Dr. Niall Muldoon:

I have already commented on the difference between medication and counselling. With regard to geographic supports and the idea that young people have been taken away from their homes, the UN committee is very clear that the highest attainable standard of health care needs to include support and closeness to the highest possible level of support. The way I always describe it is that it needs to be accessible, appropriate and timely. The committee will see in our report that one young person was in an inpatient unit six and a half hours away from home and did not see the family for ten weeks. That is a difficult thing to do at the best of times and we are doing people a huge disservice if that is the best we can offer. International options are a huge problem, in my view. We have all sorts of concerns about children who are held in clinical centres in England. We find this happens with eating disorders because patients need to be PEG fed, for example. Again, it is an area where we can increase our professionalism in order to bring those young people home. From our perspective, this is a concern because it damages their rights to the best attainable health care within their own community. I would also have a question mark as to the clinical and governance system when people are sent across to another country.

Deputy Crowe asked about Linn Dara. I assume he is referring to last year's closure of 11 beds due to the difficulty in recruiting nurses. My understanding is that it was back up to full capacity from October or November of last year and I have not heard of any difficulties since then. However, it does show the vulnerability we have in that recruitment can be a difficulty for us and can lead to problems for children. An average stay there is about six weeks, which means some 60 young people may have lost out on that opportunity while those beds were closed. It is something for which we can plan.

Mr. Saunders talked about the 16 to 20 years age group. We still have CHO areas where CAMHS teams do not take anyone above 16 years of age, which is a disgrace. We have a centralised operating procedure which says they should do this but some of them are not. It is not even from 18 to 20 years but from 16 upwards that children are lost to a proper CAMHS service. We still have a lot of work to do in this regard.

The committee has heard perfectly today about the impact on families. If we had a service where they looked after our young people when they came in to us, the families would not have to fight, search, navigate, cajole and protest. None of those things would have to happen and they would still have a difficult time. If we were to do it properly, we would have a holistic service that provides support for everybody in that family that has an issue in regard to siblings, and parents would have some support. We have to start by giving the identified child every support possible and making it as easy as possible for the families. That is where an advocacy service and similar services can help, so they do not have to do all of the fighting.