Ms Kate Mitchell:

I thank the committee for inviting Mental Health Reform to appear before it today to discuss youth mental health. Mental Health Reform is Ireland’s leading national coalition on mental health. With over 75 member organisations, we work together to drive progressive reform of mental health services and supports in Ireland. In partnership with our membership, many of which work in the area of child and youth mental health, including Jigsaw, SpunOut, the ISPCC, the Children’s Rights Alliance, and Barnardos, we have consistently advocated for improvements in mental health services and supports for children and young people living in Ireland.

In recent years, Mental Health Reform sat on the national task force on youth mental health, developed evidence-based research and guidance on meeting the mental health support needs of children and young people in Ireland, actively campaigned on the need for investment in child and youth mental health services and supports, including with regard to budget 2020, and has delivered a dedicated campaign on the need for out-of-hours crisis services for children and young people in all communities across Ireland.

From the outset, it is important to acknowledge the progress that has been made in the provision of child and youth mental health services and supports. This includes the expansion of Jigsaw youth mental health sites; the publication of CAMHS standard operating procedures, including a revised version; the development of digital technology mental health supports for children and young people; and the establishment of a mental health crisis text line.

Despite recent Government efforts, the reality is that significant challenges continue to exist for numerous families, children and young people who require mental health services and supports. To start, there is no doubt that Ireland's child and adolescent mental health services are at breaking point. Just over half of the required CAMHS staff are in post, which ultimately has a significant impact on access to and quality of services. As of June 2019, there were almost 2,500 children on the waiting list for CAMHS, of which 10% were waiting more than a year to be seen. There are ongoing practices of admitting children to acute adult services, with a total of 20% of all child admissions to adult inpatient units in 2018. There continues to be a lack of out-of-hours crisis mental health services for children and young people, with many being unable to avail of such supports in their communities. There are ongoing difficulties with the implementation of the CAMHS standard operating procedures, which seek to promote consistency and standardisation in services across the country, difficulties with transitions from child to adult mental health services, and continued gaps in mental health legislation, which fails to protect adequately the rights of children and young people when they go into hospital for mental health care and treatment.

This is further compounded by the continued absence of a national advocacy service for children and families engaged in mental health services, who may require support in having their voices heard. Unmet mental health need is also evident in the lack of specialist mental health services to meet the needs of particular groups of individuals. These include children with a mental health and intellectual disability, children with autism, children and young people from the deaf community, children with a dual diagnosis of addiction and a mental health difficulty, and children and young people in the care system.

There are significant shortfalls in supports outside of the specialist mental health services, including in primary care. For example, there are more than 8,500 people on the waiting list for primary care psychology nationally, of which almost 25% are waiting more than a year to be seen. It is important to recognise that the majority of individuals on this waiting list are under the age of 18 years. In addition, there has been a lack of investment in enhancing the capacity and resources afforded to other primary care professionals to meet the mental health needs of children and young people adequately.

No doubt, there are myriad additional gaps in mental health service provision, including in perinatal and early years mental health supports, a lack of investment in community and voluntary organisations that provide essential mental health services to children and young people in communities throughout the country, a lack of focus in investment in prevention and early intervention, and of particular note, inadequate inter-agency collaboration.

Overall, there remain significant challenges to bring about the type of mental health supports for children and young people that fulfil national policy and international human rights obligations. There are various measures that must be taken. These include, to name a few, increased investment in child and youth mental health services; a national roll out of crisis out-of-hours services for children and young people; investment in primary care psychology; the implementation of the CAMHS standard operating procedures; the reform of Ireland’s Mental Health Act 2001 to promote compliance with international human rights treaties, including the UN Convention on the Rights of the Child; the establishment of a national independent advocacy service for children, young people and families engaged in mental health services; the implementation of a nationwide schools programme on mental health promotion and well-being; the establishment of a universal approach to responding to perinatal and infant mental health needs; and a greater focus and investment on the prevention of mental health difficulties.

The prevalence of mental health difficulties among children and young people in Ireland is significant. Almost 20% of young people aged 19 to 24 years of age and 15% of children aged 11 to 13 years have had a mental health disorder. In July 2019, a report published by Eurofound showed that young Irish women are suffering the highest levels of moderate to severe symptoms of depression among their EU counterparts. Demand for services is increasing substantially with a 40% increase in referrals to CAMHS from 2011 to 2019. The cost of mental health difficulties is enormous. The figures suggest that this may amount to as much as 4% or more of GDP in some countries equating to approximately €12.4 billion each year based on Irish figures.

To enhance mental health services and supports for children and young people effectively, a cross-departmental agency approach is essential. This must be complemented by the required investment and resourcing from prevention and early intervention to specialist mental health services. This includes the full implementation of Better Outcomes, Brighter Futures, including its recommendations pertaining to child and youth mental health. Mental Health Reform's specific appeal to the committee today is that it takes on the fundamental need to improve the mental health outcomes of children and young people living in Ireland as an immediate priority in terms of parliamentary oversight.