Seanad Éireann díospóireacht -
Wednesday, 5 Mar 2014

Adjournment Matters

Mental Health Services Provision

Senator Mary Moran

I thank the Minister of State, Deputy Kathleen Lynch, for taking this Adjournment matter. Previously, I have raised the issue of the lack of a child psychiatrist for children with an intellectual disability in the mental health services in County Louth. I have been perturbed lately to find that there is no child psychiatrist. I was in touch with the HSE and I was informed that interviews have taken place for the position, but the executive has been unable to fill the post. I find it baffling and concerning that there is no child psychiatrist for children with an intellectual disability for the entire area.

Recently, I worked on the case of a constituent who had a child in need of such services, as are many other children according to reports from the disability services in Dundalk. They have several children in need of these services, but they have been unable to provide them. More concerning was the fact that as the child in question was 16 years of age, paediatric services refused to consider him. Child and adolescent mental health services, CAMHS, have refused to consider him since he is over 16 years of age. They have also said they do not have a child psychiatrist to deal with intellectual disability issues. When the child was brought to the general practitioner, the parents were told that the doctor could provide sedation. I find it concerning - this ties into the second part of the Adjournment matter I have tabled - that there are no services, there appears to be no services or else there is a difficulty in getting services for children with an intellectual disability, especially in this age group.

The more I examine the matter, the more it appears that one Department is saying that people should go somewhere else and that it is not its responsibility. It is as if a magic switch comes on when children reach the age of 16 years. Exemptions and certain circumstances should be taken into consideration when children approach this magic age of 16 years. I had heard and read about this milestone but where are these children to go? We cannot turn around to parents and say we are sorry but that they should take their children home and do nothing. What if there are other family members or other people who need to be taken into consideration? It is important that the services are provided.

Having said that, I realise that disability services in the area are good and seem to be providing support for the people who need them. I have never heard anything but praise for the people who work there. However, this issue needs to be examined as a matter of urgency for the many parents who do not have a voice or a place where they can raise the issue. I am raising the issue with the Minister of State tonight in the hope she can do something for them.

When parliamentary questions are tabled Deputies get the same answer all the time to the effect that it is a matter for the HSE or that the Minister will refer the matter to the HSE. I spoke to the disability officer last week and was told there was nothing the executive could do. To me, that is not an answer. We cannot simply sit back and say there is nothing we can do about it and decide that is it until it comes knocking on our door. I hope the Minister of State will give me some positive news.

Minister of State at the Department of Health (Deputy Kathleen Lynch)

Before I give the Senator the official reply, I emphasise that we have got money for the past two years and that a further €20 million has been allocated this year for additional development funding for mental health. I discussed the matter with some people in advance of the allocation this year. The two areas where we knew we needed to work on this year with the additional money were the areas of old age psychiatry and intellectual disability. This is because if children or young adults have an intellectual disability it does not protect them from difficulties with mental health. Sometimes there is a crossover and we need a specialised area to deal with the matter.

I thank the Senator for raising this topic. The Government has prioritised reform of mental health services in line with A Vision for Change and it is committed in particular to the delivery of more and better quality care in the community. This includes enhancing and streamlining, as appropriate, service interactions for under 18s between the mainstream mental health and disability care programmes.

Total HSE mental health funding in 2014 is in the region of €765 million but that does not include the development money. This reflects the additional funding of €90 million, together with approximately 1,100 new posts provided in the past three years to modernise services. Primarily, the modernisation has focused on the following: strengthening community mental health teams for adults and children; enhancing specialist community mental health services for older people with a mental illness, including services for those with an intellectual disability and mental illness; and upgrading forensic mental health services in line with A Vision for Change.

The Senator raised another important point. We have held discussions with CAMHS for the past two years in respect of children between the ages of 16 and 18 years. We cannot possibly say to people, whether they have a disability or otherwise, that somehow or other they do not exist because they happen to be in that age bracket. I have been assured that this age cohort is now going up to 17 years with a view to it going up to 18 years in subsequent years on the back of the additional resources we have provided.

The recent establishment of a new mental health management structure within the HSE has been designed to bring greater clarity to services, including multidisciplinary care at national and local levels.

We have given greater recognition to the fact that child and adolescent mental health services, in both policy and practical terms, will inevitably have a role in some cases, at least in cases of difficult diagnoses, and in terms of specialist episodic treatment of acute mental disorders. This is a specific implementation requirement of A Vision for Change.

