Wednesday, 26 January 2022
Nithe i dtosach suíonna - Commencement Matters
Mental Health Services
I thank the Minister of State for being here this morning.
It has been a turbulent January. We had Covid spiking. Now a lot of people are nervous about society re-opening so quickly and that will be stressful for many. We also had the tragic events in Tullamore which rocked us all, as well as tragic suicides. I want to send my condolences to all families affected by loss and premature loss.
This is an opportune time to talk about our mental health and specifically, the resourcing and management of psychologists in the HSE, of which there is a shortage in acute care, in community health teams and in disability and social care. There also needs to be a wider focus, not just on HSE resources, but also on mental health resources in education, higher education, Tusla, the Irish Prison Service and acute hospitals. They all need psychologists and a HSE plan will not take into account the breadth of the resource requirements.
We must address the current shortages while also focusing on the future. A recent Government disability capacity review projected that in 2030 there could be a need for an increase of 107% in the number of psychologists for child disability services alone and a national project office report estimated that there was a need for 500 additional psychologists. That is an enormous number but at the moment, we have only 66 clinical psychologists coming on stream. The additional complication is that even if the allocated funding in this year's budget for additional training places on professional training programmes was to be increased, the psychologists would not be on the front line before November 2025. It takes four years to qualify so whatever we do, we must do it now.
When I raised this issue previously, I was told that a project team was tasked with considering the preparation of a workforce plan for psychological services in the HSE, including an examination of the current framework for training psychologists for the health service and the type and skill mix required for the future. The report would also set out the significance of a review of the current funding model for future psychologists. I note a report, entitled The Report of the National Psychology Project Team: Establishment of a National Psychology Placement Office and Workforce Planning, was published last January. What recommendations contained therein have been implemented or progressed since then? What is the plan?
It was recommended that a placement office be established to make sure that trainee and qualified psychologists are recognised and accredited. That was deemed urgent in 2018. I raised the issue previously of trainee psychologists and the inequity they face in their training. Trainee clinical psychologists are paid €34,000 per year for their placements and get 60% of their fees paid by the HSE but trainee educational psychologists do not, even though they are working side by side. Educational psychologists pay their higher education fees and work for free on the front line in education settings, in the National Educational Psychological Service, NEPS, and in section 38 organisations.These people work three years for free on the front line and pay to do so, while their colleagues and peers are supported through that period, as they should be. We gave a commitment to review that. It is vitally important that we do not oversee a system that is so difficult to get through. I speak to people who are absolutely committed to their vocation. In the way that I am committed to this job, they are committed to theirs and they have sacrificed so much. They must step away from a career they have invested in because they cannot afford to do this. A recent petitions by the Psychological Society of Ireland was signed by 2,400 people. I hope I will hear a positive update today.
I thank Senator Currie for giving me the opportunity to update the House on this important matter. I acknowledge the enormous contribution made by psychologists in the healthcare system during the challenging times of the Covid-19 pandemic and before that as well.
In February 2019, the HSE community operations unit convened a project team chaired by Dr. Cathal Morgan to consider the preparation of a workforce plan for psychological services in the HSE, including an examination of the current framework for training psychologists for the health service and the type and skill mix required for the future. The work of the project team has been informed by a thorough stakeholder consultation process. Unfortunately, due to the Covid-19 pandemic, the work of the project team was delayed.
The report of the national psychology project team, titled Establishment of a National Psychology Placement Office and Workforce Planning, was completed in January 2021. In line with its terms of reference, the project team report sets out proposals to establish a national psychology placement function within the HSE. The report outlines considerations for a workforce plan for psychological services in the HSE. A recommendation on the consideration of funding of counselling psychologists along the same lines as clinical psychologists was also included.
Currently, clinical psychologists in training are funded for 60% of course fees and are employed as trainee psychologists for the duration of their training. This is unlike any of the other health and social care professionals. A chapter of the report, titled Psychology Services into the Future, identifies a number of the key drivers that are likely to produce significant changes to the way and extent to which psychological services are delivered. It also notes the implications this will have on workforce planning and the future psychological workforce.
The projected global shortfall of healthcare workers by 2030 means consideration should be given to alternative and flexible approaches to how health services are delivered. The changing role of professions and greater fluidity in skill mix will require a greater alignment of skill sets to work tasks. This is critical in the context of community-based working through different modalities. While new technology is unlikely to impact on the demand for mental health professionals, its effects on service provision can be transformational. The psychological workforce will increasingly work in tiered arrangements and the workforce will require robust governance and supervision structures. Memorandums of agreement and programme boards in higher education institutes will need to align with innovations and change within the healthcare landscape.
While it is a matter for the HSE at operational level to determine the level of recruitment required across staff categories, given the level of workforce expansion required, it is likely that there will be additional posts available for professionally trained psychologists. Implementation of the report's recommendations and the creation of a national psychology placement office must take priority.
I take this opportunity to highlight that there has been a significant reduction of over 19% among under-18s waiting more than 12 months to be seen by primary care psychology staff. This follows an allocation of €4 million I secured last August to address such lists through targeted initiatives, enhanced capacity of mental health need and ease pressure on and reduce waiting lists for specialist mental health services. This will ensure that children and young people will get the support they need when they need it. The second key part was the announcement earlier this month of the establishment of the psychology assistant post on a permanent basis. This also marks a significant achievement in promoting enhanced access to vital primary care psychology supports, which I know was very much welcomed by the sector.
I thank the Minister of State for the update. The report is a year old and now that Covid is, hopefully, coming to an end we need to prioritise this matter. The solutions are there. We need to increase the number of psychologists, address the inequities and support people through the process. The Department should look to the North and what it does in the area of funding because there are examples there that we could use.
Under our current system, someone could become an assistant psychologist and be paid but trainee psychologists must pay for their degree or doctorate and work for free. We need to adopt an holistic approach to this and address the shortage of posts. A placement office is essential because we must co-ordinate. I think there is a cliff-edge date where someone who has not worked in all three areas will not get the same qualifications. We need to sit down with representatives of the Psychological Society of Ireland and we need a timeline for implementation. We also need clear direction on who is responsible. We need to know whether the Minister of State, the Minister for Health or the Minister for Education are responsible for this. I would appreciate if the Minister of State could clarify the matter because different people have sent emails back and forth seeking clarity.
I have met representatives of the Psychological Society of Ireland.
Sláintecare reform supports the implementation of Sharing the Vision 2020-2030 under the enhancing community care workstream. The need to build a more accountable and transparent health service is a focus of Sláintecare. It is also a key objective of the new Sharing the Vision policy in the context of mental health service delivery.
There has been an unprecedented investment in recruitment across the health service, including for health and social care professionals, in response to the Covid-19 pandemic. This has included an increase in capacity of primary care psychology services recently through the introduction of two initiatives, as previously mooted. When I took up my post a year and a half ago I was concerned that approximately 10,000 under-18s were waiting for psychology supports. I learned that 5,000 of them had waited in excess of 12 months. Last September, I secured €4 million and we ran a programme for four months under which each community healthcare organisation, CHO, had to see what it could do. Some hired locums, some provided for overtime and others outsourced. We managed to have 19% of those on the waiting list seen, which is a good proportion. However, 81% remain on lists. I will roll over the initiative again for the next four months. The Minister has spoken about a targeted approach to waiting lists and we have made a submission on a long-term approach.
Earlier this month, there was a second announcement on the permanent establishment of a psychology assistant grade. The establishment of these positions on a permanent basis marks a significant achievement in promoting enhanced access to vital primary care psychology supports. I look forward to the scheme being implemented as it will make a significant change. I thank the Senator for her interest.