Oireachtas Joint and Select Committees
Tuesday, 8 November 2022
Joint Oireachtas Committee on Education and Skills
Mental Health Supports in Schools and Tertiary Education: Discussion (Resumed)
Paul Kehoe (Wexford, Fine Gael)
Link to this: Individually | In context | Oireachtas source
We will meet with relevant academics from the NHS child and adolescent mental health service, CAMHS, and education authority, Dorset, United Kingdom; the Irish Universities Association, IUA; the Technological Higher Education Association, THEA and the Higher Education Colleges Association, HECA. On behalf of the committee, I welcome the following to the first session: Professor Paul Downes, professor of psychology and education and director of the Dublin City University, DCU, Educational Disadvantage Centre; Dr. Siobhán O'Reilly, postdoctoral researcher, DCU National Anti-Bullying Centre; and Ms Sarah Stockham, clinical lead of the Dorset mental health support team, Dorset healthcare university NHS trust.
The witnesses are here today to discuss mental health supports in schools and tertiary education. I will invite Mr. Downes to make a brief opening statement followed by Dr. O'Reilly and Ms Stockham. This will be followed by questions from members of the committee. Each member has a five-minute slot. As the witnesses are probably aware, the committee will publish the opening statements on its website following today's meeting.
Before we begin, I remind members of the long-standing parliamentary practice to the effect that they should not comment on, criticise or make charges against a person outside the House or an official, either by name or in such a way as to make him or her identifiable. The witnesses are reminded of the long-standing parliamentary practice that they should not criticise or make charges against any person or entity, by name or in such a way as to make him, her or it identifiable or otherwise engage in speech that might be regarded as damaging to the good name of the person or entity. If their statements are potentially defamatory in relation to an identifiable person or entity, they will be directed to discontinue their remarks and it is imperative that they comply with any such direction.
Ms Stockham will give evidence remotely from a place outside of the parliamentary precincts and in such a way, may not benefit from the same level of immunity from legal proceedings as a witness physically present does. You have already been advised of this matter. As a witness participating in this committee session from a jurisdiction outside of the State, you will already have been advised that you should also be mindful of the domestic law on how it may apply to the evidence you give.
Members are again reminded of the long-standing parliamentary practice that they should not criticise or make charges against any person or entity, by name or in such a way as to make him, her or it identifiable or otherwise engage in speech that might be regarded as damaging to the good name of the person or entity. If their statements are potentially defamatory, I will ask them to discontinue.
Professor Downes will begin, followed by Dr. O'Reilly and Ms Stockham. Each of you have five minutes.
Professor Paul Downes:
First, I congratulate the Minister for Education, Deputy Foley, on the considerably progressive announcement of the specialist counsellors in primary schools. Second, I will thank and commend this committee for its immense work in driving this issue forward and acknowledge your commitment, Chair, to this issue. Having said that, there is a glaring gap and system absurdity in what has been announced in that secondary schools will not be included in the specialist counselling national pilot. We now have a situation in Ireland in which primary schools will have specialist emotional counsellors on site in schools. Third level routinely has such a service for many years and, yet, the most vulnerable group of adolescents are missing out on this specialist service. In some ways, what has been announced is an Irish solution to an Irish problem that solves nothing for Irish teenagers in society today.
Early intervention does not just mean intervention for youngest groups. It means at the beginning or early stages of a problem which may be manifested at secondary school level. The terminology of early intervention needs to be understood as meaning intervention for adolescents also. It is clear that guidance counsellors are not at the area of trauma and adverse childhood experiences. Let us be clear that the National Educational Psychological Service, NEPS, is not offering one-to-one specialist emotional counselling services. This is a system gap at second level that needs to be firmly addressed. We cannot wait for a pilot to happen. There is too much urgency to wait for the results of a primary school pilot for secondary school.
With regard to another major issue, I propose to the committee an implementation structure that is in some way ready-made at area level for the specialist counselling service, that is, to look at the local area partnerships in conjunction with schools and the local-area-based childhood programmes and family resource centres. These are obvious area-wide structures that can be used to implement the primary school pilot. I urge that the pilot be one in which the Department has not just contracted in rotated specialist counsellors. The counsellors need to be imbedded in one to two schools, at most, in order that they are not wasting time travelling between schools. An area-wide team of counsellors is needed, with a head of team that is led by a counsellor, which can also see the wider family perspectives. There may be issues that involve siblings in different schools. An area-wide based counselling team which would have clinical supervision with regard to a supervisor who could be structured at a regional level is needed. A local-area-based structure would be an optimal approach for this.
In the submission, we quoted the national project manager for the area-based childhood programme, Ms Bernie Laverty. She endorses the idea that the area-based childhood programmes, ABCs, could be a key site for linking this in conjunction with schools. I also quoted two area-based partnerships: the Northside Partnership in the Coolock-Darndale area and the Dublin Northwest Partnership. The CEO in the latter has also endorsed the area partnerships. The area partnerships are a national structure throughout Ireland. They are a very natural structure to lead a consortium bid in conjunctions with schools whereby schools would show they had space for in the school for the specialist emotional counsellors. The proposal is to have a team of four counsellors that would go across eight primary schools and have a head of team. They would all be counsellors. Let us be clear this would be a counsellor team and would not diffuse focus into other areas.
In our report for the European Commission a decade ago, Professor Anne Edwards, then head of research at Oxford University's school of education, and I emphasised the notion of going beyond endless chains of referrals. The phrase that was used was, "passing on bits of the child". We want to avoid that type of situation. I call it "referral-itis". Having the direct-delivery support of the specialist counsellors in schools at second level and primary school with an area-based structure of a team is the way in which I recommend the committee go to implement the national pilot.
Dr. Siobh?n O'Reilly:
Good morning, Chair. Thank you for inviting the DCU National Anti-Bullying Centre to attend this meeting of the Joint Committee on Education, Further and Higher Education, Research, Innovation and Science. I welcome the opportunity to represent my colleagues at the centre. We are very happy to continue to support the committee’s work on school bullying and mental health.
