Ms Julie Ahern:

I will first address the waiting lists for child and adolescent mental health services, which are underdeveloped and for which demand continues to exceed availability. Between January and March of this year, a total of 2,818 children were waiting for a first appointment with CAMHS, of whom almost 300 had been waiting more than a year.

In 2016, the UN committee examined Ireland and expressed concern about access for children and young people to mental health treatment and about the long waiting lists for support. It recommended that the State act to improve the capacity and quality of mental health services. The Children's Rights Alliance acknowledges there are significant staff shortages in CAMHS, which we heard about earlier and which contribute to the long waiting lists for children. Of the recommended 127 specialist teams, the most recent figures we could find show 67 CAMHS teams are in operation. Not all of these operate to full capacity and there are significant geographic variances in provision. For example, there are no services for those aged 17 in north Tipperary because the HSE has not been able to fill a clinician's post there. Achieving the full staff complement of CAMHS is vital to ensure children and young people are not put at risk by waiting too long for support. Reducing these waiting lists requires ongoing investment in the development of child and adolescent community mental health teams.

The UN Committee on the Rights of the Child clearly states that where placement in a psychiatric unit is necessary children should be separated from adults where appropriate. It emphasises that any decisions on their care should be made in accordance with their best interests. In 2016, the committee expressed concern at the ongoing practice of admitting children and young people to adult wards due to the lack of suitable age appropriate facilities. It recommended the State take action to address the issue by improving the capacity and quality of services for inpatient treatment. The Mental Health Act 2001 is outdated and not in line with Ireland's international human rights obligations, particularly those relating to children. The Act does not require children and young people to be admitted to age-appropriate facilities. As a result, we all know children and young people are placed in adult facilities. In 2016, some 17.8% of all admissions of children under the age of 18 were to adult units. The mental health commission's code of practice states the placement of children in adult wards should be phased out by the end of 2011, but it is very clear this non-legally binding code has not been effective. There is an overall shortage of inpatient beds, and existing beds are not always used to full capacity. As we have heard, A Vision for Change recommended 108 beds should be operational throughout the country. However, at the start of the year, only 66 beds were in operation and since then we have seen a 50% reduction in state-of-the-art facilities such as Linn Dara in Cherry Orchard. These have been due to staffing issues. The 2013 report by the Inspector of Mental Health Services showed children are placed in adult facilities even when adolescent bets are available. Investment and support is needed to ensure all adolescent inpatient beds are available and used and units are fully staffed. Investment in primary care services and the establishment of emergency out of hours community support are also necessary.

I will briefly address the issue of advocacy services for children and young people. An independent advocacy and information service exists for adults in mental health difficulties, but there is no equivalent national independent service for those aged under 18, particularly those using inpatient services. This means children cannot access their right to information, their right to be heard and their right to participate fully as service users in mental health services. The UN committee has recommended establishing a mental health advocacy service for children that is accessible and child friendly. We echo this recommendation and call for the establishment of a national independent advocacy service for all children under the age of 18 engaged in mental health services. I thank the committee for its attention, and I am happy to take questions afterwards.