16 years should be admitted to an adult inpatient unit and that the same should apply from December 2010 to any child under 17 years and from 2011 to any child under the age of 18 years.

The length of stay varied. In this regard, Deputy Seán Ó Feargháil was correct to raise the issue of emergency care at weekends. With 60 beds available and 48 in use, 12 were available, although the statement told us none was available. Some 105 beds are promised by 2015.

Perhaps the Minister of State might comment on the progress he expects to be made on the plans. I also draw attention to the fact that in the original plan 20 beds were to be provided in the mid-west region, but that has not happened and we are told it will probably not happen at all now. The Minister of State might have some information on this.

Alex White (Dublin South, Labour)
Link to this: Individually | In context | Oireachtas source

I thank both Deputies for raising the issue for discussion. The Government has prioritised the reform of mental health services in line with A Vision for Change and is committed, in particular, to the delivery of more and better quality care in the community. To this end, funding of €70 million and 890 posts were provided to develop community mental health services in 2012 and 2013. In budget 2014 the Government again committed to ring-fencing a further €20 million for 250 to 280 posts to be recruited by the end of 2014. This means that despite serious resource pressures overall, funding of €90 million has been made available since 2012, specifically earmarked for new mental health and suicide prevention initiatives.

Acute inpatient admissions of children and adolescents are prescribed in A Vision for Change as being to age appropriate acute in patient units which are approved centres registered with the Mental Health Commission. The provision of inpatient beds is an integral component of the range of services required to appropriately meet the needs of young people. Interventions are provided through community mental health teams in the first instance and, if required, access to the relevant inpatient service is provided. Nationally, inpatient bed capacity has increased from 12 beds in 2007 to 56 at present. There are 16 beds in Dublin, 20 in Cork and 20 in Galway, an increase of 400% in seven years. In 2008, 25% of admissions of children to HSE acute inpatient units were to age appropriate child and adolescent acute inpatient units. By 2013, this had increased to almost 80% of admissions. The Minister of State, Deputy Kathleen Lynch, considers - I agree - that this is still not acceptable, nor is it in line with Mental Health Commission regulations which require that all children under 18 years be admitted to age appropriate acute inpatient facilities, except in exceptional circumstances. However, Deputies will agree that significant progress is being made on this matter.

The admission of children and adolescents to age appropriate child and adolescent mental health services, CAMHS, acute inpatient units reflects best practice and supports better outcomes for individuals. This is a key priority for the HSE and its service plan for 2014 includes a specific quality key performance indicator to ensure the focus remains on meeting this objective. Community child and adolescent mental health teams are the first line of specialist mental health services for children and young people. They provide acute secondary mental health care in the community. The assessment and intervention by such teams are determined by the severity and complexity of the presenting problem. The ring-fenced funding allocations for CAMHS I have outlined allowed for the provision of an additional 230 posts in 2012 and 2013, of which 80% are in place. Recruiting to the remaining posts is ongoing.

The foregoing is proof in real terms of the Government's commitment to the continued development of mental health services for children and adolescents. It is in this context that the Minister of State will examine in detail the report of the Inspectorate of Mental Health Services to determine the scope for further improvements and ensure the HSE can continue to make progress towards achieving the desired best practice as resources permit.

Seán Ó Fearghaíl (Kildare South, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I accept that progress has been made. I also accept the expertise of my esteemed friend, Deputy Dan Neville, who has campaigned in this area for many years. However, people's eyes glaze over when they hear talk about the millions of euro expended in it. What they want to see is tangible improvement. They want to their adolescent children being able to find centres where they can be cared for when difficult and traumatic circumstances mean that care cannot be provided at home and to ensure the safety of the child and the family. All Members of the House went before the people to campaign for the amendment of the Constitution in the children's rights referendum. We said the rights of children had to take centre stage. I would love the Minister of State to provide the House with a commitment that in 2014 no child under the age of 18 years will be committed by CAMHS or any other State agency to an institution which is not age appropriate.

Dan Neville (Limerick, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I too recognise that the Government has allocated considerable funding to mental health services as promised and that progress has been made. However, I question the effectiveness of the HSE in using the funds to obtain maximum improvements to services. Does the Minister of State accept that one of the key aspects is to establish an emergency service, especially at weekends? Of all admissions, 23% took place on Saturdays and Sundays when emergency services were not available. If emergency services were to be introduced immediately, this would go a long way towards correcting the issues Deputy Seán Ó Fearghaíl and I have raised. We urge the Minister of State to ensure the moneys allocated to the HSE are applied to emergency services.