The National Anti-Bullying Centre is located in DCU’s institute of education and staff at the centre have been doing research and education on bullying for 26 years. The centre works closely with the Department of Education with which we have a service level agreement, as well as the Department of Justice and the Department of Further and Higher Education, Research, Innovation and Science, with which we have research agreements. The centre also hosts the UNESCO chair on bullying and cyberbullying and the Irish Research Observatory on Cyberbullying, Cyberhate and Online Harassment.
In addition to our research activity, the centre delivers a number of educational resources, including FUSE, Ireland’s nationwide anti-bullying and online safety programme for primary and post-primary schools. With financial support from Meta, Rethink Ireland and the Department of Education, FUSE is offered free to all schools in Ireland and is proving highly successful in improving the self-efficacy of children and adolescents in tackling bullying and online safety issues.
With financial support from Meta, Rethink Ireland and the Department of Education, FUSE is offered free to all schools in Ireland and is proving highly successful in improving the self-efficacy of children and adolescents in tackling bullying and online safety issues.
Our opening statement represents the full cohort of over 50 scholars and educators working with the centre and builds on our two previous submissions, from November 2020 and March 2021, and our presentation to this committee in June 2021.
The first area we wanted to emphasise was the importance of schools as safe spaces, free from bullying, intimidation and harassment. From research and practice perspectives, our centre believes young people must feel safe to learn at their optimum level. A safe school is free from bullying, intimidation and harassment. Students and learners who feel safe at school tend to have better emotional health and are less likely to engage in risky behaviours. That sense of safety contributes to an overall feeling of connection. School connectedness is measured as feeling happy, safe, close to people and a part of school, and also as believing teachers treat students fairly.
A safe school is committed to a range of preventive measures and also prepared to intervene or respond, or both, when the space is experienced as unsafe. A multi-tiered system of support facilitates a systematic approach in a learner-centred manner. A safe learning environment, social emotional learning and being trauma informed are core preventative strategies that support self-regulation, empathy, self-esteem and caring relationships and that can support "the all" in the school setting. Specific or specialised strategies may be required to support "the some" or "the few" to ensure children and young people with more complex needs can be effectively supported and feel safe at school. Optimally, this would include a family or community-based element, or both.
Safe and connected schools are adequately supported to create and sustain a caring climate for all, which may require differentiated responses for the some and the few, based on the needs presenting. Various professional roles, including those involving adults from the wider community context of the school, can work collaboratively to ensure the school climate is one where children and young people feel safe and connected. School climate is one of the key protective factors with regard to bullying prevention. We are aware that the Minister is launching the new action plan on bullying in December. In this regard, it would be great to see the inclusion of a school climate survey as one of the actions to be implemented as part of that plan.
Let me turn to the impact on mental health if schools are not safe. Health is defined by the Department of Health as everyone achieving his or her potential to enjoy complete physical, mental and social well-being. As outlined in our 2020 and 2021 submissions, previous research has consistently shown that being involved in bullying as a target, as a child or young person displaying bullying behaviour or as a bystander at school can be associated with several mental health problems, including psychosomatic complaints, anxiety, depression and suicidal ideation. Issues of identity seem to continue to remain at the heart of much bullying behaviour. UNESCO research from 2019 showed that physical appearance and race were the most common reasons for a child being a target of bullying behaviour.
The Anti-Bullying Centre would like to build on the research and work it has done through the FUSE programme and examine the areas of special educational needs and children with autism. Very little research has been done on the prevalence of bullying based on autism in schools in Ireland, and very little international research has been done on effective preventive programmes for those with autism.
A whole education approach to school safety within a community-based context is another approach we would emphasise. This ensures that, in line with the Department's well-being guidelines, there is scope to work at both universal and targeted levels, depending on the complexity and endurance of need to support "the all", "the some" and "the few". We welcome the Minister's announcement on the piloting of specialist emotional counsellors in primary schools and the extension of that pilot to second level.
We emphasise the importance of school policy and initiatives to implement school policy in a whole education approach. We ask that schools be given the space to create safe spaces and to be supported in doing so in their context, drawing on the community-based resources around them.
Our recommendations are as follows: the implementation of a school climate survey as part of the action plan on bullying to be released in December; that research be carried out on the prevalence or common forms of bullying experienced by autistic students attending Irish schools, and that, subsequent to that research, specific guidelines be developed for those students; that the development and introduction of multidisciplinary teams in and around schools be considered; and that schools be supported in taking a whole education approach in policy, procedures and practice.
Paul Kehoe (Wexford, Fine Gael)
Link to this: Individually | In context | Oireachtas source
I thank Dr. O'Reilly. I invite Ms Sarah Stockham to make her presentation.
Ms Sarah Stockham:
On behalf of Dorset HealthCare University and the Dorset Mental Health Support Teams in Schools, I am pleased to have been invited to make this opening statement to the members regarding the mental health support teams in schools, MHST, service we offer.
MHSTs involve a jointly funded approach through Health Education England, the Department of Education and NHS England to offer mental health support for all children in education, as well as supporting school and teaching staff through a whole-school approach. The teams were set up originally following the publication in 2017 of Transforming Children and Young People's Mental Health Provision: a Green Paper.
We know that, in England, one in six children or young people aged from five to 16 was identified as having a probable mental health problem, which is an increase over the previous estimate from 2017, namely one in eight. We also know that, based on data from 2018-19, 16% of 17-year-olds reported experiencing high levels of psychological distress, 24% reported self-harming, and 7% reported self-harming with suicidal intent. In a tutor group of 32, this equates to approximately five or six pupils per class who potentially could be open to services that fall under the wider child and adult mental health services umbrella.
