Mr. Jim Gibson:

Tusla welcomes the opportunity to make a submission on this. In many ways, as chief operations officer I can empathise very clearly with parents whose children have mental illness episodes. I am a corporate parent for over 6,300 children in State care. Last year, we lost five children to suicide. That causes me great grief as a public servant. I listened to all the submissions today. We made a written submission. I would prefer to talk about some of the key points about which we need to be mindful.

A child and adolescent mental health service of very high calibre makes an extremely good impression and makes a difference to the well-being of a child or young person who accesses it. We strive, as a State agency, to have good working relationships with other State agencies. We recently signed off on a joint protocol for children in care to have priority access to disability services and mental health services. Having said that, as a State agency we receive over 43,000 referrals per annum. Many of the young people who present at our service do so with mental illness episodes. It is very difficult, when they have access to a child and adolescent psychiatrist, to obtain a diagnosis. I am talking about adolescents heading into adulthood. Our experience on following the affected children and young people is that when they enter young adulthood and engage with adult mental health services, they seem to get a diagnosis quite quickly and, therefore, get a medical treatment plan and medication to resolve their issues. In the case of personality disorder, for example, the diagnosis seems to come quickly in adulthood. I am not a medic and acknowledge there may be very good reasons diagnosis is not as quick for adolescents. This is a theme we see regularly. When those affected receive a diagnosis and treatment plan from a mental health perspective, their behaviours de-escalate in all walks of life in the community. That is an important point.

What parents and staff in Tusla require when young people or children present with mental health difficulties is an accessible and immediate service. I am very much aware that CAMHS operates at the acute end of the spectrum and that many times when we do have access to that service, it reaffirms the professional's assessment of the child's needs. Therefore, it reduces much of the anxiety experienced by other professionals in trying to manage children and adolescents who present with mental health issues. Interagency collaboration is easy to talk about but much harder to make happen. There are developments within Tusla in this regard. The Government has invested heavily in the children and young people services committees. Many of those committees have sub-groups for children and adolescent mental health and they do very good work on awareness, early support and family support across all agencies and within the non-Government sector. I ask the committee to consider this model a vehicle of investment to ensure we have good programmes on information-sharing, early intervention and supports for children or adolescents experiencing mental health difficulties and their families. The committees have been running for several years and their meetings are well attended by an interagency forum and well supported. They are a good vehicle. A good example is in Kerry, where there was a serious rate of youth suicide. The committee got together and put together very good programmes with information on accessing immediate support. It works well. With the acute service, it is a matter of accessibility and timeliness.

May I use a case example to show how we were able, along with other agencies, to provide an immediate, assessable support to a family with a single mother? Coming up to Christmas, her daughter experienced suicidal ideation and had carried out many attempts on her life. The mother found her daughter hanging in the landing one night and was able to rescue her. She was admitted to the general hospital. The out-of-hours CAMHS assessed her. In the professional opinion of the assessors, she required an inpatient bed in a child and adolescent psychiatry setting. That young person remained in the general hospital for three weeks. Tusla was contacted at an early stage on the grounds of there being a child protection issue. We responded to that and made our assessment, namely, that it was not a child protection issue but a mental health issue. The mother was a good mother, a very concerned mother who loved her daughter but felt she could not manage to ensure her daughter's safety. Therefore, the young person remained in hospital. Unfortunately, the adult psychiatrist attached to the hospital reassessed the child and made a professional decision that she was fit for discharge. The hospital telephoned us and said the matter was for Tusla. We said we would be part of an overall plan of intervention and support but we asked it not to expect Tusla to have the capacity to look after the matter on its own.

The immediate response from a social work perspective was that we needed a residential service. As a manager, and with a management team, we disagreed. We said we need to put a service in the family home of the mother and daughter if they are willing to accept that. We put a social care team in with the mother's consent because her main concern was that she could not ensure her daughter's safety at night. We said we could remedy that and that we could, with her consent, put a team into the family home for a period of three months. One social care worker in that team was given a brief to develop a relationship with the young person that would remain on an ongoing basis thereafter. That young person is well and safe and living at home in her community with her family. She does have mental illness episodes but they are well managed. The point for us was that CAMHS was very agreeable to being involved in the integrated response, which was immediate, timely and proportionate to the need of the young person and her mother. If there is anything we can do as a State agency today, it is to state the need for an integrated, timely response characterised by togetherness, true collaboration and working together to ensure the well-being of children and young people.