Victor Boyhan (Independent)
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I welcome the Minister of State to the House. I would like him to make a statement on the 6,000 children currently waiting for professional psychological services. He will be aware from his engagement with my colleague, Senator Freeman, of the demands on child and adult mental health services, CAMHS. I pay tribute to RTÉ for the recent "RTÉ Investigates" programme that was broadcast on this issue. It is a harrowing story. I met a woman in Dún Laoghaire by appointment last week who introduced me to her three children. She is having social housing difficulties. When she presented to Dún Laoghaire-Rathdown County Council to discuss her housing application, she was told that she needed a professional psychologist's report. Most local authorities do not take GP letters into consideration. They require a letter from someone in the psychology field. While that costs money, more important, people have to wait. Politicians put their own hands in their pocket to pay for these reports because they are decent people and they want to assist their constituents to access professional psychological services in order that they can initially bring a report to the housing authority when they need help.

The "RTÉ Investigates" programme outlined many stories of families becoming desperate as they sought intervention, including assessments, for their loved ones. I have spoken to teachers who experience great difficulties with children. They have to call parents to come to the school to collect them. These parents need support. I constantly read about cases of juveniles involved in serious crime, including attempted murder, who did not get the resources and support they needed for many years. I do not doubt the Minister of State's commitment but if there is not early intervention for vulnerable children, what does the future hold for them and their families and our society?

I like to think that there will be a time every child will have a health and psychological assessment at least twice during the junior cycle. That happens in Canada and parts of the US. Children are assessed, not for benchmarking purposes, but to identify weaknesses, needs and supports and to put them in place. Will the Minister of State outline what is the plan going forward? It will be slow but something needs to be done. The Irish Nurses and Midwives Organisation conference begins in Cork this afternoon. I spoke to an official earlier who mentioned patient trolley counts and said they should be published more regularly. The organisation is suggesting the number of children awaiting psychological services should be published on a monthly basis to hit the Government hard with facts about what is happening and that a formal count system should be put in place for social workers and children in care for whom a care plan is meant to be in place.

Clearly, the priority should be vulnerable children. The fact that 6,000 are waiting for services means we are at crisis point and something needs to be done about it. What is the Government's plan to address this significant issue?

Jim Daly (Cork South West, Fine Gael)
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I thank the Senator for raising the issue of counselling for children in primary care. Psychology services in primary care settings can play a key role in promoting good mental health. There are high rates of mental health problems among young people, and the research shows adolescence and early adulthood is the peak time for the onset of such issues. One in five young people have been found to have a diagnosable mental disorder at any one time. Given the scale of this challenge, it is essential that adolescents and young people with mild to moderate mental health needs should be able to access services in their local communities in a timely manner. Those with more severe mental health difficulties will require referral to secondary care services.

To address the current waiting lists for psychology services in primary care settings, additional Government funding of €5 million has been made available for the recruitment of 20 staff grade psychologists and 114 assistant psychologists. I understand that the vast majority of these posts were filled during the first quarter of this year, and there should be progress in more young patients being seen, and being seen more quickly.

It is also important to acknowledge the progress that has been made, and there has been a reduction in the numbers of children waiting for access to counselling services in primary care since July 2017, although I agree that much more needs to be done. As well as additional investment, the HSE is also examining the scope for improved ways of working through a service improvement initiative for counselling in primary care. These new ways of working include: standardised psychology protocols; a single point of contact for all non-crisis and non-complex emotional and behavioural referrals; and assistance for service users in stepping "up to" and "down from" more specialist health services. Other options to tackle waiting lists are also being pursued, including a computerised cognitive behavioural therapy programme. This programme utilises new technologies, delivering supports through weekly sessions based around a computer, with a healthcare professional as support.

Such developments build upon the investment in mental health services over recent years. I am sure the Senator and others Members will join me in welcoming the fact that funding made available for suicide prevention has more than tripled from €3.7 million in 2010 to €12 million this year, while the overall mental health budget has increased by €200 million since 2012 to more than €900 million today.

The Government acknowledges that waiting lists for counselling services for children in primary care are too high. That is why additional funding has been provided for psychology and assistant psychology posts, and the number of children waiting for services should now reduce further as these posts start to make an impact on access times for services. This investment and the service improvements I have outlined will facilitate further advancements within primary care and help improve and enhance the lives of young people who suffer mental illness and that of their families.

I particularly welcome the Senator's approach. The focus has always been on the upper end of services, which is CAMHS. We can keep chasing the queues for these services and focus all our attention, resources and reactive remedies on them or we can examine what is causing this to happen and provide solutions. We can treat the symptoms or treat the cause. I very much believe in treating the cause and that is what the Senator is suggesting. We need to intercept these issues at an earlier stage and we need to be more proactive in our screening, which the Senator is seeking. We need to pick up the issues at a lower level of intervention in order that when people are treated, their care is not escalated to CAMHS. Much of the debate in the media and political circles is about treating people at that level. Some people need to be treated by consultant psychiatrists but many young people who seek access to mental health services do not need to see a consultant. It is only in recent weeks that we have completed the recruitment of 20 staff grade psychologists and 114 assistant psychologists into the system at primary care level specifically to treat teenagers and other young people and to pick up their issues at a lower level of intervention, as advised by the Senator, thus preventing them from being escalated to CAMHS and a consultant psychiatrist. We are making significant progress. Additional Jigsaw sites have been announced and we are trying to beef up the supports that it and many other service providers are offering, which is very significant and helpful in this area.

Victor Boyhan (Independent)
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I am mindful, given all the ongoing health-related controversies, that the Government will be judged on three issues - health, housing and education. Anyone who is on the ground will be aware of this. I met a woman the other day who said the political universe is meant to revolve around Leinster House. She asked what we were all doing in here and why it is always the HSE or some other body that is held responsible for issues. I replied that she had a point. We are the policymakers.

This issue revolves around early intervention and picking up on vulnerable children in school. Teachers in Montessori and primary schools can identify vulnerable children and behavioural issues that will lead to further problems for 90% of the children. The Minister of State is fully committed in this regard. I downloaded two speeches the Taoiseach made while doing some research for this debate. He said he was extremely disappointed but he leads the Government and the Minister of State is one of his appointees.

This is an important issue and targets should be set. Perhaps when I raise this again in three or four months, targets will be set in respect of how the Government is delivering on professional psychological services. This important, critical issue relates to the future health and well-being of our people and our country.We need to keep an eye on the issue and see progress made. I thank the Minister of State for coming to the House and I thank him for his comprehensive response.

Jim Daly (Cork South West, Fine Gael)
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We can talk all day about figures and statistics, but much of that can hide the realities of real people who are struggling, looking for these services. The mental health budget has increased by €200 million up to €930 million in the past five years. I do not know of any other country that has increased its mental health budget by such a percentage over that time. That is not enough. It is easy for me is to secure additional funding and throw money at it. How we do what we do is much more important to me.

I am really focused on championing what the Senator has mentioned, which is redoubling our efforts down to the base of the pyramid to be more proactive and intuitive there. I want to roll out the STEPS-A programme in schools. That is a programme coming in from America related to the DBT programme which gives young people the ability to recognise feelings, articulate those feelings and deal with those feelings at a much younger age before they escalate to an acute stage. Too much of our approach to date has been reactive where we have been chasing the extremities and the acute side of mental illness. We need more action focused on the lower levels. I genuinely welcome the Senator's approach and the opportunity to outline some of the steps the Government is taking on that front.