Pauline Tully (Cavan-Monaghan, Sinn Fein) | Oireachtas source

Gabhaim buíochas leis an Cathaoirleach. I wish everybody a good evening. I thank the witnesses for their opening statements. I will go to HIQA first. HIQA has the right, as we know, to inspect centres. Centres must be registered. How does HIQA ensure that all centres which should be registered are registered? I am aware of some organisations that might not register services because of a fear of HIQA going in, although they should have their services registered. Are HIQA's visits announced, unannounced or a mixture of both? I would like to know the breakdown. Ms Grogan talked about HIQA's inspectors engaging with residents. Are they able to speak to children without an adult present? How do they speak with someone who has communication difficulties, such as a person who is non-verbal? Some people could be afraid of telling the truth if they are afraid of a staff member. Most centres are very good and the staff are very supportive, but there are incidents where they are not and it is about ensuring people are able to tell the truth. Does HIQA provide any support to people who are whistle blowers or make protected disclosures?

Moving to the Ombudsman for Children's Office, I commend its Nowhere to Turn report, which is very important in highlighting what was happening, with families feeling they are forced, due to a lack of supports, to leave their children in hospitals, respite centres or schools. I have met many parents who have a teenager or a child who has just turned 18 or 19 and who have felt they had to contact the Garda because of behavioural issues. This has ended up with the young person being removed from the home, which is not what the parents wanted. They were looking for support and they did not get it. I am aware of a number of cases where the young person has been referred to a mental health institution or the mental health unit of the local hospital and detained there under the Mental Health Act. This person does not necessarily have mental health issues. They may be autistic, and this may be combined with other issues, but they end up detained because of the lack of support they received in the community from the CDNTs. They may have developed behavioural issues, but it is not a mental health issue and the hospital is not the appropriate place. The hospital staff may recognise it is not the appropriate place, but they will say there is nowhere for the young person to go. All the family wants is for the person to be home with the appropriate supports. Many families have their children referred to CAMHS and they are put on a waiting list. If the child is assessed, sometimes parents are told the child is not appropriate for the services and the child is then left in limbo with nobody to support them. Alternatively, parents are told CAMHS will accept the child and give them an appointment in six months. Six months is not good to a young person who is threatening suicide or is self-harming.

The witnesses from the Mental Health Commission and the Ombudsman for Children's Office talked about more joined-up thinking, the fact that our services are being siloed and the need for a single point of contact. That has been talked about at this committee several times and been brought up with different Ministers and Ministers of State. There is no co-operation, but there needs to be. Our biggest problem is that none of the services are properly staffed. The CDNTs are understaffed and CAMHS is understaffed. Some of the CAMHS teams are excellent, but some of them are not providing the supports. There seems to be an overreliance on medication, that it is not monitored and a lack of other interventions as well.

The commission has no remit over CAMHS standards and rules, but Dr. Hillery said the powers to do that can be granted under current legislation. Why have they not been granted? We all know there are major issues with CAMHS. Dr. Hillery said the commission has the power to inspect inpatient services. Does that extend to the psychiatric wards in hospitals as well?