Dr. Geoffrey Shannon:

I thank the committee for its very kind invitation and I acknowledge publicly the outstanding work of Senator Freeman. It is important that an issue like mental health has a champion. I am here to express my personal support for the work she is doing, not only in convening this session but also in respect of the Mental Health (Amendment) Bill, which is very worthwhile. I had the opportunity overnight to examine it forensically and I have a few suggestions which I might share with the Senator privately rather than to detain the committee. It will make a very real difference.

I have often said that the measure of any democracy is the manner in which the needs of the most vulnerable are considered and met. There is no more vulnerable group than children with mental health needs. I have consistently raised, as Mr. Hughes referred to it, the Cinderella response to mental health issues. I have just finished what has been acknowledged as the largest worldwide audit of the exercise by a police force of its emergency child protection powers. I have looked at over 500,000 fields of PULSE data. One of the key messages emanating from my review of thousands of cases is that, linked to the substance and alcohol abuse one finds in many of them, mental health issues underpin much of the abuse.

Across many of those cases there is substance and alcohol abuse. Linked with that there are mental health issues underpinning much abuse. What we have, as we heard from many witnesses this afternoon, is a lack of cohesion between services. The key finding from my report is that agencies operating under the umbrella of protecting vulnerable citizens need to work together seamlessly to protect children. We have poor inter-agency communication and co-operation across all agencies. My report shines a light on this. It is a unique window onto what happens when parents fail children and also when the State fails children. The State fails children when its agencies fail to co-operate to provide a service. My colleagues from the ISPCC referred to the need for a 24-hour service for families. Families operate 24 hours a day, seven days a week. They do not operate from 9 a.m. to 5 p.m. Our services appear to focus on 9 a.m. to 5 p.m. provision, and that must change.

I also acknowledge the outstanding work undertaken by front-line workers such as nurses, hospital doctors and consultants. Those professionals do their best at the coalface but we must ensure they have the proper infrastructure. The system fails many children experiencing mental health difficulties. The failure to recognise mental health issues at an early stage can have a profound impact on the family. After thousands of hours of work I found that warning signs are sometimes ignored, referrals are not timely and appropriate and the consequences can be devastating and cost the State much more in the long term. I listened to Peter Hughes and it struck me that we have had much vision but very little change. We need implementation. Senator Freeman will have heard me repeat on a number of occasions yesterday that we can have the best implementation plans in the world but unless they deliver for service providers, they are meaningless. We have had hollow promises which have not delivered for vulnerable citizens.

I also share the views expressed by the Children's Rights Alliance. I am delighted to be the founding patron of the alliance. The report card is a useful exercise in benchmarking where we are performing on key child protection issues. When a child is taken into the care of the State and is placed in a service, the State is saying it can do a better job. When the State fails those children it is failing them a second time. That can have devastating consequences. We are saying the care they receive in a family setting is not good enough but we fail to provide a better service. We have raised expectations only for those expectations to be dashed in the context of poor communication between agencies and the failure to deliver on services.

The representative of the ISPCC referred to preventative services. I passionately share that view. Working upstream prevents problems downstream. If we seek to tackle these issues at a much earlier stage, it will relieve the pressures on mental health services at a later stage. Over a long number of years, and having reviewed thousands of cases, I have found that we are very good at crisis intervention but preventative services rank very much second best towards when we must deal with the crisis. We pump all of the finance into the crisis because it becomes a political issue. However, dealing with the matter in the first instance would have a much better outcome for both families and children.

I also believe that the system is unable to cope with children with emotional or behavioural problems or mental health problems. Again, the Children's Rights Alliance and the ISPCC referred to the fact that we end up exporting our problems to other jurisdictions, at a significant cost to the State. We must now develop home grown solutions to problems for our children. That must be done as a matter of urgency. Article 19 of the Convention on the Rights of the Child requires the State to protect children from harm and ill-treatment. It is a mandatory obligation to promote the welfare of children who are not receiving adequate care and attention.

In terms of international best practice in this area, I believe we must take a rights-based approach. We must consider the Convention on the Rights of the Child and its attention to four general principles. The first is non-discrimination under Article 2 of the convention. We are not treating children equally. We have heard a powerful story from another organisation, BeLonG To, that does outstanding work for children in minority groups who do not get the type of service they need.

