Dáil debates

Thursday, 22 April 2021

Saincheisteanna Tráthúla - Topical Issue Debate

Mental Health Services

8:15 pm

Photo of Martin BrowneMartin Browne (Tipperary, Sinn Fein)
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I thank the Minister of State for taking the time to hear this matter.

I am becoming increasingly concerned about the ability of children and young adults with special and complex needs and disabilities to access the psychological services they need. This is an issue that has presented itself to me on a number of occasions since the first lockdown last year, when I was approached by the families of children with special needs who were beside themselves with worry about their young children.

Recently, I was approached by a parent in my constituency whose family has found itself in this situation. Jack, on whose behalf I am speaking today, is a young adult with special needs. However, like so many others around the country, his ability to interact on a social level has been restricted. These restrictions have resulted in him not being able to attend the local centre that he has used so much in the past, and whose contribution to his life has been immeasurable. He loves GAA but restrictions have prevented him from accessing this social outlet as well. In designing these restrictions, what has been forgotten about are the measures that need to be in place to help families deal with the consequences that these limitations have for their loved ones.

During the first round of restrictions last year, Jack’s anxiety increased and his sleep patterns changed. He was given some medication to deal with this but soon the benefits began to wear off, which brings me to the situation as it is right now. Six weeks ago Jack’s anxiety increased to such a level that he could no longer sleep. For four days and four nights, he did not get a wink of sleep and his levels of anxiety continued to increase. His parents were burning the candle at both ends and a doctor’s appointment could not be secured for a week and a half.

However, when he got that appointment, his emotional needs were not addressed. Jack, of course, was in need of psychological assessment and counselling. His mother has told me that every avenue she went down ended in a brick wall. There were no accessible or immediate psychological services available for her son because he has special needs.

The more she tried, the more disheartened, worried and desperate she got. She described it to me as like drowning. Finally, through the supreme efforts of the local MooreHaven Centre, which, she said, went above and beyond in helping her, she managed to link up with a psychologist. The Minister of State might think that I am now going to detail a happy resolution to this issue. In fact, Jack is now on a three-week waiting list. All the while, his level of anxiety has to be dealt with by a family that are struggling and feel let down and left out because their son happens to have special needs. The family is trying to remain positive for him, keep his spirits up and keep him well, but they are fearful of the consequences of all of this for their son if his needs remain unaddressed.

The Minister of State will appreciate that in all situations like this, time is of the essence. If the family gets the scheduled appointment for Jack, this episode in their lives will have gone on for nine weeks. I have reason to believe it is not an isolated case. If Jack's family were here today to tell the Minister of State about all of this, what would he say to them? Could he tell them the extent to which he foresaw this type of eventuality and what measures he took to deal with such? Can he tell me what he intends to do to resolve Jack's situation and the similar situations countless families are experiencing? When the Covid restrictions were being considered, was enough done to deal with the impact the measures would potentially have on people's mental well-being? Jack's mother has described the system of accessible psychology supports for people like her son as atrocious.

8:25 pm

Photo of Frank FeighanFrank Feighan (Sligo-Leitrim, Fine Gael)
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I thank the Deputy for articulating the very difficult situation of Jack and his family and the issues they are dealing with, especially during the Covid crisis. Developing all aspects of mental health, including improving links with other care programmes such as disabilities, is a priority for me and for the Government. This is underpinned by our new mental health policy, Sharing the Vision, the HSE service plan for 2021 for both mental health and disability care programmes, and the range of initiatives developed by Government to maximise all healthcare provision in the light of Covid-19.

Recommendation 48 of Sharing the Vision aims to improve intensive supports for people with complex mental health difficulties and intellectual disabilities. The HSE and its service partnership agencies, particularly their front-line staff, have met various serious Covid challenges so far and will continue to do so. If the Deputy sends in the details of Jack's situation, we will try to address the issues. The Department and HSE continue to plan for the evolving situation overall, including any surge in demand as it arises.

In line with Government recommendations to minimise the spread of Covid-19, children's disability services were stepped down, as the Deputy noted, in March 2020. In July, the HSE issued guidance to support resumption of the services. Throughout the pandemic, specialist mental health services have operated at 80% to 90% of pre-Covid levels, but the remaining 10% are causing issues. Children and adolescent mental health services, CAMHS, intellectual disability teams have continued to work with children with intellectual disabilities and their families, with the aim of offering the best possible service throughout the pandemic.

