Oireachtas Joint and Select Committees
Tuesday, 6 July 2021
Joint Committee On Health
Impacts of Covid-19 on Youth Mental Health and Psychological Services: Discussion
As we have a quorum we will commence the meeting in public session. Are the minutes of the meeting of 17 June, which have been circulated, agreed? Agreed.
I welcome our witnesses to the meeting this morning. They will be presenting virtually. This meeting has two elements. We will hear about the impact of Covid-19 on youth mental health. We will also hear about the difficulties facing psychological services. I welcome Ms Gabrielle Cummins and Ms Megan Reynolds from Beat 102-103 who will speak on the impact of Covid-19 on youth mental health. To speak about the difficulties faced by psychologists I welcome CARE. Representing CARE are Ms Marina Dillon, Mr. Adam Chambers, Mr. Mark O'Flaherty and Ms Siobhan Thomas. They are all very welcome to the meeting. We thank them for their time and the opening statements they have circulated. We very much appreciate them.
Before we kick off I want to draw the attention of the witnesses to privilege. There is uncertainty as to whether parliamentary privilege will apply to evidence from a location outside the parliamentary precincts of Leinster House. Therefore if they are directed by me to cease giving evidence in relation to a particular matter they must respect that directive. I call on Ms Gabrielle Cummins to address the meeting. She is very welcome.
Ms Gabrielle Cummins:
I thank the committee for the opportunity to speak about the research that Beat 102-103 commissioned Spark Market Research to conduct on the impact of Covid-19 on school and college goers aged between 16 and 22. Beat 102-103 is Ireland's first regional radio station. We target those aged between 15 and 34 in counties Waterford, Wexford, Carlow, Kilkenny and south Tipperary. I am joined today by our associate director at Spark Market Research, Megan Reynolds, who will field specific questions on the research carried out, should members have any. I will begin by reading some of the communication we received directly to the radio station from our listeners: "My life has become incredibly hard, and I have nowhere to turn, please can you help me"; "My mental health hasn’t been the best of late ... today I'm struggling but you have made me smile"; "I was feeling suicidal a few months back, thanks for helping me get the support I needed".
A total of 3.1 million people in Ireland tune in to radio every day. It is an important live immediate platform where real stories are heard and responded to by real people every day. Over the past year, Beat 102-103 has seen an increase in communication from young people verbalising their mental health struggles. With 42% prime time market share we know they listen to us throughout the day. We felt it crucial that we understood what they were going through and how to help them. This is why we commissioned Spark Market Research to conduct a study entitled "My So Called Covid Life". The findings of the BAI-funded research are grim. A total of 83% of respondents said their mental health has been negatively impacted by the pandemic. Worryingly, 73% who were affected mentally said they had yet to avail of any support service to help them better cope with their mental health concerns. This was the big takeaway for us. If they are feeling like this now how will they feel in six to 12 months if they have not availed of services. Also, seven out of ten respondents said they believed the Government does not understand their age group. They feel they are not being heard. The research indicates a clear disconnect between the Government and this demographic, with a quarter revealing they do not know who the Taoiseach is or believing that it is the Tánaiste, Deputy Leo Varadkar.
We asked students to describe their experiences in lockdown. They could have picked any positive or negative word. The four top words they chose to describe their experiences were "bored", "stressed", "depressed" and "anxious". They need help now more than ever. Sadly, they do not always know where to go or who to talk to. I want to share two examples with the committee of how radio stations have helped young people in the past year. Committee members are familiar with the work of SpunOut. We have worked with SpunOut to raise awareness of its new free text line 50808. This has been shared on every radio station in Ireland. It was great for us to hear that Ian Powers said that radio had directly help the organisation to successfully recruit hundreds of candidates to its volunteer programme.
The Spark research has also shown that young girls are really concerned about their future and have been emotionally impacted by the various lockdowns. Beat along with the other three leading youth radio stations - iRadio, Spin and Spin South West - all teamed up with the national social enterprise group The Shona Project in March and presented Shine 2021, which was the first of its kind. This was a virtual online event that targeted young women by young women. We had 40,000 registrations over three days with 80 female inspirational speakers from Ireland. The content was viewed over 1 million times across the three days. We saw this as a really good example that demonstrated the power of collaboration and joined-up thinking.
Youth radio is a powerful platform where youngsters are reaching out and letting our presenters know that they are hurting. We take our responsibility in this regard very seriously. Our presenters have been trained in HSE Safe Talk-Living Works Start suicide prevention programmes but we know from organisations like the National Youth Council of Ireland and SpunOut that youth services are grossly understaffed. As CEO of a youth station, if I am encouraging our Beat presenters to direct our valued and often vulnerable listeners to a service, I need to be confident their needs are going to be met when they pick up the phone or text the crisis text line. Consequently, the station 100% backs the call from the National Youth Council of Ireland for both a youth employment task force and a national lead for youth mental health.
We are sharing this data with the committee today so that the findings can hopefully help inform the Government's approach to further addressing young people's mental health in the future. The results also provide some external insight into which platforms should be used to communicate key messages to this crucial demographic. Unsurprisingly, TikTok secured top spot in the survey we conducted with Spark as the fastest growing social media network with 86% of 16-17 year olds highlighting that it is the app they now use the most on a daily basis. Beat has paid attention to this and now has over 200,000 followers on Tiktok. We are the leading radio station in Ireland on TikTok and we have used this in an effective way in the past few months where we have worked with county councils across the south east on a road safety awareness programme. This is just an example of how we can use these platforms to continue to connect with our audience, which is ever-changing and can be fickle at times. Ireland’s youth radio stations collectively target over 1 million listeners weekly and have over 3 million social media followers. Working collectively, we know early intervention will provide assistance to young people. For our part, as radio stations, we know we will do all we can to assist the relevant agencies provide a more targeted communications approach with this crucial demographic.
Ms Marina Dillon:
Thank you for inviting CARE for Psychologists in Ireland here today to discuss the difficulties facing psychologists. CARE’s plan has always been to raise awareness of the current situation for early career psychologists in Ireland. We argue that the current employment practices within this sector are unjust, discriminatory and in need of reform. Given the current climate in Ireland with incredibly long waiting lists for child and adult mental health services as well as assessments for special needs, we propose that the expertise and experience of our psychology graduate population be utilised to help address this crisis.
