Dáil debates
Tuesday, 8 November 2016
Topical Issue Debate
Counselling Services Provision
6:15 pm
Pat Buckley (Cork East, Sinn Fein)
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The demand for counselling in primary care, CIPC, is steadily growing. The number of referrals increased from 14,407 in 2014 to 17,000 in 2015. Waiting lists for access to a first appointment are long and growing. A total of 2,496 people were waiting for counselling at the end of the first quarter of 2016. Of these, 45%, or 1,119 people, were waiting for between four and 12 weeks; 21%, or 520 people, were waiting for between 12 and 24 weeks; and 5%, or 139 people, were waiting over 24 weeks. In the improving access to psychological therapies, IAPT, service in the United Kingdom, the target is that 75% of referrals be seen within just six weeks and 95% within 18 weeks. These waiting times for those in need of emotional and mental support at very difficult and troubled times in their lives are not acceptable. A long wait for counselling is not just a possibility; it is the norm. Over 26% of people waited at least a quarter of a year for their first appointment. Who knows what people in a vulnerable state may go through in this time? How many on the lists engaged in self-harm or self-harming behaviour, made an attempt on their life, or sought emergency support which, of course, was found wanting.
Even when people gain access to the CIPC model, they are only offered eight sessions. That may well be enough for some, but it is also far too little for many. Mental Health Reform which has been to the fore in raising this issue has called for an expansion of the number to 20 sessions, as in the United Kingdom. The Minister of State must also work to expand the CIPC service to be available not just to medical card holders but also to people on low incomes who are above the medical card threshold. Far too many people on low incomes forgo needed counselling because they cannot afford it. This in the end has untold costs.
The CIPC service is only available to adults. This is a major gap, given the clear potential for positive outcomes from counselling for younger people who are particularly at risk and poorly placed to afford such counselling. Jigsaw and other programmes do good work, but they could and should be supplemented when needed, particularly when we know that child and adolescent mental health services, CAMHS, remain understaffed in most cases based on a recent HSE report.
A major concern for people who wish to see an improvement in this and other mental health services is the failure by the Government to live up to previous pronouncements on budget increases for these services. The Government has now promised to increase the mental health budget by just 1.8% or €15 million in 2017 - less than half what it claimed on budget day. Will the Minister of State commit to reviewing this funding level which is clearly inadequate to address growing demand and the need to improve services generally to implement A Vision for Change? This €15 million is simply not enough and feels like a box-ticking exercise by a Government that, having promised an increase, felt obliged to provide the crumbs off the table but dressed them up as something better when the media were watching.
Helen McEntee (Meath East, Fine Gael)
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I thank the Deputy for raising the issue. We all agree that there has been a change in the mental health services and that change needs to continue towards a more preventive and community-based model. It should not commence when a mental illness becomes too difficult; we need to protect people's mental health in the very early stages.
A commitment was given to improve access to psychological therapy and early counselling therapies. Following on a commitment in the 2011 programme for Government, the HSE counselling in primary care, CIPC, service was established and formally launched in July 2013. The primary task of the CIPC service is to provide accessible short-term counselling for adults on low incomes who hold a medical card and present with mild-moderate psychological difficulties in a primary care context.
The service is overseen and managed within the framework of the HSE national counselling service, NCS, and provided in each community health organisation, CHO. Each director of counselling within the NCS is responsible for the overall clinical governance framework for the CIPC service in their area. It is co-ordinated on a day-to-day basis in each area by one or more counselling co-ordinators. There are ten counselling co-ordinators in the CIPC service which sources suitably qualified counsellors on a sessional basis to provide for the needs of individuals using these services.
The Deputy mentioned some of the figures. It is important to go through them because obviously the figures have increased. There has been a growing demand for the CIPC service and consistent growth in the level of service provision. The referral rate increased from 14,407 referrals nationally in its first year to 17,000 in 2015, an 18% increase. In the first quarter of 2016 alone there were in excess of 4,500 referrals nationally to the CIPC service.
Since its launch the CIPC service has offered in excess of 128,000 counselling sessions, with 42,000 offered in 2014 and over 65,000 in 2015, a 50% increase on the figure for 2014. Some 6,000 counselling sessions are being offered every month by the CIPC service. If it continues at this level, it will represent a 12% increase on the figure for 2015. The number of referrals is increasing, as is the number of counselling sessions.
In keeping with its primary task of providing accessible short-term counselling for adults in order to facilitate timely intervention with psychological difficulties, the majority of clients are seen within three months of referral, as evidenced by a breakdown of waiting times at the end of March 2016. Of the 2,496 clients waiting for counselling nationally at the end of the first quarter of 2016, 718 were seen within the first month. A total of 1,119 were waiting between one and three months. I agree that we need to get that figure down to or as close to one month as we can. We also need to reduce the figure of 520 clients who were waiting between three and six months. Analysis of the 139 clients waiting over six months indicated that the majority of this group had specific requirements such as limited client availability to attend counselling.
The Deputy expressed concern about young people's ability to access the CIPC service. As part of the programme for Government investment in 2016, €5 million has been allocated to primary care services to provide counselling and psychological supports for children under 18 years. Additional initiatives to enhance early intervention and prevention services include embedding the existing Jigsaw services and the planned addition of five more youth mental health services - two in Cork, two in Dublin and one in Limerick.
Pat Buckley (Cork East, Sinn Fein)
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I thank the Minister of State for her reply. She accepts that there is a significant and growing demand for the CIPC service. We have had numerous discussions in the House about mental health and it keeps coming back to the same thing. We know that there is increased demand for the CIPC service. Why can we not fund it properly? The Government had promised to spend approximately €30 million on mental health services and now we are talking about €15 million. We know that there is a demand for 24/7 crisis intervention centres. We also know that there is a huge issue with understaffing in the CAMHS. The mental health budget has to be increased. I, therefore, ask the Minister of State to look at the issue again. I cannot overemphasise that not enough money has been invested in mental health services and people will suffer as a result.
Helen McEntee (Meath East, Fine Gael)
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We need to look at the funding increase in the mental health section within the Department of Health. Between 2011 and 2016 an additional €115 million was allocated at a time when the budget of every other section within the Department of Health was cut. There has been a focus on mental health and increasing the funding available for mental health services. In previous years we found that when funding was allocated, it was not spent. There has been an increase of almost 24,000 in the service plan for this year, with an additional €50 million for the national forensic mental hospital, which is very much part of implementing A Vision for Change.
This will allow us to outline the service plan which we are currently in the process of doing. The further development of counselling supports for those with mental illnesses for people over and under the age of 18 will form part of that plan. Our priority, and my priority, is to set out €35 million worth of projects that can be planned in a way that every single penny of the €35 million will be spent. The last thing I want is to stand here in one year and say we have not been able to spend all of our funding or that all of the allocated funding has not been spent. We are initiating €35 million worth of new development and new projects. Some €15 million of that will be spent next year. Almost an additional €10 million will be spent in increasing our staffing resources. This additional €10 million will go in to staffing wages which is an integral part of improving our services. If we do not pay our staff, if we do not retain our staff and if we do not attract new staff to the service then we will never reach those figures the Deputy speaks about. We need to continue to increase our funding, we need to continue to invest but we also need to plan and make sure we spend the money we say we will spend.