Jim Daly (Cork South West, Fine Gael) | Oireachtas source

Gabhaim buíochas as ucht an deis labhairt ar an ábhar tábhachtach seo. Is pribhléid dom é a bheith ar ais arís sa Teach seo ag plé an report seo.

I am here with my officials, Mr. Jim Ryan from the HSE and Mr. Greg Canning, principal officer at the Department of Health, who have been monitoring the development of this report. I thank them for their interest and work to date on that.

I welcome the opportunity to speak on the report produced by the Seanad committee. This report is an important contribution to advancing the debate around how mental services for children and adolescents might be framed and delivered over future years. Members of the committee will be aware that I addressed the committee last July, as its work was beginning. Since then the work of the committee has been complemented by other initiatives such as the symposium on mental health organised by the Ceann Comhairle in Dublin Castle last September. We also had the report on positive mental health in schools by the Joint Committee on Education and Skills and the work of the Joint Committee on the Future of Mental Health Care. All these initiatives are to be welcomed and have formed an important part of the parliamentary duties and work in the year since I took office as Minister of State.

I have noted in particular the context, themes and recommendations of this report. We all share a common desire to have the best possible mental health policies and services for children and adolescents. This must take account of the practicalities involved in order to achieve real and sustainable change. Nobody seriously concerned with having the best possible services for some of the most vulnerable children in our society could disagree with the principles and overall themes reflected in this report. My Department, the HSE and all providers of mental health services to young people have long advocated for the three high-level themes - access, recruitment and service outcomes - highlighted in the report. There is broad consensus too regarding the 12 recommendations and other concepts highlighted such as better prevention and early intervention, listening to and learning from service users, acknowledging service improvements while tackling service gaps and addressing staff shortages. I also agree with the need for better transition arrangements for those leaving CAMHS and the need to promote more seamless care for those aged 18 to 25 into adult services. All of these strategic aims have been embedded in HSE service plans for mental health in recent years.

In conjunction with my officials and the HSE, I have given full consideration to all aspects of this report. That includes the submissions made and quoted in the document and the personal stories highlighted of experiences of child mental health services. All the recommendations have been reviewed to see how improvements might be incorporated into better policy and practice. Some of these, such as triage and improving links between child mental health and other services, are long standing practice in the HSE. The report and various legislative proposals suggested by Senator Freeman, among others, raises the practice of placing those under 18 in adult psychiatric facilities. Good progress has been made by the HSE on this compared with ten years ago. The position has been reversed since then, with approximately 75% of young people now placed in age-appropriate facilities. This is minimised in practice to the greatest extent possible by the HSE with built-in safeguards for the young person. Relevant factors here include, for example, individual assessments, duration of stay, distance to CAMHS units and the wishes of the young person and families.

Similarly, the views on other matters raised in the report, such as the organisation or expansion of CAMHS, have been noted, along with the need for improved mental health intellectual disability care. Members will appreciate, on the other hand, that proposals regarding remuneration for nurses or other health care staff can only be addressed in the wider context of pay discussions. We look forward, therefore, to the forthcoming publication of the Public Service Pay Commission's report.

I strongly reiterate this afternoon that mental health remains a key priority for the Government. The HSE mental health care programme has to be prioritised and delivered in the context of the annual budgetary process and in line with its annual service plan. My commitment and that of the Government is reflected by the allocation of an additional €35 million for mental health services in 2018. That is for new developments in addition to the increases that have come about in the previous five years. This brings the total amount available to approximately €910 million for the year. This amount is significant by any standard but I will continue to press for further resources annually in line with programme for Government commitments. However, it is important to note that funding availability in itself is not the only issue right now for mental health. Staffing recruitment and retention are currently proving difficult and the lack of availability of specialist grades in the area of mental health is a global issue that requires new and innovative approaches to recruitment and retention to be identified and implemented. The emphasis must be on putting in place the correct skills mix to ensure that we modernise services in line with A Vision for Change. This may have taken longer than we had hoped but progress must be made in recruiting and training appropriately skilled personnel rather than staffing for outdated systems.

