Tuesday, 21 June 2016
Mental Health Services Provision
I am honoured to be a Member of the Seanad and grateful for the opportunity to serve my country and to be a representative of the most vulnerable people in our country. It is no secret that I do not have a political bone in my body, and perhaps that is a good thing. However, I take the role of Senator very seriously and for however long the Government exists, I will work tirelessly to help the mental health groups which are trying to bring about change in our mental health system and will support them every step of the way.I have put in motion the setting up of meetings with various interested reform groups, which have been relentless in their quest to bring about change. I have pledged that I would be their voice on the inside and that I will highlight to all the political parties the need to bring about these recommendations. However, because of my experience over recent weeks in the House, I am sure of the united consensus among all political parties and of their support and belief that the needs of the most vulnerable people in our society must be addressed.
Besides highlighting and helping mental health groups, pushing their agenda and resolving their concerns, I also have an agenda. My heartfelt desire is to address the problems concerning our children. The Taoiseach once said that Ireland is a great country to grow old in. I hope, following this term in office, he will be able to say Ireland is a great country for our children to grow up in. However, to do this, we must begin with the most defenceless, which are children with emotional and mental health problems. They rely on our existing mental health services and they turn to the State for treatment, support and a brighter future, but I am sorry that we are very much letting them down.
Before I focus on the issues and difficulties facing us, I would like to emphasise that my concerns do not relate to the hard-working men and women in clinical services such as the child and adolescent mental health services, CAMHS, because they are equally frustrated by the ever-increasing waiting lists and poor staff levels. I am outraged about the grinding slowness of promised changes that these children have to endure, which expert groups have recommended but no one has listened to. It is not only these groups that have demanded these changes. In 1997, the European Court of Human Rights, ECHR, found that Ireland was in breach of its commitments in respect of the temporary placement of mentally ill minors in adult institutions due to lack of age-appropriate care places. Despite these findings, the Mental Health Act 2001 has still not been reformed to provide for these children.
Let us consider the seriousness of the lack of urgency or commitment to change the existing admission procedures. The Government may argue that, at the end of 2013, there was a 5% decrease in the admission of children to adult units but the Mental Health Commission reported yesterday that there was an increase at the end of 2015. Five more children, giving a total of 95 children, were admitted to adult psychiatric units. There will be reasons to justify their placement in these units - lack of beds, difficulty accessing beds outside office hours and difficulty in conducting assessments outside office hours and at weekends. However, these are the same excuses that have been expressed for the past seven years since the Mental Health Commission issued an amendment to the code of practice relating to the admission of children. Meanwhile, 15 years later, the Mental Health Act still ignores the fact that children are placed in adult units and, 19 years later, the Government continues to ignore the ECHR.
While the Minister of State's advisers may suggest the children are placed in these units for their own safety, many of them are placed in the psychiatric wards of general hospitals in which there are people experiencing significant mental health difficulties ranging from addiction to schizophrenia to dementia and eating disorders. Everyone will recall the terrible tragedy on a psychiatric ward in a general hospital in Dublin where one patient stabbed another. However, the Government is saying children are being transferred to a safe place.Many Senators have young children and teenagers and I call on them to imagine if one of their children had an eating disorder, was depressed or had suicidal thoughts. If they were told that they needed to wait almost two years before they could be seen to, what would they say?
Many of us have been fortunate to enjoy a healthy childhood without having to experience the inadequacies of the mental health system. Yet most of the children in our mental health system are waiting for us to help them. We can help them. We can help them to grow up and become well-balanced individuals despite their earlier difficulties. With the right supports and care our children can put these difficult years behind them. All of us, at some stage in our lives, have had a second chance. I am asking that these children be given just one chance at leading a life like every other child.
I appreciate that the Minister of State has come here today to listen to these issues and I hope she realises that I do not see my role as criticising her, the Department or, indeed, the Government. Rather, I see my role as helping her achieve what the Government has promised for years, namely, a loving nurturing society in an environment that is full of dignity and respect and that will allow our children to look forward to the future.
