Wednesday, 13 March 2019

Questions (14)

Oral answers (10 contributions) (Question to Health)

Question No. 14 will be taken by Deputy Quinlivan on behalf of Deputy O'Reilly.

Louise O'Reilly


14. Deputy Louise O'Reilly asked the Minister for Health the staffing levels for CAMHS teams, by community healthcare organisation, CHO, and local health office, LHO; the way in which this compares with the necessary full complement of staff as outlined in A Vision for Change; the number of vacant posts in whole-time equivalent terms in CAMHS, by specialty, by CHO and LHO; and if he will make a statement on the matter. [12175/19]

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Will the Minister of State provide the staffing levels for CAMHS teams, by CHO and LHO? How do the levels compare with the targets set out in A Vision for Change? In whole-time equivalent terms, what is the number of vacant posts in CAMHS, by specialty, by CHO and LHO?

The Government is strongly committed to developing all aspects of HSE mental health services, including CAMHS, as envisaged in A Vision for Change. Significant progress has been made in recent years, underpinned by additional funding since 2012 to develop mental health services overall, which was reflected by an additional €55 million in budget 2019.

Improvements to various aspects of CAMHS are delivered by the HSE under its agreed service plans.

CAMHS have standardised operational procedures to support timely access to services, which is based on professional clinical assessment to address the mental health needs of all children presenting to this specialist service. Despite increasing demands overall on CAMHS, individual cases that are assessed as urgent receive priority, irrespective of the source of referrals.

At present, there is an acknowledged shortage of consultant psychiatrists and allied mental health professionals, including CAMHS. This, rather than funding availability, is the main difficulty facing the HSE, but steady progress has been made in recent years in filling the type of posts needed to modernise the service. There are approximately 600 whole-time equivalent posts approved for CAMHS.

In January 2019, there were a total of 222 CAMHS posts with the HSE national recruitment service at various stages of recruitment. The latest available data from the HSE personnel census indicate that consultant posts have increased nationally by approximately 14 in the past year.

In conjunction with the Department of Health and the HSE, I am progressing various initiatives to enhance CAMHS by alleviating pressures on the specialist CAMHS service. These include maximising the impact of primary care assistant psychologists recruited in 2018 to relieve pressures on CAMHS, the roll-out by the HSE of various e-mental health pilot projects; additional mental health nurse training places coming on stream to help fill existing vacancies, and a review of CAMHS under the refresh of A Vision for Change.

There is also regular monitoring of CAMHS activity and staffing data. In addition, I have held meetings with, and recently sought further information from, the chief officers and executive clinical directors of the community healthcare organisations of the HSE, specifically on CAMHS vacancies. I have received more detailed information from the HSE in respect of this question, which I will furnish directly to the Deputy.

CAMHS are in utter disarray. At the end of 2018, approximately 2,560 children and young adults were on the CAMHS waiting list and almost 300 of them had waited for more than a year to be seen. In my CHO area, which includes Limerick, approximately 245 children and young people are on waiting lists for assessments, while 60 of them have waited for more than a year. As the Minister of State will know, early intervention is crucial but early intervention in mental health cases is not possible when there are extensive waiting lists and a sheer lack of capacity within the system. Children and young adults desperately in need of care and help, who are reaching out for same, are not receiving in a timely manner the appropriate support they need.

The current situation is totally unacceptable. We cannot approach every year in the same vein by paying lip service to mental health services rather than properly funding them or, more crucially, staffing them properly. Will the Minister of State commit to tackling the issue and providing the funding and staffing for CAMHS teams to meet at least the target set out in A Vision for Change?

The funding for all CAMHS teams is available and, therefore, it is not an issue of funding where there are gaps. I strongly disagree with the Deputy's description of the CAMHS system as being in disarray.

That is very disrespectful to those who work in it, those who avail of its services and those we are encouraging to reach out and avail of the system. It is not helpful for someone to make such a statement.

The Deputy referred to 300 people waiting for more than a year to access CAMHS. There are a number of reasons for those 300 people waiting for more than a year. Most of them relate to issues-----

There are not enough staff.

I ask the Deputy to let me finish; this is a two-way thing as far as I know.

Allow the Minister of State to speak.

Much of it relates to people being inappropriately referred. If someone who is acutely sick and is referred to a CAMHS team, no psychiatrist will say they must wait 12 months. They will see people who are seriously ill. Some people with lower levels of illness are left waiting longer. There are gaps in the system and areas where we fail to recruit consultants for myriad different reasons. It goes across all disciplines in health. It is a worldwide issue. I agree with the Deputy that we need a lower level of intervention.

An independent evaluation done by the University of Limerick projects a reduction of 1,350 in the waiting list for primary care psychology as a direct result of the actions I took last year to recruit 114 assistant psychologists, 20 psychologists and ten advanced nurse practitioners, ANPs, into community primary care specifically for younger people. That is the future of CAMHS. We will solve the issue relating to CAMHS by reducing the number of people going up to it. That is a proactive approach that is working.

Deputy James Browne is not here.

Question No. 15 replied to with Written Answers.