The next principle is in Article 3 of the convention, the best interests of the child. I support the suggestion put forward by the Children's Rights Alliance in terms of defining "best interests" in the context of the Mental Health (Amendment) Bill. We must be able to benchmark what "best interests" means. We should set down a number of principles that would assist the court in determining, if there is a failure on the part of the State, what best interests means for children with mental health issues. I will be happy to share with Senator Freeman some suggestions as to how that might be realised. In 2012, the people of Ireland voted that children would have a special status in our Constitution. That must mean something. The people of Ireland said that the best interests of the child should be at the core of our decision-making. For that reason, I believe this is very good draft legislation. It attempts to prohibit the placement of children in adult psychiatric facilities, save in exceptional circumstances where it is in the best interests of the child. There is pragmatism in the proposal. It will put pressure on the State to ensure that more is done in this area. I believe this legislation will deliver and I urge Senators to engage with it in an enthusiastic manner. The legislation ups the ante in ensuring that we outlaw this practice. There are parallels. Ten years ago, everybody said we could not outlaw the detention of children in St. Patrick's Institution but it has been outlawed. It is not beyond the State to erase poor practices and practices that grievously breach its human rights standards.

The other standard is the right of every child to life, survival and development. Every child should have a fair chance in life, including those children who end up in psychiatric units because we do not have the correct facilities. I am no expert in mental health but why can we not have adolescent and child psychiatric facilities alongside each other? I am conscious of the difficulties that this Bill might create. I had an opportunity overnight to discuss it with a number of medical practitioners. Some concerns were articulated around the fact that there could be a possibility of a child ending up in a hospital where the expertise is not available. However, we must come up with solutions, and this Bill is hugely important in providing the impetus for dealing with this issue.

Most important is the voice of the child. We heard powerful evidence this afternoon from BeLonG To on what it means for children. Those statistics are shocking, as is the fact that children in an LGBT setting could be so vulnerable. The State must react to this. I have always argued that the poor practices of the present become the tribunals of the future. For that reason, it is incumbent on the State to act in a speedy fashion. There was also a reference this afternoon to the UN Convention on the Rights of Persons with Disabilities. There is no need to wait for the ratification of the convention. The Children's Rights Alliance referred to Article 24 of the Convention on the Rights of the Child, which states that every child has the right to the highest attainable standard of health. By any standard, placing a child in an adult psychiatric facility does not equate with the highest attainable standard of health.

Very useful guidance is provided on Article 24 in general comment No. 15. If members are in any doubt as to what that provision means, they should look at general comment No. 15. I would argue that the State, by allowing children to be placed in adult psychiatric facilities at present, is grievously breaching international law. If we are concerned about our reputation internationally, we will move very quickly to address this huge injustice for children. Another provision that is arguably breached is Article 3 of the European Convention on Human Rights, which prohibits inhumane or degrading treatment. I defy anybody to say that placing a child in an adult psychiatric unit is not inhumane or degrading treatment. The European Convention on Human Rights, which is binding on all State bodies, albeit it has been introduced at a sub-constitutional level, provides, under Article 8, that the best place for a child is within his or her family. If we are taking the child out of the family into what I would describe as a sub-optimum environment, in other words an adult psychiatric unit, I argue that we are in breach of Article 8 and also Article 3 of the European Convention on Human Rights. It is also arguably in breach of the Constitution under the new Article 42A. There are two such provisions of the Constitution, namely, the new children's right provision and the personal rights provision in Article 40.

I am conscious of the time constraints. Pages 72 to 75 of my report document poignantly mental health issues arising for those children who require an emergency out-of-hours service. It is quite striking that many of those children access the Irish Society for the Prevention of Cruelty to Children, ISPCC, line. I wish to publicly acknowledge how important the ISPCC's Childline is for children. In the sample that I ended up examining, I was surprised to that so many of the children had accessed the Childline service. The service does an outstanding job protecting very vulnerable children.

Children aged between 16 and 18 are in what I would characterise as the twilight zone. Those are the children who most suffer because they are neither getting a child service nor an adult service. We need to make sure that their rights are fully vindicated.

I would argue that childhood is for a limited period of time. If we do not provide the right service at the right time to a child, it will have very significant consequences. I remind those in this Chamber that childhood, once it is interrupted, cannot be restored.