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Mental Health Services

Dáil Éireann Debate, Tuesday - 15 February 2022

Tuesday, 15 February 2022

Questions (66)

Joe Flaherty


66. Deputy Joe Flaherty asked the Minister for Health the number of children waiting for a child and adolescent mental health service, CAMHS, appointment in the Longford-Westmeath local health office area; the number of these children who are also on a waiting list for a primary care psychology appointment; if he plans to audit, review or reform CAMHS in the area in the wake of recent issues; and if he will make a statement on the matter. [7875/22]

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Oral answers (9 contributions) (Question to Health)

We will all have to be here if the Minister is going to come in and announce the new facility will be on the south side of Cork. There will be some fun that day.

My question for the Minister of State, Deputy Butler, is whether she can identify the number of children waiting for a CAMHS appointment in the Longford-Westmeath local health office area, the number of these children who are also on a waiting list for a primary care psychology appointment and if there is an audit, review or reform planned of the CAMHS service in the Longford-Westmeath area in the wake of recent issues.

I thank the Deputy for his question. The HSE confirmed that as of 2 February, the latest available data show there were 23 children on the Longford-north Westmeath CAMHS waiting list and 14 on the south Westmeath list. The primary care psychology service does not cross-check its waiting lists with CAMHS or other services to see whether children are on more than one list. It is my understanding, however, that there are children on both waiting lists. All children are accepted or not accepted to primary care psychology services based on their clinical presentation and the appropriateness of primary care psychology to meet those clinical needs. Just before Christmas, I allocated €4 million for an initiative to reduce the number of children and young people under 18 years of age who have been waiting more than 12 months for a primary care psychology appointment. I am delighted that we were able to reduce the list by more than 1,600 young people in that time. Further investment of approximately €1.4 million for quarter 1 has been secured to support that ongoing initiative.

All 73 CAMHS teams throughout the country will be audited. There is a three-pronged approach from the HSE, with the first part consisting of a full nationwide audit of compliance with existing CAMHS operational guidelines, structures, processes, teams composition, skills mix and standard operating procedures. The second component will involve qualitative research to identify the experiences of children, and their families, who use CAMHS. All three components are important but I consider the third to be particularly so. It will involve an independently led audit conducted across all CAMHS teams, to include a random selection of files proportionate to the medical caseload from a continuous six-month, predefined time period in 2021. Coupled with that, the Mental Health Commission, representatives of which I met with yesterday, is conducting its own review.

I am heartened by the Minister of State's response and I pay tribute to her efforts in this area. Since taking office, she has been very passionate about her work and a great support to me and many colleagues. She and her officials have liaised with me on a number of difficult cases and I thank her for that.

In regard to the audit, will she give some indication as to a timeline for when we might see it unfold? Will it be done in every CAMHS area at the same time or area by area? The third point of the review relates to medication. The Minister of State noted that only some files would be randomly selected. Overprescription of medication and, in some cases, over-reliance on medication are a huge issue for many parents. I would like to hear more detail on that aspect. Another point that needs to be addressed is the deficiency in staffing and the difficulty in recruiting staff right across CAMHS. I heard the Minister of State respond to a Deputy from Kerry on that point earlier. It is something about which I have a concern and I would like her to elaborate on it.

Provisional figures indicate that, for 2021, referrals received were up by 5,171 on the previous year. In total, 22,600 children were referred. There are now 73 CAMHS teams, compared with 49 in 2008, and we have three paediatric liaison teams as well. There are more than 1,000 CAMHS staff, including 660 clinicians, and 93% of consultant psychiatrist posts are filled. Last year, with the money I secured in the budget, we recruited 53 more clinical staff into CAMHS teams all over the country.

The Mental Health Commission is hoping to start its review in two weeks. It has secured two consultant psychiatrists, one from Scotland and the other from Ireland, to ensure it is independent. The HSE audits will start in this quarter. There is quite a lot of work to put in place, which I will explain if there is time.

I thank the Minister of State for her detailed response. I ask her to home in, in her final response, on the specifics of the over-reliance on medication and parents' concerns in this regard. Following what has emerged in recent weeks and months, the entire CAMHS process has been discredited to some extent. It is important and reassuring for the public to see she has come out strongly on this issue and has detailed plans in place and a commitment and resolve to put this issue right. Parents are worried and I am deeply concerned that it will put many young people and parents off engaging with the service. I ask her to expand on the medication aspect in the short time that remains.

To build confidence in the 73 CAMHS teams around the country, where a huge amount of really good work is done on a daily basis, I felt it was very important, with the support of the Minister, to initiate a sample random audit of children throughout the country who were being prescribed medications. Dr. Maskey looked at 1,300 files in Kerry and we discovered 1,000 files showing that 500 children were medicated without having any adverse reactions and another 500 were not medicated. We then discovered there were issues with the 227 remaining files. This look-back was initiated by way of a sample taken of 50 files that were randomly audited. That raised red flags straight away. We will adopt a similar structure throughout the 73 CAMHS teams across the country. I believe this template will work. If it is necessary then to do a look-back into a particular team, we certainly will do so.

There is no Deputy to put Question No. 67. Is Deputy Niamh Smyth here to put Question No. 68 on behalf of Deputy O'Dea?

That is fine. As there is no Deputy present to put Question No. 69, we will move on to Question No. 70.

Questions Nos. 67 to 69, inclusive, replied to with Written Answers.