There are currently just over 9 million children in education in England, which is an increase of 88,000 over the number in 2021. Some 3.5 million children and young people are accessing secondary education in state-funded schools. Based on the figures from NHS Digital in 2021, one in six of those children probably has a mental health problem. Therefore, approximately 595,000 children in English state schools meet this criterion.
MHSTs comprise a national project and are currently in their third year of roll-out. In the south west, of which Dorset is part, we have established teams across the region, and further expansions will be happening. We work with school-age children from reception years right up to 18 years.
The MHST has three specific core functions set out by the national team. These are to provide evidence-based interventions for mild to moderate emotional and mental health issues using low-intensity approaches in a one-to-one setting with children, young people or their parents or carers; to support the designated mental health lead in each school to introduce and develop a whole-school approach to emotional well-being; and to give timely advice to school and college staff, signposting and liaising with specialist services to help children and young people get the right help and support at the right time.
Each service we have in Dorset has a clinical or service lead; a team lead; a supervisor practitioner; a counsellor; a mental health practitioner in a core profession such as nursing, occupational therapy or social work; and education mental health practitioners. Depending on the sizes of the teams, the numbers vary, but the expectation is that each team of four education mental health practitioners and one supervisor will cover a population of approximately 7,500 children.
The benefit of the programme is that it is developing a new and skilled workforce from people who may not have traditionally entered healthcare work. To qualify as an education mental health practitioner, people must complete a year-long course run by one of the accredited universities in the UK. The prerequisites are that they need to have evidence that they have studied previously at degree level and evidence of having worked with children and young people. In the south west, this training is provided by the University of Exeter, where the education mental health practitioners qualify with a postgraduate diploma in mental health practice in education settings. They attend university full-time for the first three months. Then they spend two days in practice and the remainder at university. Over the remaining year, the time spent being taught is reduced such that by the end of the course, the students are working within the services full time and are completing assignments based on competencies.
The mental health practitioners are supervised weekly in both individual and group settings, and this is key to the model. They are supported by dedicated supervisor practitioners who have also completed a further year of specific supervisor training at university to ensure they can support these practitioners. All other practitioners are supervised monthly in line with their professional registrations.
This qualification enables the mental health practitioners to practise low-intensity cognitive behavioural therapy interventions for children or young people, or their parents, to address mild to moderate mental health needs, such as low mood, anxiety or panic. The aim of the service is to provide preventative support at the first sign of a young person displaying a change in his or her emotional state. Education mental health practitioners work within a model of the child and young person that recognises both the effects of adversity on children and the limits of their autonomy.
We offer core interventions such as psychoeducation. This is to be able to provide evidence-based information and psychoeducation to young people, parents, carers and education staff. Also offered are peer mentoring, which focuses on interpersonal relationships and well-being in respect of mental health; training others, the objective being to support structured workshops and training, based on principles of cognitive behaviour therapy, to help children, young people, parents and carers; and classroom skills. We also offer consultation to education staff, which relates to common problems children and young people experience, group work, and parenting groups.
The whole-school approach is an integral part of the MHST model and moves away from providing only one-to-one interventions. This improves the accessibility of mental health, emotional and well-being supports in a universal manner. The approach enables many more children and young people to access mental health information and support.
Within the whole-school approach, we also offer consultation or signposting; whole-class interventions; staff stop-and-think sessions, which entail individual reflective space using a cognitive behavioural therapy framework for teachers to access support; staff training; and support in developing well-being or behaviour policies.
We also offer an audit and resources.
The educational mental health practitioner, EMHP, title, along with other qualifications, will soon be accredited with a registered body, thereby giving these staff a protected title. In order to be accredited, completion of a recognised and registered course will be required, as will key performance indicators, a required number of clinical hours and ongoing continuing professional development. This is due to be launched in January 2023.
I am excited that this model to support the mental health of children and young people is being considered as a possible approach within Ireland. I thank the committee for inviting me to appear before it. I will be happy to take any questions.
Rose Conway-Walsh (Mayo, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
I thank the witnesses for their submissions. This is a topic we have discussed many times. Anybody who has had a child, sibling or friend who has experienced bullying, particularly sustained bullying over time, will have no doubt about the link between bullying and student mental health problems.
Dr. O'Reilly highlighted the fact that there are no specific guidelines for schools and parents when it comes to supporting autistic students who experience bullying. Even more surprisingly, she stated that there is no research exploring the prevalence of common forms of bullying experienced by autistic students attending Irish schools. How is this lack of research affecting our ability to protect and support students with autism as well as parents and schools? How could this research be funded and supported?
Dr. Siobh?n O'Reilly:
There is very little research internationally on the prevalence of bullying of the autistic population in schools and even less research on preventative strategies for that cohort. We would like to see a preventative approach for the many, the some and the few - whatever proportion of the population falls into the autistic population within the school. There are nuances regarding how those preventative approaches would be developed. FUSE has a lot of experience regarding the general population of students. Every year, it checks with teachers and students about how the material and content have worked for them. That needs to be continued in terms of programme development.
The challenge with the autistic population is that because of the communication and social challenges, that would have to be worked into any prevention or intervention programme. It can be done but it does need resourcing and that is the million dollar question asked by the Deputy in terms of how that would be resourced. We are doing some research in the anti-bullying centre on a European project around the possibility of creating some youth advocates for those affected by disability, including autism, in our schools. It is a very small research project, however, and it definitely needs further resourcing.
Rose Conway-Walsh (Mayo, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
Does DCU work with the Middletown Centre for Autism in Armagh? I visited the centre some years ago after the Good Friday Agreement and thought some of the work done - obviously in the context of autism - there was very impressive.
