Erin McGreehan (Fianna Fail)
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I welcome the Minister of State, Deputy Feighan, to the House.

Garret Ahearn (Fine Gael)
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I thank the Minister of State for coming to the House for this very important Commencement matter. I thank him for being here, because it is in his Department. I would like to acknowledge the good work he is doing as Minister of State in the Department of Health.

I tabled this Commencement matter on foot of the retirement of Dr. Victor O’Loughlin from his post as a consultant child and adolescent psychiatrist for children with disabilities. There has been no replacement found for this role. We now have children in the south east of Ireland waiting indefinitely for psychiatric assessment because we do not have any psychiatrist. Under the Disability Act, a child is entitled to have an assessment of needs completed within six months, including a service statement that lists the services the HSE proposes to provide to meet a child’s needs. However, this is not happening.

I would like to mention two examples of families and parents who are at their wits' end because of the lack of services within the HSE. The first one is Mark Darmody, who is from my parish of Ardfinnan-Grange. He stated:

Our son Neil ... is severely autistic and was diagnosed with autism in 2016. He was reassessed in 2018, but his development has been almost non-existent. The severity of his presentation is now obvious as he is 100% non-verbal, has almost no comprehension, is not toilet-trained and is sporadically violent towards himself and others. We had been urging the HSE to intervene from early 2019 onwards as it was clear to us that Neil's diagnosis with a mild intellectual disability was not accurate for his presentation.

In February 2020, as a result of a referral ... Neil was examined by Dr. Victor O'Loughlin... on behalf of the HSE. He emphatically stated by letter ... that Neil was in the severe range of intellectual incapacity and that he required reassessment "as a priority" before [psychiatric services] could be considered. This urgent letter was sent to three HSE managers.

On the 29th June 2022, as a result of substantial pressure from us as parents, we received a letter of apology from ... [the] disability manager in Clonmel. She stated that the letter of Dr. O'Loughlin was never actioned [on] and she speculated that she could only conclude that Covid must have been the reason. What is certain is that our son was never considered for assessment ... during that time period.

This situation is now [exacerbated] by a telephone call I [received from] the HSE services manager in Clonmel... who informed me that Neil would now sit on a waiting list "indefinitely." Despite my requests for an approximate indication of when he [would] be seen, she continued with her "indefinitely" statement. She also informed me that there is no psychiatrist presently recruited by the HSE in the south east of Ireland.

His wife, Noelle, is now attempting to source private therapies that could cost up to €9,000 for the entirety of the type of service that Neil requires.

There is another lady in Clonmel and I do not have permission to use her name, so I will not. She is at her wits' end as well. Her boy needs to be assessed in order to be on the correct medication to ease his constant frustrations. He constantly stims, so he is always shouting, hitting and breaking things in sheer frustration. He even does it in his sleep. His parents are reducing their working hours to ensure that someone is always there. I will read out part of what she said to outline the frustration that she feels. She stated:

Our home is now and has been at complete crisis point for a long time which ye are [well] aware of since our last emergency professionals meeting a number of months ago. I would like to point out that our ability to cope is beyond that of the norm, however the current situation outweighs any degree of coping. Simply put “the demands are too high and the professional expertise is non-existent which is contributing to the bleakness of the present and future of our beautiful boy and family”. We have no support, we are at a point of total burnout and it has fallen on deaf ears. There are currently so many acute and enduring issues in our home that we do not know where to turn.

Those are families who are struggling immensely because of the lack of services in the south-east region. It needs to be addressed as a matter of urgency.

Frank Feighan (Sligo-Leitrim, Fine Gael)
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I thank Senator Ahearn for raising this important matter today. On 9 September, the Minister of State, Deputy Butler, launched the child and adolescent mental health services, CAMHS, intellectual disability model of service. This marked a significant achievement for mental health services in line with the Government’s ongoing commitment to improve all aspects of mental health services and ensure they remain person-centred and accessible to all. As the Senator knows, the CAMHS intellectual disability model of service was developed to enhance supports for children and adolescents with intellectual disability by advancing specialist mental health services nationally and standardising the care provided to children, adolescents and their families.