Unlike in the UK where there are numerous and various paid roles for psychology degree and master's graduates, in Ireland, paid roles are extremely rare and much sought after. State-run agencies, including the HSE, advertise to fill unpaid assistant psychology roles, requiring years of experience and a minimum master's level education to even apply. Due to the requirement to often work for free, many psychology graduates are ultimately unable to pursue their chosen career as they cannot fund
years of such experience leading to elitism within the sector. In general, assistant psychology roles are temporary, often one to two-year contracts, providing no job security or progression. Many of our graduates are left with no choice but to move to the UK and further afield to find relevant employment despite our ever-increasing waiting lists for mental health and disability services here in Ireland.
In general, in order to follow a career within psychology in Ireland, a person is required to complete a four-year degree, a master's and roughly two years relevant work experience, which is hugely difficult to get and often unpaid, to gain a place on any of the professional psychology doctorate courses, which involve a further three years of study. Places on these courses are notoriously difficult to attain meaning that most applicants will apply numerous times before being accepted, if ever. Many, however, after years of investment and sacrifice are left with no choice but to give up on their pursuit of a career in psychology.
This trend combined with the high turnover of undergraduate psychology students being accepted into colleges annually nationwide has only served to create a huge bottleneck of highly qualified postgraduate students desperately trying to earn a place on the course. This is cause for much frustration, angst and disillusionment. It involves not knowing if there will ever be an end in sight, not knowing how long more you can afford to wait to get on the course and having to put your life and future plans on hold, etc. Huge sacrifices have to be made and, frankly, are expected. A Vision for Change recommended the establishment of an assistant psychologist grade within the HSE as a stepping stone to assist with career progression into professional training programmes. Consequently, in 2017, the Department of Health provided funding for a two-year pilot involving the provision of 114 assistant psychologists in primary care services for children and young people who earn €25,000 per year. A new panel of assistant psychologists was then formed in April 2019 with data suggesting that the assistant psychologist project is having a positive effect on services. Despite the clear need for clinical support, the HSE is currently looking for expressions of interests in assistant psychology posts that expire at the end of September 2021 - three months time - which seems completely illogical given that we need them more than ever.
I will now turn my attention to one of the most serious and pressing issues within our profession, namely, the funding inequity among trainee psychologists. It is time we put an end to the glaring inequalities that exist between professional psychology doctoral training courses in Ireland by funding both the educational and counselling psychology doctoral courses in line with clinical psychology doctorates. Those interested in pursuing careers in psychology tend to be channelled down the clinical psychology route as they are the only funded courses even if their preference is to become an educational or counselling psychologist. This should not be the case. The clinical psychology route is a sponsored programme entailing the payment of a trainee salary, which is €108,000 in total over the three-year programme, and a 60% contribution towards fees along with a signed contract to work for a further three years post-graduation with the sponsoring agency. In stark contrast, trainee counselling and educational psychologists must work a minimum of 250 days, which is approximately 2,000 plus hours, unpaid and pay fees of up to €45,000 on the doctorate while not receiving any income for the work they provide. Considering the fact that both clinical, counselling and educational psychologists are entitled to apply for staff grade psychology posts within the HSE post-qualification and are put on the same pay scale in post, it is only right and fair that they are treated equally while in training.
It must also be said that prior to entering a doctoral programme, most of these trainees had been working either in low-income jobs or as volunteers to gain the relevant clinical experience needed to secure a place on a doctoral course and so are already in a very vulnerable financial position. It is even more of a financial hardship for those trainees with families and mortgages to pay since they are embarking on what are full-time doctoral studies with little free time to earn a salary. Many of these trainees have to take on additional part-time work in the evenings and weekends to resource themselves. Given their busy academic and placement timetable, this leads to insufficient time to rest and study thus negatively impacting their mental health. The possibility of burnout is a real concern. It must also be stressed that the current situation of no funding restricts applications from minority groups and those from low socioeconomic backgrounds favouring those from middle to upper-income backgrounds instead. It drives elitism.
To conclude, CARE for Psychologists in Ireland calls for equity of funding for trainee counselling and educational psychologists by setting up the proposed national psychology placement office as a matter of urgency and an increase in the number of places on all psychology doctoral programmes.
We also call for the expansion and extension of the role of assistant psychologist to help address the mental health and waiting list crisis, an end to unpaid, voluntary assistant psychology posts, the provision of clinical placements on all master's psychology courses and practical placements during the final year of accredited undergraduate psychology degrees, and more transparency and consistency in the application process for clinical doctorates.
A core value of psychology is the promotion of well-being and quality of life. Therefore, it seems like a tragic irony that the profession is not doing that for its own. Many early career psychologists are working to support individuals suffering with hopelessness and mental health difficulties while the current positions and systems in place give them little to feel hopeful or confident about in their own lives. Far too many highly competent and compassionate people have had to give up on their dreams of pursuing psychology and left the profession for this very reason.
I thank the committee for taking the time to listen. We welcome whatever questions members may have.
I thank Ms Dillon and her colleagues. We like it when we get clear and definite recommendations. We will be making a report and such recommendations will help inform that.
Members will now have an opportunity to engage with the witnesses, usually for ten minutes, but there is an opportunity for latitude. I should also pass on the apologies of our Chair, Senator Black, who is unavoidably absent. I am filling in on her behalf. Apologies have also been received from Senator Dolan.
I thank the witnesses for their presentations, which were interesting. Often, when young people say this, that and the other and that the Government does not understand, others dismiss them as just being young. As such, it is useful to have the evidence base of the witnesses' research. Not that we should have to have a study in order to believe someone, of course. Sometimes, a great failing of the political class is that we refuse to believe what people say unless it is presented to us in a paper or study.
I was particularly interested in the remark that the top four emotions were bored, stressed, depressed and anxious. We are members of the Joint Sub-Committee on Mental Health, so we are all obviously concerned about mental health. Otherwise, we would not be here. Young people have got a bad rap during the lockdown and there is a collectivist belief that they just need to put up with it. It would be problematic going forward if there were such an attitude towards young people in employment and social welfare offices and across society at large. Ms Cummins referred to the role that she believed youth radio stations could play. Will she elaborate on how they might tackle young people's bad rap? There is a significant problem coming down the line. The current young generation is not the first one to have experienced this, but the belief that young people just need to get on with things and pull themselves up by their socks is heightened at the moment.
I will make a second point, after which the witnesses might reply. When I worked in further and higher education - it is my area - we always asked about who was not in the room. I imagine I already know what the response will be, but the diversity of representation in the psychology sphere is probably not what we would like it to be because of the elitist aspect of people having to take unpaid internships and so on that lock people out of a career. Will Ms Dillon elaborate on this and what impact it will have? We cannot have the same people constantly represented in a profession. It is not good for the profession or the people with whom psychologists work. What impact is the requirement of unpaid internships having on the sector's diversity?