Rose Conway-Walsh (Mayo, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
It is very important that we do so. One speaker referred to 26 years of research. This is the thing about which I despair the most. Dr. O'Reilly described matters in terms of a whole school and whole community approach. I was involved with Trinity College's anti-bullying centre with Dr. Stephen Minton 15 or 16 years ago. I will separate issues relating to autism because I am not familiar with those matters. What is happening such that the research is not transforming into implementation? Sometimes it appears that silo research is being done. One institute will be doing this while another will be doing that. There is almost an industry around bullying and mental health. Actually, I would not say "almost an industry"; there is an industry. Huge amounts of money have been spent on it across the board over the past three decades. Is there less bullying in schools now than there was before this started three decades ago? Are we really making an impact when we see some of the figures that are still coming out relating to the number of children experiencing bullying in schools?
Professor Paul Downes:
I might pick up on the Deputy's point about the work of Dr. Stephen Minton and the example in Mayo she gave. At the time, that was pioneering research. The notion of community-based bullying research is underdeveloped internationally. It is certainly hugely important but it has not been given the policy focus or the focus in the international research community that it deserves. You could extend it. How can we create community spaces for well-being and co-operation and to undo conflict between different ethnic groups? How do you create these spaces for co-operation? That speaks to the new national children's strategy. How do we create those spaces? We need to rethink how we do this. We have a focus on playgrounds for very young children but where are the spaces for later primary-school children to play and co-operate in? Where are the spaces for early and older secondary school students to do the same? We need a spatial strategy that includes the community level. Covid has also accelerated a focus on issues like access to nature. This would include spaces for well-being where conflict can be overcome through co-operation. At a school-based level, this includes things like school gardens. It is a very simple space. The Educational Disadvantage Centre studies show the impact of school gardens on the well-being, co-operation skills and social and emotional development of children and young people. Again, it is about how we create our spaces in our school system that foster co-operation and collaboration. The first stage would be to develop the social and emotional competences of our young people. In one way, bullying is a failure of communication on the part of our young people because they have not been given the spaces to communicate and collaborate in.
Rose Conway-Walsh (Mayo, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
Dr. Minton's model looked at international best practice and a whole-community approach, such as involvement of GAA and soccer clubs and everybody else within the community. There is an evidence base. This evidence is presented, recommendations are made, they are left at that, someone decides to do another piece of research and two or three decades later, we still do not see the impact. Who follows up on this research to see how it is being implemented or its outcomes?
Dr. Siobh?n O'Reilly:
I will respond to the Deputy's question about what we focus on when we measure. I understand the frustration about whether we are seeing any decrease in prevalence. We would advocate looking at a school climate survey and the things across a school that create a caring and safe climate. If we focus solely on prevalence, we run the risk of exactly what the Deputy is talking about, namely, wondering why it is not more effective. Regarding measuring self-efficacy, we see significant improvements in terms of students' confidence levels and ability to recognise bullying and intervene as bystanders. This year, the anti-bullying centre looked at how teachers perceive their own capacity. They feel more confident after delivering the FUSE programme. They are really important factors.
As somebody who was involved in implementing programmes in the community for a very long time, I sometimes share the frustration. We talk about evidence-based practice. Why does it not hit the ground? Some of that is around context. Some of the evidence we have is not in the same context in which we implement it. This is why we advocate implementation that takes account of the school and the community around it. How can that be facilitated on the ground?
Rose Conway-Walsh (Mayo, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
That is exactly the point. We must also ask how we can scale up the models, the pilot programmes that are being used.
I am interested in the EMHP model to which Ms Stockham referred and how it might work. From my experience, I think it could work effectively in Ireland. How is the impact of that model going to be measured as we go along? I will give her an opportunity to explain the specific model.
Ms Sarah Stockham:
EMHPs are trained in low-intensity interventions, which are based around the principles of cognitive behavioural therapy, CBT. The training includes behavioural activation, behavioural experiments and cognitive restructuring. As part of that, we have an organisation that provides us with routine outcome measures, which are done pre, post and during the intervention with our young people. We measure and report to our national team. We are looking at paired outcomes through the routine and outcome measures. A key measure is our revised anxiety and depression scale for children, which is used nationally and allows for comparison between interventions across the board. We also complete our own audits within the schools in which we are working. That is one of the interventions that the EMHPs do as part of their training. It is on that basis that we can help to work with a school community on where its gaps are and support it to meet those needs. The model is evidence based. That is part of the rationale. I hope that answers the Deputy's question.
Rose Conway-Walsh (Mayo, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
It does. I will talk to Ms Stockham and Professor Downes another time about the partnership model, but one of the biggest barriers we have is that we lack a skilled workforce. We can say this looks like a good model that could work in a community but fall short because we lack those who can implement it, whether they are counsellors or other clinical practitioners. Ms Stockham said the NHS is developing a new and skilled workforce-----
Rose Conway-Walsh (Mayo, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
-----from people who may have traditionally entered healthcare work. Did the NHS face the same problems we do? Does it not have suitably qualified personnel to implement the model and is the EMHP model the answer? I might ask Professor Downes if the model would work here.
Ms Sarah Stockham:
That is certainly one of the reasons to pursue the model. We have traditional child and adolescent mental health services, CAMHS, across the country. Those services include the core professions that require three years or more training. Those professions include nursing, occupational therapy, social work, counselling, psychology etc. The idea behind this model is that EMHPs can be trained in one year while they are on the job. The people working in the schools who can complete these skills come from any background. They must only be interested in learning those therapeutic techniques. Because they are so heavily supervised by people with additional qualifications, we can work to build that workforce. For example, some of our EMHPs are ex-teachers, ex-teaching assistants and people who have in the past run fear of flying courses with airlines and who were made redundant during the pandemic. We also have psychology graduates or previous assistant psychologists who want to get a recognised qualification. They are limited in what they can offer. They can only offer low-intensity CBT interventions and a whole-of-school approach. However, that frees up our colleagues in the other services, such as our core CAMHS, to focus on those young people with additional and more specialised needs. It is a way of managing capacity and demand. The EHMP model provides early help in prevention. If more specialist support is needed, we can then escalate a case through our more core CAMHS pathways.
