Dáil debates
Tuesday, 22 January 2019
Saincheisteanna Tráthúla - Topical Issue Debate
Child and Adult Mental Health Services
6:40 pm
Joan Burton (Dublin West, Labour)
Link to this: Individually | In context | Oireachtas source
I draw the attention of the Minister of State to the fact that there are very severe shortcomings in the child and adolescent mental health service, CAMHS, in the Dublin 15 area. I draw his attention to a case I sent to the Department some time ago, on which I have yet to hear a response. It is typical of what a number of parents are experiencing. The consultant psychiatrist at the child and adult mental health service, CAMHS, in Castleknock took extended leave two months before the start of this year, with absolutely no indication of a return date. Since there is no psychiatrist available to prescribe, children with ADHD who require medication, very often to assist with their attendance at school and normal functioning, are unable to obtain their medication. Where does that leave the parents? The problem is ongoing. Throughout the service nationally, we are short approximately 60 psychiatrists. While the case I raise concerns Dublin 15, the area, unfortunately, is not untypical of the rest of the country.
The second case involves a 13 year old who has transferred to secondary school. The child has a range of conditions, from autism to behavioural issues and panic attacks. The child's mother is working practically full time. Both she and the child's father have jobs, but they do not know when they will receive help from the psychiatric service. There is no guarantee when this help will come.
The third case is that of a family who contacted me over the weekend. It concerns a young teenager who has developed severe mental health difficulties and had an emergency appointment, just for reference purposes. It appears that the earliest the child will get to talk to somebody is in about three months. It will simply be a counselling service.
We have had discussions here on mental health, an issue on which the Ceann Comhairle has led. We all know that children in need require very early access to services. When I was a Minister, I was very involved in ensuring the really lovely community facility in Corduff was opened. It was to have a child and adolescent mental health service. I know from the staff working there that there are simply not enough of them to enable this to happen. Everybody involved in government does his or her bit to help different areas - that is a matter in which I was very involved - but I am disappointed that in an area such as Dublin 15 which has a massive child and youth population, including a significant number of children with difficulties such as autism, ADHD and panic attacks, there is a lack of psychiatrists to meet children and provide them with a service in real time.
Finian McGrath (Dublin Bay North, Independent)
Link to this: Individually | In context | Oireachtas source
I thank the Deputy for raising the issue of CAMHS in Dublin 15. A priority for the Government and the HSE is ensuring appropriate and accessible mental health services for children and that services are provided in the most accessible manner for those who require them. In the recent budget an additional €55 million was provided to progress new developments in mental health services this year. It brings overall HSE mental health services funding to nearly €1 billion in 2019. The HSE service plan for 2019 commits to further development of CAMHS against a background where the population of children and the demand for the specialist service are increasing.
All aspects of CAMHS nationally are being improved by the HSE. They include better access, reducing waiting lists and strengthening links with other services such as primary or disability care services. Access is based on a professional clinical assessment and urgent cases are prioritised. Around 18,000 referrals are expected for HSE CAMHS in 2019. The number of referrals to CAMHS has increased from around 10,700 in 2011. There are widely acknowledged difficulties in recruiting and retaining specialist CAMHS staff, particularly consultant psychiatrists.
The HSE indicates that there is a treating consultant child and adolescent psychiatrist working in the Dublin 15 area. There is no consultant psychiatrist in place on the Castleknock team, owing to illness, as the Deputy rightly mentioned. However, there are two psychiatry registrars working on the CAMHS team who are qualified to prescribe appropriate medication. They have access to consultant colleagues on other teams within Dublin north city and county CAMHS, should it be required.
Concerted efforts have and will continue to be made by the HSE mental health service to recruit a locum consultant, notwithstanding the shortage of consultant psychiatrists nationally. Another factor to be taken into account in this instance is the increasing and more complex nature of the demand for services, particularly CAMHS. I understand there were 1,631 referrals by CAMHS teams across Dublin north city and county in 2018.
