Dáil debates

Thursday, 23 March 2017

Topical Issue Debate

Mental Health Services Provision

2:30 pm

Photo of Mick WallaceMick Wallace (Wexford, Independent)
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In the past month alone, my office has been contacted by four different families regarding services for suicidal children and teenagers in Wexford. We were contacted by a 14 year old girl and her mother. She has presented to the HSE twice with suicidal thoughts. Her father committed suicide when she was younger and her uncle also committed suicide. She wrote a letter to the office of the Minister for Health recently. She received an acknowledgement but nothing since. I would like to read a piece of her letter in order to reflect her own words:

Dear Minister Harris,

I am fourteen years old and from Wexford. I am writing to you to tell you my experience of seeking help for my mental health.

In January 2016 I asked for help as I was experiencing suicidal thoughts and struggling to come to terms with very tragic bereavements in family.

I was referred to psychology services in the HSE. They met with my Mam and then me in June 2016. They said they could help me, but I am on the waiting list. I was informed that I would be waiting between 1-2 years.

In December '16/ January '17, I had thoughts of suicide again and of being unable to cope. I was very confused and emotional.

On Wednesday the 18thof January ’17, my doctor put me into A&E to see a mental health group. I saw a normal doctor and he told me that I had to stay in one night so I would be seen quicker.

On the Thursday morning, I was told I was going to be seen but as the day went on, we heard no more. When the doctor was doing his rounds, my Mam asked the nurse what time were CAMHS coming at and the nurse said they aren’t coming anymore. After that I was made stay in hospital until Monday the 24th. I was scared and very anxious and did not understand why I had to stay in hospital. I just needed someone to talk to and help me deal with my low mood and emotions.

I was finally seen on Monday by CAMHS and got discharged with no appointment for help still. They said I needed a psychologist and they don’t have one on their team and they would have to contact the other service. I would like to know why there is no help for children when they ask for it? What can you do or what can be done to stop other children going through this?

I spoke about a similar matter recently in the Dáil when we had statements on hospital waiting lists. I referred to a woman who approached me in a supermarket in Wexford whose son presented with suicidal ideation and spent five days screaming for help in Wexford Hospital. Child psychiatry and child psychology services were not available through the county until someone was eventually dispatched from Dublin.

The girl who wrote to the Minister, Deputy Harris, also spent five days in hospital before she was able to speak to mental health professionals through staff from CAMHS. They assessed her and said she had no psychiatric disorder and, therefore, she did not require their services but instead those of a psychologist. The mother and teenager to whom I referred have gotten nowhere after 14 months, two GP referrals, two assessments with CAMHS and psychology services and one five-day stint in hospital, despite the fact that CAMHS and psychology services say she needs help.

The people in Wexford are tired of begging for proper services. The Minister of State can tell me about all the extra funding that is being provided and what is being done, but it is not being felt in Wexford by the people who need help from the State. Such help is not there for them. What in God's name can the Government do to help?

Photo of Marcella Corcoran KennedyMarcella Corcoran Kennedy (Offaly, Fine Gael)
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I thank Deputy Wallace for raising this important matter and acknowledge the contents of the letter he read, which was very bravely written by a 14 year old. I know the Deputy will understand that I cannot comment on nor do I have information on individual cases. Having reared two children, I now find it very challenging to get my head around the fact that so many young people are familiar with the term "suicidal ideation", never mind taking action. Our society seems to have changed to a significant extent.

Children and adolescents who present with suicidal ideation in Wexford, depending on their presentation or presenting problem, may be referred to a number of services including a school counsellor, teen counselling service in the Ferns Diocesan Youth Service, the HSE child and adolescent mental health service, CAMHS, in Wexford, the HSE primary care community psychology services, or the HSE self-harm intervention programme.

Child psychology services are delivered by a number of different agencies, including CAMHS, which employs psychologists, primary care psychology services and disability services for children with intellectual disabilities or autism. All referrals for CAMHS services come from a GP to a consultant psychiatrist and the CAMHS team. The team prioritises who is most urgently in need of psychological intervention. Children and adolescents assessed and diagnosed by the team with a mental health disorder, and assessed as needing psychological intervention and at risk of suicide or who are highly distressed, are prioritised.

