Mary Moran (Labour)
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I thank the Minister of State, Deputy Lynch, for taking this Adjournment matter. Previously, I have raised the issue of the lack of a child psychiatrist for children with an intellectual disability in the mental health services in Louth. I have been perturbed lately to find that there is no child psychiatrist. I was in touch with the HSE and I was informed that interviews have taken place for the position but the executive has been unable to fill the post. I find it baffling and concerning that there is no child psychiatrist for children with an intellectual disability for the entire area.

Recently, I worked on the case of a constituent who had a child in need of such services, as are many other children according to reports from the disability services in Dundalk. They have several children in need of these services but they have been unable to provide them. More concerning was the fact that as the child in question was 16 years of age, paediatric services refused to consider him. Child and adolescent mental health services, CAMHS, have refused to consider him since he is over 16 years of age. They have also said they do not have a child psychiatrist to deal with intellectual disability issues. When the child was brought to the general practitioner, the parents were told that the doctor could provide sedation. I find it concerning - this ties into the second part of the Adjournment matter I have tabled - that there are no services, there appears to be no services or else there is a difficulty in getting services for children with an intellectual disability, especially in this age group.

The more I examine the matter, the more it appears that one Department is saying that people should go somewhere else and that it is not its responsibility. It is as if a magic switch comes on when children reach the age of 16 years. Exemptions and certain circumstances should be taken into consideration when children approach this magic age of 16 years. I had heard and read about this milestone but where are these children to go? We cannot turn around to parents and say we are sorry but that they should take their children home and do nothing. What if there are other family members or other people who need to be taken into consideration? It is important that the services are provided.

Having said that, I realise that disability services in the area are good and seem to be providing support for the people who need them. I have never heard anything but praise for the people who work there. However, I believe this needs to be examined as a matter of urgency for the many parents who do not have a voice or a place where they can raise the issue. I am raising the issue with the Minister of State tonight in the hope that she can do something for them.

When parliamentary questions are tabled Deputies get the same answer all the time to the effect that it is a matter for the HSE or that the Minister will refer the matter to the HSE. I spoke with the disability officer last week and I was told there was nothing the executive could do. To me, that is not an answer. We cannot simply sit back and say there is nothing we can do about it and decide that is it until it comes knocking on our door. I hope the Minister of State will give me some positive news this evening.

Kathleen Lynch (Cork North Central, Labour)
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Before I give Senator Moran the official reply I wish to emphasise that we have got money for the past two years and that a further €20 million has been allocated this year for additional development funding for mental health. I discussed the matter with some people in advance of the allocation this year. The two areas where we knew we needed to work on this year with the additional money were the areas of old age psychiatry and intellectual disability. This is because if children or young adults have an intellectual disability it does not protect them from difficulties with mental health. Indeed, sometimes there is a crossover and we need a specialised area to deal with that.

I thank the Senator for raising this topic today. The Government has prioritised reform of mental health services in line with A Vision for Change and it is committed in particular to the delivery of more and better quality care in the community. This includes enhancing and streamlining, as appropriate, service interactions for under 18s between the mainstream mental health and disability care programmes.

Total HSE mental health funding in 2014 is in the region of €765 million but that does not include the development money. This reflects the additional funding of €90 million together with approximately 1,100 new posts provided over the past three years to modernise our services. Primarily, the modernisation has focused on the following: strengthening community mental health teams for adults and children; enhancing specialist community mental health services for older people with a mental illness, including services for those with an intellectual disability and mental illness; and upgrading forensic mental health services in line with A Vision for Change.

The Senator raised another important point. We have held discussions with CAMHS for the past two years in respect of children between the ages of 16 and 18 years. We cannot possibly say to people, whether they have a disability or otherwise, that somehow or other they do not exist because they happen to be in that age bracket. I have been assured that this age cohort is now going up to 17 years with a view to it going up to 18 years in subsequent years on the back of the additional resources we have provided.

The recent establishment of a new mental health management structure within the HSE has been designed to bring greater clarity to services, including multidisciplinary care at national and local levels.

We have given greater recognition to the fact that child and adolescent mental health services, in both policy and practical terms, will inevitably have a role in some cases, at least in cases of difficult diagnoses, and in terms of specialist episodic treatment of acute mental disorders. This is a specific implementation requirement of A Vision for Change.
In regard to the issue raised by the Senator, the HSE has indicated that until last year, there was no dedicated service available in County Louth in mental health for either adults or children with mental health issues and an intellectual disability. Notwithstanding the lack of services available locally, there were none the less some supports from child and adolescent mental health services, and as the Senator rightly pointed out, voluntary organisations and disability services have been doing their best. These in turn were supported by a consultant psychiatrist providing two sessions per week. That is clearly not enough.

In terms of new service development posts approved for 2013, two teams, each led by a consultant psychiatrist were approved for the north east for adults, and this service is currently being established. The recruitment process to fill these posts is progressing. In addition, the local HSE is exploring the question of appointing a CAMHS consultant with a special interest in intellectual disability for children. This proposal is at a very early stage and the Department of Health has asked to be kept informed of developments on this matter. The HSE national service plan for 2014, including associated operational plans for regional and local services, commits to a number of key deliverables for this year. As I have indicated on many occasions in the past, early, appropriate and effective intervention is key, coupled with a strong recovery-based approach for young people with mental health issues.

By raising this issue tonight, the Senator will again put the focus back on that service. We must ensure that when an adult with an intellectual disability has a difficulty with mental health, there is a service available to him or her. I will once again take this up with the director as appointed.

Mary Moran (Labour)
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I have the height of respect for the work that the Minister of State has been doing. However, I can only be honest and say that I am completely disappointed with this response. Saying that progression is in at an early stage is fine, but how long more will that take for the 16 year old child? The psychiatrist who was there retired a year ago. He was an adult psychiatrist who kindly took an issue and dealt with disability services for children.

I was told last Friday, following the report back from CAMHS, that there is nothing that can be done for that child because he is 16. It is like a magic number and services are cut off after that age. The more I delve into it, the more parents and children I have seen. There was a dreadful case before Christmas and we cannot afford to let this go. The centre for excellence is in Drogheda in County Louth. A new mental health unit will open up in Our Lady of Lourdes Hospital, which is brilliant, but something has to be done and I plead with the Minister of State tonight to take on board all the children with an intellectual disability, no matter what age they are. This is such a serious matter. I have the height of respect for the work done by the Minister of State, but I will be back and I will keep pushing this.

Kathleen Lynch (Cork North Central, Labour)
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We cannot allow that gap to remain. I will be pursuing this and I appreciate the Senator raising the issue. It gives me the insight in a small area with very few people, but people who none the less are important to us. I will be raising this issue with the people responsible.

Mary Moran (Labour)
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I cannot get an answer as to how many child psychiatrists there are. If the Minister of State could get that answer, I would appreciate it.