Seanad debates
Thursday, 1 June 2023
Nithe i dtosach suíonna - Commencement Matters
Mental Health Services
9:30 am
Tim Lombard (Fine Gael)
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The Minister of State is more than welcome to the Chamber. I want to put on the record my correspondence in the past 24 hours from the Minister of State, Deputy Mary Butler, who contacted my office. She said she is taking questions in the Dáil today and is unavailable to attend this debate. I acknowledge that.
This is a very serious issue. I ask for an update on child and adolescent mental health services, CAMHS, in the Cork-Kerry region, community healthcare organisation, CHO, 4. The CAMHS issue in Cork and Kerry is beyond belief. The need in the community is frightening in many ways. Parents, teenagers and children have come to my office weekly to ask for an update on when they can get appointments.
When I began researching the current waiting lists in CAMHS in the Cork-Kerry region, it frightened me. There are 888 children looking for services in the region. That comprises approximately 20% of the entire national profile. Over one year, 343 children and teenagers, or 50% of the entire national waiting list, is in the Cork Kerry region. That is unbelievable. In the north Dublin city area, nobody is waiting. It is frightening that Cork-Kerry has a waiting list of 50%, but in one part of Dublin there is nobody waiting.
Politics is one thing. These are people who are under enormous stress and pressure. A lady came to me a few weeks ago to tell me her daughter has not gone to school this year. She is waiting for an appointment. She is on a long-term waiting list and is considered to be a priority. She is in second year. I am pulling my hair out to see what we can do for the family. Other families have been through bereavement, eating disorders and depression. It is the tip of an unfortunate iceberg. If people do not get interaction at this stage, unfortunately the trouble only builds and goes further. I am deeply concerned about this waiting list. For one region to have over 50% of the long-term waiting list creates a major problem for me.
The Mental Health Commission published a report which stated that roughly 431 extra posts are required to cover the service nationally. The issue in the Cork-Kerry region needs to be examined. We need to have a serious look at our staffing resources nationally. Is it now time to start redeploying personnel? There are ten CAMHS teams in Cork, not all of which are fully staffed. There is a serious lack of personnel to deliver services on the ground.
The Minister of State, Deputy Butler, is very concerned about this issue. I hope to meet her in two weeks' time to see whether we can get a plan in place to deal with this issue. I have no issue with Dublin having nobody waiting more than 52 weeks. However, 50% of the waiting list being in the Cork-Kerry region means there is a regional issue that needs to be addressed. I look forward to the Minister of State's response. We need to start a real debate. Staff need to be redeployed. There needs to be a completely different ethos nationally with regard to how we deal with the Cork and Kerry region. If there is not, this waiting list, in particular for those waiting more than 52 weeks, will continue.
Martin Heydon (Kildare South, Fine Gael)
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I thank Senator Lombard. I know this is an issue that is particularly close to his heart which I have heard him raise and articulate on a number of occasions, particularly how much it impacts the Cork and Kerry area, the region he is from. It is timely that we get to discuss this here today and shine a light on it.
The programme for government commits to improving all aspects of CAMHS in line with Sharing the Vision, Connecting for Life and the annual HSE service plans. The total allocation for mental health services in 2023 is more than €1.2 billion, which includes €137 million for CAMHS. A key objective is to improve access and address CAMHS waiting lists in the 75 CAMHS teams nationally, including Cork and Kerry, in light of increasing demand and case complexity. A significant development was approval by the Minister of State, Deputy Butler, under budget 2023 for a new post of youth mental health lead at assistant national director level in the HSE, and a new clinical lead for youth mental health to provide more integrated services overall.
Approximately 2% of young people will require the specialist CAMHS service. Between 2020 and 2021, referral rates into CAMHS increased by 33%, while the number of new cases seen has increased by 21% in that same period. Waiting lists vary across community healthcare organisation, CHO, areas, as the Senator acknowledged. While some areas have relatively short waiting lists, regrettably, waiting times are longer in other CHOs. The HSE is actively working to reduce the CAMHS waiting list and there are a number of service improvement initiatives taking place as a result of the Maskey report and the Mental Health Commission interim reports. The HSE funds a wide range of agencies, such as Jigsaw, that provide prevention or early intervention mental health supports to young people.
