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

I wish to raise the issue of delays and waiting lists associated with child and adolescent mental health services, CAMHS, in Limerick and the mid-west. CAMHS are consultant-led, community-based services provided by six multidisciplinary teams in Limerick city and county. The city and county services cover an age group from zero to 18. Those in Clare cover zero to 18 and north Tipperary services cover zero to 17. I have read articles in the past that referred to ages zero to 16 in north Tipperary and Clare but that has obviously changed. That said, an age range from zero to 17 does not cover those aged 18, which is the age of adulthood. I would like clarification on this. If somebody goes on a waiting list at 16 and is on it for approximately two years, he is pushed over the 18 years threshold, thus implying he will never have got to avail of the child and adolescent mental health services.

In Limerick, the emergency and out-of-hours service offers a same-day assessment from Monday to Friday for children presenting in crisis. Consultant child psychiatrists provide an out-of-hours service to the emergency department in University Hospital Limerick but this is not replicated across the country. If inpatient treatment is required, the first preference is to admit the child to a dedicated CAMHS unit in Galway, St. Anne's. If the unit is experiencing temporary capacity pressure, then admission to a paediatric ward or public unit with special staffing arrangements in place is considered. That information is from the HSE itself. Why are there not CAMHS beds made available in Limerick? This was called for in this House some time back by my predecessor and also by me in one of my first speeches here. I have had no update on that. The circumstances that obtain have considerable implications for the people of Limerick and the mid-west. This obviously affects north Tipperary and County Clare also.

In Limerick central, there are 25 on a CAMHS waiting list. In Limerick east there are 56 and in Limerick west, which I represent predominantly, there is a waiting list of 63.

6 o’clock

The HSE has outlined the factors that are currently affecting the Limerick waiting list. One is the fact that two members of the west Limerick team are on extended sick leave, with a consultant on leave for over two months and a social care leader on leave for over six weeks. Why are some temporary staff measures not put in place to alleviate this? We do not know how long these people might be out of work. That is not their fault but I know from working in the private sector that there are flexibility arrangements whereby when somebody is out of work, somebody else can come in and take their place temporarily. It is a demand-led service. Another issue is that one psychologist on the west team was not replaced while on maternity leave and is due back at work before the end of March. Again, why is there no flexibility to alleviate this situation? Staff members who have resigned and have yet to be replaced on the Limerick team include one senior psychologist, a nurse, an occupational therapist and a community health doctor, CHD. All have been approved for replacement but why have they not been recruited?

Routine appointments were not scheduled for at least ten days to accommodate the move of the three Limerick teams to a new premises at Rosbrien Road during February 2017. That will greatly enhance the provision of the service and I welcome that. In addition, the HSE states that new referrals have increased by 15% from January to February 2017. There is an increase in demand but flexibility arrangements are not in place when people are off sick and obviously the recruitment arrangements have not been put in place to recruit staff. I would welcome clarification on these issues.

Helen McEntee (Meath East, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I thank the Deputy for raising these issues. The policy of the HSE, as reflected in its annual service plan, is that young people under the age of 18 years should receive age-appropriate treatment and, when necessary, be placed in age-appropriate settings. That does not happen 100% of the time but achieving that is the goal.

Child and adolescent mental health services, CAMHS, have been prioritised in the new funding that has been made available since 2012. In terms of additional resources it means we now have 67 CAMHS teams. I do not claim these teams are operating at 100% capacity because we know they are not. We have three paediatric liaison teams and there are 66 operational CAMHS beds nationally. While 66 beds are operational, there are 76 beds in total but there is a difficulty with the recruitment of staff. Until we hire the staff we cannot open the full number of beds. The Deputy referred to the 20 beds that were promised in Limerick. As far as I am aware, this dates back to the term of the former Minister of State, former Deputy Tim O'Malley. There was discussion at the time about opening a new unit in Limerick. However, if one adds the 76 beds, anticipating that we fill the staffing needs, with the new beds that will be available in the new Central Mental Hospital, that will bring the total to the amount that was recommended in A Vision for Change. Obviously, a review of A Vision for Change is taking place at present, including of the figures. As the Deputy said, the number of people referred in the Limerick area alone has increased by 15% and the increase in the number of children coming into the system this year is approximately 8,500, so the figures must be revisited. I am not sure if Limerick might come back into the frame at that stage.

