Dáil debates

Wednesday, 29 September 2021

Saincheisteanna Tráthúla - Topical Issue Debate

Mental Health Services

9:12 am

Photo of Bernard DurkanBernard Durkan (Kildare North, Fine Gael)
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I am grateful for the opportunity to raise this particularly sensitive, urgent and pressing issue which has become more obvious as time goes by. I do not attribute blame to any particular individual, including the Minister or anybody else. Everything that could be done has been done and I acknowledge that there were difficulties during the past year due to Covid. However, needs must, and the emerging is situation very serious, first, from the point of view of parents of a child with severe sensory and emotional difficulties who cannot find a safe location where their child can receive in-house care and therapy. Many parents continually approach us who are at the end of their tether trying to deal with this on their own.

The next group is adolescents who have difficulties of a serious nature and it is again impossible to find a place for them. They may have eating disorders and be affected in various ways, and suffer from sporadic attacks over which they have no control. These unfortunate adolescents do not understand what is happening. This is happening around them and it is the life they live. It is their little world and, as it unfolds in front of them, it is not great. The problem is the services are not available to address the issues on time.

I refer to the next group of the older adolescents and young adults. They have mental health issues, but they do not have any experience of life. They do not know whether this is normal. They are where they are and they know it is not a happy place to be. Their parents stay with and try to help them in every way. Sadly, many of them end up in prison and are detained while awaiting a court hearing. I dealt with such a case in recent weeks. This is an appalling situation.

I reiterate that this is not the fault of the Minister of State. This goes back 20 years during which time there has been growing demand and a failure to address the issue on an ongoing basis because of other competing demands, which we all accept that. I ask the Minister of State to make a special effort to identify this cohort of people who are desperate, as are their parents and siblings, and unable to cope. The stress on the families and the individuals is significant and increasing. We have dealt with many cases where, due to the stress, the individuals harm themselves seriously or, worse, find an ultimate way out that does not solve any problem, but creates more.

We need to make a salutary move on this problem now. This cannot wait. We need to address the issues. I have only given a small number of examples but every Member will have multiple examples of the same experiences. Let us do whatever must be done to put in place the measures required to accommodate the needs of such patients and to recognise their difficulties for what they are, and to address the issues in a meaningful way. Let us do this now and give them hope for the future. Let us give them an indication that society cares for them and is prepared to help them in a meaningful way.

Photo of Anne RabbitteAnne Rabbitte (Galway East, Fianna Fail)
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I thank the Deputy for raising this issue today. I am replying on behalf of the Minister of State, Deputy Butler.

We care, society cares and the Government cares. The continued development of specialist services for eating disorders, including improved access and shorter waiting lists, remain a key priority for the Government, the Minister of State with responsibility for mental health, Deputy Butler, the Department and the HSE. In response to the growth in the number of cases presenting to mental health services, the HSE developed a national clinical programme for eating disorders in partnership with the College of Psychiatrists of Ireland and Bodywhys, the national support group for people with eating disorders.

The eating disorder model of care was launched in 2018 and €5.7 million was allocated to date for the implementation of this programme. The clinical programme will establish an eating disorder network, including eight adult teams and eight child and adolescent mental health services, CAMHS, teams in total. Some €1.77 million has been invested to date in eating disorder specialist posts with 21.8 whole-time equivalent posts in place. It is of critical importance that the Minister of State secured the balance of €3.94 million to be made available to the programme, which will enable further investment in specialist posts throughout this year. This comprises the completion of the three existing specialist eating disorder teams and the establishment of three new teams. The three existing specialist eating disorder teams are located in CHO 4 CAMHS, CHO 7 CAMHS and CHO 6 adults. The three new teams in development include the adult teams in CHO 9, CHO 4 and the CAMHS team in CHO 2. Recruitment for all teams is progressing well and each CHO is fully committed to this process and is on target to have staff recruited by year end.

While there is much to be done, the progress made to date with existing teams has had a significant impact. In 2020, there was a 43% increase in the number of eating disorder assessments compared to 2019, with twice as many people starting treatment. This trend continued in 2021. Specialist outpatient treatment has been found to be the most effective and fastest way for most people with eating disorders to recover.