Rose Conway-Walsh (Mayo, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
That seems a sensible approach. I have some related questions for Professor Downes and Dr. O'Reilly. Could that system work here? What role would further and higher education play in ensuring we develop that workforce?
Rose Conway-Walsh (Mayo, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
Is the professor talking about the multidisciplinary teams in Ireland?
Rose Conway-Walsh (Mayo, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
We do not have them here.
Professor Paul Downes:
A multidisciplinary team, family scope, was designed in Ballyfermot 20 years ago. There are certain key professions and we must be clear about what we want each person on the team to achieve. We have advocated with Ministers for speech and language therapists and occupational therapists in schools. We know there are pilot schemes running in that regard. I have done two reviews for the European Commission around these issues. At a previous meeting with the committee, I argued that we need to look at the Danish and Dutch models. There are multidisciplinary teams for every school in Denmark. Ireland has been playing catch-up in this area for decades. The UK is playing catch-up now. The Dorset model we are considering would, to be blunt, be unremarkable in a European context. It depends on which professions we want in our teams to achieve which objectives.
I do not accept there is a shortage of specialist emotional counsellors in the Irish system. In our longer submission to the committee, we quoted Ms Angie O'Brien, chairperson of the Irish Association for Creative Arts Therapists, who has stated there is easily sufficient capacity to fill those roles. In respect of direct delivery and one-to-one support services, we can fill those roles in a national pilot scheme.
Rose Conway-Walsh (Mayo, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
This is an interesting topic to tease out. Why do we have such long waiting lists for CAMHS? What we hear from schools it that when children are referred to services, there is a waiting list for them to be seen and the requirement for those children to be seen regularly and consistently is not met. Will the professor respond to the point around how long children have to wait? They also receive no feedback. If there is a multidisciplinary team in place and a child attends for a meeting, no feedback is provided to the schools so there is no loop. Those children and their families do not appear to be at the centre of the process.
Professor Paul Downes:
There are a few points to distinguish here. The whole area of trauma and adverse childhood experiences also pertain to the pre-clinical stage. The focus for the specialist support services in schools, including counsellors, is on the pre-clinical level. The intention is to stop problems early before they mushroom. Those problems include bullying issues where children are internalising self-hate processes. We want to stop the internalisation process early and quickly. Those are all interventions at a pre-clinical level. We can have the staff to get that off the ground quickly in the Minister's initiative. We do not need to train external people with other backgrounds as part of our programme.
At the end of our submission and in the previous submissions from our centre, we have noted the public health model of differentiated need. Dr. O'Reilly has referred to it as the all, the some and the few model. There are different levels of prevention. There is the universal level, select prevention for moderate risk group-based interventions and the indicated prevention which deals with chronic needs and complex needs and involves one-to-one supports. The key gap in the Irish system is at the indicated prevention level and the one-to-one supports. The National Educational Psychological Service, NEPS, has been taking many aspects of the approach for which NHS Dorset is advocating. The well-being framework already includes that type of group work and a universal approach. There would be a significant duplication of function and role if we were just to transport the model to the Irish system.
There is a clear distinction to be made in respect of phase 1 of the specialist pilot in primary schools and, as we are advocating, in secondary schools. In phase one, specialist counsellors would be available to provide one-to-one support. The other group-based levels are in the schools already. Phase 2 would then ask the important question, which is, what additional professionals are required. If we want, for example, to move towards a family- and community-based model, as Dr. O'Reilly has adverted to, we need to include family support workers, social care outreach workers in homes and perhaps nurses in that team model.
It is a second layer. We need to be really clear on which professionals we want and why. Let us be clear; multi-speed teams are expensive. Therefore, we need to make sure that each member of the team has a very clear function. They also take time to develop. Our report for the European Commission with Professor Ann Roberts of Oxford noted two other issues, one of which is that something cannot just be transported from one context to another. We have an existing system of services that we need to work with and around. We also need-----
Rose Conway-Walsh (Mayo, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
Does Professor Downes mean that we need to tweak the system that is already in place and which is failing so many children today? We would all have to agree that many young children are being failed in terms of intervention and prevention at school level.
Rose Conway-Walsh (Mayo, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
No, I think we are all clear on that. Getting interventions at an early stage is the key to this, even in terms of resource allocation. We do not then have to have the other interventions as we go along. Organisations such as Jigsaw and Mindspace Mayo certainly serve a purpose in that regard. In terms of being able to really meet the need that is there, however, is Professor Downes saying the models we have here work and just need to be adjusted?
Professor Paul Downes:
There is certainly scope for dialogue with the National Educational Psychological Service, NEPS, and the well-being framework around the universal level and moderate risk group-based approach to see whether there is learning from having such a source or other models and programmes. I am sure NEPS would argue that it is looking at various strands of evidence of international practice. To be clear, a programme-based approach is much more the universal level and group-based moderate risk group. It is not just universally targeted; it is universal group-based moderate risk approaches and then complex and chronic need individual one-to-one supports. My argument to this committee, and this is my third presentation here, is that one-to-one focused support is our major system gap in Irish schools. That is what the Minister has now sought to address. I note the Minister also stated that this new initiative will be separate from NEPS. There is, therefore, a clear focus on indicative prevention level, one-to-one specialist emotional counselling supports in schools and not referrals out from schools.
Rose Conway-Walsh (Mayo, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
I want to tease that out. The counsellors would actually be in the schools.
Rose Conway-Walsh (Mayo, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
That would see each primary school having a counsellor attached to it.
Professor Paul Downes:
As I proposed earlier, we would ideally look to move towards that over time. The national pilot would propose one counsellor between two locally adjacent schools to minimise travelling. Counsellors would be embedded as staff in those schools for both structured appointments and flexible crisis management for a child who presents on the day with particular issues that may arise in class. The intention is that it would be school-based. That is what we also need in the secondary schools. We do not have this in the school system for trauma and adverse tragedies.