The Senator needs to be careful. She was allowed four minutes - usually people take two, but she took seven. When I ring the bell it indicates that her time is up. The trouble is that if I grant her latitude, someone will come along the next day and say that I gave Senator Freeman seven minutes.
The officials will be with me tomorrow for the debate on mental health. I hope the Cathaoirleach will not take time from me now.
I apologise to Senator Freeman; I was not aware that I was to take the first matter. Hopefully we will be able to resolve that. I thank the Senator for her contribution. She has represented the people of Ireland regarding mental health for some time and I know she will continue to do an excellent job representing them in her new position. I wish her the very best.
The area of mental health continues to be a priority for the Government and, as the Senator correctly pointed out, for all people within the Seanad and Leinster House. This is reinforced by the fact that funding for mental health this year will increase by €41 million, or just over 5%, to approximately €826 million, as indicated in the HSE national service plan.
The reduction in the number of children admitted to adult psychiatric units has been a priority in recent years and I assure the Senator that it continues to be a priority. Progress has been significant. The Senator mentioned that the number increased by five last year. However, in 2008 was it 247, and declined to approximately 95 last year. We are making progress, albeit that last year there was a slight increase. This is despite increasing demands on child and adolescent mental health services overall. Such admissions are made for a number of reasons, including distance from particular centres - with families not wanting their children to be sent 40 km, 50 km or 60 km away - the timing of admissions late at night, possible medical issues, substance misuse issues, family concerns and overall safety.
It is the policy of the HSE to provide an age-appropriate service, with a significant majority of young people now being treated by child and adolescent mental health services, CAMHS, teams. While figures for 2015 show 95 admissions of children to adult psychiatric units, the number of admissions does not necessarily equate to the actual number of children admitted, as a child may be admitted on more than one occasion in any given year. In 2015 there were 356 CAMHS admissions, of which 73% were to age-appropriate units and 27% to adult units. The HSE works proactively to reduce both the number of and length of stay relating to such admissions.
We are certainly not ignoring the issue. While there was a reduction to 95 in the number of admissions of children to adult units, it is not acceptable for any child to be in that position. Admissions of this nature should only take place when absolutely necessary. We need to get to a position where zero children are admitted to adult units. There has been a significant increase in CAMHS bed numbers in the past 12 months, which is where I think we can see an improvement, with 66 operational beds at present. This improvement has been further assisted by weekly management of available beds nationally. An example of progress is where an additional consultant resource has recently provided to the Eist Linn unit in Cork, which will bring the capacity there closer to 20 in the coming months. I hope the number will increase and surpass 66, which would help to improve the position.
The HSE continues to roll out protocols for the placement of 16 to 18 year olds in line with the age appropriate placements, as local operational issues allow. In regard to youth mental health, a continuation of investment in primary care responses to mental health, including the counselling services, Jigsaw projects, of which we have three rolling out this year in Cork, Limerick and Dublin, and early intervention approaches, is being developed. The question of further enhancing youth mental health services in the forthcoming budget will be considered in the context of the forthcoming Estimates process for 2017. Currently, I am establishing a youth mental health task force to consider how best to assist our young people in developing resilience and coping skills to support their emotional well being at an early stage. I hope that task force will be launched in mid July before we break for the recess.
I assure the Senator I have taken on board the concerns raised. I understand where the Senator is coming from and I look forward to working with her to, hopefully, improve the service.
A debate is taking place tomorrow on mental health when the Senator will be able to contribute again. If she wishes to put a brief question. The problem is that 12 members requested Adjournment debate this morning and I had to refuse eight. If the system was structured correctly we could take five instead of four. When a Member raises a matter it is usually a brief question to the Minister who responds and the Member is allowed in again. I will allow the Senator put a brief question.
In conclusion, I would be more than happy to meet with the Minister of State and come up with a short term response to the problems that are happening now. We could address some of these problems very quickly but we need to meet with other interested parties as well. I hope the Minister of State can agree to that.