Ms Megan Reynolds:
To give an overview on the specific research, we carried it out in two phases in early April. We began with a nationally representative study of 500 people aged between 16 and 22 years via a quantitative online survey that took approximately 12 minutes to complete. On the back of that, we recruited six candidates between 16 and 22 years of age to participate in a seven-day online community, during which we asked them to complete tasks such as video diaries and filling in the blanks, for example, "If I were in government, I would [blank]" or "I would better cope with Covid if I could [blank]". That is where we got the majority of the emotional insights from.
Ms Gabrielle Cummins:
As to what we can do with the research, communication is our bread and butter. We are aware that young people are getting a bad rap, so we have been using much of the funding that we receive from the Broadcasting Authority of Ireland, BAI, to create projects that shine a spotlight on the positive side of what young people are doing. For example, one of the projects that we just completed had to do with life after the leaving certificate, through which we brought young people on air and let their voices be heard. Cutting out the middle man, they were telling us exactly the challenges that they had experienced. They have missed major milestones like their debs. What is sad is that they are just accepting it as the way of life now. We asked them whether they would like to have their debs in September or October, and they said "No" because they viewed it as just being something that they had missed out on. My debs were not yesterday - I do not know about the committee members - but debs are a momentous milestone that everyone should have.
Ms Siobhan Thomas:
I would love to address what the lack of diversity in psychology does to the discipline as a whole. It is an important question, as that lack does a great deal of damage. Clinical psychology has become so competitive that many people have to move location or work for free to get experience. This penalises the chances of there being any kind of diversity, in particular socio-economic diversity. It immediately prices out people who are working class or who cannot afford to work for free because of family reasons, their backgrounds, etc. It penalises people who have mental health difficulties or other health difficulties that mean they cannot drive, for example. Being able to drive is a major requirement in most assistant psychology posts. If they cannot drive, they do not get the chance to gain the experience they need. When a service is self-selecting those who can work for free, we have to wonder how much the gap is widening between the psychologists who are providing services and the people who are receiving those services.
We are not rewarding diversity of experience. We are not rewarding lived experience of mental health issues and we are making sure that the psychologists who are being trained to treat people have such massively different experiences to those who are coming to be treated. We have made it very clear that we do not care about lived experience, or diversity in encouraging people from lower socioeconomic status or from people with disabilities or mental health issues. It is obvious that these people do not belong in clinical psychology because they simply just cannot afford to get to the stage where they would be trained. I am happy for my colleagues to add to my comments.
Mr. Mark O'Flaherty:
I do not know what I can add to that. I feel that it is has been said that requiring people to volunteer creates a huge barrier. I do not know about data on the profiles of Irish psychologists but I expect it is skewed towards upper middle class. That is my personal experience anyway. I am one of those people who has turned away from the profession because I just could not afford to work for free without any secure employment.
Ms Marina Dillon:
Again, talking from personal experience, I am in my second decade to qualify as a psychologist. It has been a change of career. We absolutely should be rewarding lived experience. We have a lot to bring to psychology yet those with the most lived experience, that is the most mature, would have more difficulties and barriers actually getting on board, at least to the full qualification stage because we have families and children to look after and so many other things going on that we do not have the time to double job, which is what is required of a trainee counselling and educational psychologist. On top of the placements, you have to attend full day lectures and also prepare for exams, assignments, presentations and also earn an income. You are so squeezed you do not have the time to do those jobs. People have to do an hour here or there in the evenings and at weekends. Something has to give there. There is no work life balance. I would almost say that it is unethical. We should not be pushed to our limits and we are. I believe it has a negative knock-on effect on clients. You would like to think that when you are fully qualified, you are raring to go, full of energy and vigour. I am not sure that we will be at that point when we qualify. It has a knock-on effect and that has to be borne in mind too.
Our counselling psychology course is the only one of its kind in the country. We definitely do promote diversity but there are huge fees that must be paid. There is a huge commitment. I expect the majority will agree that at one time, we have all had to work for free. I had to work for free for the guts of a decade just to gain the relevant experience. It is not sustainable.
Before Ms Dillon used the word unethical, I had written that word and underlined it. I am increasingly of the opinion that things like unpaid internships and unpaid requirements for people to qualify are unethical because it is a financial barrier by another name. My thoughts on fees are well known but unpaid internships and training are unethical and they are locking people out of the sector. We are talking about young people having a lack of hope and feeling very weighed down but then there is also the lack of opportunity, in this and other sectors, before they even get out of the leaving certificate door. It is not good enough. It is really important that the witnesses have highlighted that today. Hopefully the subcommittee can help bring these thoughts and recommendations forward.
I thank Beat and CARE for coming here today to talk about these very important issues on the roll-out and provision of services. I have some questions for CARE. Myself and Deputy Boyd Barrett met members of CARE some weeks ago on the ongoing situation. I had not been aware of it and was well informed by the briefing on the problems the trainee psychologists are encountering.
CARE's statement said there are elements leading to elitism in the sector. Will they elaborate on that? How does it manifest itself in the profession?
Ms Marina Dillon:
The financial barriers are the main factor driving the elitism. Unless someone is from a comfortable background or they can afford to take on a substantial debt they will be very hard pressed to be able to get on the career ladder. You can do an undergraduate degree in three or four years but the big issue is where someone comes out qualified with an accredited degree in psychology they are effectively left to their own devices. They must scramble around and figure out how to get on a doctorate. They are in limbo and that is the problem. The limbo can go on for over a decade, in my case. You find you are trying to get the experience necessary to get on the next stage of the doctorate. Only very few get paid assistant psychology roles so you end up working for free. I worked all my life until I decided to change career. I could have gone back to any of my old jobs but I would not have gained the relevant experience. We are given no choice but to work for free and therein lies the problem. How many people can afford to work for nothing for such a long period? The answer is very few and that is what drives the elitism.
Mr. Mark O'Flaherty:
A person with more financial resources will have more options. They can apply for the doctorates that are not funded, which are out of reach of most people but it is still an option. Master's degrees are also expensive. There are more voluntary positions. If you wanted to go abroad, that still requires money. I know people who flew back and forth to the UK several times a year because they were doing interviews there. If you are volunteering four days a week and on unemployment benefits you cannot even afford to look for jobs outside the country.
Ms Siobhan Thomas:
The elitism is not only driven by the expectation that people will work for free but it does not reward people for the effort they have put in. If they do not have the money that is it - they simply cannot do it even among those who are very qualified. For example, I have left the area of clinical psychology because I could not get the experience I needed.
