Conor D McGuinness: Urges clarity on Waterford Jigsaw rollout

It's very welcome news that Jigsaw service will finally be rolled out in Waterford, and I want to commend Jigsaw for all that you've done, indeed all who have advocated for that service coming to the South East, something that I've highlighted, my colleague David Colnane has highlighted, many others, Corleone and Oog, Councillor Donna Kamal Cahy, the fact that the South East as a region was left without such a service for a long time, so it's very good, I understand that an appropriate premises has been identified and there's some work to do around getting that ready, so I hope that work continues apace. My question is around, it's twofold, one is around personnel to staff that service, has recruitment begun, what will the total complement be when the service is stood up, and the other part of the question is around what engagement has taken place with existing mental health service providers and advocacy organisations, I'm thinking of Laechus, West Waterford Mental Health Awareness and Reassure, and there are others in and around Waterford and the wider South East, what engagement has taken place, and what engagement has taken place with the local CAM service, so that from the instant the service has stood up, there would be that good relationship in terms of referrals, in terms of maybe troubleshooting issues that might occur in individual cases. I'm happy to respond to that, thank you for the question. So as you said, at the moment the focus is really on securing the premises, obviously we've got plans in training in terms of recruitment of the team, we have some expressions of interest from within our existing network, people who are interested in a lateral move to a new service in Waterford, which would be amazing, because that will, I suppose people who already have experience working within Jigsaw, so I think the plan is, as soon as we have a little more clarity on our line of sight, on timeline around the premises, we're ready to press go with the recruitment campaign, and hopeful, as you say, as a population centre that we'll be successful in recruiting a full team that will cover Waterford, and as we've said, you know, also South Wexford and South Kilkenny, so it will give us that footprint in the South East that, as you've pointed out, has been long, long a gap in the Jigsaw map, so to speak. In terms of the engagement with the other services, again, that's very much the plan, that in advance of the doors opening on that service, so we've reached out to the local HSE contact, we're hoping to have a meeting very soon, and also have meetings with CAMS and AMS teams ahead of time, so that we're clear on our scope of practice, how we would like to work with them in an integrated way, and as my colleague Jason pointed out earlier on, we have some really good examples of where that integrated working has happened. We've done that ahead of time in other places, for example, such as Wicklow, where we've gone in before the doors are open at all to meet those other services, and, you know, work out some plans as to how we will continue to communicate, how best we might work together so that young people get a soft, easy point of access to the right service, and if they, for example, present to Jigsaw, and we believe their needs are different, or that another service is a better place to meet them, that we have that working relationship with those other services. In terms of the staff complement, I mean, it will mirror a number of our other Jigsaw services, in terms of local leads, we'll also have a member of administration staff, a youth and community engagement worker who will do a lot of the work that we've talked about in terms of working with parents, other adults, young people in the community settings, and then we will have a team of clinicians, and Jigsaw recruits and employs clinicians across a range of different disciplines, psychology, social work, occupational therapy, mental health nursing and psychotherapy are the disciplines that we recruit from, we operate in a transdisciplinary way, so the team will be made up of a combination of those different disciplines. Thank you for that, and just a follow-on question, and my colleague Senator Ryan mentioned it earlier, I live in the west of County Waterford, in Dungarvan, and I understand the outreach model that spun out has, what plans are in place at this stage to look at how that outreach might work in County Waterford and indeed in South Tipper area and South Wexford, and one of the striking things that occurs to me, there isn't, you mentioned I think earlier in response to another person's questions about engagement with family resource centres and the like, we don't have a family resource centre in the west of Waterford, it's a glaring, another glaring gap in service provision, of which there are many, so how do you see that working out, what would the nature of that service be, and how do you see it rolling out? Thank you. Yeah, so it is our intention to have an outreach presence in Dungarvan, and our plan would be to establish the service in Waterford City to start with, get the staff, get the team in, get the service up and running. I think as part of our engagement that we've already referred to with local services, we'd be keen to, I suppose, essentially put out the feelers to see what space might be available to us, you know, family resource centres are only one of the models that we've operated, we've also co-located with other community and voluntary organisations, potentially primary care settings, there are lots of avenues that we'll explore, we'll certainly be open to any local contacts that you or others might have that we could open conversations with, essentially what that looks like is our clinicians will travel a number of days a week to an outreach location and offer the appointments in person from there, so, you know, essentially access to a number of session rooms is what we need, but, you know, we'll explore any and all available opportunities in Dungarvan. That would be fantastic. I want to commend you and your team for all the work on this and getting it to the stage. I have a number of moments left and I just want to make a very short comment and put a question to families for reform of CAMHS and something that that you mentioned in your opening statement is the difficulty faced by by young people and their parents and accessing and even being seen on foot of a referral if the child is autistic or in some cases that I have encountered as in my constituency where a child isn't autistic or has no diagnosis of ASD but perhaps they have a sibling and maybe to the to the clinician or in some of the referral notes there's something that gives a clue that, you know, perhaps they might have a diagnosis at some point in the future and on that basis they refuse the referral. How common is that in your experience? And the second part of my question is with regard to the burden that this puts on parents and guardians and family members. I see it across the board whether it's in terms of physical health, whether it's in terms of family support, special education provision. The fact that parents and family members have to fight, have to advocate and have to become activists, have to become experts when really they should be nurturing and parenting their children rather than fighting the stage for service provision. That obviously comes at a cost, burnout, depression, mental health concerns of your own. What supports have you found in your experience are available or are there any supports for the parents and family members? Thank you. Yeah, thank you for your question. I think the issue around autistic children accessing CAMHS is one we highlighted a number of times and it continues to be a major concern of our group. I think 70% of our members said that having an autistic child impacted the supports they received or felt that they received. And, you know, we have families who are just telling us that, you know, they get into CAMHS and CAMHS says, we can't accept you, you need to go and get an assessment of need. That obviously takes a few years. They end up back in CAMHS and CAMHS turns them away and says they should go to disability services. And I think it's really, really important to remember that being autistic doesn't mean you inherently have a mental health issue. Mental health issues are separate and treatable. And we are very concerned that there is diagnostic overshadowing taking place. We welcomed in the revised CAMHS operational guidelines from December, we welcomed that there was an inclusion of groups who are particularly vulnerable for mental health issues and how they should be given special consideration. But very notable was the fact that autistic children were not included, despite the fact that 70% of autistic children will have a co-occurring psychiatric disorder and are much more likely to consider suicide. So we really, really, you know, we can't kind of emphasize this point enough. And I do think it was raised earlier that there is a need for neurodivergence training amongst CAMHS staff and tailored treatment for kids. In terms of the burden this places upon children, specifically for parents of autistic children, it places a burden, an extra burden of proof, trying to prove to CAMHS this isn't your child's normal behaviour, your child isn't inherently, you know, distressed that we need help. Like that's a huge burden to put on parents. But then more generally for all parents of kids, like we've spoken to so many parents and it's obviously having a child experiencing difficulties in itself distressing, but the bit that wears you down and the bit that burns you out is the fight for services, like having that extra on top of what you're already going through. It's so disheartening and it does impact carers' mental health itself. Thanks very much. Thank you very much.