Tuesday, 27 November 2018
Saincheisteanna Tráthúla - Topical Issue Debate
Mental Health Services
The reply to a recent parliamentary question revealed there were 61 vacant psychiatric positions, including 13 in community healthcare organisation area 4, covering cork and Kerry. Those positions were in child and adolescent psychiatry, the psychiatry of learning disabilities, the psychiatry of old age as well as general psychiatry.
Ireland has six consultant psychiatrists per 100,000 of population, just half the EU average. In area 4, covering Cork and Kerry, 1,191 young people are waiting more than three months for an assessment. That is a huge indictment on this Government. That is just for an initial assessment, many having been referred in the first place by their general practitioners. Children and adolescents from Kerry are having to try and access inpatient beds in Cork where there are not enough beds to cater for the number of children in crisis, which is resulting in children been admitted into adult wards in University Hospital Kerry. This situation cannot be allowed to persist. If a child or a young person needs care they will face an extended waiting period, which puts them and their mental health at serious risk.
We are focusing on the rising number of vacancies within the mental health service. I visited the Linn Dara unit during the summer. There have been problems there and also in the Cork child and adolescent mental health service, CAMHS, where services were either closed temporarily over the summer or have refused new referrals. Also, the ACCES homeless mental health service in Dublin is not taking any more referrals.
The Government claimed on budget day that €84 million was being added to the mental health budget, but that turned out to be only €35 million in terms of new money, which is €20 million short of the €55 million that the Government promised. More than 37,000 children are waiting for their first assessment.
How many children are waiting, after their initial assessment, to go into one of the services, whether a disability or mental health service?
The overall picture for mental health and disability assessment is very poor with 37,000 waiting for a first assessment and 78% overdue. The Taoiseach tried to distract from that earlier by pointing to the Cork and Kerry CHO as a scapegoat, stating that he did not believe it was under-resourced. This debate is about the services being under-resourced and the issues relating to staffing. The Minister of State can go back to check the record if he wishes. The service is under-resourced for assessment and CAMHS. Some 60 or so psychiatrist posts are currently vacant and 13 or so of those are in the Cork and Kerry region. There are 3,720 applications for assessment, or 33% of the overall number, in the Cork and Kerry area. Some 1,192 have been waiting in the system for more than three months. With regard to CAMHS services in community health organisation, CHO, 4, the Cork and Kerry region has half the recommended numbers of consultant psychiatrists. Those statistics point to the reality and are important. This issue means that young people's potential is restricted because their education is denied to them or their lives and the quality of their lives are being put at risk due to a lack of mental health supports.
I thank the Deputies for raising this important issue and I will respond accordingly. I do not doubt their sincerity about the issue. I will respond to some of the figures they presented. As is widely acknowledged, there is currently an international shortage of consultants, especially for CAMHS. The Cork-Kerry CHO has established a CAMHS medical recruitment task force to review efforts to recruit and retain medical staff, led by the head of service for human resources. Every possible option is pursued in order to recruit consultant psychiatrists. That is accepted. Acknowledging the critical impact medical vacancies have on service provision, a dedicated medical manpower office has been appointed. Local management is working with 11 national and international agencies to source suitably qualified candidates. All options are being explored, including the provision of out of hours or weekend clinics by a consultant working elsewhere, along with the potential use of telemedicine solutions.
Some 2,453 children were on CAMHS waiting lists nationally at the end of September. Some 656 of these were in CHO 4. There has been a decrease nationally in children on the waiting list for longer than 12 months from 317 in August 2018 to 313 in September 2018. This decrease is reflected in CHO 4 with 174 children waiting in excess of 12 months in September, down from 183 in August. The recent budget saw the mental health allocation increase to nearly €1 billion, a clear indication of the importance placed by the Government on the mental health of the nation. This represents an increase of more than €245 million in the HSE's mental health budget since 2012. This has helped to fund a number of initiatives aimed at reducing demand on mental health services. It has also provided an extra 130 psychiatric nurse undergraduate places each year to come on-stream in 2020 and 2021. Some 40 postgraduate posts have been funded. Together with the recent appointment by the HSE of approximately 114 assistant psychologists and 20 psychologists into primary care, and ten advanced nurse practitioners directly into CAMHS, it is anticipated that these posts will help to reduce demand on CAMHS. The issues the Deputies raise are important and we have a problem with recruitment.
I do not doubt the Minister of State's sincerity and efforts to try to address the terrible deficit in our disability services and the resources available for that. The figures we have differ from the figures the Minister of State has presented here. These come from parliamentary questions. These figures tell us that CHO 4, which is Cork and Kerry, has 1,1192 waiting who have been waiting for more than three months for an assessment. The programme for Government states that people with disabilities should be supported throughout their lives to maximise their potential by removing barriers. The promises made in the programme for Government have not been realised. This absolutely unacceptable staffing shortage in CAMHS should be addressed immediately but these promises remain unfulfilled. Will the Minister of State and his Government realise the promises they have already given and make them a reality?
I thank the Minister of State for his reply but unfortunately it does not offer much solace for the people who are suffering and their family members. To add to what Deputy Ferris said, the clinical work-time equivalent in the Cork and Kerry CHO area is lacking by 75%. How can anything be done when three quarters of it is missing? More worryingly, 656 children is too many. The Government has failed people within the mental health service, including patients, family members and staff. It has been a disaster. I was disappointed in the AV room last week when the Minister and HSE indicated what they were doing for mental health services. The first thing they mentioned was 75 CAMHS teams.
Even accepting the number the Minister of State has outlined, it is a scandalous situation. He is talking about 2,400 being on the list nationally with 656 of those in the Cork and Kerry area. That is only one area out of nine, yet it amounts to more than one fifth of the national list. Some 174 children and their families have been waiting for in excess of 12 months to be seen. That is extraordinary, no matter what context one puts it in. We have 50% of the recommended number of consultant psychiatrists for the Cork and Kerry area and it is having an impact. It impacts on the quality of people's lives. The lack of assessment restricts people's opportunities and potential. It is very distressing and difficult. There are families and children who are in extremely serious, distressing situations. The Government response has not been good enough for seven or eight years. The implementation of A Vision for Change is far short of where it should be. It is time the Government stepped up on mental health and started delivering.
I thank colleagues for raising this important issue. I point out that the substantial increase in mental health funding in recent years has helped to fund an extra 4.79 consultant psychiatrists in CHO 4 since 2016. I accept that there is a problem. The CHO has stated that there are 7.25 vacancies at consultant level in mental health. I accept that reality. Deputy Ferris has raised the issue of resources in CHO 4 and the 656 on the CAMHS waiting list. Dramatic action has to be taken on those figures. Deputy Buckley said 656 was too high and asked how we make things work. We make things work by recruiting staff and investing what is necessary. Deputy Ó Laoghaire made an important point about the need for progress on these issues. I am listening to the Deputy's arguments. Over the next week or two, we will do the Estimates for the HSE for 2019. I have prioritised assessment of needs and this issue is in my top five requests, along with emergency places, residential places and personal assistance hours. When I am divvying up the €1.8 billion that we are spending this year on disability services, I will demand action on these issues.
Of course, I have been listening to colleagues in Cork and Kerry in recent months, and Deputy Brassil knows this as well. I am very conscious of the fact there are issues in these areas and we need action on them. I will try to do something about it.