Mr. Peter Hughes:

I thank the members for the invitation to address the Joint Committee on Children and Youth Affairs. As general secretary of the Psychiatric Nurses Association, PNA, I want to highlight my concerns in regard to the CAMHS. The inadequacies and under-investment in the current provision of CAMHS is something my union has consistently drawn attention to and I hope that the committee's interest in this area will help in addressing the many gaps in CAMHS that exist throughout the country.

In 2006, the Government policy on mental health, A Vision for Change, was published outlining a ten year plan for the provision of mental health services. Chapter 10 of that widely welcomed strategy outlined the recommendations for child and adolescent mental health services. Some of the key recommendations included two multi-disciplinary teams per 100,000 population; one liaison multi-disciplinary team per 300,000 population; one day hospital per 300,000 population; and that urgent attention should be given to the completion of the planned four 20-bed units in Cork, Limerick, Galway and Dublin and multi-disciplinary teams should be provided for those teams. That will result in 100 beds for CAMHS nationally.

Most important, A Vision for Change included in it a provision for an evaluation after five years to assess the progress in the delivery of CAMHS and whether it is meeting the needs of the population. Eleven years on, we must question the commitment to the recommendations in A Vision for Change.

The PNA, in partnership with the Royal College of Surgeons Ireland, RCSI, published research last year on the implementation of A Vision for Change in adult mental health services ten years on. The results were stark and disappointing. Among the findings were that 60% of beds were closed yet only 30% of the recommended community services were put in place; there were no 24-hour crisis intervention services as recommended; we are currently conducting research, phase 2, in partnership with the RCSI, into the specialist elements of A Vision for Change, inclusive of CAMHS. Early indications suggest that 37% of the recommended multi-disciplinary teams as outlined in A Vision for Change are operational; 53% of the liaison services are in operation; and 52 beds are operational out of the 100 recommended beds. That figure has reduced in recent weeks to 48. This research will be concluded by quarter 4 of this year.

The population of children nationally is expected to increase by 8,530 between 2016 and 2017, which is consistent with the percentage growth annually in the past decade. That projection, coupled with the expansion of the free GP scheme, will create an additional demand on child and adolescent mental health services.

I also wish to make reference to the appalling situation of young homeless children currently living in hotels, guest houses and short-term accommodation. Not only does that increase the level of mental distress on those involved, that transient situation complicates the follow up of the children as they are transferred from one CAMHS to another as their accommodation moves.

According to the mental health division operational plan for 2017 there are 74 multidisciplinary teams. A Vision for Change recommended two teams per 100,000 population, which equates to 94 teams, so we have a shortfall of 20 teams. According to recent research we conducted, only 50% of the recommended teams are in operation in the greater Dublin area and most of them are not fully functional as they are missing many disciplines. There are four day hospitals nationally. A Vision for Change recommended one for every 300,000 population, which equates to 15 hospitals. This means we have a shortfall of 11 day hospitals. There are 74 CAMHS beds nationally. A Vision for Change recommended 100. However, only 48 of these are operational nationally due to staff shortages and, in particular, nursing shortages. There are 20 beds in Cork, but until recently the unit only had the capacity for a maximum admission of 15 children. This has now been reduced to 11 due to nursing staff shortages. St. Joseph’s unit in Fairview has 12 beds, but only six are operational due to nursing and medical staff shortages. The Limerick unit never materialised and the 20-bed unit in Galway is fully operational. Linn Dara in Dublin, a new purpose built 22-bed unit, which only opened 18 months ago, has in the past three weeks closed 11 beds due to nursing shortages. The unit has only 50% of the nursing resource required. These 11 beds have been closed despite a list of 20 children awaiting admission.

We know all too well that the net result of these bed closures and underprovision in CAMHS is to further increase the unacceptable admission of children to adult mental health units. We witnessed a stark example of this just last month, with the admission of a 16 year old to the adult mental health unit in Waterford. To add to the trauma experienced by this child, we know that child had to spend the night sitting on a chair. To say, 11 years after the publication of the A Vision for Change strategy, that this is totally unacceptable is, if anything, an understatement. Child and adolescent mental health services are in crisis and, as outlined, the provision of services is deteriorating rather than improving. The children and parents of our country are being let down by the non-implementation of policy and the lack of commitment or urgency in addressing the crisis. And yet we know, and have known for ten years, what needs to be done to address the crisis.

As a matter of urgency, the 100 beds as recommended need to be provided and staffed in order to provide quality therapeutic care and prevent further admissions of children to adult mental health units. The number of community mental teams needs to be increased, as recommended. They need to be fully staffed and expanded to provide out-of-hours home-based services. The criteria for clinical nurse specialists are too stringent and need to be adapted in the short term to facilitate an increase in applicants. There are approximately 20 unfilled clinical nurse specialist posts nationally, mostly due to insufficient applicants as the criteria are too strict.

The 15 day hospitals as recommended need to be provided. Of course, the full implementation of these measures will only come if there is a substantial increase in the budget for mental health services, which currently stands at 6.4% of the health budget. Bizarrely, and probably only in Ireland, we have witnessed a situation where despite the growth in demand for mental health services across the board there has been a steady reduction in the mental health budget as a percentage of the overall health budget. In 1984 the budget was 13% of the health budget, in 1994 it was 10% of the health budget and in 2004 it was 7.1% of the health budget. As can be seen, the commitment to mental health services is diminishing each decade, yet the demand has never been greater. It is little wonder the previous Taoiseach, Deputy Enda Kenny, admitted in the Dail on 23 May that mental health services have been neglected for over 30 years, and were, as he put it "the Cinderella of many Health Service Executive Votes and Department of Health Votes".

Sadly, when we look at the mental health budget it is hard not to conclude that A Vision for Change was used as a cost-saving measure on the backs of those with mental health issues. Too often we have seen the closure of beds with paltry investment in community services. We are struggling to provide vital services while trying to manage a severe shortage of psychiatric nurses, largely due to the fact that our highly skilled and committed nurses are being forced to leave the Irish health system for better pay and terms and conditions in the private sector, the UK, Australia and Canada, to name but a few of the market competitors. Who can blame them, when there is a consistent failure to address realistically the issues of pay and conditions for nurses? At the end of the day, this is the only realistic solution that will stop the haemorrhaging of our nurses abroad and encourage those abroad to return.

I thank the committee for the opportunity to briefly outline the extent of the ongoing crisis in child and adolescent mental health services, which we know is impacting severely on the children and parents of this country. I assure the committee that the Psychiatric Nurses Association is determined to see the issues in CAMHS addressed before they deteriorate even further, and we would welcome the committee's support in achieving the provision of properly resourced and staffed CAMHS that meets the needs of children, families and communities throughout the country.