I have two primary degrees. I have a master's degree that I could only do because I won a scholarship, otherwise I would not have been able to afford to do it. I got first class honours in them all. I have lots of experience working with vulnerable populations. I have lived experience of overcoming mental health issues and trauma. I have all this wealth of experience. I am a highly-qualified person but because I did not have the money to volunteer on an assistant psychologist post that should be paid or to train on the doctorate that should have been funded, I was simply priced out of the system. The really important thing is that this completely disregards the work people have put in if they do not come from the right background. That is all I would add to that.
Obviously, that is having a quite a detrimental on Ms Thomas's profession when at this moment we need psychologists in the field. Her profession is up against these odds, however.
The submission document provided to the committee by CARE outlined six points to address the issues. If those issues were addressed, what kind of effect do the witnesses think it would have, not only on their profession but also on the delivery of services to people who need them? If these six issues were addressed, what effect would that have with regard to the substantial issue?
Mr. Adam Chambers:
The lack of positions available means those people with the most resources, mainly financial, are the ones who are able to do them. That bottleneck, therefore, means that only those with the most resources can get into these positions. If we open up the number of positions then we allow people who have that sort of merit and ability to be able to come in and fill these roles. The problem is that there are not enough positions for us to get into, which then creates this bottleneck where only those who have the most resources, and who maybe live in Dublin and do not need to pay for accommodation, can step through.
I do not think it is meant to be elitist. It is that people with great experience are falling off because they cannot keep continuing to reach these ever-growing ladders in front of them. It becomes a scenario whereby a person does a degree and a master's and gets experience and now it is free experience. Like Ms Dillon said, people have been doing this now for more than a decade. That means that the people who are then getting through are actually probably not the people who are on merit the best characters for the job.
Ms Siobhan Thomas:
I will add one thought on the effect that having more funded places and dealing with this elitism might actually have. We all know how long it takes people to get mental healthcare in this country. Many people are being forced to go into the private sector. I have even heard of some people going abroad for assessments.
We have an able and willing cohort of people who could be trained to actually give these services. We have thousands of children now on waiting lists for private care services while we have thousands of psychology graduates who are completely discouraged from actually pursuing clinical practice as a career. It makes no sense. When young people are waiting in excess of three years for a learning or intellectual disability assessment, we know there is something seriously wrong with the funding and staffing in this country. Psychology graduates who want to pursue clinical training are now leaving the country because they cannot actually get training here. We are, therefore, sending highly-qualified and educated people abroad to pursue clinical practice while our mental health service is in a complete shambles and a state of crisis. While dealing with all of these, we could actually help to rectify the issues in our mental health system.
I am happy enough with that. It is really important that the witnesses are highlighting this issue today. Obviously, student nurses highlighted the issue earlier this year with regard to unpaid work. That goes across the allied professionals and the health service where a whole cohort on the front line are not getting paid for the work they are doing. That is leading to a huge amount of disillusionment and disparity between those who have resources to overcome that and those who do not.
At a time when we need people like Ms Thomas, who are educated and willing to be on the front line of our mental health situation, it does not make sense that we are putting all these barriers in front of this profession to make it much more difficult for people to qualify. What happens then is that people emigrate and some do not come back. They have been educated here and they want to give something back. This needs to be addressed, hopefully, as soon as possible. I thank everybody for coming in.
I thank Deputy Kenny. He has campaigned in this area for many years, both in the Oireachtas and in his community. We move on now to Deputy Mark Ward, who also has massive experience on the ground in Dublin Mid-West and in the Clondalkin area for Sinn Féin.
Go raibh maith agat, Acting Chairman. It is great to see the two groups here today, both of which I have met with individually in recent times. My first question is for CARE. My grandmother used to have a saying when I was growing up: "If you work for nothing, you will never be idle." Nothing can be truer from what the witnesses said in their statements and during the meeting. We recently saw a number of advertisements by the HSE for unpaid positions. I did a little bit of searching so I will read one out for the record. The job is for a voluntary assistant psychologist and states:
We are seeking five voluntary assistant psychologists. Posts are either in the adult primary care psychology service or the early intervention team in the HSE Dublin North West. These are non-paid positions. Successful candidates are required to commit to work a minimum of two days in either service.
In this day and age, that is absolutely disgraceful. As was mentioned, 8,500 children are desperately waiting for primary care psychology as we speak. We need to put something in place that will meet the needs of society but also meet the needs of and value psychologists for the journey they must take to achieve their qualifications. Nobody comes into the witnesses' line of work without having that care and empathetic background to help society.
I have one question regarding what the NHS does compared with the HSE. What can we learn in this State to improve and make things better in order for psychologists to get the experience and the paid positions that are needed, but also for society as a whole to get its needs met? As I said, for example, 8,500 children and another 1,500 adults are waiting for primary care psychology. That is 10,000 people in the State who are waiting. What can we learn from the NHS that the HSE could use over here?
I will have a supplementary question for Beat 102-103 afterwards if that is okay.
Mr. Mark O'Flaherty:
Perhaps I can answer that because I did my master's degree in Belfast. I was studying with people who were all employed in the NHS service so it was a good chance to compare how things are done differently. There are probably a number of things we could learn from how it does things. One is funded master's degrees. Obviously, assistant psychologist positions are funded and assistant psychologist are more widely employed. At the moment, the HSE only uses them in its primary care child and adolescent services.
In the UK, they are employed across a variety of services, including disability and adult services. That is one issue.
I am not sure if the committee is familiar with Improving Access to Psychological Therapies, IAPT, which is a programme run by the NHS. It is a mental health service that provides low intensity but high-throughput interventions for anxiety, depression and those kinds of difficulties. As part of this service, treatment is offered by assistant psychologists, under supervising psychologists, working in communities. In terms of taxpayer money, it is a very effective utilisation of people at that level of their training.
One other thing we could learn from the UK is to have a centralised application system for doctorates. In the UK, there is a centralised application system. A person just applies to one body and all the universities look at the application and decide, whereas in Ireland €50 has to be paid to each university with every application so it is quite expensive.
I apologise for cutting across Mr. O'Flaherty. At the moment, the role of assistant psychologist within the HSE has an uncertain future. As Mr. O'Flaherty stated, it is limited to primary care, in contrast to the NHS where there are permanent contracts and psychologists are employed in a variety of settings so expertise is built up. Is that something that can be easily fixed or is it a matter of political will? What is the barrier to that in Ireland?
