Maria Byrne (Fine Gael)
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The Minister of State is welcome to the Chamber. More than 100 children and young adults have been waiting for more than a year for mental health appointments in Limerick and the mid-west, and this is not good enough. I am aware there are many problems recruiting consultant child psychiatrists. While some have been recruited in recent times, there are six teams and they are in the process of developing a seventh but it has not happened to date.

It was reported in the Limerick Postthat 371 children and young adults were awaiting an assessment during the period of June to September 2022, 103 of whom were waiting more than one year. This stark figure is high in a short timespan. The figure represents 9.7% of the overall national waiting list for child and adolescent mental health services, CAMHS, which stands at approximately 3,800. According to available national figures, this places services in the mid-west as the fifth lowest in terms of waiting numbers. It is more concerning that the region is in fifth place.

Do more programmes need to be brought into schools? How do we begin to address this? It is frightening to find that many children and young adults are on the waiting list while availing of services. I am concerned there are probably more children and young adults not on a waiting list who have not come forward and are experiencing issues. We need to have a wider conversation on this issue. What plans has the Department to introduce programmes into schools and to deal with these people, especially the 100 individuals who are waiting more than one year?

Mary Butler (Waterford, Fianna Fail)
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I thank the Senator for raising this matter. I am delighted to be in the Seanad to discuss the issue of CAMHS waiting lists in the Senator's community healthcare organisation, CHO, and nationally because it is something on which I have put a huge focus. The Government and I remain committed to the development of all aspects of mental health services. As the Senator will be aware, the mental health budget for 2023 is in excess of €1.2 billion, which is another record budget for mental health services, and a continued focus will be on reducing waiting lists for CAMHS and primary care psychology services.

The CAMHS waiting list nationally was 2,755 in December 2020. It increased to 3,556 in December 2021 and, unfortunately, as of October this year, the provisional figure was 4,043, of which 398, or approximately 10% of the national waiting list, were in CHO 3, which covers the Limerick area. This figure is a slight increase on the same period last year, which was 355.

In the past year, we have seen an unprecedented number of referrals presenting to CAMHS all over the country. There were 25% more referrals last year than any previous year. We saw a huge spike in the number of young people presenting with eating disorders, with 504 entering the clinical programmes last year. When this programme was devised in 2016-17, they expected approximately 60 children would be referred.

Many children get referred to CAMHS but they do not all meet the criteria. Only 2% of children who are referred need CAMHS supports, with others, for example, needing supports provided by primary care psychology services, community teams and the National Educational Psychological Service, NEPS. It is important to note that the CAMHS waiting list can relate to capacities in other parts of the system where young people may not receive early intervention and their needs may escalate requiring referral to CAMHS. Access to the CAMHS system is based on a clinical assessment, with urgent cases being prioritised. Data made available to the Department of Health indicates that the mid-west CHO, encompassing Limerick city and county, has the fifth lowest waiting list for CAMHS services, as the Senator said.

The CAMHS service in the mid-west CHO is currently provided by six consultant child psychiatrist-led multidisciplinary teams. There is a seventh team, as the Senator said, in development that will facilitate additional capacity for service provision and a welcome, more timely response to referrals. Over recent months, significant progress has been made in recruiting for the filling of existing vacancies and new development posts. However, there are ongoing issues with recruitment in particular disciplines, especially consultant child psychiatrists, which is an issue reflected nationally. Several other disciplines are also affected, including nursing and psychology. My priority is to improve access to CAMHS and reduce waiting lists. As the Senator said, what else can we do? It will include measures such as better links with primary care or disability services and greater use of e-mental health responses.One of the CAMHS e-mental health sites nationally is identified for CHO 3 and the Limerick area. This will be very welcome. Referrals to CAMHS inpatient beds may not be appropriate in some instances where other options, such as CAMHS community teams, may be more suitable and effective. Each referral to an inpatient bed is triaged and assessed for overall need through a weekly teams conference of all four inpatient units.

Regarding the waiting lists, I have placed great focus on this aspect and secured funding to try to reduce it. Working through the HSE, we have contacted the various CHOs to see what they can do. We did this in primary care psychology. We targeted the waiting lists of over 12 months first, because these are the children needing these services the most. Unfortunately, when a priority case comes in, children who may have milder needs get bumped down the list, and this is not what we want to see.

Maria Byrne (Fine Gael)
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I thank the Minister of State. I apologise because I meant to acknowledge the work she and her team have done to date. The situation has improved a great deal, but we also have a long way to go. I welcome that Limerick is going to be used for a pilot scheme, as the Minister of State highlighted. When I see the figures in this regard, they are stark. I refer to the number of young people needing support and care. Good work is going on in the primary care centres and with different teams. The major issue, though, is how to recruit replacement staff when vacancies occur and how to get these posts and services back up and running as quickly as possible. This is the kernel of the issue here.

There are so many organisations, like the Children's Grief Centre and others, that support care. Many of these organisations do this voluntarily. Are we seeking to expand the programme, include organisations that have the expertise and experience in this area and bring them in to work alongside the HSE team? This is just a suggestion, but anything we can do to address the waiting lists will certainly be most welcome. I look forward to a further response later regarding how we are going to reduce the waiting lists and bring down the numbers in this regard.

Mary Butler (Waterford, Fianna Fail)
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I reiterate that there will be three new CAMHS e-mental health pilot sites nationally. One has been identified for CHO 3 and the Limerick area. I have seen this model work well in the Roscommon area. It is one of the key recommendations of the Maskey report, which resulted from the situation that occurred in south Kerry. As the Senator will be aware, an audit and a review are under way now. The audit concerns the HSE. We are auditing all 73 CAMHS teams in respect of access to them, whether they are meeting their standard operating procedures, whether the full teams are staffed and where the gaps and deficiencies are. We are also examining, for example, the issue regarding prescribing practices. In parallel to this undertaking, the Mental Health Commission is running a similar review. I hope I will have all these data available to me in the first quarter of 2023. This will give me, the Department and the HSE data we never had previously. If we have to make best practice changes, we will.

A huge amount of work is being done in CHO 3. I know the lead consultant psychiatrist there, Dr. Foley, who is doing phenomenal work. I refer again to the number of complex cases being referred in. I spoke recently about a situation where one young person was just released from CAMHS care after four years. She had 96 interventions and saw the team on 96 occasions. There are, therefore, many complex cases that need much work and support. It takes a lot of time, but my complete focus is on trying to reduce this waiting list. I thank the Senator for her suggestions. We can talk about them later.

Maria Byrne (Fine Gael)
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I thank the Minister of State.