In regard to the issue raised by the Senator, the HSE has indicated that until last year, there was no dedicated service available in County Louth in mental health for either adults or children with mental health issues and an intellectual disability. Notwithstanding the lack of services available locally, there were nonetheless some supports from child and adolescent mental health services, and as the Senator rightly pointed out, voluntary organisations and disability services have been doing their best. These, in turn, were supported by a consultant psychiatrist providing two sessions per week. That is clearly not enough.

In terms of new service development posts approved for 2013, two teams, each led by a consultant psychiatrist were approved for the north east for adults and this service is currently being established. The recruitment process to fill these posts is progressing. In addition, the local HSE is exploring the question of appointing a CAMHS consultant with a special interest in intellectual disability for children. This proposal is at a very early stage and the Department of Health has asked to be kept informed of developments on this matter. The HSE national service plan for 2014, including associated operational plans for regional and local services, commits to a number of key deliverables for this year. As I have indicated on many occasions, early, appropriate and effective intervention is key, coupled with a strong recovery-based approach for young people with mental health issues.

By raising this issue tonight, the Senator will again put the focus back on that service. We must ensure that when an adult with an intellectual disability has a difficulty with mental health, there is a service available to him or her. I will take up this matter with the director as appointed.

Senator Mary Moran

I have the height of respect for the work that the Minister of State has been doing. However, I can only be honest and say I am completely disappointed with this response. Saying progression is at an early stage is fine, but how long more will that take for the 16 year old child? The psychiatrist who was there retired one year ago. He was an adult psychiatrist who kindly took an issue and dealt with disability services for children. I was told last Friday, following the report back from CAMHS, that there was nothing that could be done for that child because he was 16 years old. It is like a magic number and services are cut off after that age. The more I delve into it, the more parents and children I have seen. There was a dreadful case before Christmas and we cannot afford to let this go. The centre for excellence is in Drogheda in County Louth. A new mental health unit will open up in Our Lady of Lourdes Hospital, which is brilliant, but something has to be done. I plead with the Minister of State tonight to take on board all the children with an intellectual disability, no matter what age they are. This is such a serious matter. I have the height of respect for the work done by the Minister of State, but I will be back and will keep pushing this issue.

Deputy Kathleen Lynch

We cannot allow that gap to remain. I will be pursuing this issue and appreciate the Senator raising it. It gives me the insight in a small area with very few people but who nonetheless are important to us. I will be raising the issue with those responsible.

Senator Mary Moran

I cannot get an answer as to how many child psychiatrists there are. If the Minister of State could get that answer, I would appreciate it.

Human Rights Issues

Senator Denis O'Donovan

A number of people and organisations have been on to me about the persecution of Christians throughout the world. In Ireland, it is often said this is not a tolerant society, but, by and large, we respect the constitutional right of people to practise their religion. In countries such as Syria, Iran, Iraq and Turkey and many parts of Africa that are predominantly Muslim, with which I do not have a problem, the persecution of Christians is a huge issue. I am not talking about the Catholic ideology. It could be Protestant, Methodist, Presbyterian and other denominations of Christianity where Christ is the centre of their adoration and adulation.

It particularly bothers me that recently in Syria, a bishop from a Christian minority was taken out and shot. In Turkey which is primarily an Islamic country - that is fair enough, that is their view - their tolerance for Christianity and Christian churches is seriously absurd. Nonetheless, there is a huge lobby, led particularly by the Americans, that Turkey should join Europe as an extension of the European Union. While this Christian persecution goes on, we should have grave reservations. Organisations such as Church in Chains and others have raised this issue. They have met the Turkish ambassador to Ireland and tried to explain it to him. Turkey is a Muslim country with about 80 million people. I remember being at a diplomatic conference in which the Americans wanted Turkey to join the European Union. Is that because it is a useful centre between Iran, Iraq, the Middle East and the Far East in which the Americans can have a European base?

If it happened in this country that a Muslim or any other minority religion was being abused, there would be great controversy. I am not in any way a holy Joe, but in many countries across the world, including in Africa, Asia and in places such as Syria, Iran, Iraq and Turkey, there is ongoing persecution of Christians. People who purport to be of a Christian denomination and who support the view that Christ was a saviour on Earth will be crucified, to use the pun.

With St. Patrick's Day coming up, we should be sending the message around the world that in Ireland, the freedom to practise religion is the norm and that other countries should respect our views also.