Ms Marina Dillon:
I will come in on that. I do not know if the Deputy recalls that I sent him a video on a similar system that was set up in Roscommon. It was a pilot project called access to psychology services Ireland, APSI, and it worked very well for participants. There were no waiting lists, people were taken in off the street and there was no delay with referrals and all of that. Someone could walk in off the street and be seen to. The way it worked was that five assistant psychologists worked under the supervision of one senior psychologist. Normally, a senior is needed to supervise at that level. He supervised these five individuals, the flow was great and the feedback from clients was very good. I sent the committee the video but I do not know if members got to watch it. It is something that could easily be rolled out nationwide.
There is no shortage of assistant psychologists. However, there may be a shortage at the level of seniors unless there is an agreement on staff grade psychologists supervising assistant psychologists. That could be a barrier. To be honest, the lack of seniors is a problem anyhow, even when it comes to supervising trainees. Not only that, it is not mandatory for a senior to supervise trainees. It is voluntary. It could be a case that one year a senior will supervise a trainee but it may not suit him or her the next year or he or she might be unavailable and, therefore, there is no place on a particular site for a trainee. That is probably worth bearing in mind.
There is another role in England called the psychological wellbeing practitioner, PWP. As far as I understand, it is a permanent role to do with what Mr. O'Flaherty talked about, which is the low-level CBT-based approach. A PWP deals with the earlier stages of anxiety and depression and, ideally, nips it in the bud or catches it in time so there is less delay. We need to roll that out in the community so there are less barriers to going in. To be honest, I am all for working hand-in-hand with the doctor on the ground, which means you either turn left for the GP or right for the psychologist. That is how it should be done in future but that is for another day because I do not know how long that would take to set up.
To echo that, the Irish College of General Practitioners, ICGP, has also called for the same thing. It would like to see a one-stop shop for people's physical and mental health under the same roof. Many ICGP members have room in their practices to be able to provide that service. It is something we have been calling for and we need to start pushing for it. I thank the CARE representatives.
I will turn to the Beat 102-103 witnesses. I recently met Ms Cummins with Deputy Cullinane and she gave a very interesting presentation. I have not got my notes. I will have to do what I usually do, which is to wing it.
It has got me this far. We all know that young people have been adversely affected by mental health issues, especially because of the restrictions. Their structures have been taken away, including access to schools and colleges. Jobs they would have availed of in the bar trade, restaurants or whatever it might be have been curtailed, as has access to their sports clubs. They are told to have an outdoor summer but when they gather outdoors they are being looked down on by certain members of society. It is very difficult time to be a young person. Beat 102-103's survey captures how difficult it is for young people to take part in normal society. Young people should be out with their peers, making mistakes, learning from them and doing all the things we did when we were growing up. That has been curtailed for young people.
One of the statistics in the Beat 102-103 survey was that 73% of young people who stated that they had mental health difficulties during the restrictions did not avail of any help. Do the witnesses have any insight into why that was? Did young people know about the services that were out there? Was there a stigma about accessing them? What might have led to that?
To follow up on the issue of a youth director for mental health within the HSE, that is something I would definitely support but the problem is we do not even have an overall clinical director of mental health in the HSE. We need to look at the issue at that level so we can start putting structures in place that will help young people, or anybody, affected by mental health issues. Does Ms Cummins have any insight into the 73% figure?
Ms Gabrielle Cummins:
Some 83% of respondents stated that their mental health had been negatively impacted but 73% had done nothing about it. Another statistic indicated that 62% had used none of the services. A long list of options was given on the survey, including Jigsaw and SpunOut. Ms Reynolds probably has the list of how many services-----
Ms Megan Reynolds:
Yes. We asked a question on whether respondents' mental health had been affected during Covid and the various answer options under "yes" were; "significantly", "somewhat", "a little" and "no". From that question, we were able to ascertain that 83% of young people agreed in some capacity that their mental health had been affected by Covid. Following on from that question, they were then asked whether they had availed of any services. Counselling was one option offered on the survey, which 9% of people said they had availed of. Some 15% stated they had availed of mental health services such as Jigsaw or SpunOut, etc. The remaining 73% stated "none of the above", which meant they were not reaching out to anybody to talk about how they were feeling.
Ms Gabrielle Cummins:
We argue that this is a big concern and all of us, collectively, have to work together to figure out how we can communicate more to young people to allow them to realise that early intervention is key. Deputy Ward mentioned that there is no director of mental health in the HSE. We argue that the need to have a youth director of mental health is more important than anything because the earlier we are able to support young people the more likely they are to have a better life further down the line. We absolutely back the need for a national lead for youth mental health.
I will highlight the importance of collaboration within departments. We got funding from the Broadcasting Authority of Ireland, BAI.
Then we had to go to the HSE to help raise awareness. For example, this week we are raising awareness on those under 35 years being able to get vaccinations. We had to go through a lot of hoops with the HSE to ensure that we get the necessary access to provide that awareness. It is important that there is more interdepartmental collaboration. We are there to help, we are willing to do so and we have the resources. It is about using what we have to offer as much as we can.
I thank Ms Cummins. I have to run out of this meeting as I am on the Joint Committee for Children, Disability, Equality and Integration meeting at the same time and I must pop in there.
The top four emotions mentioned were that people were bored, depressed, stressed and anxious. Those are perfectly normal feelings especially during what we are going through at the moment, but as Ms Cummins said, early intervention is key to stop those feelings from becoming more acute as a result of which young people will need more acute services. If you can give the young people the services they need now, that would make a big difference. I really appreciate the feedback from the meeting and I appreciate CARE for taking the time to meet myself and Deputy Cullinane a couple of weeks ago. I wish everyone well.
I thank everyone here today. It has been a very interesting discussion. I will have a question for Beat 102-103 later but I will start with CARE. The representatives have done a very good job today of outlining the huge challenges to their sector. Professionalisation of a role and that pathway becoming a barrier to people taking part is something that we see in other sectors too but in health it is particularly onerous on people and very difficult. It is not only a barrier to diversity but in my previous professional life where unpaid internships became part of the deal and are not available to those of us who do not have someone to pay for us, the research shows you lose an awful lot of women. I am mindful that we are moving into an era of the implementation of Sláintecare and cross-disciplinary teams and, hopefully, a proper model of primary care. It was interesting to hear about the access to psychology services Ireland, APSI, experiment and there being five assistant psychologists, APs with a senior psychologist. In a perfect world, is that AP model the right model? In a perfect world, would the CARE representatives like to see that model progressed or is the version they would like to see in the future more one of in-the-role learning and continuing professional development being recognised as part of the career trajectory so that it could be made more aligned with paid work? In the UK, there is far greater integration of on-site and in-the-role learning as part of particular qualifications or professional registration. They seem to be further down that road than we are. I would generally like to hear more about that APSI model. Was that a primary care type situation?
