Dáil debates
Tuesday, 23 January 2018
Topical Issue Debate
Mental Health Services Provision
6:15 pm
Frank O'Rourke (Kildare North, Fianna Fail)
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I welcome the opportunity to discuss this matter with the Minister of State, Deputy Finian McGrath. No disrespect to him, but I was hoping to discuss it with the Minister of State who has responsibility in this area, Deputy Jim Daly, because I met him before Christmas and he knows how pressing and difficult the issue is. Nevertheless, I will use this opportunity to discuss it, in the hope the Minister of State, Deputy McGrath, will bring back the message and perhaps schedule a follow-up meeting for me with the Minister of State, Deputy Daly, after this discussion today.
We have a lack of mental health services in Kildare and I will focus on the constituency of Kildare North, in particular the areas of Celbridge, Leixlip, Maynooth, Kilcock, Clane and Naas, which have a population of approximately 120,000 people. The real issue is that services are not available on the ground. I will give three brief examples of this, before I discuss a possible solution I am trying to pursue with the Minister, Deputy Harris, and the Minister of State, Deputy Daly.
The post of primary care child psychologist in Kildare was left vacant for more than two years and the appointment was made only last year. When we balance this with how serious mental health issues are we must ask ourselves why such a critical appointment takes so long.
Last year in Clane, an area very close to me, a 15 year old minor, who was on suicide watch, was taken into the care of the State but allowed to go from A to B unattended. As a result he went missing twice, on one occasion for up to five days. This was despite the fact gardaí were out looking for him. When he was returned to the care of the State it was allowed to happen again. This is a serious issue and it is a major concern. As I stated, he was on suicide watch. Another issue arose with a young individual who was affected by a brain injury. He received treatment and care but was discharged without any follow-up treatment or care. As a result, he was badly affected in September and October when he was sleeping rough, walking the streets and could not be found. He was not at home. Eventually, through the voluntary organisation which I will discuss later, we got him back into follow-up treatment and services. Another individual reported to the public health service over Christmas for mental health services. He was told in Celbridge that no services were available, that he could not be helped and that nothing could be done for him. Eventually we got him seen and put him in contact with Pieta House.
This is what is happening on the ground, despite all of the delivery and funding announced and despite all of the positive news coming from the other side of the House about these services. They are not being delivered. These are three brief examples because I am conscious of my time.
In Celbridge, a voluntary group has been operating for the past ten years. It provides counselling and dual diagnosis. It has more than 40 cases on its books. It operates purely from bucket collections and cake sales. I have met HSE senior officials in the past 15 months. I have met the Minister, Deputy Harris, the Minister of State, Deputy Daly, and his predecessor to try to get public support for the organisation and finances to help it. To date it has received absolutely nothing.
It is acknowledged that this is a good partnership approach. Where an organisation works with professionally qualified people, providing a service that is not being provided by the State, the State should partner it and support it, once it operates in a coherent and proper manner, which this organisation does. It has gone through the task force and it has engaged with senior officials in the HSE. The paperwork is done and all the boxes have been ticked.
It is disappointing the services are not being delivered through the public health service and that the agency working on a voluntary basis, despite all my efforts, still does not receive support.
Finian McGrath (Dublin Bay North, Independent)
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I thank Deputy are for raising this very important issue. I am well aware the Minister of State, Deputy Jim Daly, has had discussions with him on the subject and will continue to engage with him. He appreciates the Deputy's very constructive approach in dealing with the issue and he apologises that he cannot be here today to take the debate.
With regard to this serious issue, the HSE National Service Plan 2018 commits to further develop all aspects of child and adolescent mental health services, CAMHS, including acute bed provision, better out-of-hours liaison and reducing waiting times, especially for those waiting more than 12 months. The demand for CAMHS has seen a 26% increase in referrals since 2012 and therefore CAMHS is a strategic priority action for the HSE.
In 2018, the Government has provided for an increase of €35 million in development spending for mental health. Part of this increase will pay for developments commenced last year. There also will be additional funding of €22 million for pay-related costs. This will result in a mental health budget of €910 million, which reflects an increase of around €200 million, or approximately 28%, since 2012. Mental Health is also guaranteed a further €55 million in 2019.
Additional resources and facilities means there are now 69 CAMHS teams, and three paediatric liaison teams, supported by 70 operational CAMHS beds nationally, with further beds planned to come onstream as approved staffing posts are filled at local level. It is envisaged that the increased funding will help develop the CAMHS service overall through provision of: a seven day per week service to enhance supports for vulnerable young persons in line with Connecting for Life; eating disorder specialist community teams; day hospital provision, in-patient admissions, and more appropriate supports for community teams; and enhanced access by older adolescents to specialist mental health services and, for those requiring acute admission, their continued appropriate placement and care.
