Mick Wallace (Wexford, Independent)
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8. To ask the Minister for Health his proposals to end the practice of admitting children to adult mental health units and cope in an age-appropriate way with the rise in the number of children and young persons receiving acute inpatient mental health care; and if he will make a statement on the matter. [20611/16]

Mick Wallace (Wexford, Independent)
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According to Mental Health Reform, 75% of mental health difficulties arise before the age of 25 and almost one in three young people has, at some time, experienced mental health difficulties but there are only 12 acute mental health inpatient beds for children in the south of the country. These are in Eist Linn in Cork. A young person who happens to experience a mental health crisis in Wexford may have to travel 200 km and might not even get a bed. Does the Government intend to do anything about this?

Helen McEntee (Meath East, Fine Gael)
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I thank the Deputy for raising this issue. He is right that many mental health problems arise at a very young age, sometimes a younger age than people like to speak about or even admit. Inappropriate admissions is a very sensitive issue. The reduction in the number of children admitted to adult psychiatric units continues to be a priority for the HSE's mental health services and it is a priority for me. It is something that has been raised on a weekly and daily basis.

Last week, I met the HSE specifically to review progress on this issue and to see what further improvements can be made in this regard. I will be progressing this with the HSE over the coming months, particularly in the context of opening additional child and adolescent mental health beds and enhancing community-based care for young people across the regions while additional mental health staffing comes onstream. I also intend to improve, where possible, the multidisciplinary approach at local level to ensure that existing best practice is standardised nationally. Bearing this in mind, the Deputy will have to see we have made significant improvements in recent years. In 2008, we had 247 admissions to adult units and this declined to 89. While we saw a small increase last year, we are starting to see it move in the right direction.

If we look at the figures, where a child has been admitted to an adult psychiatric unit or an inpatient unit, the length of stay has been kept to an absolute minimum. The child is generally 17 to 18 years of age and while I am not saying this is okay or appropriate, we need to continue to put a variation of measures in place to see these figures reduce. Our target is 95% and I would like it reach 100%.

Mick Wallace (Wexford, Independent)
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I am sure the Minister of State is aware that under A Vision for Change, the idea was to introduce community mental health teams to reduce the need for acute inpatient mental health care. As the head of the Psychiatric Nurses Association of Ireland, Mr. Des Kavanagh, recently stated, community-based mental health services remain a mere aspiration. Surely the Government must target this area much more. While we are complaining about the lack of facilities for inpatient mental health care, we all agree that unless the State is prepared to invest in community care and start actively working towards it now, we will not address the problems. I come from the county with the highest suicide rate in the country. This is directly linked to the fact we have more than 20% unemployment and more than 30% youth unemployment. Sadly, we do not have the necessary facilities for people at community care level or for inpatient care. For want of a better word, Wexford is a deprived county and problems in deprived areas, such as County Wexford, must be specifically addressed.

Helen McEntee (Meath East, Fine Gael)
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I agree with the Deputy that we are nowhere near where we need to be. As he rightly pointed out, we have four acute inpatient child and adult mental health services, CAMHS, units in Dublin, Cork and Galway. We have additional resources and facilities, which means we have 69 CAMHS teams.

4 o’clock

While I admit they are not all full, we need to get to a position where the teams are full and we have an adequate number of staff. If one looks at the figures it will be seen that the overall demand for CAMHS is rising. In January 2,325 people were seeking the service while in May 2,612 were seeking it. While those figures have increased, if one looks at the number of children admitted to the HSE adult inpatient units, in April there were 12 but that figure has now decreased to six. In that regard, we are moving in the right direction, but a lot of work needs to be done. Specifically, A Vision for Change is being reviewed. A tender has gone out to carry out that review, which I hope will happen by the end of the year. That vision has not changed. We need to start moving towards a more community-based model.

With regard to the Connecting for Life document, which specifically deals with suicide, there is a youth pathfinder project team which is dedicated to implementing the youth element of that. We need to tackle the youth element of suicide and the problems arising at a younger age because if one tackles them at an earlier age, they are less likely to become problematic later.

