Mick Wallace (Wexford, Independent)
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8. To ask the Minister for Health the steps he will take to address chronic underfunding of child and adolescent mental health services; the further steps he will take to tackle CAMHS staff shortages which are affecting the delivery of the service across the country; his views on the fact that County Wexford, with 14 other counties, does not have an on-call mental health service for children; and if he will make a statement on the matter. [20738/17]

Mick Wallace (Wexford, Independent)
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I can see Deputy Jack Chambers replacing Deputy Billy Kelleher soon as health spokesperson for Fianna Fáil.

Child and adolescent mental health services outside the hours of nine-to-five Monday to Friday are non-existent in many parts of the country. If one has a referral accepted, nobody can lift a finger to help the child, unless the consultant psychologist assesses him or her. There is usually one in each child and adolescent mental health service, CAMHS, team. If a child is assessed and qualifies for child psychology services, he or she will go on an endless waiting list. The HSE informed my office last week that it was recruiting to fill 120 assistant psychologist posts. The persons concerned will work within the primary care service under the supervision of clinical psychologists. Does the Minister know when the posts will be filled? Will any of them be filled in Wexford? Are there plans to extend the hours of availability of CAMHS services in Wexford and other parts of the country that are being failed by the HSE?

Helen McEntee (Meath East, Fine Gael)
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I thank the Deputy for raising this issue which he has raised before. I stress again that I remain committed to developing all aspects of the mental health service, including CAMHS, which is a particular priority not just for me but also the HSE.

Additional funding in the budget for this year has resulted in an overall provision of €853 million for HSE mental health services. It takes into account significant additional resources for mental health services generally since 2012. However, funding is not the core issue in CAMHS, to which the Deputy has referred in his question. CAMHS services face particular challenges in the recruitment and retention of staff. The turnover rate for CAMHS teams is particularly high. That is an issue we are trying to address. The HSE is addressing it on an ongoing basis. We have recruited 1,150 staff in the past four years, of whom 270 have been for CAMHS teams. The HSE has also given priority to reducing the CAMHS waiting list, especially for those waiting over 12 months. This is dependent on the availability of key clinicians within teams, particularly CAMHS consultant psychiatrists. I know that the issue the Deputy is raising is the fact that there is no child consultant psychologist on-call within emergency departments 24/7. That is an issue of which we are very aware. Additional resources have assisted in supporting 67 CAMHS teams, with three paediatric liaison teams. There are also 66 CAMHS inpatient beds in operation nationally, with additional beds to come on stream as staffing levels permit. The new standard operating procedure introduced in 2015 has provided greater clarity and consistency on how the service is provided.

As the Deputy knows, during normal working hours, nine-to-five cover is provided Monday to Friday within mental health services by a number of interlinked components, including community mental health teams and emergency departments. During the on-call period, between 5 p.m. and 9 a.m., Monday to Friday, and throughout the weekend period there is a consultant psychiatrist, together with a psychiatric registrar or senior house officer, on duty in acute hospitals. Since 2014, this has been supplemented by the development of the self-harm clinical programme under which specialist nurses are available. A preliminary review of weekend access by the HSE mental health division shows that weekend mental health services are provided in only eight of the 17 mental health areas. In a further eight areas there is partial cover, in which in certain geographical areas within the service a weekend service is provided. The HSE has prioritised the need to ensure access to a weekend service for current service users is provided in all areas. A service improvement project was commenced last November to carry out more detailed mapping of current provision at weekends and the uptake in the extended hours services, taking account of international best practice and the service user perspective. The position in Wexford will be addressed as part of the overall service improvement initiative.

I will answer the other questions asked when I speak again.

