Wednesday, 17 April 2019
Saincheisteanna Tráthúla - Topical Issue Debate
Child and Adolescent Mental Health Services
Maith go leor. Tá mé buíoch don Leas-Cheann Comhairle fá choinne deis a thabhairt dom labhairt ar an ábhar tábhachtach seo. Tá mé sásta an Aire, an Teachta Phelan, a fheiceáil anseo, ach tá mé míshásta nach bhfuil an tAire ceart i láthair.
This Topical Issue matter is about the consistent failure by the Government to deliver adequate and effective community mental health services in north Louth, and especially child and adolescent mental health services, CAMHS.
In October 2016, I visited the Ladywell mental health centre in Dundalk which should provide these services for north Louth, but despite the heroic commitment of the staff, it cannot deliver the services because the building is crumbling. The Ladywell centre was built 70 years ago as accommodation for nurses working in the Louth county hospital.
It was never intended, and is not suitable, for the delivery of community mental health services. Thirteen years after the publication of A Vision for Change child and adolescent mental health services in my constituency are in crisis. Figures released last week show that 345 young people in CHO 8, which covers my constituency, are awaiting CAMHS services. Of these, 140, one-third, have been waiting for more than three months. Other figures released to my colleague, Deputy Louise O'Reilly, show that the staffing deficit in CAMHS is such that at least €40 million is needed to address it. In this regard, there are just over half, 54%, the number of the staff which A Vision for Change said was necessary. There is no consultant child and adolescent psychiatrist in this area and five senior medical social worker positions, two senior psychologist positions and a range of other senior positions remain unfilled. This means that thousands of children and young people are not receiving the mental health supports they need within the appropriate timeframes. What steps is the Government planning to take to address this issue and what additional funding will be made available for staff?
The Minister of State, Deputy Jim Daly, is reported to have said recently that A Vision for Change is being "refreshed". What does that mean and when will the new version be published? Thirteen years ago, Louth mental health services were allocated additional staff. Even if they all arrived tomorrow, there is no building from which they can operate. People from the north of the county, from Carlingford, Omeath, Faughart, Shelagh, Dundalk, Dromiskin, and many other places have to travel as far Ardee or Drogheda to access community mental health services. This places an unfair burden of travel on vulnerable individuals and families, some of them dependent on declining public bus services.
Last August, when I asked about the lack of suitable premises I was told that community health services would be provided within the new primary care centre in Dundalk, which was first advertised in 2008 but has not yet moved off the drawing board. In November 2016 I was advised in response to a parliamentary question that it was hoped that the operational lease process for the primary care centre in Dundalk would be completed in the first quarter of 2017. Last August, the HSE stated that the planning application would be submitted by the end of 2018, that work would commence in 2019 and the centre would be open early in 2020. None of these deadlines has been or will be met. I would like an update on this process. I hope the Minister of State, Deputy John Paul Phelan, who I acknowledge is standing for the Minister of State, Deputy Daly, this evening will be able to respond to my questions.
I thank the Deputy for raising this matter which I am taking on behalf of Minister of State, Deputy Daly, who is unavailable this evening. I will relay the points made by the Deputy directly to him because mental health services and funding thereof are serious issues that need to be dealt with.
Significant additional Government funding since 2012 has provided for approximately 1,700 new development posts for mental health services, including the child and adolescent mental health services, CAMHS. Budget 2019 provided an additional €55 million to progress new developments in mental health this year, bringing overall HSE mental health funding to approximately €1 billion. This, in turn, will allow for continued improvement to all aspects of mental health care services across the nine HSE community healthcare organisations, including CHO 8, which incorporates County Louth.
Enhancement of the specialist CAMHS service, including improved access and reducing waiting lists, remains a priority for Government and the HSE. The total number of children on the HSE CAMHS waiting list was approximately 2,580 in February 2019, inclusive of just over 300 who are waiting over 12 months. Cases assessed as urgent are seen as a matter of priority. As of February 2019, approximately 80% of young people were offered a first appointment within 12 weeks in community CAMHS settings. At that time, 98% of young people were seen within 12 months by community CAMHS services. There are now 70 CAMHS teams, three paediatric liaison teams and 74 CAMHS inpatient beds in four acute units nationally, with additional beds planned in the new children’s hospital and at the new national forensic mental health complex now being built at Portrane. In CHO 8, there were 345 people on the CAMHS waiting list, which is down from 358 in the same period last year. Waiting lists in CAMHS above 12 months posed a significant challenge during 2018. However, since the recent commencement of a sixth CAMHS team this issue has been actively addressed by the HSE to the extent that within nine months the waiting list for those over 12 months dropped from 57 children to seven.
Currently, the provision of a CAMHS service to north Louth is provided from the child and family centre in Drogheda. Louth-Meath mental health services are currently examining a new town centre location in Dundalk with a view to providing improved CAMHS to north Louth. The HSE is hopeful that this will come on-stream towards the end of this year. Staffing in CAMHS teams in Louth is above the national average. One of the CAMHS teams has a consultant vacancy, which as the Deputy mentioned is currently filled by a locum. The post has been approved by the HSE and it will be filled as soon as possible.
Louth-Meath mental health services continue to improve the level and quality of service being delivered and the environs in which this is done. It supports clients in their recovery and rehabilitation as close as possible to their homes and communities. All of this is being done within the resources available. The recently agreed HSE service plan for 2019 outlines the priorities and actions to enhance mental health care nationally this year. This relates also to CHO 8 and County Louth and encompasses a range of services covering acute or community-based CAMHS, general adult services and psychiatry-of-late-life. In addition, the Minister of State, Deputy Daly, has progressed a number of mental e-health initiatives aimed at boosting the supply of services at primary care level. While the service plan also acknowledges widely accepted challenges to developing services, including increasing demands and difficulties around staff recruitment and retention, the objective of the Minister of State, Deputy Daly, and the HSE, is to deliver overall service improvements for Louth this year.
In the information provided to Teachta Louise O'Reilly three weeks ago Dundalk primary care centre was not mentioned. In my opening statement I outlined the number of times that promises have been made, some of which date back to 2016, but others date back to 2008. The response today states:
Louth-Meath mental health services are currently looking at a new town centre location in Dundalk with a view to providing improved CAMHS to north Louth. The HSE is hopeful that this will come on-stream towards the end of this year.
There is no reference to a primary care centre. While that new facility will be welcome if it comes on-stream, it is not the primary care centre that is needed in the area.
As I said earlier, the Ladywell centre was built 70 years ago to accommodate nurses. It was never meant to be a place where people with mental health issues could be treated. The Leas-Cheann Comhairle was in the Chair when I raised issues earlier about answers from Ministers. I acknowledge that the Minister of State, Deputy Phelan, is standing in for the Minister of State, Deputy Daly, but this reply is entirely and absolutely inadequate. A consultant child and adolescent psychiatrist, five senior medical workers and two senior psychologist posts remain to be filled. That is the reality.
I do not want to be giving out to the Minister of State about the fact that citizens have to put up with this. We are dealing with elderly people who need psychiatric help. There is a lack of services for children who need such help. It is just out of order. If I may say so, when the Minister of State is asked to step into this position to give an answer, he should refuse to do so. It will not help the people of Louth. It certainly does not help me, but that is not the main issue. These people deserve services that they have been promised for decades but are still not getting.
The Deputy's points are well noted. I will ask the Minister of State, Deputy Jim Daly, to revert directly to him strictly on the staffing positions to which he referred in his concluding remarks. The other matters-----