Wednesday, 13 March 2019
Ceisteanna Eile - Other Questions
Child and Adolescent Mental Health Services Administration
I want to ask the Minister for Health the waiting times for child and adolescent mental health services in the Dublin 7 and 15 areas, and if he will make a statement on the matter. We have an ongoing crisis in CAMHS, with recruitment shortages, ongoing delays and many children being dismissed and turned away from a service because their diagnosis or presentation does not match the severity which the service can provide for. With Deputy Daly as Minister of State with responsibility for mental health, there has not been any improvement in the quality of the service. Children continue to be admitted to adult units and there is not a 24-7 call service, which is shocking in the context of a €17 billion budget.
Developing all aspects of mental health remains a priority for Government, reflected by the additional €55 million provided in budget 2019, bringing overall HSE funding this year for this key care programme to €987 million. Demand for CAMHS has had an increase in referrals of over 20% since 2012. All aspects of CAMHS nationally are being improved by the HSE under its annual service plans. This includes better out-of-hours and 7-7 day cover, progression of day hospital care, developing specialist teams such as those for eating disorders, and improved prevention and early intervention services. There are now 70 CAMHS teams and three paediatric liaison teams. Approximately 18,100 CAMHS referrals are expected in 2019. Cases assessed by professionals as being urgent are seen as a matter of priority.
There are 76 CAMHS inpatient beds in four acute units nationally, with plans for additional beds in the new children's hospital, and the new forensic mental health hospital which is being built at Portrane and is due to open next year. Additional funding allocated to mental health services since 2012 has provided for the recruitment to more than 1,500 posts in mental health, including a significant number relating to CAMHS. There were 2,523 children on the HSE CAMHS waiting list in January 2019. In community healthcare organisation area 9, which covers the areas of Dublin 7 and 15, there were 193 on the CAMHS waiting list. There is currently no waiting list for the north inner city CAMHS team, Grangegorman, which covers the Dublin 7 area.
There is currently a waiting list of 68 for the Dublin 15 area, primarily due to a consultant on leave which has resulted in delays in routine appointments. A locum consultant psychiatrist has taken up duty with the Castleknock CAMHS team since 5 February. This will see a return to more normal levels of activity and a reduction in the waiting list. Prior to this date, cover was being provided via an arrangement between existing CAMHS consultants across other CAMHS teams in Dublin north city and county.
I regularly meet with the HSE to review progress on all aspects of CAMHS. In addition, I recently wrote to all executive clinical directors concerning recruitment and retention issues with a view to improving staffing levels on CAMHS teams thus improving access and reducing waiting lists.
We have received the classic response that more funding is being allocated. We accept that but one problem is that the Government throws money at issues without getting service delivery. We have the second highest health spending per capitain the OECD but what parents and children care about is actual delivery. It is not about how much the Government is allocating or how many more consultants it is talking about, but how people can see a consultant as quickly as possible. The figures are worse, with 193 now versus 186 in November. The Minister of State mentioned a consultant being out and nobody being in an area to cover a population in Dublin 15 that is the size of some cities. There is nobody to see someone and the burden of care is on other consultants who already have significant waiting times. I am aware of children who have a particular diagnosis, have been referred by general practitioners, GPs, and are told by CAMHS that their diagnosis does not match the level of severity that it can deal with, despite it being within the diagnostic guidelines for its own service delivery. That is a serious issue. If someone presented to an emergency department with a significant acute physical problem-----
I am not sure if the Deputy has ever heard me speak on this before because if he had, he would not make some of the statements that he has made. I have always said that throwing money at it is not a solution. It is interesting to hear that from Fianna Fáil because it has always looked for more money in this area and everything else relating to health. I do not agree that additional moneys are required. Additional, real reform is needed. I have a serious issue with the referrals to CAMHS. In many cases, the referrals are not appropriate and I am glad to hear that CAMHS teams are pointing to the fact that they are not appropriate.
If the Deputy does not want to listen, that is fine. He asked the question.
With respect, the Minister of State made a political charge in his response relating to a very serious matter, the diagnostic management of patients with severe mental illnesses. As Minister of State with responsibility for mental health, I have heard him talk more about rural taxis and telepsychiatry to get headlines in the Irish Independentthan I have heard about solutions for mental health services. It is a disgrace that the Minister of State has made a political charge. I was trying to be constructive. I agree that it is not about throwing more money at the HSE. It is about delivering services and that is what the Minister of State is in an executive position for, to deliver mental health services. It is not about making political charges and talking about Fianna Fáil. We are trying to be constructive and to provide solutions, but the Minister of State is not doing that. He is not delivering. He has not made any positive changes relating to CAMHS in my area, where we have seen worsening of waiting lists and where his Government has allowed vacant consultant positions to leave behind children with particular diagnoses. It is the Minister of State's responsibility to act, not to get headlines about Ruxi, coalitions with Sinn Féin or telepsychiatry.
I would be delighted to answer the Deputy's questions if he is prepared to listen. I was about to inform the Deputy, while I did not realise he was so sensitive to politics, that I have built a lower level of infrastructure across the country over the past 12 months. We have recruited 114 assistant psychologists, 20 psychologists and ten advanced nurse practitioners for young people across the country, including in the area that Deputy Chambers represents. An independent evaluation that was produced by the University of Limerick for me last week has shown that it will reduce the waiting list for primary care psychology by 1,350 young people this year.
That is real progress and it is the future. It is not about reacting and throwing more money at CAMHS to deal with waiting lists. Rather, proactive investment in lower-level interventions will prevent people escalating to that level of acuity.