Thursday, 27 September 2018
Child and Adolescent Mental Health Services Provision
I welcome the Minister of State. This issue relates to the Cherry Orchard campus in Dublin 10. My last Commencement matter on it was in July and dealt with by the Minister of State, Deputy Jim Daly. It was tabled in response to desperation and queries from patients - children - their families, the staff and others at the coalface with experience of how day services were being shut down. On 11 June the consultant was told by the director of services of concerns about staffing in child and adolescent mental health services, CAMHS, to cater for the Linn Dara day programme. The problem arose because a supporting CAMHS service in Clondalkin was in dire straits. The consultant was willing to support the service in Clondalkin and, with staff, formulated a solution to help with capacity in Clondalkin. Staff travelled to Clondalkin in the morning and returned to Linn Dara in the afternoon to carry out assessments, attend appointments and provide therapies included in the diary to provide long-awaited services for adolescents and children. Nothing else happened between 11 and 27 June.
On 27 June an email was circulated by senior management advising of the closure of the day hospital programme on 6 July. The senior manager went on to say families should not be informed directly about the closure and that appointments should continue to be made for children who had been on the waiting lists for a long time. The order not to inform families was the entire concern of management at the time. It refused to communicate directly with families and stated it would not issue letters to cancel appointments because it did not want them to end up on the Joe Duffy radiol show. The closure was kept quiet and low key. I urged the Committee on the Future of Mental Health Care to visit the campus in July prior to the recess and the House recommencing last week, but the issue remains unresolved.
As the Minister of State is aware, I spent more than 30 years as a psychiatric nurse. From a service provision perspective, I know only too well the deficits and the impact on children and families. I want to talk to the Minister. I spoke to one of the mothers, whose story exemplifies the failings of CAMHS.Her child has been on the waiting list since May. He was waiting for a particular psychologist, to whom he was allocated, but the psychologist has since moved out of the area, leaving the Cherry Orchard campus one psychologist post short. I am sure the Minister of State is aware and I am sure she also gets this all the time. I have been inundated with requests for help from parents of young children in dire need of the mental health services. This child's waiting list has been frozen and the parents were told that, realistically, it would be at least another six months before a replacement psychologist was hired. This child is just one of many children who are in distress. It is unacceptable. The child is ten years old, is isolated and has major socialisation issues. He is boiling with frustration that is destructively displayed at home. I am aware of parents who care for and are concerned about their children and family members and are trying to keep them safe being advised to call the Garda to deal with children as young as five. Some have done so. I ask the Minister of State to outline how the position at Cherry Orchard campus will be improved. Will she provide concrete, tangible plans for day services and fast-tracking recruitment to the vacant psychology post?
As Senator Devine's colleague in the same constituency, I am all too familiar with the issues she raises. The work done by staff in the child and adolescent mental health services is challenged daily by the shortage of professionals in the service.
On behalf of the Minister of State, Deputy Jim Daly, I thank the Senator for raising this matter. It is the policy of the HSE, as reflected in its annual service plan, to provide an age appropriate mental health service for those under the age of 18. I reiterate the Government’s commitment, in view of the significant additional funding given over recent years, to the development of all aspects of mental health, including that relating to young people. The Minister of State, Deputy Daly, will continue to make the case for further resources annually, in line with evolving demands and in accordance with A Programme for a Partnership Government commitments.
The HSE's National Service Plan 2018 also commits to further developing our child and adolescent services through CAMHS. This is against a background of demand for CAMHS increasing by 26% between 2012 and 2017. Various initiatives on youth mental health other than the specialist CAMHS are also being progressed. We have 69 CAMHS teams and three paediatric liaison teams supported by 75 CAMHS beds nationally. Further beds are planned to come on stream as quickly as possible. Some 18,500 CAMHS referrals are expected in 2018, with 14,500 young people set to be seen by this specialist service. It should be noted that this figure of 14,500 is up from 8,600 in 2011. On behalf of the Minister of State, Deputy Daly, I pay tribute to the staff of mental health teams for the work they do daily in dealing with this rapid increase in demand for their services. Cases assessed by professionals as being urgent are seen as a matter of priority.
The Government has funded an extra 130 psychiatric nurse undergraduate places each year to help improve the planning and delivery of services over the next few years. A key difficulty being addressed by the HSE is the issue of staff recruitment and retention, particularly in CAMHS. The recent appointment by the HSE of 114 assistant psychologists and 20 psychologists will help to develop counselling services in primary care. It is anticipated that these posts will deal with the less complex child and adolescent cases, thereby reducing the demand on CAMHS.
In addition, the Minister of State, Deputy Daly recently approved ten new posts for advance nurse practitioners, ANP, who will be specifically directed to the CAMHS service nationally. These new ANPs will play a key role in delivering better service co-ordination where local service pressures are greatest.
The HSE's Linn Dara CAMHS service covers County Kildare, west Wicklow and south Dublin, reflecting a total population of some 420,000. There are seven multi-disciplinary community CAMHS teams for these areas. The HSE has confirmed that there is a psychologist on each CAMHS team and the current vacancy in psychology, in this instance, is due to a temporary absence and will be filled as soon as possible.
The HSE has a statutory responsibility to ensure that safe, adequate and sufficient services are provided by all areas of CAMHS. The Linn Dara inpatient unit remains fully operational as normal, with 22 beds available as well as functioning community teams. I assure the Senator that the Minister of State, Deputy Daly, will keep the matter under close review and that all efforts will continue to be made by the HSE to address the ongoing needs of Linn Dara to a maximise its services.
I also pay tribute to the staff working at the coalface. They have the solutions, as was clear in the case of the closure of the day programme at Linn Dara when they were ignored. Around 80% of A Vision for Change has not been implemented. This is especially glaring in the delivery of child and adolescent mental health services. We are spending €300,000 per week or €3.2 million per annum on agency staff in nursing and psychiatry. I acknowledge the extra undergraduate nursing places that have been introduced but, as nurses told me last week, no one with sufficient experience is available to mentor these undergraduates. While we fill the vacancies with graduates, the experienced staff who would normally mentor them have left the health service, leaving young and inexperienced staff running wards and clinics. The 700 vacancies in the service is a matter of concern.
Will the Minister of State revert to me with a timeline and process for filling the vacant psychologist post in the Cherry Orchard service? There are many children on the waiting list who will still be waiting in six months. Let us try to fast-track this. The Oireachtas Joint Committee on the Future of Mental Health Care would like to know when the day programme will reopen. Perhaps the Minister of State can engage with the HSE on the Cherry Orchard campus.
I thank Senator Devine and bow to her expertise in this area as I know she spent some working in that area of medicine. I cannot give the Senator answers to her questions but I will follow up with the Minister of State, Deputy Daly, and ask him to revert to her. I am also concerned that there are numerous children who have to wait a long time to access CAMHS. The Minister of State is doing his utmost to recruit people to the service. Unfortunately, some people find this line of work very difficult. As Senator Devine is aware, mental health issues can be very complex, especially with children. I will speak to the Minister of State on this matter and ask about the day-care services in Cherry Orchard and whether he can provide the timeline the Senator seeks.