More than 90% of people with eating disorders can be supported in the community, avoiding more serious inpatient treatment. However, a small number of people may require inpatient care for short periods for structured refeeding and stabilisation. Inpatient care is currently provided in the four regional CAMHS units across the country. Linn Dara and Merlin Park have dedicated six and eight beds respectively, and while there are no dedicated beds in the remaining two CAMHS units, all beds are available to eating disorder admissions. A further eight beds are planned for an eating disorder unit in the national children's hospital.

I am aware that the Minister of State, Deputy Butler, recently visited the CAMHS eating disorder teams in Dublin and Cork to get an understanding of how the service operates on the ground. Adults who require inpatient care are admitted to local general adult approved centres. CHO 6 has three dedicated beds for eating disorders based in St. Vincent's University Hospital. The number of adult beds will increase, including an additional three beds in St. Vincent's, five in north Dublin, five in Galway and five in Cork. These beds will be linked to eating disorder hubs. Significant enhancements have also been achieved in the area of digital supports for people with eating disorders.

In March 2020, the free national clinical programme for eating disorders and Bodywhys application was launched. Telehealth has rapidly been enhanced and existing service users can access specialist eating disorder teams, who are providing ongoing care throughout the pandemic. More than 500 therapy sessions have been delivered to date. The development of all aspects of mental health services, including specialist services for eating disorders, continues to be a priority for Government, the Minister of State, the Department and the HSE. This is reflected in the current programme for Government and our national mental health policy.

9:22 am

Photo of Bernard DurkanBernard Durkan (Kildare North, Fine Gael)
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I thank the Minister of State for her extensive reply on behalf of her colleague. I accept that the Minister of State is doing everything possible and is very active on the ground. As we all know in this House, no matter how active someone is, some things get away from him or her. Often, if things are supposed to work a certain way, it does not necessarily follow that they work that way. Another complication for young adults and adults is if they have an addiction. If they have an addiction, they will not be taken by most places. They have to seek treatment for that. People have to take time out to get treatment first, otherwise they will not get accommodation at all. This is crazy. I do not blame the Minister of State. The exigencies within which we work are ridiculous and they do not address the significant challenges in front of us.

I know of one case where an individual is in prison because he has a mental problem. He got into a situation where he broke the law, as has happened many times in the past and will happen in the future. The sad part of it is that he will probably receive a prison sentence, having done nothing else wrong but being unable to access treatment for his condition. That is a recent issue and there are numerous other such incidents. We all have to join parents at night, sometimes as late as midnight, where they have been waiting all day, or for two or three days, to gain access. It is challenging all the way. I compliment the Minister of State on the work that has been done but there is a need to poke the bear more, identify the snags, and ensure, whatever is being done now, that efforts are redoubled in a way that brings the necessary treatment within the reach of parents, siblings and all of the families of those affected.

Photo of Anne RabbitteAnne Rabbitte (Galway East, Fianna Fail)
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The continued development of a special service for eating disorders, including improved access and shorter waiting lists, remains a key priority for the Government, the Minister of State, Deputy Mary Butler, the Department of Health and the HSE. As stated, €3.94 million is available to the national clinical programme for eating disorders and will enable further investment in specialist posts throughout the year. Only last night, the Minister of State acknowledged in the House that there is a fundamental flaw with regard to waiting lists, which is the recruitment process. It takes 50 weeks to recruit a person into a post. She was successful in securing the funding but the funding is only as good as the people when they arrive through the doors of their units. I have announced a lot and re-announced what the Minister of State has committed to, but until the people arrive in the posts, we will not see that service delivered or any relief whatsoever for those families, no matter what age they are presenting at, whether they are looking for support at local hospitals or from CAMHS teams. I listed a number of CHOs but I notice that Deputy Durkan's CHO was not included. It needs to be addressed at a local level.

There is not a Deputy in this Parliament who has not been impacted by dual diagnosis. We all know that when people have mental health issues, there is always something else coupled with it and there is usually an underlying condition. It breaks out in other formats, whether drinking, drugs or antisocial behaviour. There needs to be understanding and empathy but we need to look at dual diagnosis. When the Deputy talks about poking the bear, I think that we have the right Minister of State in the right role to do that.