James Browne (Wexford, Fianna Fail)
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48. To ask the Minister for Health the plans in place to expand talk therapies in mental health services. [23529/18]

James Browne (Wexford, Fianna Fail)
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What are the Minister for Health's plans to expand talk therapies in mental health services?

Simon Harris (Wicklow, Fine Gael)
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The choice of care for a patient is determined by the needs of the individual patient. Both talk therapy and medication are included in this process as options to consider. HSE specialist mental health services provide a wide range of talking therapies in both child and adolescent mental health services, CAMHS, and adult mental health services.

The HSE also provides talk therapies at primary care level through directly employed staff, for example, psychologists in primary care and counsellor therapists in counselling in primary care and the National Counselling Service. Counselling in primary care was launched in July 2013. This was established to provide counselling for patients experiencing mild to moderate psychological difficulties who present in the primary care setting. All adults in receipt of a medical card are eligible for the service. Since its establishment the service has grown rapidly with almost 19,300 referrals during 2017 and counselling provided from more than 180 locations nationwide. These services have been enhanced recently through the recruitment of 114 assistant psychologists in primary care. The HSE also employs counsellors, therapists and psychologists in primary care addiction services.  In addition to directly employed staff, the HSE funds partner organisations such as Jigsaw to provide talk therapies.

In order to ensure greater consistency and equity of access to these services HSE mental health commenced a service improvement project in January 2018 with a view to developing a model of care for adults who attend specialist mental health services accessing talking therapies. While the project focuses specifically on adults attending specialist mental health services, it will also describe other services that currently provide talk therapies from HSE funding. Building on a stepped care approach, the model of care is expected to involve an assessment of the need for talking therapies taking into account stakeholder perspectives and the prevalence of mental health disorders within the adult population. It will consider evidence-based talking therapies that are best suited to meet the identified needs and outline a recommended operational model for talking therapies provided by general adult community mental health teams.

James Browne (Wexford, Fianna Fail)
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I thank the Minister. In its submission to the Joint Committee on the Future of Mental Health Care, the Irish College of General Practitioners said: "Our health system would appear to value machines, hospitals, and drugs over talk therapy, time to care and social support." Irish general practices are slowly getting bigger. As the proportion of single-handed GPs, which is now at only 18%, is reducing and more GPs are working in practices with three, four or more GPs, these larger practices could very usefully incorporate an on-site strand of talk therapy delivered within GP practices. The trendsetting practices are actively exploring the use of relevant innovative care.

The HSE spends 40 times more on medication than counselling services to treat mental health illnesses. Counselling and talk therapies can often be effective for mild to moderate mental health difficulties but these therapies are vastly under-resourced in Ireland. People battling mental illnesses need more access to counselling and talk therapies with less reliance on medication. Much of the evidence suggests that because of a lack of alternative pathways in giving mental healthcare support to their patients, GPs are either relying on accident and emergency departments or on medication. I am not saying that medication is being prescribed inappropriately but that GPs are having to rely on it because of a lack of alternative healthcare pathways.

Simon Harris (Wicklow, Fine Gael)
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I thank Deputy Browne. I agree with him and I know that the Minister of State, Deputy Jim Daly, does as well. The HSE's mental health services are working with the Department of Health on a project which aims to improve access to mental health information and support through the harnessing of communication technologies. There are a number of strands to this project. First, there will be enhanced web-based mental health information which will be signposted to ensure the widest possible access to information on both mental health conditions and on our mental health services. There will be an enhanced text-based live chat active listening service which will respond to queries on mental health and a telephone service that will direct people to appropriate and relevant mental health support services. There will also be a feasibility study on the provision on online therapies and a framework for the quality standards required for the provision of such services. Included in this work will be a pilot study examining the feasibility and utility of providing access to Internet-based counselling services from a primary care service.

HSE specialist mental health services provide a wide range of talking therapies in both child and adolescent mental health services, CAMHS, and adult mental health services. These include specialist behavioural therapy, specialist cognitive behavioural therapy and behavioural family therapy. Additionally the HSE provides talk therapies at primary care level through directly employed staff, including our psychologists in primary care and our counsellor therapists in counselling in primary care and, as I have outlined, the National Counselling Service. As I have already stated, these services have been enhanced but there is absolutely room to do more in this regard. I agree with the Deputy's sentiment in that respect.

James Browne (Wexford, Fianna Fail)
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I thank the Minister. I would simply repeat the figure that I previously stated. We spend €400 million a year on psychotropic drugs but we only spend €10 million on talk therapies. We hear about pilot studies and programmes but they are not being rolled out nationwide. Things seem to take so long. Take Jigsaw as an example. It started as a pilot and is a phenomenal programme. However, I was told 18 months ago that it was going to arrive in Tipperary within a couple of months. It is still not there. It needs to be rolled out across the country. There is a crisis in the waiting lists for our child and adolescent mental health services. That is partially because there is a crisis in our waiting lists for access to child psychologists, which in turn is developing because there is a crisis in respect of the complete lack of availability of talk therapy. In other words, when children first need supports they are not there. They then need access to psychologists but cannot get to them and the next thing is that they are in CAMHS. When children who are growing rapidly, both biologically and emotionally, do not get early intervention very quickly the long-term effects can be profound. Talk therapies need to be provided at a much greater level than they are at the moment.

Simon Harris (Wicklow, Fine Gael)
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I thank Deputy Browne for his point. We are in agreement on this issue. We need to see a greater roll-out of these services. However, I would point out that the data are encouraging in terms of the number of people now being seen. Taking the example of counselling in primary care from 2015 to 2017, in 2015, 17,002 people were referred to the service, which increased to 18,471 in 2016 and increased further to 19,279 in 2017. We have also seen an increase in the number of people opting in to the service from 9,835 in 2015 to 11,454 in 2016 and 11,810 in 2017. We expect the total number of both children and adults in that service to be 20,528 in 2018, up from 19,279 the previous year. We expect the number of people opting in to the service to increase to 13,008, up from 11,810 in 2017.