The point we made in our submission was that this is routine in many international contexts and has been for years. Our report for the European Commission on early school leaving also highlighted that this has been embedded as a feature of the systems in many European countries for a long time. We have always had that system gap in Irish schools.
Rose Conway-Walsh (Mayo, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
Have costings been done on that?
Rose Conway-Walsh (Mayo, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
When Professor Downes says a national pilot, if we had the situation then where there was a counsellor for every two schools, how much would that cost?
Professor Paul Downes:
The ombudsman gave some figures around that regarding the amount of money on the pay scale for therapists. That can range depending on the seniority of the position. It is a relatively modest fee for the kind of gains and benefits we can get from this across a whole range of policy perspectives, however, including post-pandemic mental health, bulling prevention, LGBTI+ identity issues that may arise in schools that want support and children in care or care leavers who may be accessing our systems. There are many vulnerable groups who could avail of this.
Rose Conway-Walsh (Mayo, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
I completely think that it is the right way to go. What workforce planning must we do at this point? We do not have enough counsellors to meet the existing need. Have we quantified the number of counsellors we would need anywhere? What would we need to do right at this point to have, say, an intake of fully-trained counsellors next September?
Professor Paul Downes:
My understanding, and I have talked with others who have also noted this, is that there are enough counsellors on the ground to operate in large numbers in large urban centres. When I say urban centres, I mean schools in large cities and in every county in Ireland. We would have enough capacity. The issue is not the shortage of-----
Rose Conway-Walsh (Mayo, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
We have enough counsellors as it is at the moment. That is interesting. Professor Downes is saying we haves a sufficient number of counsellors.
Professor Paul Downes:
Yes. They operate on a part-time or ad hocbasis. They have been in and out of Irish schools for several decades but they have never been embedded in the system. What this then brings up is that we do not have the relationship building. They are brought in on a short-term contract. They foster relationships with the children over bereavements, for instance, and then they disappear.
Rose Conway-Walsh (Mayo, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
I thank Professor Downes for that; I understand. That would contradict the fact that if somebody looks for a counselling service tomorrow in County Mayo, it may take months for that person to get that service. The fact that we have enough counsellors would almost contradict that. I am only trying to join the dots.
Paul Kehoe (Wexford, Fine Gael)
Link to this: Individually | In context | Oireachtas source
I will also come in on that point because I am actually quite interested. We are on the same train of thought. The Deputy can butt in if she wants; I have no problem with that.
Professor Downes said there was no shortage of counsellors yet a constituent rang me yesterday and told me the earliest session they can get for counselling is February of next year. Professor Downes said there was no shortage of counsellors. Will a lot of these counsellors be taken out of the services to which they already provide counselling and placed into 9-to-5 roles? They may be working or volunteering in the evenings or at nighttime and everything like that. Are we going to put these voluntary organisations that work on a donation-type basis in jeopardy? They are in my constituency and no doubt that of Deputy Conway-Walsh and do a fantastic job. Does Professor Downes think this may drain counsellors from those?
Professor Paul Downes:
I have had extensive dialogue with a range of different counsellors and groups on this issue. It is clear that they are very enthusiastic about the school-based model. They do not see this as taking from their other work. Many of them work part-time on short-term contracts here and there. I quoted Ms Angie O'Brien, Chair of the Irish Association of Creative Arts Therapists, who stated on the record in a submission that there are enough in the system. One other advantage of the area-based approach for counsellors is that as I said, it can avoid duplication if we can also perhaps get a family dimension in this. We can see there may be similar issues coming up with siblings in different schools. If a team of counsellors with a head of team is in place, it can build that coherence at an area-based and family-based level, which would be an important dimension. The area partnerships and area-based childhood programmes already do this here and there but they are ripe for expansion. They both stated in our submission that they want to expand in this area.
Paul Kehoe (Wexford, Fine Gael)
Link to this: Individually | In context | Oireachtas source
I welcome Professor Downes's comments about what this committee and the Minister and Department have done and about the roll-out being in primary schools not in secondary schools, which I will address in a second. No matter what model the Department of Education will roll out, however, there have to be links with the HSE. Professor Downes is forgetting this in some of his answers and in his opening statement - the HSE has kind of been left to one side. I am not sure if the Deputy would agree with me but no matter what model we have, I expect that it will have a very close relationship and links with the HSE for referrals to further services and everything like that. It could be an issue regarding CAMHS. Issues could be picked up in primary school-going children. It is normally when people are younger but they can be picked up in later years as well.
In that case there must be links with the HSE. I know the model and understand what Professor Downes is talking about but he seems to be excluding the HSE. Am I right in saying that or am I just getting that vibe?
Professor Paul Downes:
My understanding of the Minister's initiative is that it is funded by the Department of Education. It is also recognising that many mental health issues have a knock-on educational impact and that is another reason for the key role of the schools in this. It is certainly not excluding the HSE. In the model proposed with the area partnerships and the area-based childhood programmes, they already have strong links with the HSE in their local communities. These are embedded in systems. The idea is that we have pre-existing systems and structures there. Maybe certain area partnerships or certain area-based childhood programmes are already more developed in their links with the HSE. I declare something of an interest; I chaired an area-based childhood programme for five years and was on an area partnership board for six years. I am no longer in those roles but am aware of the work they do on the ground. They can integrate with the different services to build on that network and their leaders state as much in the submission. I am not excluding family resource centres here, as they also operate on-the-ground counselling.