It is not a large number of children we are discussing, but it is a vital cohort for whom the service must be provided. I again draw attention to the concerns of the people who know about the admission of minors, some of them children under the age of ten years, to adult mental institutions. These children are in serious need of inpatient care. We do not want to see people going to mental institutions and units, but on occasion it is absolutely necessary. These are acutely ill persons in need of the maximum treatment leading to recovery. If we were even to get a commitment to the introduction of emergency services today, it would be progress.

Alex White (Dublin South, Labour)
Link to this: Individually | In context | Oireachtas source

I thank the Deputies for their contributions. I understand Deputy Seán Ó Fearghaíl's point that sometimes people's eyes glaze over when figures are provided. Behind the figures, however, lies a considerable improvement in the real and actual experiences of people who need the services. For example, where more staff and resources are provided, even though we describe them to the House in terms of numbers, considerable improvements in the way the service is received are experienced by those who need it. I accept what the Deputy said about the objective of ensuring no child under 18 years should be admitted other than to an age appropriate, acute inpatient facility, other than in exceptional circumstances. That is the objective the Minister of State, Deputy Kathleen Lynch, is committed to achieving.

Deputy Dan Neville makes the point about the actual use of funds, which he understands very well. He is right to say those who know the services should always have their views taken into account and implemented as far as possible. Something in the order of 17,000 children are availing of CAMHS and all community teams screen the children and adolescents referred to their services on the basis of urgency of need. Children and adolescents in need of an urgent appointment are seen as a high priority, as one would expect, while those with a lower acuity may have to wait longer.

I accept what was said about the configuration of services and the importance of emergency services and will communicate everything the Deputies have said to the Minister of State who is very engaged with the issue and on which she has made considerable progress.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

Gabhaim buíochas leis an gCeann Comhairle as an deis seo chun ceist fíor-thábhachtach a phlé.

It is a very serious matter that nine clinicians in the area of mental health in the Carlow-Kilkenny, south Tipperary area have withdrawn their confidence in the HSE's management of the service. They cited nine suicides in the area over a period of just 17 months, as revealed in an investigation aired last Sunday on RTE's "This Week" programme. I have raised this as a Topical Issue, while our party leader raised it with the Taoiseach yesterday, because the HSE and the Minister of State with responsibility for mental health services, Deputy Kathleen Lynch, must account publicly for the fact that these clinicians believe their concerns have not been taken seriously, despite being raised repeatedly.

In a letter received by RTE under freedom of information, the nine doctors wrote to the Minister of State, Deputy Lynch, to express "serious concerns" about local services in light of the nine fatalities. The doctors questioned the safety of governance in the service and said they felt devalued and ignored in their attempts to raise their concerns internally in the HSE. That a group of front-line clinicians should feel strongly enough to co-sign such a letter is alarming. The clinicians highlighted nine deaths in the period from August 2011 to January 2013. What makes this most worrying is that they raised their concerns first in November 2012 and by the following June they were writing to the Minister of State to say that those concerns had not been properly addressed. The clinicians said they were not informed of the outcomes of HSE reviews of these tragedies. The fatalities concerned included three suicides of inpatients by the same means, four suicides in home-based settings, and a further suicide in a crisis house.

I have a number of specific questions. Did the Minister of State act on the consultants’ call to intervene with the HSE to ensure proper investigation of incidents and that review findings would be properly communicated and appropriate reforms implemented? Did the Minister of State accept the contention of the HSE briefing document supplied to her, which claimed the fatalities in the service are not out of line with figures for the preceding 11 years, citing Central Statistics Office statistics for Counties Carlow and Kilkenny and south Tipperary? What does the Minister of State say to retired consultant Alan Moore, who said on RTE that CSO figures do not reflect the number of suicides occurring in hospitals, which he believes is unusually high? Can the Minister of State confirm that an investigation is being carried out by the Irish Mental Health Commission into governance structures within the service and that a separate review is under way by Dr. Colm Henry of the national lead clinical directors programme?

It is also serious that the local consultant group has described clinical governance systems in the area as unsafe and that participation in them would be a dereliction of duty. This is serious. These revelations came just three days before today’s publication of the annual report of the Mental Health Commission, including the report of the Inspectorate of Mental Health Services. That report shows that only 44% of psychiatric hospitals and mental health facilities are compliant with staffing level regulations. I ask the Minister of State to address the questions posed.

Alex White (Dublin South, Labour)
Link to this: Individually | In context | Oireachtas source

I am taking this matter on behalf of my colleague, the Minister of State, Deputy Kathleen Lynch. I thank the Deputy for raising this issue for discussion. As Deputy Lynch has indicated on several occasions in the past, the HSE has been reconfiguring mental health services in the Carlow, Kilkenny and south Tipperary, CKST, area to provide a modern mental health service in line with the recommendations in A Vision for Change, including the strengthening of community mental health teams for adults and children. It is acknowledged by the HSE, and by the Minister of State, that the CKST mental health services have undergone a radical reform programme and that considerable work has been done to date to achieve this fundamental objective. Significant additional investment has been provided to underpin this reform. It is also noteworthy, also, that the mental health resources allocated to CKST on a per capita basis are some of the highest in the country.