However, service delivery has changed, based on restrictions and considering the additional physical needs of service users. There has been a significant shift to online service delivery, teleconference clinics and meetings, including the Attend Anywhere initiative, and telephone consultations. Where needed, face-to-face appointments and hospital visits have been maintained. Families are being facilitated by not having to travel to clinics for prescription collection, as this can be done with pharmacies via secure health mail accounts. Where there are appropriate facilities, regular medication reviews with families, schools and teams are taking place via telemedicine arrangements. Due to school closures, school assessment visits were not happening. However, any new assessments are similarly being held via video consultations. Before the school closures, there were online forums and teleconference meetings to provide school observations and meetings with teachers and special needs school staff. This approach was also taken to liaise with respite services and other services, as needed. CAMHS intellectual disability teams also aim to maintain care through regular contact with residential homes in their areas. In addition, all telehealth and online cognitive behavioural therapy, CBT, supports are available to people with disabilities. Counselling for those with sight impairment can be delivered by telephone.

I do not have all the answers to the issues the Deputy has raised but if there is any way we can address the situation for Jack and his family, we will try to do so. I ask that the Deputy send the details to me and I will try to address the matter as quickly as possible. He has articulated a very difficult situation and I thank him for taking the time to come in here and do so. I hope it can be resolved.

Photo of Martin BrowneMartin Browne (Tipperary, Sinn Fein)
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I thank the Minister of State for his response. The problem I have raised is an example of how the importance of mental health provision in this country is continuously overlooked. We discussed that during the debate on Deputy Ward's motion that was passed earlier in the week. People like Jack are suffering because of a poorly provisioned mental health service. The World Health Organization advises that 14% of a country's health budget should be set aside for mental health provision. We fall way short of that in this country. Successive Governments have fallen short by ignoring the issues and allowing them to pile up year after year.

I appreciate that the Covid crisis has set the situation back and everything had to be done in that context. However, that is little comfort to parents like Jack's, who have been up four nights on the trot. I know the family well and his mother came to me a couple of years ago, at the start of all of this. The issues are continuous. They started when he was underage and, when he reached 18, he fell between the cracks. There are families like Jack's all around the country, in my constituency and in those of the Ministers of State, Deputies Feighan, Rabbitte and Butler. People are falling through the cracks because there is not enough funding for mental health services.

If the Government does nothing else before it finishes its term, I ask that it address this issue and ensure that families like Jack's, when they go looking for services because they are worried about their children, will find that the help is there for them. It should not be a case of scraping the bottom of the barrel. In Tipperary, all our services were taken away. If people have a mental health issue and need help, they must go to Kilkenny if they are in the south of the county and to Ennis if they are in the north of the county. Tipperary is the largest inland county in Ireland and it does not have health services for people like Jack. I plead with the Minister of State and his colleague, the Minister of State, Deputy Rabbitte, to get control of this situation. Allocating 14% of the health budget to mental health should be the aim of this Government before the end of its term.

Photo of Frank FeighanFrank Feighan (Sligo-Leitrim, Fine Gael)
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I thank the Deputy for keeping this important issue to the fore. He can rest assured that my colleagues, the Ministers of State, Deputies Rabbitte and Butler, and I will continue to do likewise, particularly in the context of the Government roll-out of the Covid vaccination programme nationally, as this will, in turn, benefit our respective care sectors. The Deputy described how Jack's parents are awake four nights a week. It is a very difficult time for them and I hope their situation can be addressed. It is essential that children with disabilities have access to timely and appropriate mental health and other services. We are committed to ensuring that such supports are developed and enhanced through the implementation of national policy, including Sharing the Vision, mental health clinical care programmes and the HSE's national service plans.

There is much good work being done and I pay tribute to the people in the front-line services, especially these particular services. It has been a difficult time for the people providing services and a very difficult time for people like Jack and their families. Whatever we can do in this House to iron out those difficulties, we will do it. I hope we can ensure, in the coming days, weeks and months, that the Deputy will not have to come in here again to articulate the situation of Jack and his family. I thank him again for raising it.