Wexford mental health services have advised that the CAMHS psychologist relocated in November 2016 but that a replacement psychologist has been appointed for CAMHS. This psychologist will start next week on 27 March. I know the Deputy will welcome this news. Upon commencement in the post, it is intended that the CAMHS psychology waiting list will be triaged and appointments will be offered based on prioritisation of clinical need. In addition, approval has been granted to recruit a staff grade psychologist post in CAMHS and the process for recruitment is under way.

Psychology services in Wexford are delivered through primary care and disability services across the catchment area of Wexford. Children or young people are usually referred to primary care psychology services for a number of behavioural or emotional concerns. It is more common for young people to raise suicidai ideation as a concern during their assessment or intervention rather than it being a reason for referral to primary care psychology unless a previous assessment has been completed, for example, by CAMHS.

When a young person discusses suicidal ideation within an assessment and-or intervention, he or she receives a thorough psychological assessment and intervention is offered to a high standard. In recent years a number of factors have impacted on waiting times in psychology services. These include population growth in the Wexford area, significantly increased service demands and more complex demands and, as referred to earlier, staffing challenges. As with many other areas throughout the country, there are staffing challenges within Wexford psychology services, including maternity leave, sick leave and reduced working hours, which are impacting on waiting times. Unfortunately, there is also an overall national shortage of psychologists at this time which has contributed to increasing waiting times both locally and nationally.

The HSE tells me that it continues to endeavour to address such issues that arise through a number of measures. These include continuing to actively fill approved posts, monitoring waiting lists in line with available resources and prioritisation criteria and reconfiguring children’s disability services into geographicaIly-based early-intervention and school-aged teams as part of the national progressing disability services for children and young people programme, which will ensure a more equitable delivery of services.

2:40 pm

Photo of Mick WallaceMick Wallace (Wexford, Independent)
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I thank the Minister of State for her response. I know this is not her responsibility but the truth of the matter is that not only are psychology services in Wexford poor and not only is the HSE's approach to the problems that prevail in Wexford very poor, but there is not near enough emphasis on psychology. I am not even sure if there is a psychotherapist on the books of the HSE. Perhaps there is, but I am do not know of it.

The girl I mentioned needs psychological help, psychotherapy or counselling. CAMHS have psychotherapists but not psychologists on their team. Publicly-funded psychotherapy and counselling is practically non-existent in Wexford. The girl and her mother met the HSE psychologist in Grogan's Road in Wexford in June 2016. The psychologist stated that the girl was a candidate for the service and that it could help her but that there is a waiting list. The Minister of State spoke about the waiting list problem. However, in February 2017 her mother asked for an update on child psychology services for the girl. She was told that the HSE psychologist the girl met in June 2016 had left and that there was now only one psychologist working with children in the county.

We were also contacted this month by the mother of a seven year old boy in Wexford. This boy has waited for a year and a half to access CAMHS and occupational therapy. The boy goes to his local school in Wexford but he does not attend the mainstream classes there as he has expressed a wish to kill himself in front of other students. He is seven years old. The boy was referred to the senior child psychologist in Wexford in March 2015. He has been waiting since then to see a child psychologist. He has now been waiting for more than two years. A seven year old child has expressed a desire to kill himself but he is yet to get the help he needs.

We have had one of the highest rates of suicide for a number of years. The last time I checked - a couple of weeks ago - we had 19% unemployment. We are not getting the help that we need and the HSE's approach leaves too much to be desired. Will we ever get a Government to address the dysfunctional nature of how the HSE operates? The mental health services available in Wexford today are pathetic and something has to change. Something has to give.

Photo of Marcella Corcoran KennedyMarcella Corcoran Kennedy (Offaly, Fine Gael)
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I reiterate the good news, which is that a psychologist will start next week. This will certainly be an advantage. As I stated earlier, prioritisation of those on the waiting list will have to commence as soon as possible. I wish to provide some form of reassurance because I know the Deputy is frustrated at particular issues - we all are. It is heartbreaking to think that the child the Deputy referred to would be experiencing such thoughts at that age. The self-harm intervention programme that was established in Wexford in 2004 is a free and confidential service. Children under 16 years of age experiencing that are referred by a GP or another medical professional to the service.

Ferns Diocesan Youth Service, which is funded through the HSE and partly funded by Tusla, is doing additional work. It provides supports for young people who are referred into the HSE substance misuse services. We must recognise that those engaged in the misuse of alcohol and other psychoactive substances are more prone to suicidal ideation. Those in the LGBTI community are also impacted in this regard and, in particular, are at risk of self-harm. To try to be positive, that there was a new appointment should certainly try to get things back at the level we want them in Wexford.