CARE's opening statement discussed the difference between clinical psychology and the recognition of education and counselling psychology, and different payments or sometimes no payments for particular roles. In light of the movement into new models and Sláintecare, hopefully, it is useful to understand how that came about. How did such a divide come about between clinical education and counselling, a different recognition? Is that something that has evolved from HSE hiring practices? Sometimes that evolves through university practices or recognition by particular hospitals. How has it come about that there is such a dichotomy between disciplines when we seem to need them all?
Ms Marina Dillon:
I thank the Deputy for those questions, they are very relevant. Back in the day, say more than 15 years ago, educational psychology and counselling psychology did not require a doctorate, it would have been master's level then. The standard route everyone was channelled through to work for the HSE was the clinical psychology route. Clinical psychology route was nearly associated with working for the HSE. That has changed radically. If someone wants to become a staff grade psychologist today in the HSE, they have a choice of getting on either a clinical psychology doctorate, a counselling psychology or an educational psychology doctorate. Any one of those three strands can get you into a staff grade post. It is the same recognition now. I applied for the counselling psychology doctorate but I also applied for the clinical psychology doctorate. I did not apply for the educational psychology doctorate because that was not my niche but I could have done so. We are coming in with the same qualifications across the board. It is becoming quite standardised. That is not ideal. We do not want that either. We do not want only to be in a position to work for the HSE. The way we are trained, we can work in other areas such as the prison services, in an array of private hospitals and all sorts of other areas, as can the others.
There is a lot of flexibility. The training is in-depth across the board. It is at a very high level. The main difference, having explored it, is that apparently a national psychology placement office, the NPPO, should have been set up some years ago. It is within its remit to fund all doctoral psychology courses. Ideally, we should be brought up to speed once that opens. We sent in numerous parliamentary questions over the years but we still do not know the cause of the delay. We are waiting on that office to be established. I believe it is under Dr. Colm Henry's remit to set that up. Perhaps he is the person to talk to on that. We had it in mind to reach out to him but if the sub-committee can do that for us, so much the better. Those are the differences.
Does the HSE's requirement set a standard across the sector when people apply for private roles or roles in, say the Department of Education or a prison? Do the HSE staffing requirements have a knock-on effect across the sector?
Ms Marina Dillon:
I do not know if I am best placed to answer that but I would say yes, it does. Only 47% of the posts that should be filled in the HSE are filled. There is a great need for more psychologists in the HSE. I also heard a statistic from the Psychological Society of Ireland that only one fifth of all fully qualified clinical psychologists go on to work for the HSE even though they are the only ones being funded. That is poor investment, as I see it. Being a counselling psychology trainee myself, I have to pay €45,000 in fees over three years. I am also working on placements for free. I have a family and very little time to earn an income but I am doing that, squeezing it in the evening and at the weekends.
It is unsustainable and totally unfair. I have colleagues who are doing the same job as clinical trainees and even working with the same clients yet they are not being paid and the clinical trainees are. There is no rhyme nor reason as to why that is and it must change.
It seems like a legacy that is completely disjointed from what is actually happening on the ground. I have a super-quick follow-up question. Ms Dillon mentioned in the APSI discussion there is not a requirement that senior psychologists engage in training. Does she believe that should be written into contracts?
Ms Marina Dillon:
There is a shortage and I think everyone would agree with that. How one goes about addressing that is another matter. Could it be that a basic grade psychologist, after X amount of years can take on a supervisory role even if he or she is not the senior? My understanding is that after three years of being a basic grade psychologist, a person can then apply to be a senior. Maybe it should be made mandatory. It would have a positive knock-on effect. It would mean the supervisory role was spread across all those who have three or more years experience in the role of a psychologist and would mean more trainees could be supervised. To be honest, as the Deputy can probably see from my opening statement, one of our key points is we should increase the number of places across all doctorates. That is the only way to make up for the deficit of 53% in the HSE.
That is exactly the sort of question that would have to be addressed by this office, so that is probably germane to that.
If I have time, I have a quick question for Beat. I wanted to follow up with it because the work it is doing is really interesting. I am interested in the methodology of the project that was undertaken because it has come up in other committees and with other issues. I refer to reaching out to people online during Covid, particularly through social media. There is a bit of fear around TikTok and that Beat has gone onto that medium and conquered it a bit is very interesting. On the methodology, did it find there were pitfalls to engaging with people through social media? Also was there an issue with self-selecting in the particular group who engaged with that? I ask because some people do not have access to digital technology or even access to a space where they can engage with that technology in private. That is a big issue where domestic violence is concerned, for example, in that often women do not have a room where they can go to make a call. I imagine there are plenty of teenagers out there who do not have a private space where they can interact with something around mental health. Similarly, was there a barrier to young people with disabilities engaging with that kind of a study through online media or social media? Is that something Beat factored in?
Ms Megan Reynolds:
That is a very interesting question. From the point of view of the quantitative piece of the survey, that is, the nationally representative piece that went out to the 500 16 to 22-year-olds, Spark used a panel provider in order to find all those people. They would have signed up previously and said they were interested in opting in to surveys, marketing communications and things like that, so that is where we sourced those particular respondents. For the qualitative piece, that is, the online community, we went through a professional recruitment agency which was able to find us the right candidates, in that we were looking for people from specific areas, who were of the right age. We were looking for school attendees, college attendees and new graduates to be involved. We used third parties to access the various different participants and respondents we had.
Ms Gabrielle Cummins:
On the diversity question, I would have thought the fact this was online encouraged more people to get involved. We saw that with our Shine 2021 project as well. The feedback we received was that we were able to be more inclusive and encourage more people to access the content they would not normally be able to access. One of the people who contributed to the seven-day online video day referenced the fact she found it quite difficult at the start because she was in a rural area and did not have access to Wi-Fi. That left her struggling to engage. She really missed socialising and was paying less attention in class because of remote learning. She was unable to get access to it as her counterparts in urban areas were. We asked Spark to ensure there was a good urban-rural split because our area of the south east covers quite a range of rural and urban areas so it was important that was factored into the research as well.
I thank Beat and Spark for that work. If anything, if has impressed upon me that however much communicating we have done on the issue of mental health supports we have not solved it yet. We have not quite got there and we have a lot of work to do.
I thank Deputy Hourigan, that was an excellent engagement. I welcome Deputy Buckley, who has a huge interest in this area, and has been involved in many organisations in the Cork North-Central area. He has a few questions for our guests.