Paul Kehoe (Wexford, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Okay. I look at my own county and specifically my own area back home in Enniscorthy, where there is a huge number of rural primary schools. The number of pupils attending each school ranges from 50 up to 200. That is the average for most primary schools in rural Ireland. As you move into the urban centres, you get bigger schools. St. Aidan's Primary School in Enniscorthy is the biggest primary school outside Dublin with almost 1,000 pupils. If Professor Downes was advising the Minister on how to roll out counselling services in those primary schools, what would he suggest? In rural Ireland, you could be talking about a distance of between 7 km and 10 km between the different schools. One school might have 50 students and another 7 km down the road might have 200 students. A further 7 km away, there might be a school with 100 pupils and then 5 km away there could be a school of almost 1,000 pupils. We should have a permanent service in the larger schools and then share it between three to five schools.
Going back to family resource centres and everything like that, there is a very small number of pockets in Country Wexford where there are family resource centres. There are only two in my home area that I am aware of. I do not know whether we should have more but there are other services that offer very similar services to those offered by the family resource centres in communities.
Professor Paul Downes:
On the Chairman's last point about family resource centres, since 2011 Eurochild has advocated for multidisciplinary teams that are community-based through family centres. It wants this across all of Europe, so there is the argument about developing the capacity of family resource centres for multidisciplinary teams that can come into schools.
Going back to the Chairman's other point, obviously the size of the school is going to be important. Much of the debate about counsellors at third level is about the ratio between the students and the specialist counsellors for the one-to-one sessions. It would be great to get even that level of debate for secondary schools and primary schools.
Professor Paul Downes:
We are miles from that. It is about getting them into the schools first. I support the argument that the service needs to go into the larger schools first, but on a pilot model the idea the therapists give me is that you do not want to spread yourself too thinly. The therapist needs to be known in the school and seen as a member of the school for relationship-building and trust. Thus, when we spread it over five schools, that is a kind of contracting-in model that is highly questionable. We want them embedded in the schools. The idea I would express is of a phased universalism here. I would add a DEIS angle or an areas-of-higher-poverty angle on this. This is not just an issue of poverty - absolutely not - but we might have some selection of areas based on socioeconomic exclusion as well.
Paul Kehoe (Wexford, Fine Gael)
Link to this: Individually | In context | Oireachtas source
My sense is we either give the service or we do not give it, but we do not give half a service.
Paul Kehoe (Wexford, Fine Gael)
Link to this: Individually | In context | Oireachtas source
All right. I have some more questions for Professor Downes before I ask Ms Stockham a couple of questions. I will be meeting her on Thursday and Friday so I will not ask her too many questions. Professor Downes spoke about secondary schools and guidance counsellors. Guidance counsellors cannot give the service we are looking for here. They cannot.
Paul Kehoe (Wexford, Fine Gael)
Link to this: Individually | In context | Oireachtas source
I do not expect them to either, but they are expected to at the moment. They are expected to offer a full range of services on career choice and everything like that as well as problems and issues pupils might be having personally, but many guidance counsellors and schools are not prepared for that.
Paul Kehoe (Wexford, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Absolutely. We have home-school liaison officers in many secondary schools and that is welcome. Some of them have told me that they get to the heart of the matter when they get into the home and talk to the parents. It is then that they can identify points, problems and issues that are in the home that they will not identify with the child in the school. I very much welcome that. Does Professor Downes believe that if this is to be rolled out in primary schools, and we identify a huge number of problems, we might have those problems sorted out by the time children get to secondary school? Does the question make sense?
Professor Paul Downes:
Yes. Early intervention is of course key. We are trying to prevent problems getting worse. It depends on the scale of the trauma. Certainly you can alleviate the educational impacts of the trauma or adversity through these supports. I am referring to lowered concentration, low motivation, peer conflict and conflict with teachers. Suspension and expulsion is another one. We suspend over 13,000 students every year. Many of them would benefit from specialist one-to-one counselling supports to keep them in the school system. It would certainly help to alleviate so many of the negative outcomes we see arising. The whole area of prevention is very hard to quantify because by definition you are stopping something happening and so you cannot necessarily measure it as precisely but that does not undermine the importance of prevention and early intervention.
Paul Kehoe (Wexford, Fine Gael)
Link to this: Individually | In context | Oireachtas source
I have one last question. We have another group outside as well. With secondary schools, we are often afraid to speak of issues around teenagers, sexuality and everything like that, and also suicide. These problems only hit in the teenage years at 15, 16 and 17 years of age. Does Professor Downes feel we need counsellors to meet those types of challenges head on?
Professor Paul Downes:
They are happening earlier as well but we need that urgently, yes. This is why we cannot wait for just the primary school pilot to take place and review. This is why we need the secondary school to have a similar pilot. It is psychologically nonsensical to have one for primary and have services at third level and not have them at the time of development of most risk and complexity, and coming out of a pandemic as well. What we will end up having, ironically, is that by the time it comes into secondary schools, the students who have had the benefit of the service in primary school will be the ones getting the service in secondary schools. However, we will have missed a whole generation if we wait.
Paul Kehoe (Wexford, Fine Gael)
Link to this: Individually | In context | Oireachtas source
On the issue of suicide within secondary education specifically, has any research been done showing that if there were such counselling services in place a teenager would talk to the counsellor even when they do not have the confidence to talk to parents, teachers or peers in the school? I ask on the basis that the counsellor is on campus and the teenager is comfortable talking to them and chatting to them. Would that prevent suicide?
Professor Paul Downes:
I have material on the related area of self-harm. We did focus groups some years ago with secondary school students. They stated clearly to us, in this qualitative research, that young people are self-harming because they have no one to talk to. That was the firm message of that qualitative research. I was invited to Dublin city Comhairle na nÓg in 2015. Its priority issue for secondary school was to have emotional counsellors, namely, someone students can talk to who is a specialist in the area. That is what participants were crying out for. Can we state that those who are suicidal will definitely go to a counsellor? We cannot. They may hide the fact, but at least it puts in a really important system support there.
Therefore from a suicide prevention perspective, this could be one element, among others, that could be another key policy goal in the area.