Deputy Kathleen Lynch

I thank the Senator for raising this issue, which I am taking on behalf of the Minister of State, Deputy Paschal Donohoe.

I could not agree more with the Senator. Intolerance has probably caused more wars than anything else in the world. I thank him for taking the time to consider this issue which has become more pressing in recent years.

The Middle East is home to some of the world's most ancient Christian denominations. It is not the case that Christians in Syria, Iran or Iraq are generally unable to practise their faith. In fact, all three countries have traditionally been noted for an officially tolerant approach. Regrettably, however, there has been a significant reduction in the numbers of Christians in the region in recent years, as the political turmoil across much of the Middle East has heightened concerns about the safety of Christians across the region. The descent of Syria into violence and disarray has left small Christian communities very exposed and sometimes subject to direct attack.

Recent threats by a radical jihadist group to force Christians in the city of Raqqa in Syria either to convert to Islam, pay a tax or face death are nothing less than abhorrent. Similarly, the attacks by the Assad regime on Christian communities and churches in opposition-held areas expose the false claims of the regime to be protecting the rights of minorities.

In Iraq, as in Syria, small Christian communities scattered among larger Sunni or Shia Muslim populations were especially vulnerable during bitter sectarian violence between those populations between 2006 and 2009 and up to half of the Christian community are estimated to have emigrated in that period. Violence in Iraq has significantly reduced since, although it is unfortunately very much on the increase, and the ability of the Iraqi Government to protect all of its citizens remains a major concern.

In Iran the ancient Christian communities long established in the country, the largest of which is the Armenian Church, are able to practice their faith, maintain churches and have small reserved representation in Parliament, although there are also many areas of national life reserved for Muslims. There is a less tolerant attitude to more recently arrived evangelical forms of Christianity.

While some Christians from the Middle East have found refuge in Ireland, asylum in Ireland or Europe is not a solution to this problem because the numbers are too great and there are others also at risk and because it would spell the end for ancient Christian communities which have survived in the region since the earliest days of Christianity.

The protection of fundamental rights for all communities, particularly now in Syria but also across the wider Middle East, including Christian communities, many of which are faced with rising intolerance and threats, is integral to Ireland's engagement with these countries and societies. Ireland raises the issue of the safety of Christians through its official bilateral contacts with the countries in question, stressing the responsibility of the government to protect all minorities.

The Tánaiste has raised the protection of Middle Eastern Christian communities at meetings of the EU Foreign Affairs Council, where Ireland has argued for stronger references to pressure on minority communities, as well as in his bilateral meetings with representatives of Middle Eastern states. Officials from the Department of Foreign Affairs and Trade have frequently met local Christian leaders from the Middle East region and discussed the issues affecting their communities. Many of these groups have requested that efforts made on their behalf be carried out discreetly as any special attention from western countries might increase their difficulties. This is why EU and Irish interventions are often framed in general terms of minority rights, or freedom of religion.

On the broader international plane, Ireland has worked at UN and EU level to promote resolutions and actions on the principle of freedom of religious belief, notably during our 2013 EU Presidency and now in our membership of the UN Human Rights Council in Geneva. The Government remains committed to this important issue.

Senator Denis O'Donovan

I thank the Minister of State for her encouraging response. I ask her to convey to the Tánaiste my view that we should redouble our efforts to preserve human dignity and something we accept generally in the Constitution. The religion that seems most at risk worldwide is Christianity, which is unfortunate. Ireland is tolerant of most religions and while we have had our faults and failings, we should be cognisant that there is an effort in many Middle Eastern countries, Africa and elsewhere to diminish the Christianity with which we are associated. Even China has 5 million or 6 million Christians who are allowed to practise - which is more than the number of practising Christians in Ireland. We are swimming against the tide as Christians. I thank the Minister of State for her response and ask her to ask the Tánaiste to redouble his efforts to keep the issue to the fore.

Deputy Kathleen Lynch

I believe he will do so because he is very conscious of the issue. However, it needs to be framed in the context of freedom of expression and freedom to practise one's religion. I am very conscious that the Christian leaders who are met at private meetings are anxious that efforts made on their behalf be made discreetly. We can only imagine the pressure they are under and the fear in which they live on a daily basis. We need to be conscious of their fears. I will convey the Senator's sentiments to the Tánaiste.

The Seanad adjourned at 7.55 p.m. until 10.30 a.m. on Thursday, 6 March 2014.