I thank the Acting Chairman. I will be very brief because time is short. All of us have meetings after meetings for a meeting about a meeting before we go to the meeting to talk about that meeting. Anyway, much has already been raised but there are some main issues that keep coming up. I love our guests' frankness about it because I am black and blue in the face from listening to Government parties say over the last few years that we have a problem with recruitment. We know we have a problem with recruitment because they make it too difficult to qualify. A while ago Ms Dillon mentioned the assistant psychologists and how around 2017 or 2018, or maybe later, the Government promised to employ 114 assistant psychologists. From my information at the time, when I was sitting on a different committee, they did not do any psychology. They did not do any assisting. The only assistance there was was wetting envelopes to send out appointment consolations. I know of people who left the service over that and got into the Prison Service and who feel more appreciated there. I can see Ms Thomas and Mr. O'Flaherty's frustration. When we get involved with these specific topics, 99% of the time it is because we have had some connection to it be that emotionally, personally or through friends or whatever. I have been listening and it was mentioned that we do not have a national lead. Having listened to the statements our guests from CARE have made, no matter how passionate I was, there is not a hope in hell that I would be seriously thinking about going into this as a profession because there are so many barriers. I have no problem saying it. I have used this line before but as a penance you would actually have a better chance of emptying the Red Sea with a bucket with no arse in it. It just cannot be done. I am being honest here.
It is debates like this which need to be aired, and aired publicly. I am thinking of what Ms Cummins said about things being outside the box. I can remember that less than ten years ago, if you mentioned mental health you were shut down straight away. You had something that was contagious and if you spoke about it you were putting ideas into somebody else's head. Now you can address it through social media, radio and so on. Our guests are right that we must reach out to the younger generation but we must also listen to them. That is the problem. We are not peer-led in this country. We will tell people what we think is best for them instead of saying we should shut up for a second and ask people what they think would be best. That is what we have lost in society. I do not envy our guests. I am not going to quiz them on anything because a lot of the stuff has been covered. However, I encourage every one of them to not let this go, even if it means thinking outside the box. I am absolutely dumbfounded. I knew it was bad as far as education and trying to qualify for anything like this is concerned but there are so many preventative barriers it is just beyond belief. I was a member of the Joint Committee on the Future of Mental Health Care a number of years ago. We have talked about funding but there is also massive wastage of funding.
More than €1 billion was spent on mental health services in 2017 to 2018, but the HSE could not tell us where it had been spent. We try to balance resources.
Mr. O'Flaherty referred to people going to England or elsewhere. They are not valued here. These are services and I am black and blue listening to the HSE talking about problems with recruitment and retention. It will not train or pay people yet still expects them to stay and then scratches its head wondering where it is going wrong.
I used to be our spokesperson on mental health. Deputy Ward has taken over, but it is still my passion. If the committee can assist the witnesses in any way, they should not hesitate to contact us. When people like them get together, they have a bigger and better voice. Could they work in collaboration with Ms Cummins, Ms Reynolds and others to push this? It should be a national issue. I suspect that, from next March onwards, we will see a tsunami of mental health problems and mental health-related problems due to anxiety, stress and depression. They are just the little firelighters. There will be knock-on effects on families, friends and so on.
I do not envy the witnesses. I thank the Acting Chairman for his patience. I thank the witnesses, including for their honesty. We have been at this for a long time. The most important issue is that we must get the message out that some people cannot qualify in this country. Let it be written in black and white that people can buzz off if they think others will break their backs. People are not expected to feed their families for free, so why should they work for free? We are told that there is a recruitment problem when we are not even backing their training. People can go across the water to the NHS. It might not be perfect, but at least it has joined-up thinking, a plan and a bit of openness, empathy and understanding. It also has a common sense approach. A major issue in this country is that there is no common sense. People protect their own patches and do not like others getting on better than them. Instead, people should work collectively. The main issue is patient safety.
The greatest reward in life is to help someone, regardless of what with or in which profession, and to be told "Thanks". It cannot be taken to a bank to be cashed, but a person can hold onto it for as long as possible. It is well worth the effort. The witnesses should keep going with what they are doing. If we can assist them in any way, they should not hesitate to contact us. I wish them well and the best of luck. I hope that, the next time we are speaking at a meeting of this committee, we will not be giving out about X, Y and Z, something will have moved forward and there will have been more of a positive outcome. I am not optimistic, though. I am a realist. I am angry, although I am toning it down. I normally raise my voice much more than this. I am angry for the likes of the witnesses, who are passionate about this matter but who have been pulled and dragged through muck for five or ten years and for whom muck is their thanks. I would go away to a different profession, write to the relevant Minister and say that I was sorry, I tried, the Minister did not give me help and I was out of here.
I will always acknowledge Deputy Buckley's passion. He is a strong advocate and never gives up. I thank him for that.
Do any members have supplementary questions that they would like to put to our guests? No.
I agree with much of what Deputy Buckley said. Everyone is trying to achieve a common goal. I found the survey to be of particular interest. What was especially insightful was the engagement knitting social media to radio. I have often regarded social media as having circumvented radio to some extent, albeit in a pitiful way. Radio is controlled and managed and can be much more effective than social media. Marrying the two as our guests have tried to do through TikTok and so on is the way to go. Have they built up relationships with other radio outlets, in particular community radio? Community radio stations operate in small communities. They do not have large audiences, but they do phenomenal work supporting people. Has Beat 102-103 reached out to them or are there plans to do so?
Ms Gabrielle Cummins:
I appreciate the acknowledgement of our work and our embracing of social media. All of the commercial radio stations are members of the Independent Broadcasters of Ireland. We work effectively on collaborating on various projects, for example, the campaign to highlight the work of SpunOut and the Shona Project. Across the year, we regularly collaborate with other radio stations. With a listenership of 3.1 million people, we are a powerful medium collectively, so it is important that we collaborate where possible.
In terms of community radio stations, that is an opportunity where we can engage further. During Covid, we have often met the community sector virtually as part of events presented by the BAI. If there are further opportunities for us to collaborate with the community sector, we are open to engaging where we can.
That is great. Community radio is embedded within communities in inner cities and rural areas. I come from County Clare, where there are two effective community radio stations - Raidió Corca Baiscinn in west Clare and a radio station in the Scarriff area in east Clare.
Regarding the issues raised by CARE, there is clearly a major problem, one that has been discussed widely at this meeting. I hope that this forum will shine a light on the glaring gaps that exist. I was interested in Deputy Ward's comparisons with the NHS. I will give CARE the opportunity to go through its recommendations again, as this committee will carry out an interim report over the summer and later a final report, which we hope will influence the policies of this and future Governments. There is a significant job to do, and it will take time, but it needs to be done correctly. All of CARE's recommendations are important, but do Ms Dillon and her colleagues wish to elaborate on the critical ones?