Mick Wallace (Wexford, Independent)
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The truth of the matter is that the service is not good enough in Wexford. I recently asked the HSE what services were available for children and adolescents who presented with suicidal ideation but who were not deemed by CAMHS to have a psychiatric disorder. The reply from the head of mental health services, Ms Liz Kinsella, stated individuals could access a health service on a 24-hour basis, despite the fact that I was asking about mental health services. She went on to refer to a few of the services which were not available on a 24-hour but a nine-to-five, five days a week basis. She referred to a school counsellor who was available during school hours and the Ferns Diocesan Youth Service which was available in Wexford town. Again, it is a nine-to-five, Monday to Friday, service. We rang two of the organisations she mentioned - I think the Minister of State mentioned one also - the HSE community primary care and disability psychology service and the HSE self-harm intervention programme, on the day we received her reply after 5 p.m. but it rang out. She also referred to the CAMHS team in Wexford, but the question was what would happen when the CAMHS team put someone on a waiting list for psychology services? The HSE needs to provide talking therapies for children that are affordable, easily accessed and promoted as part of the HSE child and mental health services. The services available in Wexford are not what the Minister of State seems to think they are. They are abysmal. We are inundated with complaints from parents about the current situation.

Helen McEntee (Meath East, Fine Gael)
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I agree with the Deputy that there is a gap within the services, but there are others that are available or were not mentioned. The self-harm intervention programme was established in Wexford in 2004. It caters for young people, aged 16 years and over. Last year 155 persons aged under 18 years were referred to it. There is the Ferns Diocesen Youth Service that provides services in Enniscorthy, Gorey, New Ross and Wexford town. It is for young people aged 13 to 25 years. There are four day hospitals, Tara House, Carn House, Summerhill and Maryville; as well as the nurse specialist liaison service that is available seven days a week and the suicide crisis assessment nurse, SCAN. I agree that there is a gap in the services, which is why, similar to the exercise happening in identifying where the gaps are in the sevens day a week service, progress has been ongoing with the HSE, service providers and the mental health teams to identify where consultant psychologist posts are not being filled within emergency departments on a 24-7 basis. They are working with the HSE to identify how they can implement the initiative in the best way possible, obviously including in Wexford. The assistant psychologist posts have been approved and recruitment is starting. That will happen throughout the country. It is a much needed support, not just in Wexford but also elsewhere.

Mick Wallace (Wexford, Independent)
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The self-harm intervention programme mentioned by the Minister of State is actually based in Waterford. It is one of the places we rang after 5 p.m. At 5.15 p.m. the telephone was not being answered. One of the parents who contacted me recently has a ten-year old boy who has been diagnosed with severe verbal and oral dyspraxia, a sensory process disorder and as suffering from high anxiety. It is suspected that he has other undiagnosed disorders. CAMHS has seen him, but it does not believe it can help him. It has closed his case but never notified his mother who wrote to us. I would like to quote a few of her words:

My son wants to be dead. He is ten years of age. I spend my days trying to convince him being alive and with his family is more fun. My son is majorly suffering but nobody seems to care. We are on the psychology waiting list for two years now. I spend my time trying to convince him being alive is so much better even if it doesn't feel like it. It is heartbreaking watching him suffer and listening to how he feels about himself and why he thinks being dead is the answer to his problems. He wants to know why he is different, why he has struggled so much, but I don't have the answers.

What I do not understand is why there has not been a greater emphasis on psychotherapy. There are psychotherapy services available in the county. I know that the HSE was hiring, but psychologists are not in place. There are two CAMHS services in the county and two leaders. It is not good enough. There has to be a rethink.

Helen McEntee (Meath East, Fine Gael)
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It is not acceptable that a ten-year old feels he does not want to live. That is part of a much wider conversation we need to have with young people in order that they will be able to express what it is they are feeling and identify the supports they need. We also need to ensure we have programmes in place that are suitable for individuals. We have always had a one-size-fits-all approach. If a young person had a problem, he or she was automatically sent to CAMHS, but we know that it is not the answer for everybody. That is why we are trying to look at the supports available within the community which would be best suited and best provide for young persons at the age of ten years.

It is also why we are developing the assistant psychology posts and why we are looking at providing supports that are tailored towards people's needs, specifically for our younger people.

We had another meeting of the task force yesterday. Work is ongoing. The recruitment of staff is key to this, and that is a problem we are facing not just in Wexford but throughout the country. We are trying to invest in our services. The Deputy mentioned that people are not keeping in touch and that if a person is referred on to another service he or she is not then coming back. There is no easy flow forwards or backwards. That is down to technology and a change in people's attitudes, and it is something on which we need to work with service providers to try and improve.