Dáil Éireann Debate, Thursday - 1 June 2023
5. Deputy Mark Ward asked the Minister for Health if he plans to reduce the number of child and adolescent mental health service, CAMHS, teams from more than 70 to 50, as suggested by the chief executive officer of the Health Service Executive at a meeting of the Oireachtas Joint Committee on Health on the 24 May 2023; if he can guarantee this will lead to better outcomes for young people; and if he will make a statement on the matter. [26974/23]
Amharc ar fhreagraDuring the meeting of the Oireachtas Joint Committee on Health of 24 May, Mr. Bernard Gloster, CEO of the HSE, stated in reply to me that the HSE had "a serious question to ask as to whether we continue to maintain more than 70 partially staffed [CAMHS] teams or reduce them to 55 or 50 full teams". Are there plans to reduce the number of child and adolescent mental health service teams from 75 to 50? What discussions has the Department had on the matter?
I recently completed a series of high-level round-table discussions bringing together the Department of Health, the HSE and the College of Psychiatrists of Ireland in the first instance. The second meeting included representatives of all the NGOs that provide supports in the community, while the third related to the National Educational Psychological Service, NEPS, primary care psychology, disability and CAMHS. A lot of it involved brainstorming to see what we could do to improve access to CAMHS and to see how we could build capacity into it.
One issue we discussed concerned the fact there are currently 75 CAMHS teams in the country and we await the outcome of the Mental Health Commission review and the results of the HSE independent audit into CAMHS teams. While we were discussing that, much of the discussion related to whether we would be better off having a hub-and-spoke model in some areas, especially rural ones, and reducing the number of teams to perhaps 50 or 55 in a scenario where they were fully staffed and funded and able to offer the supports families want. We discussed whether it would be better to ask a family to travel an additional 20 or 30 minutes to be assured the supports they needed would be available to them. A total of 40% of referrals to CAMHS are ADHD related and the majority of teams are well equipped to deal with that, but in the case of young people and adolescents presenting with extreme eating disorders or suicide ideation, self-harm, depression or anxiety, we are very conscious we have seen 31% more referrals to CAMHS teams in recent years.
As I said on the floor of the House last week, I am going to hold a meeting with the Deputy and others to discuss what we can do and what the best plan is. At the moment, we are at the talking stage.
I accept that, but we are getting mixed messages. For example, when Mr. Gloster said what he said at the health committee meeting, that was the first I had heard of it, although I had heard inklings on the grapevine. The Minister of State now indicated that the number of CAMHS teams might be reduced from 74 and that parents might be asked to drive a little further to get a full service but I got a response from the HSE yesterday stating there were no active plans to reduce the number of CAMHS teams nationally. Mixed messages are at play.
Are the HSE and the Department on the same page on this? Parents have a right to know exactly what is happening. If the hub-and-spoke model works, the Minister of State will get my full support on it. Parents want to see better mental health outcomes for children who have to attend CAMHS. I will touch on the increase in the number of referrals to CAMHS in my follow-up response. I know that has an impact on waiting times for CAMHS as well.
There have been discussions generally over recent times with a view to possibly refocusing CAMHS teams, not least given the staffing difficulties, although the HSE has no plans at present to do this. A new assistant national director, AND, has accepted the post in the HSE and a new clinical lead has also accepted that post and will be in place shortly. I look forward to interacting with both the AND and the clinical lead in regard to which model they feel is in line with best practice. I want to ensure young people and adolescents who need the support of CAMHS in their community area will be able to access that support.
Currently, there are actually 75 teams, given a third team has gone into north Wexford, but when we get the audit and the review, we will hear that not all those teams are fully staffed. We are trying to see what will be the best way forward to ensure children can get the supports they need.
The Minister of State rightly mentioned the increase in the number of CAMHS referrals, which amounted to more than 300,000 in the past year, according to what she told me the previous time we spoke. I want to put on record the good work CAMHS staff are doing, despite the challenges, to provide all these appointments. Even so, the number of children who are awaiting their first appointment with CAMHS has doubled, to 4,500, and that is under the Minister of State's watch. CAMHS is only for children with acute and moderate mental health problems, but children with less acute mental health issues are not getting the primary care they need.
A separate response I received earlier indicated that more than 15,000 children are awaiting primary care psychology appointments, and more than 9,000 of these were on the list when the Minister of State came to office. That is an increase of 6,000. Further information I received from the HSE shows there is no additional funding for eating disorders or early-intervention psychosis. Does the Minister of State accept there is a direct connection between children not getting basic primary care and the increase in the number of referrals to CAMHS?
As the Deputy will be aware, in regard to the number of referrals relating to primary care psychology, progressing disability services, PDS, teams and CAMHS, getting 33% more referrals is massive for any system. I compliment all the teams on the ground because they saw 21% more children last year with the same levels of staffing and issued 225,000 appointments. CAMHS is there for children and young people with moderate to acute mental health needs and they need a primary diagnosis to avail of it. Some children will have a secondary diagnosis of autism, an intellectual disability or something else.
As for primary care psychology, we have been running over the past two years a targeted initiative to remove long waiters from the list, but for every child for whom we do that, two more present in their place. Their needs are more complex, so it is taking more time for them to come through the system.