Prior to the development of this model of service, there was no nationally agreed framework that would enable existing and future CAMHS intellectual disability teams to deliver services in a consistent and co-ordinated manner across the country. This model addresses that vacuum by providing national guidance on how to deliver integrated person-centred services consistently nationwide. It will increase the confidence and ability of service providers, both the HSE and independent agencies, to deliver successful and safe mental health intellectual disability services to a high-quality standard. It proposes effective partnerships between healthcare providers, children and adolescents with lived experience, their families and local communities.

The CAMHS intellectual disability model of service was informed by the broader policy context in which it was developed and Sharing the Vision, Sláintecare and the findings of the Maskey report were also significantly considered throughout. The process of developing teams in Ireland in line with Sharing the Vision recommendations has begun, with the development of several teams across the country. The Sharing the Vision implementation plan 2022-24, which was launched earlier this year, will ensure we are closely monitoring the development of further child and adult teams. The launch of the model of service coincides with the reconfiguration of disability services into the children disability network teams, which adopt the health and social care approach to the provision of relevant disability supports to children. The model of service provides clear guidance to ensure these network teams work closely and collaboratively with CAMHS intellectual disability teams to the benefit of those accessing the services.

North Tipperary lies within Mid West Community Healthcare in community healthcare organisation, CHO, 3 and south Tipperary lies within South East Community Healthcare in CHO 5.A full-time mental health intellectual disability child consultant has been recruited in the mid-west area. The consultant will work on a 0.8 whole-time equivalent basis. The HSE is looking at how best to deliver the child service to the full population of mid-west community healthcare. South-east community healthcare in CHO 5 recently interviewed for a CAMHS intellectual disability consultant for the region. A candidate has been offered the position and the HSE is working through the recruitment process for a start date to be finalised.

South-east community healthcare continues to liaise with national colleagues to secure funding for the multidisciplinary staff required to populate the adult and CAMHS intellectual disability teams. CHO 5 is endeavouring to populate this team at the earliest opportunity and it is a priority for the south-east community healthcare senior management team.

Garret Ahearn (Fine Gael)
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I thank the Minister of State. I know he has been working on this because we have spoken privately about it. I am grateful that a candidate has been offered a position. The start date cannot be soon enough. A professional from the UK currently comes over once a month. In this regard, the HSE is not fit for purpose. Certainly from the perspective of parents of children with disabilities, it is just not accountable.

Staffing and recruitment are issues. The HSE should be using the work permits scheme more to find people outside of the jurisdiction to work in the sector. It does not seem to be using it as much as it should. Mark and Noelle Darmody have looked at prices to get a private assessment and it is approximately €9,000. Parents who go private should be able to claim back the cost. It is not their fault they have to go private. It is because of the lack of services we provide that they, for the good of the child, scrape to try to find money to make sure the child gets assessed as quickly as possible. On the back of the HSE's incompetence, the State should reimburse people who go privately. This should be done during the period we are waiting to get people into position so we can get the backlog fixed. That would certainly recognise the pressure parents are under at present.

Frank Feighan (Sligo-Leitrim, Fine Gael)
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I thank Senator Ahearn for raising this very important matter. He has been very consistent on the lack of services. The CAMHS intellectual disability model of service is being progressed in CHO 3 and CHO 5. It reflects the ongoing commitment of the Government and the HSE to ensure that mental health services for children and adolescents with intellectual disabilities are on a par with services available to those in the general population. This objective will be enhanced with record funding of €1.2 billion for mental health in budget 2023. The new HSE service plan for next year has now been finalised.

Senator Ahearn raised the question of reimbursing parents who spend up to €9,000 because of the lack of services. That is a fair comment. The service should have been in place. The services will be available eventually but parents are at the pin of their collars trying to provide very important services for their children. I will take this issue back to the Minister and see whether it can be addressed. Again, I thank Senator Ahearn for raising this very important matter.