It is important to stress that a lack of funding for mental health services is not the problem. The Deputy correctly pointed to the difficulties with the recruitment of staff. As regards the two staff members who were sick, the difficulty is that it was extended leave so one does not know when they will return. Replacement for maternity leave is a problem across the board and particularly in mental health services, where a huge number of nurses are young women. The fact that we cannot replace any maternity leave is something we are trying to work on outside the Department of Health as well. In the case of new staff, replacements have been approved but the services have been unable to fill the posts. There is a huge difficulty with recruitment and retention of staff and it has nothing to do with funding.

The new standard operating procedure introduced in June 2015 has provided greater clarity and consistency in how the specialist mental health service for children is delivered nationally. A huge amount of work is being delivered by the HSE, which is trying to ensure that younger people stay away from the CAMHS. CAMHS should be specifically for young people under the age of 18 years who have severe mental health problems. There are self-harm nurses in all the level 4 hospitals. They not only work with young people but also train people within the hospital on how to deal with young people when they come to the hospital. We have developed new eating disorder hubs and the dual diagnosis clinical programme, for young people who present with alcohol and drug related issues which are affecting their mental health as well. There is also the development of the new transgender programme, which at present is focused on people over 18 years of age. However, there will be a new programme for young people as well.

The HSE service plan for 2017 provides for further development of the CAMHS, including better out-of-hours liaison and seven-day response cover against a background where we expect an increase of 8,500 young people this year. Approximately 18,500 children will attend CAMHS this year, including approximately 14,000 referrals. All of this information is available on the HSE website. With regard to community health care organisation, CHO, 3, which includes Limerick, consultant-led community-based services are provided by six multi-disciplinary teams in Limerick city and county, Clare and north Tipperary. To answer the Deputy's question regarding children under 18 years, the reason there are no services for 17 year olds in north Tipperary is that this requires a clinician or consultant post and the HSE has been unable to fill that post.

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

I thank the Minister of State. I do not question her commitment to this issue. One of the big developments she has progressed is the 300 hours of mental health classes to help students maintain their well-being in the post-primary school sector. That is very welcome in terms of prevention and helping people as early as possible. However, I must highlight my frustration and that of the people who are on the waiting list in this regard. We must conduct an examination of work practices if there is no flexibility with regard to providing cover for people on certain types of leave or on indefinite sick leave. The bottom line is that people on the waiting list are suffering and the waiting list is increasing because of this. It is a demand-led service.

I have worked in the private sector for most of my professional life. When one works in a demand-led service and one of the team members is out of work, there is a flexible arrangement or a flexible work model in place whereby somebody or the team can cover those hours to maintain the service. That is something we must examine with respect to everybody working in the service. I do not question their commitment and enthusiasm in how they approach their work but this is a systemic change that we must examine. Obviously, there are recruitment challenges and the HSE must work harder in addressing the recruitment shortfalls. It must find solutions to this. There is always a solution in recruitment. The issue is finding it and looking at how the HSE is working on this. However, I must highlight that people are on these waiting lists and we must catch these problems as early as possible because this is all about early intervention.

Helen McEntee (Meath East, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I fully agree with the Deputy. The Minister for Education and Skills is present and he will be responsible for rolling out the 400 hours of health and well-being classes in our schools, which are much needed. This is an area we must focus on more and develop further. Again, it means keeping our young people out of the mental health services and specifically out of CAMHS. When one looks at where the funding is going, one sees that 80% goes towards the specialist services which are dealing with 20% of our people. We need to start bringing more of those people into the primary care services under the primary care teams. We are developing these programmes outside the clinical specialist CAMHS teams so that young people do not have to go into the CAMHS.

We have also found, and this is a snapshot of the whole country and not just of the Deputy's area, that the number of people waiting under three months is over 1,000 but that the number has come down dramatically. The number of people waiting over 12 months has halved in the last two years. We have found that many of the people who are waiting up to 12 months are waiting for a diagnosis. The system has turned into one where if one manages to get a diagnosis, one finds one is able to access services or the supports one needs much easier. That is not the way we should be going. Sometimes there are young people in the CAMHS who do not have a severe mental health problem but they are left within the system for too long waiting for that diagnosis. That is something we are trying to address at present with the development of services through education, our primary care system and through the CAMHS.

I agree that we have a massive difficulty with the recruitment of staff for our CAMHS teams. Some of the teams are operating at less than 50%, which is not adequate. A body of work is being done at present to examine how we can bring in various other organisations or skills that will be able to work with our younger people who do not require specialist psychiatric nurses or the clinical teams. I will keep the Deputy updated on our progress.