In collaboration with local CAMHS services, a waiting list initiative is under way in six CHO areas, including CHO 4, specifically targeting those waiting longer than nine months. CAMHS community services in Cork Kerry Community Healthcare are delivered across ten community sector teams and also a child and adolescent regional eating disorder services, CAREDS, team. In addition, Cork Kerry Community Healthcare provide a CAMHS liaison service at Cork University Hospital and the Mercy Hospital.
There has been a recent significant increase in the number of new referrals to CAMHS in this area. In September 2022, CAMHS received 219 new referrals in the month. In March 2023, this figure had increased to 267 new referrals. This has had an impact on the number of children waiting for services. As per March 2023 data, the total number of children waiting more than 12 months to be seen is 341.
The HSE is committed to improving access to all of its services. In this regard CAMHS teams in Cork Kerry Community Healthcare are taking a multifaceted approach to improving access to their services. An ADHD waiting list initiative has been approved for funding and, once operational, it is anticipated that the ADHD team will remove 120 children from the waiting list over six months. As the numbers waiting to access CAMHS in north Cork are particularly high, innovative telemedicine clinics are being developed for this area. Furthermore, additional consultant-led clinics are provided at weekends to support children and young people in north Cork to access assessment and supports.
I understand the human impact of this on these young adults, who need this support from the State, and on their families and the constituents the Senator deals with on a daily basis. I want to reassure the Senator and the families that the Government is aware of this issue. These waiting lists are not acceptable and we are working across agencies to bring all the different groups together that can impact this to make that change and to make significant progress on those unacceptable waiting lists.
Tim Lombard (Fine Gael)
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I thank the Minister of State. I want to home in on the data in regard to the 12-month waiting list. The Minister of State’s figures are from March 2023 and state that there were 341 children. My figures are from February 2023 and there were 343, so we have literally taken two children off that long-term waiting list in a month. I do not want to do the maths on this but if we are to continue to take just two per month off the long-term waiting list, I am already grey and I would be bald by the time this thing is over. We need to have a serious look at what needs to be done. I realise there are staffing issues. However, we can do it in other areas. If Dublin can be down to zero with regard to 12-month waiting lists, what is it doing that we are not doing? What can be taken from the Dublin experience, and in particular the north Dublin area, where no child is waiting more than 12 months while we have 341 children waiting? It is a frightening statistic.
It is not about politics. Deputy Mary Butler is a brilliant Minister of State and a lovely person. However, this is something that we have to look at. An initiative has to be put in place nationally. It has to involve everybody in the entire services because unless we get people into Cork and Kerry shortly, I do not know what will happen. This is as serious as it gets.
Martin Heydon (Kildare South, Fine Gael)
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The Senator is dead right. It is as serious as it gets. What the Senator outlined is not acceptable in terms of the progress, which is why a number of initiatives across our multifaceted approach are being set up, including the ADHD team I mentioned, which will hopefully take 120 off the waiting list in a six-month period, as well as a number of different initiatives. I appreciate how frustrating an experience it is for families whose children are waiting to receive a service. I assure the House the Government remains committed to the development of all aspects of mental health services nationally, including those for children and young people. The Minister of State, Deputy Butler, recently completed a series of three high-level round-table discussions, bringing together the Department of Health, the HSE and other key stakeholders across the youth mental health area to drive improvements in CAMHS, with a focus on executive leadership, clinical expertise and service provision. The Government is awaiting the outcomes of all audits under way on CAMHS nationally, including the final report of the independent review by the Mental Health Commission currently under way across all 73 CAMHS's teams nationally. This will help to inform any next steps necessary regarding CAMHS.
I take the Senator’s point on board. Good practice has made serious inroads into waiting lists. We need to take that good practice and make sure it is implemented in Cork and Kerry. I thank Senator Lombard for raising this very important issue today.