James Browne (Wexford, Fianna Fail)
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4. To ask the Minister for Health the action being taken on the ongoing difficulties in the provision of CAMH services; and if he will make a statement on the matter. [21081/17]

James Browne (Wexford, Fianna Fail)
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What action is being taken on the ongoing difficulties in the provision of child and adolescent mental health services?

Helen McEntee (Meath East, Fine Gael)
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In line with the programme for Government, I remain firmly committed to developing all aspects of our mental health services, including child and adolescent mental health services, CAMHS. Additional funding in budget 2017 has resulted in an overall provision of €853 million for all HSE mental health services. The HSE service plan for 2017 prioritises improvement of all aspects of CAMHS, including the development of early intervention counselling and prevention services in primary care to reduce pressures on CAMHS and improvements to specialist CAMHS community-based and acute inpatient care.

CAMH services have benefitted from the significant additional investment in mental health in recent years, although these services face particular challenges in recruiting and retaining staff. The HSE is addressing this on an ongoing basis.

The HSE is also giving priority to reducing CAMHS waiting lists, especially for those waiting over 12 months. This is dependent on the availability of key clinicians within teams, in particular CAMHS consultant psychiatrists. We know that within mental health services, in particular CAMHS services, there is a high turnover of staff. This is something with which we are trying to deal. It can be a very challenging but rewarding environment.

Additional resources have assisted in supporting 67 CAMHS teams and three paediatric liaison teams. I agree with the Deputy that we need to increase the number of people working in these teams. There are also 66 CAMHS inpatient beds in operation nationally. A new standard operating procedure, introduced in June 2015, has also provided greater clarity and consistency on how the service is delivered. Despite increasing demands overall on CAMHS, irrespective of the source of referrals, individual cases professionally assessed as requiring urgent access to services receive priority. Further acute inpatient beds will also come onstream as staffing levels increase.

The HSE service plan for this year provides for better out-of-hours liaison and seven-day response cover in CAMHS, against a background where the population of children is expected to increase by 8,500 in 2016-17. Around 18,500 children will attend the HSE CAMHS service this year, including around 14,000 referrals. Detailed activity data for CAMHS, published in the HSE monthly performance reports, indicate that 68% of children referred are seen within a 12-week period.

Additional information not given on the floor of the House.

As primary care services are usually the first point of contact for children and adolescents when problems initially present, those with mild to moderate presentations are seen by psychologists in the service, unless there is a significant risk of harm, a rapid deterioration or a crisis which requires a specialist response. In order to develop early intervention services for those under 18 years of age, €5 million has been allocated to include the recruitment of 114 assistant psychologists in primary care. These posts have been sanctioned for recruitment. Despite the challenges outlined, I am satisfied that significant efforts are under way to develop all aspects of CAMHS. I am continuously liaising with the HSE on the implementation of its service plan priorities for this service.

James Browne (Wexford, Fianna Fail)
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Recently released figures show that 82 posts are vacant in CAMHS, including consultants and clinical nurse specialists. The scale of the vacancies is frightening. Essential consultant, psychologist, nurse and social work posts have not been filled. About one in eight positions is vacant. The situation is made worse by the fact that the Government continues to fail and fall short of what is required under A Vision for Change. The figures show that CAMHS is clearly struggling, with only half of the required staff in place to provide a full service. Successive Ministers have promised to prioritise mental health services, but the reality is that the area continues to be a blind spot for the Department of Health. There have been recent staff shortages which have resulted in the cancellation of services in Cork, as highlighted by Deputies Billy Kelleher and Micheál Martin. This is reflected across the country, including in my county of Wexford.

Helen McEntee (Meath East, Fine Gael)
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The Deputy is aware that the issue is not funding; rather, it is the recruitment of staff. As primary care services are usually the first point of contact for children and adolescents when problems initially present, those with mild to moderate presentations are seen by psychologists in the service, unless there is a significant risk of harm, a rapid deterioration or a crisis which requires a specialist response. In order to develop early intervention services for those aged under 18 years, €5 million has been allocated, to include the recruitment of 114 assistant psychologists in primary care. They have been sanctioned and are being hired. Despite the challenges outlined, I am satisfied that significant efforts are under way to develop all aspects of CAMHS. I am continuing to work with the HSE on its implementation. The recruitment of psychologists will be key in reducing waiting lists for child and adolescent services. Many children who have been referred to CAMHS services do not need to be there. Services are for those with a moderate to severe mental illness. We know that when we can provide a level of support within the community at a much earlier stage, young children are less likely to be referred. It is not just about the recruitment of key posts such as consultant psychologists. Assistant psychologist posts will also play a key role in addressing the problem we are discussing.

James Browne (Wexford, Fianna Fail)
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I thank the Minister of State. I heard what she said, but I have to question whether the matter is being dealt with with the urgency and imagination required. The National Treatment Purchase Fund was in place under previous Fianna Fáil-led Governments. Would it be appropriate to consider using it to deal with mental health services until such time as they are brought up to speed and proper services are put in place? I refer, in particular, to psychologists. Parents are deeply concerned. Over 50% of all mental health issues manifest before children reach the age of 14 years. The longer they go without proper assessments the longer they will go without treatment and the greater the consequences for them, their families and society as a whole. I ask the Minister of State to consider alternative options in order to recruit the necessary staff.

Helen McEntee (Meath East, Fine Gael)
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I agree with the Deputy that mental health problems arise at a much younger stage. That is why we are introducing a well-being programme in secondary schools and supports are being provided at a much younger age in primary schools.

The Deputy referred to clinical consultant posts. Recruitment to fill such posts is especially difficult. There is a shortage not just in Ireland but also throughout the world. We are working on hiring staff, in particular given the high turnover. We will increase the number of nurse training places in colleges by almost 45% in the next three years. We are increasing wages and restoring community allowances. We are working with the unions and front-line staff to make mental health services a place where they want to work. We are also investing in infrastructure to make sure the surroundings in which staff are working are appropriate. A lot of work is ongoing. As I said, the issue is not about funding; rather, it is about the recruitment of staff. We are doing everything we can in that regard. I will, of course, keep in touch with the Deputy on developments.