Opportunities to continue to develop services that will treat children and adolescents at the lowest level of complexity, thus avoiding the need for specialist interventions, remain challenging. The executive is focusing on the consolidation of earlier interventions and building more proactive services at primary care level, rather than secondary specialist mental health services for children and adolescents. Developing these services will also enhance community teams to ensure higher quality services for those individuals with higher acuity and greater need.
I ensured that there were various new initiatives agreed to in the HSE service plan 2019 to bring about change in a way we could promote youth mental health and deliver services, particularly at prevention and early intervention levels, thus helping to reduce pressures on the specialist CAMHS. The measures include new digital mental health services, improved supports for relevant sports, community and voluntary groups active in this sphere and expanded out-of-hours CAMHS provision.
The Deputy raised three important cases. From the point of view of a family or young person, waiting three months is not good enough. I totally accept this and will push to address the matter. The Deputy also highlighted the issue in Corduff.
Joan Burton (Dublin West, Labour)
Link to this: Individually | In context | Oireachtas source
I thank the Minister of State for his reply. Any parent faced with the difficulties outlined will be very disappointed by it. Let me quote from the letter from the first parent I mentioned:
The consultant psychiatrist from CAMHS Castleknock has taken extended leave some 2 months ago, with absolutely no indication of a return date. This means no kids with ADHD, some barely able to read ... without the assistance and monitoring of extremely important medication are being seen/treated. They're ... being backlogged onto an already packed waiting list [this is basically what the Minister of State said to us in his rather complicated reply]. There has been no consultant at all with CAMHS Castleknock for this period. While Blanchardstown CAMHS sees kids with ADHD after a maximum of a year, Castleknock are working with emergency cases only because of this situation.
I know the mother who wrote the letter which also states: "So kids like mine have absolutely no idea if they’ll receive the urgent medication within the already unacceptable waiting time of a year."
The Minister of State said: "Opportunities to continue to develop services that will treat children and adolescents at the lowest level of complexity, thus avoiding the need for specialist interventions, remain challenging." When the IMF came to Ireland, when the country had collapsed, it used the word "challenge" all the time. When Sinn Féin sat down many years ago to work on the Belfast Agreement, I would say there were those who said it was difficult and "challenging". Very often bureaucrats use the term "challenging" when mentally putting up their hands and saying there is not an awful lot they can do about a matter. If children develop mental health difficulties that cannot be addressed, the problem may become more, rather than less, difficult.
6:50 pm
Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
Link to this: Individually | In context | Oireachtas source
6 o’clock
Thank you, Deputy.
Joan Burton (Dublin West, Labour)
Link to this: Individually | In context | Oireachtas source
The Minister of State is suggesting that local GPs could provide the service, and I understand this, but it is not there.
Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
Link to this: Individually | In context | Oireachtas source
We will hear the Minister of State's response.
Joan Burton (Dublin West, Labour)
Link to this: Individually | In context | Oireachtas source
What is the Minister of State doing to provide this earlier baseline level of service that would at least improve some of the situation? Perhaps he will share that with us.
Finian McGrath (Dublin Bay North, Independent)
Link to this: Individually | In context | Oireachtas source
I will explain in detail what we are trying to do. I take the point the Deputy raised on challenges and I will respond to it. I reiterate that improving aspects of all policies and services for promoting positive mental health for young people, including CAMHS, is a priority for me and is in the HSE service plan for 2019. This objective relates to all areas nationally, including Dublin 15. Tomorrow at the Department of Health, the Minister will meet all of the CHO leads and all executive clinical directors of the HSE to present a progress report to me on CAMHS, as well as an action plan in this regard for the year ahead. I certainly will bear in mind the specific issue raised by the Deputy and I will continue to keep under close review the efforts made by the HSE to enhance CAMHS in Dublin 15. The three genuine cases mentioned by the Deputy must be prioritised, and this is something I will push with the Minister.
Joan Burton (Dublin West, Labour)
Link to this: Individually | In context | Oireachtas source
This is the Taoiseach's constituency. What attention do other constituencies get?