Mick Wallace (Wexford, Independent)
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I accept that there have been some improvements in certain areas. I note a statistic that in 2011, 31% of child admissions were to adult units, compared to 28% in 2015, so that is to be welcomed. Sadly, however, there continue to be a huge challenge in the area. I do not expect the Government to be able to solve everything overnight. In Wexford, for example, there are a lot of different groups involved in dealing with the challenges of mental health issues, many of which are charities. We have heard a lot of talk about charities in the last couple of weeks, but the HSE is outsourcing a lot of work to charities that it should be doing itself. We are trying to co-ordinate a range of groups and charities involved in mental health issues in Wexford at the moment. One group involved is in the Campile area. Two girls working in a pharmacy in Campile highlighted to me that they are shocked at the number of young people coming into the pharmacy and accessing prescribed drugs to deal with mental health issues. It has grown dramatically. The State has to play a stronger role. The idea of the HSE outsourcing some of this to charities is not working very well. There has to be a hands-on and more active approach on the part of the State.

Eugene Murphy (Roscommon-Galway, Fianna Fail)
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I will allow Deputy Kelly to make a short intervention before I come back to the Minister of State, if that is okay.

Helen McEntee (Meath East, Fine Gael)
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Yes.

Alan Kelly (Tipperary, Labour)
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The admission of young people to adult facilities is a scandal. In fairness, funding is now ring-fenced for mental health arising from action taken by the Minister of State's predecessor. The figures are also being addressed. The Minister of State is doing her best and any support she needs she will certainly get from our side of the House because community intervention is necessary. However, I ask her to provide the House with the complete figures for the number of people accessing adult facilities, including where and by what region. Some one in five teens report moderate to severe depression in his or her final two years of being a teenager. A very good programme called the Jigsaw proposal was rolled out by Headstrong. I ask the Minister of State to support it and to advise the House about the roll-out of this proposal and its timelines. I understand a number of different areas are interested in it. Will she support their endeavours?

Helen McEntee (Meath East, Fine Gael)
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Regarding the figures, in 2015 there were a total of 356 child and adolescent mental health admissions, of which 73% were to age-appropriate units and 27% were to adult units. In May 2016, the most recent figures available, 97.2 of the bed days used were in child and adolescent inpatient units, which is an improvement of 95.4% on April. Our target is 95%. We are steadying out at the moment. I admit that any kind of inappropriate admission is not acceptable, which is why we need to continue to work on increasing our beds and staffing and to make sure that we have community-based care so that children do not need to go into acute services. In that regard, as I have already mentioned in the Chamber, the youth mental health task force, which I will announce next week, will tie in the voluntary, private, public and all the different sectors together to work together. I would very much like to get to the stage where we do not need charities to provide these services. We will have succeeded if we get to that stage, but we are a long way from there, so we need to work together. That is exactly what the youth mental health task force will aim to do.

Eugene Murphy (Roscommon-Galway, Fianna Fail)
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Deputy Buckley, one very quick comment-----

Alan Kelly (Tipperary, Labour)
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What about Jigsaw? I apologise, but my question was not answered-----

Eugene Murphy (Roscommon-Galway, Fianna Fail)
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I let the Deputy contribute. I want to let-----

Helen McEntee (Meath East, Fine Gael)
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A number of new Jigsaw programmes are coming down the line. It is not possible for every area and not every area wants or needs one. I was in Carlow only last week, which has an excellent service but it is not necessarily needed. If an area would like the service those concerned need to work on that themselves. If they do not, then there are other services.

Pat Buckley (Cork East, Sinn Fein)
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I want to put on the record of the House that I agree predominantly with Deputies Kelly and Wallace. Unfortunately, at one stage, my own town was known as the suicide capital of the world, so Deputy Wallace and I know where we are coming from. A Vision for Change is ten years old. Recently the PNA and the RCSI have said that A Vision for Change is still perfect. I could make the relevant points that have mostly been made already, but there is a growing fear out there within communities that the Government intends to scrap A Vision for Change and will seek to enter into a more privatised model using its own failure to implement reforms as an excuse. The people to whom I have spoken have said that this would be totally unacceptable. I wish to put on the record that we need to implement the plan. Let us not talk about reviews any more. I ask the Minister of State to implement the basic elements of A Vision for Change, such as the 24-7 crisis intervention and the five-day week changing to seven-day week intervention houses. At the moment there is not one crisis house in any community in this country.

Helen McEntee (Meath East, Fine Gael)
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The fundamentals of A Vision for Change have not changed and will not change. The review has to make sure that we do not just focus on mental illness; we need to focus on health and well-being and move more towards the community setting. The review is taking place and the tender has gone out. We hope that once the tender is approved and the review is finalised at the end of the year, in tandem with that, we will still be implementing A Vision for Change. As I said, the document and the fundamentals have not changed, but we need to start moving towards a more preventative model, instead of the reliance on institutions. I believe we are doing this. I take on board what the Deputy says.