Tuesday, 17 December 2019
Saincheisteanna Tráthúla - Topical Issue Debate
Mental Health Services
I have raised the issue of mental health services in Cork city and surrounding areas with the Minister of State previously. I appreciate that we have had many discussions, but on some occasion I would appreciate if the Minister for Health, Deputy Harris, was in a position to listen to some of these discussions. I appreciate the Minister of State's interest in this area and his desire to tackle it, but this is a massive issue and the community health organisation, CHO, for Cork and Kerry seems to be constantly below other areas in respect of the services provided.
Some of the waiting times people in Cork city and the surrounding areas have been experiencing are outrageous. The point of community services is to reduce the pressure on the acute services. That is the theory of them and the primary care centres. If we look at the kind of waiting times that exist for psychiatry and for psychology and for psychiatry and psychology in child and adolescent mental health services, CAMHS, it clearly is not succeeding in that regard.
I will start with psychiatry. In some areas, such as in Carrigaline, there is an average waiting time of six months. In response to a parliamentary question I asked on that issue, I was told that there is not a requirement at present to recruit further.
When one considers the pressure under which the primary care centre is, I do not understand why no positions are required. Is that under A Vision for Change or is some other metric being used to determine that? A six-month wait for psychiatry is far too long. Six months is a tortuous length of time to be waiting for any kind of treatment. Anyone who is referred to a psychiatrist is likely to be facing a crisis situation. It is unacceptable that people in the Carrigaline area, which takes in Douglas and Passage for the purposes of the community health area, are waiting six months to be seen by psychiatrists.
The story is similarly grim, even worse, when it comes to psychology services. Some of the psychology waiting times in community settings include nine months for the Ballyphehane-Togher sector, six months for Douglas and Carrigaline and 17 months for Ballincollig-Bishopstown. Again, it was stated there is no requirement for further recruitment. I cannot understand the HSE’s basis for stating these times are acceptable and it does not need to do any more. It is unacceptable.
The story is similarly dreadful for CAMHS, the child and adolescent mental health services. There are 646 children on the waiting list, 192 of whom have been waiting over a year. These are vulnerable children and adolescents with real mental health issues. In many instances, life may hang in the balance. Certainly, welfare hangs in the balance. To put this in context, two years ago it came to national attention that there were spikes in suicide and self-harm in the Cork city area. It is still the case that the Cork city area is way above the national average for suicide among men and self-harm among women. That has been the case for a decade. While mental health is broader and takes in much more than that, clearly investing in psychology and psychiatry in community and CAMHS settings is crucial to assisting people in crisis situations. In that regard, people are being failed when one is looking at psychiatry lists of between six and 17 months. This is unacceptable.
Mental health continues to be a priority area for the Government. We recognise that mental health service users are among the most vulnerable in society. For this reason, €39 million has been added to the mental health services budget for 2020, increasing the annual allocation to €1.026 billion. This represents an increase of over €315 million, or 45%, since 2012.
This funding will help in the continued improvement and development of mental health services. Funding by itself is not enough, however. We also need to look at how we deliver services and how we can reduce demand for the specialist mental health services by treating people at as early a stage as possible.
In this regard, the HSE is introducing several digital mental health initiatives driven by the Department of Health. These include tele-counselling and tele-psychiatry projects, which will provide remote counselling and psychiatric consultations, as well as helping to improve access to these services. Greater use of available technology will help to deliver services at an earlier stage, helping to ensure that mild mental health issues are dealt with before they become more serious.
These initiatives exemplify the serious intent of the Government to progress and improve mental health services. We have also enhanced mental health services provided in primary care. The introduction of 114 assistant psychologists and 20 psychologists in primary care has produced a 28% increase in referrals, which will total approximately 14,000 in 2019. This has helped to reduce the national waiting list for CAMHS to around 2,000, a decrease of 500 or 20% since December 2018.
