Seanad debates

Wednesday, 1 February 2017

Commencement Matters

Mental Health Services

10:30 am

Photo of Helen McEnteeHelen McEntee (Meath East, Fine Gael) | Oireachtas source

I thank the Senator for raising this important issue. I agree that people who are suicidal or who have mental health problems should never be turned away, whether it is morning, noon or night.

Improving access to mental health services is a key priority of the Minister. In many cases, mental health issues are ongoing and may require immediate treatment at any time, day or night. Significant work is under way in this area. It is important that I outline what is in place at present in order that we can identify what we need to do in future.

The current provision of out-of hours mental health care involves various interlinked components, for example, access via community mental health teams during normal working hours, that is, from 9 a.m. to 5 p.m. between Monday and Friday. During this period, access is also available through emergency departments. If necessary, this involves the existing liaison psychiatric services for hospitals or alternative arrangements at local level. There is psychiatric-consultant-led cover in place in hospital emergency departments for both normal working hours and the weekend period.

The national clinical programme for the assessment and management of self-harm was initiated by the HSE in 2014 and is being developed on an ongoing basis. We already have seen the positive effects because while we discuss suicide, self-harm is probably more prevalent overall. The HSE has indicated that weekend access is provided in nine of the 17 mental health areas, with a further seven areas having partial cover. The HSE has prioritised the provision of improved out-of-hours liaison and seven-day responses for all people with mental health issues as a key priority under the national service plan this year. Services for all adults and those under 18 years of age are being developed in the light of significant new investment for mental health. This is balanced against an acknowledged difficulty for the executive in securing suitably qualified and experienced staff for the care programme.

My objective, and that of the HSE, is to improve all aspects of mental health care nationally for all children and adults, including better access outside of normal working hours via emergency departments. The HSE is keen to ensure that each region provides access to a weekend service for people currently attending the service. In recognition of this, a service improvement project with a dedicated project manager was set up in November last year. Data on timely access to services are collected for each team on a monthly basis. Thus far, the data indicate that 68% of children referred are seen within 12 weeks. Obviously, we need to see this number reduced further. In addition, a total of 74% of working age adults and 97% of older adults are seen within one week. This illustrates the improved response times for those with mental health problems.

Work is under way by the HSE to determine the existing level of service provision and to examine international models of best practice on the most appropriate model of service delivery for use in the Irish context in order to enhance the seven-day services. In addition, the HSE is progressing a detailed plan for provision of seven-day services throughout all HSE mental health service areas. We are keen to avoid a situation whereby some services in certain areas provide a fantastic service and provide 24-7 cover, while other areas do not even have a seven-day service. For now, the priority is to identify the gaps. Earlier, I referred to the nine areas that have full cover and the seven areas that have partial cover. Currently, we are working on identifying and providing a plan to fill in the gaps in these areas. In tandem, we are working to deliver a detailed plan for provision of 24-7 care but it is important that we walk before we can run.

The Senator referred to specific people and areas. An additional €2 million in ongoing funding was made available in 2016 to address the specific mental health needs of homeless persons in Dublin. This is part of the response to and recognition of difficult cases. To identify service needs of people with substance misuse, including alcohol and drugs, alongside mental illness, a clinical programme for dual diagnosis was initiated last year. To date a programme manager has been appointed to oversee the clinical programme. In addition, a clinical lead has been identified at interview and will be seconded pending discussions with the local addiction services. I will continue to work with the HSE on this area, taking account of agreed policy and evolving service priorities and resource availability overall.

I wish to specifically touch on the area of young people, which is a key priority. Senator McFadden referred to the task force. All the work under way at the moment will benefit all our people and society. The four key objectives of the task force are to improve awareness of our services, to improve accessibility of our services, such as the development of the seven-day week and 24-7 services, to align our services in order that public, private, community, voluntary and online services are all working together and are all aligned and to work towards supporting younger people to build up their own resilience in order that they can deal with the many stresses and pressures they face. I hope these young people will be able to take these skills with them later life. I thank the Senator for raising this important matter.

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