Thursday, 1 December 2016
Mental Health Services Staff
9. To ask the Minister for Health the measures he is taking to address the fact that just 6% of the recommended A Vision for Change staffing levels in adult mental health intellectual disability services are in post; and if he will make a statement on the matter. [38015/16]
Just 6% of the recommended A Vision for Change staffing levels in adult mental health intellectual disability services are in post. Can the Minister of State outline what measures she is taking to address this fact and make a statement on the matter?
I thank the Deputy for raising this issue and for giving me the opportunity to outline what is happening and where we are at present.
A Vision for Change recommended one consultant-led mental health intellectual disability team per 150,000 population. This equates to 31 teams, each consisting of a consultant psychiatrist, a doctor in training, two psychologists, two clinical nurse specialists, an administrator and registered nurses with specialist training. Each of those teams would equate to ten staff, that is, 310 in total.
Recognising the significant need to develop, in particular, the mental health intellectual disability teams for both adults and children, and while I understand we are only talking about adults, in 2014 a mapping of the service provision by the HSE's mental health division showed that this service was largely consultant-only provided through teams, voluntary agencies or within the HSE services. The national clinical lead for the mental health division developed a proposal to reorganise and expand the service in line with the A Vision for Change model. With the additional programme for Government funding, approximately 100 posts have been allocated to this area in the past three years. These posts are in various stages of recruitment with some already in place. This number alone represents over 20% of the recommended posts in A Vision for Change.
Currently, regarding consultants, there are 17.5 consultants for adults, 12.5 of whom are currently working with small teams following the allocation referred to earlier. These are not all full teams, but that is a problem we all will agree we are trying to address. A further 5.5 consultants with small teams have been allocated and are currently being recruited. This means that 74% of consultants recommended in A Vision for Change are either in place or soon to be in place working with their teams. While some progress has been made and recruitment of posts is ongoing, the service nationally remains below recommended levels.
In light of ongoing difficulties in recruiting consultants trained in this speciality, the HSE's mental health division has worked with the HSE national doctors training programme and the College of Psychiatrists of Ireland to modernise qualifications for these posts in line with practice internationally. This is already improving recruitment, as is the funding of a higher specialist training post in child mental health intellectual disabilities.
As the Minister of State will be aware, mental disorders are commonly experienced by persons with intellectual disabilities. Studies put the occurrence rate at 40%. A person with intellectual disabilities is, therefore, considerably more likely to have an additional mental disorder than the average person from the general population.
This is not necessarily surprising. However, 300 posts for adult mental health and intellectual disability are recommended in A Vision for Change, yet only 17.5 consultants are in post, which is only 6% of the recommended staffing level. There are only 3% of the recommended 150 posts for child and adolescent mental health and intellectual disability. Can the Minister comment on that?
I agree with the Deputy. We are talking about people who require specialist attention and help. The Deputy talks particularly about consultants but obviously those consultants are working with team members as well. I fully acknowledge that we still have a massive amount of work to do and that we remain below the recommended levels. The 17.5 consultants are working with teams that include psychologists, clinical nurse specialists, registered nurses and doctors in training. The 5.5 consultants currently being recruited will be working with teams as well. In the case of the children's teams, we currently have 4.9 consultants working with small teams and a further 5.5 consultants are being allocated. There is a significant problem with recruiting nurses, particularly in this area. We have added 60 nurse training places for this year and that will increase to 70 next year. Over the next four years that will increase by 45% in total. That is taking into account maternity leave, retirements and so forth. I agree we have a huge amount of work to do and that we are below average. However, a huge amount of work has taken place in the last number of years and that will continue.
As the Minister said, a significant amount of work must be done if the standards in A Vision for Change are going to be implemented. The Minister will have to be extremely ambitious to achieve that. Some type of special protocols or plans will have to be put in place to achieve it. Otherwise, it is difficult to see how it can be done. Can the Minister set out timeline targets or processes to ensure the requirements in A Vision for Change will be met?
I realise this area is of particular interest to the Deputy. The most important issue is that we plan. We will face difficulties in recruiting staff across the board until we build up those numbers. That is the reason certain measures have been taken. It is the reason we have brought back the community allowance and we are increasing the number of placements. We have almost €10 million in additional funding to increase wages as well. In addition, last June the Department funded a development clinical lead to work with our national clinical lead. That is to support the services in line with A Vision for Change once these consultant posts have been allocated. That means looking at data and activity data in the various areas to identify where there are immediate needs and where those in most need receive the support straight away. I cannot give the Deputy definite timeframes. This is a priority so these posts will be filled as soon as possible. We will deal with this.