Arising from concerns at both clinical and management level in this area, two reviews have been undertaken in recent months relating to governance and patient safety issues in the CKST service. In 2013, the HSE quality and patient safety, QPS, division commissioned a review of governance structures within CKST mental health services. The findings of the review are being finalised. In March 2014, at the initiation of the Mental Health Commission, the Inspectorate of Mental Health Services carried out a targeted intervention into safety and governance for service users in CKST. The outcome of this comprehensive review of service delivery in the area will be reported to the executive of the Mental Health Commission as soon as possible.

Following completion in 2013 of a national QPS audit by the HSE of sudden and unexplained deaths within community mental health services, the HSE mental health division has progressed implementation of its recommendations over the past year. These include engaging with the Mental Health Commission to consider how to encompass the expansion of community services within the notification process and offering additional training in HSE incident management policy and procedures to staff in the mental health services, which incorporates a formal recording and reporting process. I agree with the Minister of State, Deputy Lynch, who welcomed the significant governance and management changes which have taken place in the CKST area in recent times, a process that is continuing. We recognise also the significant leadership being provided by consultants, other health professionals and HSE management in this process. We share the common goal of having the best possible mental health services in this particular area, as we are doing elsewhere in the country. We urge, therefore, that all parties in the CKST region facilitate implementation of the recommendations that may arise from the reviews when these are finalised, in tandem with co-operating on all remaining policy and service management issues reflected in A Vision for Change. Our priority must be to continue to strengthen the community mental health teams in this area to meet the needs of all service users.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

I appreciate that the Minister of State is delivering a response on behalf of his colleague, but the critical questions were about whether the Minister of State had acted on the consultants' call to intervene with the HSE to ensure proper investigation of the incidents and whether the review findings would be properly communicated, with appropriate reforms implemented. The Minister of State said that the findings of the review commissioned by the HSE quality and patient safety division are being finalised, that the Inspectorate of Mental Health Services carried out a targeted intervention into safety and governance for service users in CKST, and that the outcome of this comprehensive review of service delivery in the area would be reported to the executive of the Mental Health Commission as soon as possible. This is work in progress and has not reached a critical point. If we were to look at the shelves for matters pertaining to Carlow, Kilkenny and south Tipperary, we would find reports aplenty that have not been acted on. There is a serious problem with progressing with the required speed reviews and reports that are pertinent to the level of service provision in mental health services and across the health services generally, particularly where there is the potential for loss of life. On many occasions we have had documented tragic outcomes in respect of the general hospital network, but we are talking specifically about service users within the mental health services. In the view of the clinicians, there is an inordinate level of suicide in this area. It is a hugely worrying situation when clinicians of experience act with such unanimity. It is an alarm bell ringing loud and clear for all of us to hear. I must ask the Minister of State to speak to his colleague, Deputy Kathleen Lynch, and to appeal to her to make the necessary interventions of which I have spoken and to encourage the conclusion of the process of review and reporting and, most critically, to oversee and ensure implementation of all recommendations at the earliest possible date.

Alex White (Dublin South, Labour)
Link to this: Individually | In context | Oireachtas source

That will certainly be done. The Minister of State, Deputy Lynch, will do so. I reassure the Deputy and the House in respect of the apprehension that reports could be prepared and concluded with no action taken. Following the completion of the QPS audit in 2013, the HSE mental health division has been progressing the implementation of those recommendations. As well as the two examples I gave in my initial contribution, I should report to the House on tangible work that is ongoing and critically important in this area.

First, the mental health division has ensured there is engagement with the Mental Health Commission to consider how to encompass the expansion of community services within the notification process. Second, additional training is being offered in HSE incident management policy and procedures to staff in the mental health services, which incorporates a formal recording and reporting processes. Third, all executive clinical directors, area directors of nursing and integrated service area, ISA, managers have been written to and reminded of their responsibilities in regard to the notification and investigation of sudden and unexplained deaths, in line with legislative requirements, policies and procedures. Fourth, all of the mental health services are reviewing their internal clinical protocols to ensure the clinical director is formally advised in writing of an incident and that this notification is formally recorded. Fifth, the national mental health division has formally appointed an assistant national director for quality and patient safety and he is formally notified of all sudden and unexplained deaths, in accordance with the policy requirement, with immediate follow up put in train. Sixth, all executive clinical directors and ISA managers have received the final quality and patient service audit, QPSA, report and have been reminded of their obligations in regard to the creation and management of records of incidents.