Lisa Chambers (Mayo, Fianna Fail)
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I have read the opening statements and accept the point that mental health funding has increased. However, there are cases that I have dealt with in my office that are deeply upsetting and which have stayed with me. A number of mental health cases involving young people have shone a light on the lack of services in the community. I refer to the west of Ireland in particular. I am from County Mayo and we do not really have youth mental health services. There are voluntary organisations like Pieta House and other charitable bodies trying to bridge the gaps and provide some level of service. The biggest issue is that if young people are sick after 5 p.m., the only place they can go is the emergency department. If they have mental health issues, are suffering from severe depression or anxiety and are having an episode or a difficult time, the last place they want to go is the emergency department of a hospital. As most people know, most emergency departments in this country are overcrowded, manic and chaotic. That is not the right kind of environment for young people who are ill but that all that is available.

A young girl came to my office who had spent three weeks in an adult mental health unit in Castlebar Hospital. She was there involuntarily. There were no activities and no structure to the day. There was a list of activities on the wall so that if the unit was inspected, it looked as if things were happening every day but none of the listed activities ever took place, apart from a weekly one-hour music lesson and mass on Sunday. That is all that was available. She was not able to leave the facility. It has a small courtyard or garden, no bigger than this room, which is a glorified smoking area. That was all of the outdoor space that she had in the three weeks that she was there. She got out of there only because her parents could afford to put her into private care. She fundamentally believes that she is better now and doing well only because she got private mental health care in St. Patrick's. She felt that if she had been left in Castlebar, she would be in a very different space today. Thankfully, she is doing well and is in college. She is determined now to help others in that situation who cannot get out. She spoke about a culture of sleeping tablets and medication, with no psychological services. If the first sleeping tablet did not work, patients were given a second one two hours later. She said people were left sobbing and crying in the middle of the night with nobody there to show any compassion or to check on them. She described people of all ages with all types of illness in the same small facility with no way out. In a wealthy, first-world country, that is disgusting and unacceptable. This is a HSE facility. A few months ago I was told that everything was fine in that facility, that services were good and resources and staff were plentiful but the girl who came to me spoke about bedclothes not being changed and elderly patients being left untended. She talked about the place having a smell and being unhygienic. This is unacceptable. I am sure that conditions in that facility are replicated right across the country. I have no doubt that Castlebar is not an outlier. It is a fine hospital and provides great services. As Mr. Ryan pointed out, it is not the fault of staff, who can only work with what they have.

I received a reply to a parliamentary question recently on staff vacancies in the mental health unit in that hospital which runs to two pages. A basic-grade psychologist post has been vacant since 2015 but there is no date or deadline for the filling of that vacancy. There are several vacancies in CAMHS itself, most of which are six months to a year old, if not longer with no final date for those posts to be filled. Clearly the staff that are working there are doing the job of two or three people. I cannot see how that is not the case. How can there be no psychological services within a mental health unit that is treating people who have been involuntarily committed for a number of weeks? How is that even possible? There are no gym facilities, no structure and no place to exercise. If any of us were in such facilities for three days, not to mention three weeks, we would be climbing the walls. The girl who came to me spoke about not being able to sleep at night because of the noise and because there was no way to burn off energy during the day. Patients were wide awake in bed at night. One can imagine the noises in a facility of that nature, where people are stressed and upset and suffering from severe mental health episodes. I do not think I will ever forget the day that lady called into my office. I am still in contact with her but she is one of the lucky ones. She sent me a poem that she wrote but I will not go through it today. She is an exceptionally talented young person. She went on to speak to me about her experience in St. Patrick's, the private hospital that she went to afterwards. She talked of the wrap-around care that she received. There were basic things like the fact that every service user or resident had to get up for breakfast every morning; that was part of being there. There was structure to the day. Bedclothes were changed and patients were made take showers. There were activities during the day like yoga, dance or art. There was positivity during the day. She felt that she was being cared for and given the opportunity to get better. What really upsets her is the fact that people are being readmitted all the time to mental health units. The same people are going back into these units because they have not been given the opportunity to get better. When are we going to change how we deal with this? If one robs children or young people of the opportunity to get better at a young age, what hope do they have in later life?

That is not all on Mr. Ryan's shoulders, he is merely the HSE representative today and it is an opportunity for us to ask questions and put those things across, but we need to change how we do things. Perhaps the HSE needs to look to the private facilities and ask how they do it. Of course it will be expensive but the proportion of our health budget allocated to mental health is far too small. We all know this. It is not enough to tell us that the budget has increased since 2012 to over €200 million. That is buttons. It is not working and is not enough. I am sure that Jigsaw will agree. It is on the coalface dealing with it daily. A nice office in Temple Bar is great and it caters for some young people. It is great that it is in the community but we are failing young people in this country and committing them to lifelong mental health issues, as they will not be able to recover. Could we have a bit of honesty from the HSE to the Government about the vacant posts and why they cannot be filled, that it requires more money for mental health services and that this has to be a priority? This is far more important than the next motorway, or extension to the Luas or DART. The most basic thing that a country can do for its citizens is make sure that they are healthy. The saying is "your health is your wealth". If one does not have one's health, one has nothing. Our health service has to be the top priority and at present, the mental health service is the poor relation. We need more honesty, rather than being told that things are great and we are progressing in the right direction. Things are far from good and the Government needs to hear that from those on the front line as when it comes from politicians, it just slides off and does not have the same weight. I do not know what the HSE can tell Hannah. She is not the first individual I have met in those circumstances but she has left a mark on me and by having the bravery to come out and tell her story, she will help others. She is a young woman who is very determined to ensure that the services improve.