Tuesday, 14 May 2019
Nithe i dtosach suíonna - Commencement Matters
Child and Adolescent Mental Health Services Provision
I thank the Minister of State for coming here to give me a response. I am running a campaign called the 31 Days of May where my colleagues and I and communities do something every day to raise awareness about mental health and well-being. It can be something very small all the way up to something bigger like stopping traffic, which we did on Meath Street on Saturday with community dancers - young girls dancing with a green ribbon. It is promoting conversation that will reduce stigma.
The Minister of State will know about the escalating seriousness of the situation regarding mental ill health and how the lack of well-being in our communities is escalating and is in quite a crisis. Not a week goes by that I do not know of at least three or four people who have completed suicide. One instance that took place the weekend before last involved a 12 year old child. It is just insupportable and quite upsetting.
I ask the Minister of State to discuss the statement in the HSE's service plan for 2019 that it is working to develop a seven-day per week service for child and adolescent mental health services, CAMHS, to ensure supports for vulnerable young persons in line with connecting for life. The response to a parliamentary question that was submitted asking about this was shocking in that it stated in black and white that there was no planned date for completion of costs and implementation plans for providing 7-7 child and adolescent mental health services. The cost of the implementation plan is the first step. We have all agreed within these Houses, the HSE and among Ministers to deliver the 24-7 services that have been requested. However, 7-7 services are the initial ask and task for us. It is essential that we follow the service plan for 2019. The HSE does not seem to be meeting its commitment to develop such services. When will these vital services be delivered? I guess the HSE needs a reminder.
We all know the importance of services that are provided from Monday to Friday. However, crises do not happen that neatly between Mondays and Fridays. It has been repeatedly proven throughout Europe and in Ireland that crises occur between Thursday evening and into the early hours of Sunday morning.That is where the 7-7 services are required, prior to the excellent care that will be provided under the 24-7 system.
I thank the Senator for raising this important issue in mental health services. I welcome any campaign that deals with stigma.
On the issue raised by the Senator, the HSE service plan for 2019 commits to developing all aspects of child and adolescent mental health services, CAMHS. This includes developing a seven-day per week service for CAMHS to ensure improved support for vulnerable young people, as well as related initiatives in enhanced early intervention and day hospital care. Community based CAMHS teams provide specialist mental health services for young people up to the age of 18 years and operate on a five-day per week basis. Expanded CAMHS provision will be in line with adult services where a seven-day service is being developed.
Where a child has a mental health crisis, the initial consultation should be with the child's general practitioner, GP, and if the GP assesses that the child requires an urgent mental health assessment, the GP should contact the local CAMHS team. Where a person under 18 years of age presents to an emergency department following self-harm, it is important that he or she receive a compassionate and empathic response. He or she should receive a bio-psychosocial assessment from a suitably qualified mental health professional prior to discharge from hospital. It is recommended that children under 16 years of age be admitted overnight to a paediatric ward. The paediatric team should ensure the child receives a bio-psychosocial assessment prior to discharge from hospital, thus following international best practice. In some hospitals the child will be assessed by a non-consultant hospital doctor, NCHD, who can discuss the case with the on-call CAMHS consultant. In other services, there might be no on-call CAMHS consultant and the paediatric team will be advised to wait until the CAMHS consultant is available.
The HSE national clinical programme for the assessment and management of patients presenting to an emergency department following self-harm aims to ensure all such patients receive a bio-psychosocial assessment. The programme is being extended to include the three paediatric hospitals in Dublin. Three clinical nurse specialists, one for each of the three Dublin paediatric hospitals, are being recruited. The addition of a specialist in each of the hospitals will improve follow-up care. In addition, all three Dublin paediatric hospitals provide a comprehensive liaison psychiatry service. In Temple Street Hospital it is provided in conjunction with the local mental health service 24 hours a day, seven days a week. In Crumlin and Tallaght children's hospitals the liaison psychiatry service is available Monday to Friday, from 9 a.m. to 5 p.m. Outside these hours, children are assessed by paediatricians and admitted to a paediatric ward. In Cork University Hospital there is a liaison psychiatric nurse available Monday to Friday, from 9 a.m. to 5 p.m. This nurse is supported by a consultant from CAMHS. Outside these hours, a NCHD completes assessments and CAMHS consultants provide input, as appropriate.
CAMHS inpatient units currently operate a 24-7 tertiary model of care for young people with severe or complex mental health issues. There are 74 CAMHS inpatient beds in four units in Dublin, Cork and Galway. The new children’s hospital will have an additional 20 CAMHS beds. There will be ten CAMHS beds in the new forensic mental health complex which is due to open at Portrane next year. It will be the first such unit nationally.
I do not wish to thank the Minister of State. First, only 50 of the 74 CAMHS inpatient beds are operational. In his reply the Minister of State gave me an education on CAMHS and the services already available, but he did not address the importance of having seven-day services for children, from the peak time of Thursday to Sunday. As for waiting in an emergency department for a CAMHS consultant, they do not exist. Many children leave with their parents before they are assessed having waited for hours and days for a consultant to arrive.Many child patients leave with their parents before they are assessed, having waited hours for a consultant to come. The day hospital at Linn Dara is also still closed. It has been closed for the last eight months and I cannot get a response from the HSE as to the plans for that facility. It is a white elephant. It is lying empty. It was state-of-the-art when it was opened two or three years ago.
The Minister of State's answer does not touch on 7-7 service provision at all. What is available for our children now is just not good enough. We are failing them. We know the difficulties. It was pledged that we would have services seven days out of seven, moving towards 24 hours a day, seven days a week, but nothing is happening and the HSE is not responding to its plans in this area for 2019.
On behalf of the Minister of State, Deputy Daly, I will say that the Senator can rest assured that this Government and the HSE remain firmly committed to developing all aspects of our CAMHS services. This involves a more holistic approach to CAMHS overall than was taken in the past and includes out-of-hours provision, enhanced primary care, and disability supports for those vulnerable young people for whom these would be more appropriate than specialist CAMHS care. The Minister of State is also strongly supportive of developing new initiatives such as e-mental health supports, which have been proven to work abroad. These supports can either be used for early intervention, thus helping reduce service pressures on CAMHS, or can be an aid to CAMHS teams in progressing individual cases. In addition, the new capital initiatives for the new children's hospital in Portrane, which I have already outlined to the Senator, will increase the number of CAMHS beds nationally from 74 to 104.
The Minister of State, Deputy Daly, and the Department of Health will continue to closely monitor CAMHS activity nationally in the context of implementing agreed HSE service plan targets for this year. I will, of course, bring the Senator's concerns back to the Minister of State.