Barry Ward (Fine Gael)
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I raise the issue of medication for ADHD. ADHD is a condition that is real. It is not something that does not exist, although I think there is a traditional view that it is just badly behaved kids and they will grow out of it. We know now that is not true and that it is something that is identifiable. It is a chemical imbalance that can be dealt with by medication. The importance of having that medication for children with ADHD, and indeed adults with ADHD, cannot be overstated. When ADHD and a whole other range of similar conditions go untreated, those who suffer from the condition are left behind. If they are children, they get left out of education or they certainly do not benefit to the fullest extent from education. They get left behind and excluded. The treatment for these conditions is, therefore, extremely important.

Currently, medication like Ritalin, which covers ADHD, is provided for under the long-term illness scheme by the Department of Health. Parents with children who have ADHD can avail of that scheme and they receive that medication for free. I am told it costs about €50 a week. Obviously, the cost depends on the medication, the dose, etc., but that is the level we are talking about. However, for some reason that is either inexplicable or, if the reason I have been given is correct, outdated, that cover stops at 16 years. Where a child with ADHD is going into leaving certificate at 17 or 18 years, it is one thing if his or her parents can continue to pay for the medication but there are many kids whose parents cannot pay for it. A situation could arise where a child is doing fine in school, working away, benefiting from a medication that is keeping the condition in check, functioning within the educational system and availing of all the opportunities that normally come the way of every child, but for some reason the Department has decided that at 16 years, there is a barrier and once the child has crossed that line, it no longer accepts responsibility for providing that treatment as part of the long-term illness scheme. That is a real mistake and missed opportunity by the Department.

This applies not just ADHD. There is a whole spectrum, if I can use that term, of conditions that are covered by the long-term illness scheme only up to 16 years. This is an important scheme, which provides for people who, through no fault of their, own have conditions that endure throughout their lives. For some reason, in the case of ADHD, the coverage the State gives to parents of children who suffer from the condition stops at 16 years. That is a mistake.

As we head into the budget next week, I ask that the Department of Health reconsider its position on this issue. That is not a huge financial ask or an unreasonable ask. More important, I do not think proper consideration has been given to the effects of not providing these medications to those over 16 years on children aged 17 and 18 years, as well as young adults in their 20s who suffer from ADHD. Why on earth should they be disadvantaged or excluded? Let us be reasonable about this when we know that it is a life-long condition, the same as diabetes, which is covered by the scheme, or COPD and other conditions for which medications are provided throughout the person’s life. It seems there is a misguided view within the Department. Whether that is the case or not, I do not know but the evidence suggests that people think kids grow out of ADHD. They do not. It is a life-long condition. Let us recognise that and the expense burden placed on those people throughout their lives by compensating them for the medication they require throughout their lives.

Mary Butler (Waterford, Fianna Fail)
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I thank Senator Ward for raising this important issue. The answer I have was prepared by the Office of the Minister for Health, Deputy Donnelly, but ADHD comes under my remit, as Minister of State with responsibility for mental health. Therefore, I will deal with it in two separate ways. I will speak first to the long-term illness scheme. Established in the 1970s, the scheme provides for the supply without charge of medicines and medical appliances to persons suffering from any of 16 prescribed conditions, including mental illness in a person under 16 years. That is the point the Senator raised and it is a fair one.

While there are no plans to extend the scope of this scheme, it is important to reflect that the long-term illness scheme exists within a wider eligibility framework. This Government has put a significant focus on improving access to and the affordability of healthcare services, advancing substantial policy, legislation and investment to deliver expanded eligibility and services in line with Sláintecare. Among these are the removal of public inpatient charges in public hospitals. We have also focused on reducing costs in primary care and have delivered one of the largest expansions of free GP care. The two GP access measures provide eligibility for approximately 500,000 additional people. Some 52% of people in the country have either a medical card or a doctor-only card.

People who cannot, without undue hardship, arrange for the provision of medical services for themselves and their dependants may be eligible for a medical card. The HSE may exercise discretion and grant a medical card, even though an applicant exceeds the income guidelines.We know that can be very difficult. We all know that from dealing with it in our constituency offices. Of course, the drug payment scheme threshold now stands at €80 per month. All of these measures work.

The point the Senator raises is very fair. I say that because 40% of all children who attend CAMHS have an ADHD diagnosis. I know that from speaking to the consultants and from the review of the audits we did over the last couple of years. We have 1.2 million children in the country aged under 18. Approximately 2.5% of those children attend CAMHS and, of those, 40% have ADHD. The medicines used in the treatment of ADHD are available under the long-term illness scheme and are also available to medical card holders and those eligible for the drugs payment scheme, subject to the payment of the statutory charge.

Attention deficit hyperactivity disorder has long been recognised as one of the most common psychiatric disorders in children and it is now known to persist into adulthood. When I came into this role, I discovered very quickly that there were no supports for adults with ADHD. I launched a clinical programme in 2021 which is really important. To date, starting from nowhere, we now have seven teams funded. Five are in place and two will be operational by the end of this year. Five more teams will roll out the full clinical programme across the country. I am hoping to do more in next year's budget and two more years will conclude it. It is really important that we do that.

Working with ADHD Ireland I secured recurrent funding for the understanding and management of adult ADHD programme called UMAAP. It is a six-week programme run by ADHD Ireland which has proven highly beneficial and effective for adults who have completed it. Before I leave this role, whenever that may be, I wanted to make sure that the funding for that was recurring. It will be available every year. The funding was stopped earlier this year but I reinstated it.

The Senator's point about those young people who are 17 or 18, who may be in college before they start working their way through life, is very valid and I will consider it further.

Barry Ward (Fine Gael)
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I appreciate the Minister of State's bona fides on this and welcome the fact that she is telling us about expanded services for ADHD sufferers. I particularly welcome her acknowledgement of those in the 16 to 18 age cohort. They are still children. Many of them are still in school while some of them are going to college and it is really important to support them. I hope she will do that. This was brought to my attention by a young councillor in my area, Councillor Dan Carson, who is newly-elected in Blackrock, and by Ms Emma Weld-Moore who heads up Neurodiversity Blackrock which is part of Neurodiversity Ireland, an organisation that does so much good work for children, young people and adults afflicted by a condition that is treatable. The Minister of State has acknowledged that and I appreciate what she has said. Maybe we could bring this in on a means-tested basis or just for that 16 to 18 cohort. Let us do that first and then expand it because it is entirely worthwhile from the point of view of the State and wider society, but particularly for the people who benefit from it. It is entirely worthwhile to put this in place so that we do not lose out and they do not lose out. They have so much to give and we are just disadvantaging them and losing out as a country.

Mary Butler (Waterford, Fianna Fail)
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To conclude, I do not have a medical background myself but one thing I have learned from speaking to clinicians is that 40% of young people who are in CAMHS have ADHD. Their condition can be dealt with very well with medication. Once they get that diagnosis and they are put on the correct medication in the correct dosage, they can do extremely well. The situation we had was that when they turned 18 there were no follow-on supports but we are rectifying that. I take on board the point the Senator has made about the 17 to 18 year old cohort for whom it can be very difficult but as I understand it, a lot of them may be eligible under the medical card scheme. I will certainly consider this further, specifically in relation to ADHD. We have made great progress in the last few years on the clinical programme. We now have a model of care for ADHD that we did not have previously. We need to support the 16 to 18 year olds. I would hate to think that any person who needed medication but could not afford it would be left without it. I thank the Senator for raising a really important issue.