Funding for seven of these psychologist posts and 16 of the assistant psychology posts for the Cork-Kerry area has ensured this trend is reflected in this region. The number of young people waiting to access CAMHS has reduced by 14% from 667 in January 2019 to 574 in October 2019. Despite this, it is recognised that the Cork-Kerry region CAMHS waiting list number must be reduced further.
Adult services in Cork are provided through 19 adult community mental health teams, five psychiatry of later life teams, three home-based treatment teams, a specialist rehabilitation team, a specialist homeless team and a mental health and intellectual disability team. In addition, dedicated liaison teams are based in Cork University and the Mercy University Hospitals with plans under way to develop a liaison service in University Hospital Kerry. There is an adult community mental health team for Carrigaline, providing outpatient services in Ravenscourt, St. Finbarr's Hospital, Cork. Cork-Kerry community healthcare faces ongoing challenges in recruiting and retaining both psychologists and psychology assistants. Psychology managers are working to meet these challenges with the HSE's recruitment service and the academic institutes on an ongoing basis.
I am more than disappointed by the reply from the Minister of State. It does not contain a significant amount of detail on the positions in question and the Minister of State has not answered my questions. The replies to parliamentary questions stated there is no intention or requirement to fill additional positions in areas where the waiting lists are unacceptable. What is the opinion of the Minister of State on this? How can it be the case that the HSE believes this is acceptable? It cannot be acceptable for people to wait six months for psychiatry services, as they are forced to in Carrigaline.
On top of that, when I asked these parliamentary questions in the late summer, many of the positions had not been filled. While I accept the Minister of State may not have the information to hand, will he furnish me later with information concerning a position required to be filled for psychology in the Douglas-Carrigaline sector, two positions in the two different sectors in south Lee for CAMHS psychology, a position for psychology in the south-east area, Blackrock, and other positions in CAMHS psychology? That still leaves places which the HSE or the CHO feel they are doing enough and there is no point in asking for more staff. I do not understand this. I would appreciate if the Minister of State could give us an insight into the target being used. Is it A Vision for Change or something else?
A significant number of our problems with mental health services are due to a lack of clinical psychologists and psychiatrists, essentially a shortfall of staff. We have large numbers of students studying psychology and related courses but for whom becoming a psychologist is not a realistic career option because it is too expensive to gain the clinical experience they need to qualify as a clinical psychologist. We need to crack that. Many more people would like to be psychologists but they do not have the opportunity to do so.
The House and the Deputy will appreciate that two minutes will not give me an opportunity to answer his questions or address the range of issues outlined.
There are 34 young people in the Carrigaline-Douglas area on the waiting list for psychiatry. That is what the HSE means when it could not justify taking on an additional psychiatrist in a full-time position. Instead, it is about the better utilisation of resources. I suggest to the Deputy that he engages with the head of mental health services and local management in the CHO 4 area. They will give him more detail rather than me trying to give it across the floor of the Dáil in two minutes.
The overall CAMHS waiting list has reduced by 20% this year across the country, including in Cork. It was done by introducing 134 psychologists into the system last year, on top of the existing infrastructure. It was also done by bringing in a lower level infrastructure which is catching people at an earlier time and preventing it from escalating. That is not a waiting list initiative which will see it shoot back up again. It is a structural reform with better organising what we do and how we do it and building lower level infrastructure. While we could continue to keep employing more psychiatrists, we need to pull back and look at lower level interventions and building that up. That is what we have done and it has worked. The figures have been independently verified. This year it could even be a 25% reduction. That is a significant reduction in any waiting list. More importantly and crucially, it is sustainable.
In my time in office, I have tried to ensure that everything we do is sustainable and replicated year after year. It is not about just throwing an extra €10 million at it this year to bring a waiting list down when it goes back up next year. It is about structural reforms such as the introduction of the phone line which has resulted in better alignment of services and appropriate referrals. Online counselling and psychiatry are sustainable solutions which will, while not building utopia, go a long way to fixing the system.