The acute CAMHS unit at Linn Dara, Cherry Orchard, covers the Kildare and south-west Dublin areas. There are three consultant-led multidisciplinary community CAMHS teams serving County Kildare. The north Kildare team is based in the new Celbridge primary care centre, the mid-Kildare team in Sycamore House, Millennium Park, Naas, and the south Kildare team is based in the new Kildare primary care centre.
In line with the recommendations contained in A Vision for Change, a fourth team is coming into operation in Kildare from mid-February 2018. The fourth team has been established to meet the increasing population of the county. The new team will facilitate a realignment of catchment areas of existing teams, in line with the new primary care networks. It is planned that this team will be co-located with the south Kildare team, pending the completion of a CAMHS suite in the new Clane primary care centre. Six posts have been recruited for this team.
There are also plans to increase the consultant staffing in the Kildare area to allow further service development. The Linn Dara community teams also have access to a dedicated adolescent day programme and, from February 2018, to a specialist eating disorders team. Both of these are located on the Cherry Orchard Hospital campus.
The Deputy can rest assured that CAMHS will continue to receive priority from the Minister of State, Deputy Daly, the Department of Health and the HSE. One aspect in particular that the Minister wishes to develop is improved cross-referral within the HSE, and better inter-agency links between the executive and the education, disability, and child care sectors. The Minister of State, Deputy Daly, will ensure that, in light of the significant funding provided in budget 2018 for mental health, CAMHS will continue to be prioritised by the executive, including improvements relating to Kildare.
Frank O'Rourke (Kildare North, Fianna Fail)
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I thank the Minister of State for the detailed reply.
I do not disagree with the Minister of State's comments and I would not even suggest for a second it is down to a lack of funding. It is a lack of accountability, people taking responsibility and delivery on the ground. I accept everything the Minister of State spoke about in his statement but if it is the case, who is responsible for not delivering the service in just the three cases I have outlined to the Minister of State today because I was short of time? With the last case I mentioned, the individual was turned away from the Celbridge primary care centre between Christmas and the new year, when he showed up with mental health issues. He was told they could not help him as they had no services or resources. He made contact with me and we got him into Pieta House.
I am not coming after the Minister of State, the Government or the Minister because of a lack of funding. I do not doubt them for a minute. I have spoken with the Minister of State about other matters in his Department and despite the funding, we can clearly see cases that are not isolated. When I raised this with the Taoiseach, he said they were isolated cases but they are not. There is a trend here and the reality is services are not being delivered on the ground. Can we get to the people who are responsible and accountable in the Health Service Executive, HSE, for not delivering these services? Will there be consequences for not delivering them? Why was a minor allowed to roam on his own last year? He went missing twice on suicide watch. This is happening and it is a reality. We must find out why if there is no issue with funding. The Minister of State has indicated the resources are there and more are coming, which is great news, but why are services not being delivered on the ground? Why are there gaps in the service and why are we seeing such massive problems?
Will the Minister of State extend an invitation to the other Minister of State, Deputy Jim Daly, to come to Celbridge to visit the Abbey Community Project, which has done wonderful work for the past ten years? Will he pursue the HSE on the commitment to funding for it that was promised? Does the Minister of State know how much money was given last year for its two professionals providing dual diagnosis for 45 cases? It was €3,000 and they were told it was only to be used for stationery and renting office space. That is how bad it is.
6:25 pm
Finian McGrath (Dublin Bay North, Independent)
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I thank the Deputy for raising the matter. I take his points relating to accountability. He has accepted the point that we are investing money in services and I appreciate his acknowledgement of that, as many people in the Opposition do not even bother to say it. The question is about accountability and delivering services on the ground. I will bring the message to the Minister, Deputy Simon Harris, and the Minister of State, Deputy Jim Daly.
As part of the changes we are advocating in the Department - I include my section dealing with disability services - we are trying to invest in services, as the Deputy acknowledges. We are also seeking to reform the services. The Deputy made the key point about having accountability and delivering on the ground. It is a valid argument and a debate we regularly have around the Cabinet table. It is something I will bring to the Minister.
The Clane case is a very serious matter, as is the case of the person with brain injury who is sleeping rough. I acknowledge that these are real cases, involving real human beings. We must ensure the money we fought very hard for is put in on the ground. I take the Deputy's point that these are not isolated cases. We speak with colleagues regularly and hear about cases. The Minister of State, Deputy Jim Daly, will meet the Deputy and his door is always open. People must be accountable within the HSE. I will raise the Deputy's request for the Minister of State, Deputy Daly, to visit Celbridge with him.