The HSE service plan for 2018 commits to further development of CAMHS and wider services and supports for young people to meet evolving demands. This is against a background where the population of children is increasing and where the demand for CAMHS has increased by 26% between 2012 and 2017. Approximately 18,800 referrals are expected for HSE CAMHS this year, with approximately 14,300 being seen by this specialist service. CAMHS has been prioritised in new funding provided by the Government over recent years. Additional resources and facilities means there are now 69 CAMHS teams and three paediatric liaison teams supported by approximately 75 CAMHS beds nationally. Further beds are planned to come on stream as quickly as possible.

The staffing difficulties I mentioned are also an issue for CAMHS teams, particularly with consultant psychiatrist posts. Recruitment efforts are ongoing, notwithstanding a serious shortage of suitably qualified CAMHS consultants, at both a national and European level. The HSE is working to provide the best possible service within available staffing resources. A key focus is on managing clinical risks and prioritising referrals accordingly.

Mental health services, including CAMHS, will continue to deliver service improvements aimed at increasing productivity and efficiencies. Other CAMHS-specific measures in the HSE service plan include an initiative to increase the number of CAMHS referrals to be seen this year by 27% compared with 2017. It is an ambitious target but I am very confident we can achieve it. There will also be provision for a seven day per week service for CAMHS to ensure supports for young people in line with the recommendations in Connecting for Life, as well as improvement of day hospital services within CAMHS and development of eating disorder specialist community teams for young people. The HSE is also focusing on enhanced access by older adolescents to specialist mental health services in parallel with continued appropriate placement and care in CAMHS-specific settings. Detailed data in respect of waiting times for CAMHS is published by the HSE in its regular performance reports.

A key approach to developing early intervention services for young people at primary care level was the decision by the Government to increase access to counselling services in primary care with the recent appointment by the HSE of approximately 114 assistant psychologists and 20 psychologists. It is anticipated these posts will deal with the less complex child and adolescent cases, thereby reducing the burden on CAMHS.

Since becoming a Minister of State, one of my priorities has been to look beyond existing funding and structures to see what practical new measures can be applied to better plan and deliver services.This new approach sits in the context of wider initiatives such as the review of the Mental Health Act and the refresh of our current mental health policy A Vision for Change.

I share the objective reflected in the report to explore the potential to make progress where possible, without awaiting completion of these inherently longer and more complex processes. A key focus for me is continued investment in innovative, digital technologies which are well placed to support access to appropriate services particularly to prevention and early intervention services. The HSE has established a working group to progress a national telephone-text helpline and digital information supports for those requiring access to services. It is my intention that the roll-out of the new telephone helpline will commence before the end of this year. I have also requested the HSE to pilot a project providing remote access to counselling services in the primary care setting. This approach will help underpin improved implementation of Connecting for Life and the report of the task force on youth mental health.

The national youth mental health task force report contained 22 recommendations that will be implemented over a period of three years. Many of the recommendations are already being delivered, such as the development of an interdepartmental youth mental health team known as the pathfinder project, the establishment of additional training supports, online and in schools, and the creation of a pilot tele-psych unit. The introduction of mandatory mental health training for teachers and medical staff, along with additional training for parents in both the NGO sector and online is also being progressed. It is hoped that this additional focus on prevention will reduce the numbers being referred to specialist care and thereby improve wait times for those accessing child and adolescent mental health services, CAMHS.

The expert group review of the Mental Health Act 2001 made a number of recommendations regarding the provisions of that Act which relate to children. In particular, the group recommended that legislative provisions relating to children be included in a standalone section of any future mental health legislation rather than being spread though the Act as is currently the case. Work is under way on this comprehensive review, with text of the heads of a revised mental health bill to be advanced by the end of the year.

Senators will be aware that two Private Members' Bills related to mental health have been discussed in this House recently. Both Bills include revised provisions relating to children. Deputy James Browne’s Bill seeks to introduce a set of guiding principles for children while Senator Freeman’s Bill seeks to ensure that orders to detain children are necessary, in line with protocols and to age-appropriate facilities.

There is a broad range of initiatives under way or planned across mental health, including child mental health. Some of these are CAMHS-specific, while others are interrelated by legislation, policy and service links across care programmes or with other Departments. The core objectives of this report are reflected and being progressed, to varying degrees, in annual HSE service plans. These cover, for example: promoting mental health on many fronts; having more integrated, evidence-based and recovery care; delivering timely, effective and standardised services; listening to the voices of service users and advocates; and having highly trained and engaged staff.

I thank the Members of this House for inviting me here today. I look forward to a constructive and collaborative discussion.