Wednesday, 26 March 2014
Special Educational Needs Services Provision
I welcome the Minister of State to the House. I tabled this debate to highlight the impact that the underfunding of Beechpark Services and child and adolescent mental health services, CAMHS, is having on children in the north Dublin area. It makes it impossible for children with autism and other special needs to get a proper education and puts their welfare and that of their fellow pupils at risk.
As the Minister of State is aware, Beechpark is a regional, community-based HSE service that provides specialised clinical supports for children with autism who attend designated special schools, outreach preschools and outreach classes in Dublin, Kildare and Wicklow. The speech and language therapy, occupational therapy and psychological services that Beechpark provides are essential to the personal development and education of children with autism. Without these therapeutic services, children with special needs cannot get a proper education. It is distressing for the children and their parents and teachers to be deprived of this essential service.
Schools that have opened special autism spectrum disorder, ASD, units want to be able to provide the education that the children in their care need and deserve, but they are being frustrated in their efforts by the lack of therapeutic and psychological supports. One school has advised me that the underfunding of Beechpark Services and the CAMHS has created a serious risk to the welfare and safety of its pupils as a whole. The school has asked me not to identify it on the record, but I have sent details of its name and specific incidents to the Ministers and Minister of State, Deputies Reilly, Quinn and Kathleen Lynch, via private correspondence.
The school was traditionally served by Beechpark Services. Eight of its existing 24 pupils in ASD classes are getting services from Beechpark, but the others are not because Beechpark is not in a position to take on new enrolments. Children who need therapeutic interventions like occupational therapy and speech and language therapy are not getting them. As a result, some of those students have become impossible to manage and are presenting a danger to themselves and others. The primary school in question has had to expel a child this year due to a serious assault. One of the students about whom the principal is concerned is an eight year old boy who has self-harmed. Another has assaulted the principal and other staff a number of times. There was a further serious incident yesterday. The principal rang me extremely upset after a student ransacked a classroom and created a dangerous situation for the student in question, the teacher and the other children who were present. The principal is concerned that a pupil or teacher will be seriously hurt if these children do not get the help they need as soon as possible.
In addition to needing occupational therapy and speech and language services from Beechpark, some children also need mental health interventions. Indeed, some pupils were previously being served by the CAMHS, but it was withdrawn and they were referred to Beechpark. Since Beechpark cannot take them, they have been left with no services. The principal has also told me of instances of children who, having received a mental health service from the CAMHS at preschool age, saw it withdrawn as soon as they were enrolled in a special ASD unit in the school, presumably on the assumption that they would receive the service there. However, there is no one at the school to provide it. Yesterday, the principal was determined to stress to me that an ASD class in a mainstream school was not a medical intervention and that it was inappropriate for children to have medical interventions withdrawn simply because they had been enrolled in an educational service.
I am sure the Minister of State will appreciate the seriousness of this issue. I have called for this debate to bring the matter to his attention. I appreciate that he is representing the Minister for Health, Deputy Reilly, and I hope he will raise it with the Minister. I hope the reply he has been given by the Department on the Minister's behalf will outline when funding will be provided to ensure that Beechpark and CAMHS can serve all of the children who have been assessed as needing their services. When will early intervention teams be in place in Dublin North so that children with special needs can get the assistance they deserve?
I thank the Senator for raising this matter, which I am taking on behalf of the Minister for Health. The HSE's 2012 report, entitled National Review of Autism Services Past, Present and Way Forward, and the programme for progressing disability services for children and young people, that is, zero to 18 years of age, set out the overall policy context for the provision of ASD services to children and young people. The latter's objective is to achieve a national, unified approach to delivering disability health services for children with disabilities, including those with ASD. It provides for a clear pathway to services for all children regardless of where they live, what school they attend and the nature of their disabilities and that available resources be used to the best effect. A key part of the programme is its emphasis on strong links with primary care and specialist services such as CAMHS. The programme aims to remedy the variations in service provision that persist throughout the country.
In 2014, the HSE is taking a number of key steps in implementing the reorganisation of services in line with the programme. An additional €4 million has been allocated, equating to 80 additional therapy staff, to support the initiative. As part of the programme's roll-out in 2014, local implementation groups, LIGs, in Dublin North, including the north city, and Dublin South, Dublin South-East, Dublin South-West and Dublin South-Central will finalise their consultation phase, complete implementation plans and begin reconfiguration and service delivery in line with the new service model. The Minister is confident that this will have a positive impact on the provision of therapeutic services for all children requiring access to health-related supports, including those with ASD.
