Dr. Niall Muldoon:

I love the idea of the school journal. I will certainly steal that and see if we can get engaged with it in some way or other. The mental health complaints are, as the Senator mentioned, on access to services, continuity of services when moving from child to adult services, and continuity when being transferred from one area to another. Timelines are also a huge issue. I will ask Ms Ward to come in if there are more issues on top of that.

On the overall mental health system, the work that Senators Devine and Freeman did is huge. They identified that we do not have enough staff. We do not have the staffing in the right place. We do not have it in primary care where we need to prevent mental health issues. There are difficulties with diagnosis and with consistency between child and adolescent mental health services teams. One might diagnose a child as being ready to go in for an overnight bed and another might say that diagnosis does not fit, so the child does not get the bed. Those issues are coming up continuously.

When I met with the Minister of State, Deputy Helen McEntee, who had responsibility for mental health at that time, she talked about at least five or six unfillable posts for psychiatrists. These are posts which have not been filled for more than five years. No organisation or business in the world would leave its offices open for five years without having found another way to fill the gap. It is doing a huge disservice to our children in that area. Up to now the clinical lead has always had to be a psychiatrist. As I have suggested before, I wonder if there are other professionals who could take that lead for certain stages and at certain times. If we look to other countries some have used psychologists to offer medication. Certain nursing professionals have been allowed to dispense medication. It may not just be about medication. There may be other issues.

We have to look at the system as needing an overall change. In that particular Seanad committee the Senator brought in some great witnesses. They were fantastic. There were a lot of good ideas which could be used. Up until now we have been continuously trying to fix a broken system as opposed to seeing how we could look at the issue differently. Primary care is a crucial part of that. Tusla has talked about establishing what it calls therapy teams, which would include a range of therapists such as play therapists, drama therapists, art therapists and family therapists. There would be a range of people who could intervene in a different way at a much earlier stage. Such teams would not cost the earth. That would make a huge difference at the primary care level. Within CAMHS, there is never going to be enough psychiatrists. From the people I have met, it sounds like 80% of all psychiatrists who train in Ireland go abroad.

One will never fill the vacant places if that continues to be the situation. We must, therefore, acknowledge that and consider putting somebody else in place or allowing another professional to lead the team. We have received complaints concerning children who have been left for possibly four or five days in a bed, waiting for a consultant to assess the child after he or she has come into an emergency department and said he or she is suicidal. That is not appropriate and is very far from the right way to be child-centred. Such a child is in the worst case in his or her life and the worst situation he or she can think of. He or she feels ready to take his or her own life but we are doing them a huge disservice because we do not have enough consultants and only consultants are allowed to assess such children. We are traumatising such children again and are, essentially, locking them up in a bed when they should be supported in some other way. It is a result of our system and the way the legislation is set up that we are tied into that but that legislation could be changed within a year or two if we needed to and there was a will to do so. I am not saying what professional should be given the responsibility of treating such children but if one profession is not creating enough new staff to fill that space, we have to widen it for the sake of the children, even if only temporarily. Senator Devine has got her finger exactly on the button in regard to the complaints we receive. It is a crisis that is long overdue fixing.

I have also called for a version of A Vision for Change solely dealing with children to be generated. That would change the focus because one would then assess, evaluate, fund and resource it in a different way because they will be treated as children and as rights holders in their own right. Ms Ward may wish to comment further regarding complaints.