James Browne (Wexford, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

10. To ask the Minister for Health the number of persons waiting for psychology appointments in primary care; and the number waiting more than a year. [40960/17]

James Browne (Wexford, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I ask the Minister for Health to indicate the number of persons waiting for psychology appointments in primary care and the number waiting for more than one year.

Jim Daly (Cork South West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

Some 8,415 people are awaiting psychology appointments nationally, of which 2,584 are waiting for over a year. Approximately 80% of those waiting are in the five to 17 year age group.

The HSE has a service improvement initiative under way for psychology services. This includes the recruitment of people to fill an additional 22 psychologist posts and 114 assistant psychology posts. The posts were advertised recently. A cross-divisional working group, including the mental health division, is working to ensure standardised delivery of service, setting out and communicating the arrangements for care pathways and reporting of metrics. Each community health care organisation, CHO, has been requested to submit a short-term action plan to address waiting lists in priority areas as part of the service improvement initiative.

Other developments in this area include: the counselling in primary care service for adults over 18 years of age who are medical cardholders; a greater awareness of fostering mental health promotion in society through campaigns like the Let's Talk and The Little Things Campaign; implementing the suicide prevention strategy, Connecting for Life; the ongoing reduction of child and adolescent mental health services waiting lists for those waiting over 12 months; the development of counselling services across both primary and secondary care, including early intervention at primary-care level; and the opening of new Jigsaw youth mental health services, bringing the total number of services to date in the country to 13.

James Browne (Wexford, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

It is 25 years since Ireland signed up to the UN Convention on the Rights of the Child. The statistics show that of the 8,000 on the waiting list, almost 6,000 are children, with in the region of 2,000 waiting for more than a year for primary care psychological services. That was at the end of June 2017. It is fair to say that figures like those are clear evidence that there is a crisis in the provision of mental health services for children in the community. The fact is that almost one in three children is waiting for an appointment for more than one year. It is simply unacceptable that children have to wait for that length of time to get their first appointment just to assess where they are at or what supports they need.

Vulnerable children and teenagers need the service and there is an obligation to provide it. We know there are significant regional variations across the country depending on where one is. There is effectively an Eircode lottery. In County Wexford, 230 young people have been waiting for more than a year. Cork has 456 young people in the same category and Galway has 208. There are similar lists across the country. Could the Minister of State address some of those key points?

Jim Daly (Cork South West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I can indeed. The waiting lists and the numbers behind them are an issue of intrigue for me. I am not quite like the Taoiseach who has a complete fascination with statistics but, at the same time, there is more to the figures when one looks at them. The more I have looked at them since I have come into this role the more I am aware of the myriad factors that underlie the numbers and why people are waiting so long. For example, a detailed examination has shown that the most prevalent reason for the number of people waiting over 12 months is the lack of client availability. In other words, people are not turning up for their appointments. That is not me disavowing my responsibility, as I accept there are issues with recruitment and there are teams that do not have a full complement, but we also have a major issue with referrals. People present to their GPs or at other locations and are inappropriately referred to the child and adolescent mental health services, CAMHS, in many cases. When that happens, they are left on a list because they are not seen as a priority and CAMHS will continue to deal with priority cases.

What I would like to see is, first, a more appropriate referral system. There must be a clear care pathway outlined in each and every CHO. I would like to see one person made responsible in every CHO for that pathway so that when somebody rings up with a mental health query, he or she will be referred appropriately and seen at a more appropriate level than everybody being just sent up the list and left on the CAMHS waiting list. When one asks the CAMHS teams about the people who are waiting for over a year one finds they are a low priority but the names are left on the list and add to the statistics. We have a number of challenges to deal with in this area, including the gathering of metrics.

James Browne (Wexford, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I welcome the Minister of State's response. There does need to be a type of one-stop shop for a first appointment so that a person can be put onto the correct list. Children are waiting ages for the National Educational Psychological Service, NEPS, only to be told they should have been on the CAMHS list. Likewise, children are waiting for ages on the CAMHS list only to be told they need to be somewhere else. I am aware of a parent who is terrified that their child will be diagnosed with autism because they are getting the supports they need within CAMHS but if the child is diagnosed with autism, they will be ripped off the list and put onto another list in respect of which the supports are not available. We need a child-centred approach whereby children are given first assessments and are at least put onto the right list and then given the appropriate supports. Currently, we have different lists and nobody is talking to anyone else and children wait sometimes for up to three years for a first appointment, which is simply unacceptable.

Jim Daly (Cork South West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

Deputy Browne clearly has a very good grasp of the underlying issues. I accept there are issues and challenges but there are also many management issues to be addressed. One of the initiatives I wish to drive through, which I have discussed with the Department, is what I call the front-door system whereby there is one point of contact for everybody who has a mental health issue who is seeking help. When a person dials the number, he or she is appropriately referred. At the moment, if a person wakes up and is feeling a bit low, it is not clear who to ring - ALONE, Aware, Jigsaw, primary care, the emergency department or the GP.

Deputy Browne referred to the number of children on various lists. A GP could refer a child to CAMHS, Jigsaw or NEPS. Children can be on several waiting lists. We need a point of responsibility within each CHO to take responsibility for the care pathway. I want to meet with such a person when he or she is appointed in order to ensure we have a national streamlined, coherent plan. Some of the people included on the waiting lists are waiting for one day. They could have rung yesterday seeking an appointment. I am reasonably assured, for the most part, that everybody who needs an urgent appointment gets one. That is what most practitioners on the ground tell me.