Joan Freeman (Independent) | Oireachtas source

I reiterate that this presentation aims to inform the committee of what will happen tomorrow on Ireland's very first public consultation day on mental health. I thank Mr. Gareth Noble and Mr. Peter Hughes for coming to help me with today's meeting.

The public consultation day on children's mental health in Ireland is a unique opportunity for our nation to address the provision of mental health services for children and adolescents in Ireland. I hope the publication of the report will bring to the attention of the Government the challenges that face this country in providing even a somewhat adequate mental health service for our children, whose disposition to mental health issues is increasing. The mental and emotional struggles of our young people have expanded dramatically in the past decade alone. New phenomena exist such as cyberbullying and self-image pressure from social media which put increased pressure on an already vulnerable category of youth identity. Children between the ages of 15 and 17 have the fifth highest rate of suicide in Europe, and in recent months there has been a dramatic increase in suicide among young teenage girls. In a country which purports to put the interests of such children first, we need to identify whether we are delivering on this commitment.

The purpose of the Seanad Public Consultation Committee is to hear the testimony of service users and service providers who work in the child and adolescent mental health services, CAMHS. On this point - I know this is not in my written submission - this is not about the hard-working men and women on the front line of our CAMHS and other services; it is about us looking at the system that surrounds our mental health services for children. Under no circumstances do I want to give the impression that we are criticising the people who work on the front line. Over the past month or more, the Seanad Public Consultation Committee members and I have received in excess of 100 submissions from service users, including mothers, fathers and adolescents, and service providers - consultants, nurses, social workers and lobby groups - across the country.

Eleven years have passed since the policy document governing the delivery of these services, A Vision for Change, was published in 2006. As with many of these documents, there is a lot of vision but very little change. I wish to direct members' minds momentarily to the static nature in which our services have remained since the publication of A Vision for Change. The reality is that successive Governments have fallen significantly short in implementing the recommendations captured by the report in terms of provision of services, inpatient beds, consultant child psychiatrists and support staff, out-of-hours services and accountability on spending.

The declining amount of budget funding as a proportion of the overall health budget has further prompted a reduction in staff and inpatient facilities. We have been told that the mental health budget has increased and that it is approximately €850 million, but the mental health budget for children is only 6% of that overall budget. This is never highlighted. The reality is that 6% of the overall mental health budget is allocated to 23% of the people who make up our population, that is, the young people who need this funding and these services, yet demand increases. Referrals to CAMHS have doubled from 8,663 in 2011 to 13,062 in 2013. Increased levels of staffing do not meet this demand. Recruitment and retention of staff and availability of services are in stark contrast to the demands of a child population which has increased by an estimated 17.8% since 2006. There are 55 child psychiatric consultants to a population of 1.2 million children. Even trying to figure this out is challenging.

As the committee may be aware, I have introduced legislation in the Seanad seeking to ban the admission of children to adult psychiatric units.

This has prompted a very important discussion on how these children end up in such units for short stays. By their nature, these admissions are a last resort and the reasons for the admissions generally arise of administrative expediency in a dysfunctional health system.

The submissions to the Public Consultation Committee make clear that the admissions are a consequence of structural shortcomings or cracks in the system, shortcomings that need to be exposed, such as the lack of services for 16 to 18 year olds, poor retention of personnel and a lack of collaboration between catchment areas. Often a child might be admitted to an adult unit as a result of an absence of beds or because of the non-availability of a child psychiatrist to perform the admission. In some cases, it might be because there is no closely located in-patient unit. These are not adequate justifications for a practice that is deemed to contravene the United Nations Convention on the Rights of the Child.

I have invited Gareth Noble who is a specialist child lawyer and who has more experience of the reality of these services. He, like many of the specialists in child law and those engaged in the provision of child and mental health services, is able to give a truer picture of the shortcoming of those services. Since being nominated, I have found the testimony of front-line workers to reflect the most valuable contribution to my learning in this area.

I am therefore inviting the members of this committee to support the public consultation day, to highlight the issues involved, to attend and to ask questions of those contributing if the member is a Senator, to be part of the implementation process when the recommendations are published and to create a space for the discussion of the findings as part of this joint committee in the next term. I thank the members for their time today.