Ms Marina Dillon:
I will start by reading out the recommendations, and if those attending with me would then like to contribute, I would be happy to hear from them as well.
The critical recommendation relates to equity of funding for trainee counselling and educational psychologists. For that to happen, my understanding is that the national psychology placement office needs to be established. It has been in train for the past couple of years, but for whatever reason - it is for Dr. Henry to revert on that - it has not been done. Apart from dealing with the obvious issue of inequity, this recommendation is critical because I have found that those who would prefer to go into the specialisations of counselling and educational psychology are unable to because they cannot afford to. Instead, they are applying for clinical psychology. This is far from ideal and should not be happening, and is part of the reason it is so critical that we attend to the inequity as the first priority.
The second priority would be to increase the number of places across all psychology doctoral programmes to meet need. The level of need is clear; all of us at this meeting are in agreement that the HSE is understaffed. We need more psychologists, which will only happen if we take more in. I believe it was Deputy Boyd Barrett who stated that 52 trainees had been taken on board last year.
That is far from enough if we want to cover the 40% plus of vacancies in the HSE.
The third recommendation refers to the expansion and extension of the role of assistant psychologist to help address the mental health and waiting list crisis. We have highly-qualified people, who are primary care members and beyond, who have master's degree level in psychology and several years of experience having worked for free and gained relevant clinical experience. All they are waiting for is to get on to the coveted doctoral course. In the meantime, they are literally twiddling their thumbs or earning the minimum to get by. Why are we not utilising that huge resource? Instead, they are coming up against a brick wall. The APSI is one example of how we could utilise and bring them in.
The fourth recommendation calls for an end to all voluntary assistant psychologist posts. It goes without saying that in this day and age, and particularly considering the cost of living, no one can afford to work for free. It should not be happening and particularly within the HSE.
The fifth recommendation calls for provision of clinical placements on all masters psychology courses and the offer of practical placements during the final year of accredited undergraduate psychology degrees. This was an idea of CARE's. I spoke about the limbo of bridging the gap between going from an undergraduate degree and gaining a placement. If a person gains that experience in a placement at undergraduate level, he or she is already coming in with experience and if that person has experience, he or she will have the confidence to start applying for the doctorate. People will find they do not have such a long-term limbo land. The same goes for master's degrees. All master's courses should be providing placements in order that we are better placed to apply for doctorates.
Finally, we call for more transparency and consistency in the application process for clinical doctorates. The feedback we have received from our members is that it is as if the goals move year-on-year. There is, for example, quite a complex grading system provided by the top five universities. We have noticed that early career psychologists who applied, for example, for the clinical psychology doctorate and did not get a place get comprehensive feedback as to why. There is a breakdown. They are actually scored, in some cases, based on their leaving certificate results and also how they did at the interview, etc. They take that on board and then come back another year and apply and they get much different feedback to the point they are wondering what they are doing wrong. They do not, therefore, really know what they need to do to get better placed. That seems to be an issue.
We are looking for uniformity, ideally. That would probably mean collaboration between universities as regards the application process or perhaps that is something that will also be within the remit of the national psychology placement office. Those were our six key points. My colleagues may wish to come in on that.
Ms Siobhan Thomas:
I will make one point on the final recommendation Ms Dillon highlighted around the transparency involved in applying for the different doctorates. The breaking point for me in leaving clinical psychology as a career was learning that colleagues of mine had been graded on their leaving certificate results. At the time, I was 28 years old. I had not done my leaving certificate for ten years. When I heard from a colleague that their leaving certificate results were graded equally to their postgraduate training, I then realised there was no place for me in clinical psychology. Coming from a background where I was never going to do very well in the leaving certificate anyway, if it meant that my leaving certificate results were graded equally to the effort, hard work and dedication I put in during my undergraduate and postgraduate training, it became obvious to me there was not a place for me in the service and that was the moment I decided to leave. More transparency and equity in grading to get on to clinical doctorate courses is really a massively important step to fixing equality issues in the discipline.
Mr. Adam Chambers:
I could step in. It is very clear that it is very difficult for early career psychologists to get qualified. It is very clear that there is underemployment, in general, of psychologists. Part of what we are saying today is that we must look at the context where we have waiting lists with 10,000 people who are being told to wait two or three years. It does not make any sense for us to not be able to get qualified when so many people are crying out for support. As much as we have pointed out what is wrong in terms of trying to become a psychologist, serious urgency has to be put on the fact that it is not that we are crying out for ourselves to get qualified and get jobs. People have been waiting years and years for support. They are not going to get any better by us telling them to wait for years. We are here and we want to help, therefore, employ us. We have this serious bottleneck where we need to really come to terms with the fact that we are making things very difficult for psychology graduates. We have many people who need support and we really need to start putting these two things together.
I thank Mr. Chambers. At this point, we have had a phenomenal exchange of views. I thank the witnesses for their clear and concise articulation of the problems. We all had an understanding that there were issues but hearing it clearly and concisely, with backup examples, is certainly extremely useful from this committee's perspective.
I thank CARE for its six recommendations. Hopefully, we will see some progress because I believe there is unanimity in the view that this needs to be dealt with. The whole idea of unpaid apprenticeships should really be a thing of the past. That should be the case across the working community, not just in the witnesses' profession. Unfortunately, it is also happening in many other professions and it needs to come to an end. Again, I thank CARE for its six recommendations and the meeting and support it provided.
The work our friends from Beat 102-103 are doing is phenomenal in reaching out to and engaging with young people. They are using the media young people are using to try to get an understanding and take ownership of their issues and to support and listen to them. People have two ears and one mouth and it is good when they are used accordingly. Certainly, Beat 102-103 is doing that. I wish it every success in the work it will do and thank it very much.
This brings to an end this engagement. As I said earlier, this committee will be drafting a report, which we hope will equip us in lobbying Government but, more important, inform Government. Hopefully, we will see Government take action. Funding is required and many step changes are needed. We have seen some improvements but we are certainly nowhere near where we would like to be by international norms.
I again thank witnesses for their time and contributions. I thank members for their questions and engagement. I thank Ms Iqra ZainulAbedin, our committee clerk, for her dedication and support. I also thank our broadcasting unit and technical people. Holding meetings like this, where people are dialling in from other locations, is not easy. A great job of work is being done here in the Oireachtas. I would like to pass on all our acknowledgment of that.