I recognise the distinction made by the Senator and the challenge facing the principal of the school in question. As the Senator is aware, Beechpark is a regional HSE service that provides clinical supports for children with a specific diagnosis of ASD up to 18 years of age who attend designated special schools, outreach preschools and outreach classes in Dublin, Kildare and Wicklow. The HSE indicates that, in recent years, demands on this service have increased through a growth in the number of new classes for children with ASD.
While Beechpark, like other health service providers, must live within the financial and other constraints applying, it endeavours to provide services on the basis of prioritised need. In respect of Beechpark North, the HSE has indicated that all permanent staff vacancies that arose in 2013 have been filled. In addition, six posts which have been approved are currently in the recruitment phase with the HSE national recruitment service. Importantly, the HSE has also assigned a disability manager to oversee the reconfiguration of services for children with disabilities in Dublin North and Dublin north city in line with the national progressing disabilities programme for children and young people. The Beechpark service is actively involved in the change process in the context of the local implementation groups that have been established across Dublin North-East and Dublin Mid-Leinster under the HSE's progressing disability services programme.
The Senator also raised the issue of access to child and adolescent mental health services. A major reform of mental health services is also currently underway, in line with the recommendations of A Vision for Change. That is being led by the Minister of State, Deputy Kathleen Lynch. Additional funding of €90 million has been provided over the last three budgets to support this reform programme. A key priority in this regard is to enhance and streamline the way in which the mainstream mental health and disability care programmes look after children and young people up to 18 years of age. There are currently 61 multidisciplinary child and adolescent mental health services, CAMHS, teams in place. Work is under way to enhance the skills mix of these teams and to recruit additional CAMHS posts.
Notwithstanding an increasing demand for mental health services, the focus on improving services will continue. Targeted investment of €20 million has been provided by the Government for new initiatives this year. This will include CAMHS services in north Dublin and the provision of services for hyperkenetic and other attentional problems among children and young people. While the current economic situation in the country is presenting challenges, the Minister is committed to protecting front-line services, including children's disability and autism services, to the greatest extent possible.
I appreciate that the Minister is replying on behalf of the Minister, Deputy Reilly, but I have written to the Minister about Beechpark Services previously and the issue has been raised by my colleague, Deputy Billy Kelleher, and other Deputies in the Dáil over the last two years. To be honest, the reply has not really changed since then. The Department is still referring to the fact that a review is being undertaken.
The reality is that the services are massively under-funded. There are no early intervention teams in Dublin North at present and children are waiting for massive lengths of time to access the child and adolescent mental health services. One of the children I mentioned earlier is an eight year old who self-harmed. Before the child self-harmed, the school principal referred him to CAMHS but it was only after he had hurt himself that the parent was able to get an urgent appointment. The reality is that the services simply are not there. Beechpark is not serving most of the children in the ASD classes in this school.
The Department's reply referred to the fact that there is an increase in demand because more ASD classes have opened. However, they did not open for no reason, but because the Department of Education and Skills and the National Council for Special Education have been working with schools to get them to open the classes in response to the need. They have been doing their best to provide the services that are required on the educational side. The special educational needs organisers, SENOs, are doing a good job in matching children with the resources that are available. However, the missing part of the picture in all of this is the health provision. Despite the best efforts of the SENOs and the schools involved, the health provision is simply not available.
I appreciate that the Minister of State, Deputy Sherlock, is replying on behalf of the Minister, Deputy Reilly. I ask him to bring this issue to his attention, stress the urgency and ask him to look at that correspondence personally, rather than just having it looked at by somebody else in the Department. He must ask the Minister to look at the letter I sent to him about the specific incidents I have mentioned.
I accept the point made by the Senator, but I must be frank with the House. Economic history did not start in 2011. In terms of the allocation of resources, we were handed a deck of cards in 2011 and to be fair, with regard to this service, I will defend this Government. It has provided over €90 million in the last three budgets to support a reform programme. In respect of the roll-out of a more networked system of provision of services for young people, we are facing these challenges across the country. As a Government Minister I am facing the same problems in my area as the Senator is facing in her area. Only last week I had a meeting with some of the teams there to see how we can work through some of the problems.
There is no question that there is a deficit and a growing demand with regard to CAMHS. I openly acknowledge that, but we are doing our best to work on addressing these deficits within the economic constraints that exist. The economic constraints continue but I envisage that they will get better, because we have a Minister who is determined to ensure there is a specific silo, as it were, to provide for these services. While I acknowledge what the Senator has said, she must also acknowledge, if we are to be realistic and objective in any debate of this nature, the reasons that we are in this situation.