Paul Kehoe (Wexford, Fine Gael)
Link to this: Individually | In context | Oireachtas source
We will be meeting Ms Stockham on Thursday and Friday.
Paul Kehoe (Wexford, Fine Gael)
Link to this: Individually | In context | Oireachtas source
How does one go about securing buy-in from students, parents and guardians and the school community?
Ms Sarah Stockham:
As Professor Downes mentioned earlier, it is about building it from the start. We are not going in and offering tools straight away because offering to one or two and getting it right is better than offering to everyone and getting it wrong. We worked really closely with the schools initially to discuss the service, explain where we fit in and how we can support them. We are not there to replace anything that the schools are already doing but we are there to become embedded in the support. With that, we have consultations with the school where they identify young people they are concerned about. These are, for want of a better phrase, the worried wells or the almost anxiouses; the children on the periphery about whom we ask whether, if we could do something now, it would prevent things escalating in the future. From that the schools will have a conversation with the parents, because they have that relationship, and ask them if they think this would be useful. They hand over our referral and then the parents refer-in so we have buy-in from the parents right from the start. I think that has been a key part of the model. Our over-16s can self-refer. We have had young people email us to say that they would really like some support. When I worked in traditional CAMHS, you did not really get that. Being embedded, being part of the school community and delivering whole-class interventions, as well as the one-to-one work, show that you are approachable. We very much focus on the terms of emotional and mental well-being, rather than mental health because that tends to have a slightly different connotation. We can then help navigate those young people through the system if they need to or we can just offer those six to eight sessions of one-to-one work at that preventative and early help level. With our under-13s, much of that is done with the parents with whom we work jointly. Education is only there part of the day but the children are with their families, guardians or carers the rest of the time. We need to work together to make the change and we do it with a very collaborative approach rather than the traditional "us and them" health referral where someone tells you that you need to go and get support. We want people to come to us and ask for support. For us, having the discussions and the early buy-in has been key and it has really improved our relationships with the families that we work with.
Paul Kehoe (Wexford, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Dr. O'Reilly spoke about issues of identity and so on and approaching them. If a counsellor sees something in a child and he or she knows that something is going on, how does the counsellor approach that person without the student, teacher or somebody coming to the counsellor?
Dr. Siobh?n O'Reilly:
Again, that is why we advocate for an approach that is whole-education. You are doing different things at different levels. Obviously, you cannot just walk up to someone and make that approach. I am speaking as a practitioner here. I am located in the anti-bullying centre at the moment but most of my professional career has been in education and community settings. While I think it is really important that those emotionally counsellors are put in place and I really support that, massive amounts of work are being done at school and community level around these very issues. There are youth workers, substance misuse workers, social-care workers and community contacts doing great work around issues of identity and opening conversations and dialogue. It is very relational. It is the social world that we live in. You cannot underestimate the relationship that somebody can have in his or her community context, such as his or her local youth club. When I worked in Ballyfermot I worked in FamiliBase and previously Familiscope there. When we were setting that up, we realised that a young person might start off with a very universal space like a Friday night youth café where he or she might just come in and play pool, access a music workshop or whatever. It is only over time that such people may feel comfortable enough to have a conversation with the youth worker and tell him or her what is actually going on for them. The youth workers then needs to use their set of skills or their tool kit and ask themselves: where is their scope to work here; how far can they bring this and does this require a specialised intervention? Sometimes it may not. Sometimes it may need a supported conversation with mam and dad at home. Sometimes it may need a supported conversation with the school. As Professor Downes said, it is a tiered level of service and intervention and identifying where is the right role for the right piece of work.
I would make another point around family work in particular. Sometimes we found that families were only ready to do therapeutic work two, three or four years down the line when initial situations had been resolved such as conflict in the community or family or maybe an adolescent who was acting out and creating great parenting difficulties and detracting from the younger children. It was possible only when all that was addressed. That is why I really support multidisciplinary working in a community context, including the school. School is a huge part of that. For me, as an educationalist, it is non-formal and formal education. Let us bring those together as much as we can. That would be my practice experience.
Paul Kehoe (Wexford, Fine Gael)
Link to this: Individually | In context | Oireachtas source
I have one last question for Professor Downes. Is there merit in the Dorset model that we can learn from? This is about learning from other jurisdictions and organisations. Professor Downes spoke about the Danish and Dutch models. We can learn so much from them. Can we learn from what they are doing in Dorset? I am conscious that we will visit them tomorrow and Friday.
Professor Paul Downes:
It goes back to Dr. O'Reilly's point. If you have a clear phase 1 indicated prevention, one-to-one stuff, that is the pilot project, which is separate in some way. A phase 2 will ask towards where we will evolve and for what other multidisciplinary members are we looking? Ms Stockham spoke about the whole-class stuff where you have the external team member coming in to talk to the class. Our research for the European Commission would say that the social and emotional development-related issues are better done by the teacher and by upskilling the teacher, rather than an external professional coming in. There could be an interesting debate around whole-class level. Much of the research, including that on bullying, would say that should be the teacher's role, not that of an external professional. The day of the external professional coming in to give the talk are somewhat over. It is about upskilling the teacher for the universal, whole-class level.
What is most interesting about the Dorset model is the moderate-risk group and the group-based approaches. There may be particular strategies in the group-based model that could work. But I go back and invite the committee to visit FamiliBase in Ballyfermot. It is just down the road. It has had youth work and social care workers, that is, the other layers of professionals, going into the homes. The family support dimension is a key neglected area of bullying. Deputy Conway-Walsh asked earlier about neglected areas of research. There are immense studies internationally on family dimensions to bullying that may be manifested in school but do we have a strategy around that in Ireland? Arguably we do not and that is as well as the dearth of community strategy around bullying. I would argue that yes, our phase 2 of the multidisciplinary teams needs to look at youth workers and social care workers - I would argue the latter at primary school and the former in secondary school - and then there is the question of how you integrate them with the home-school liaison teacher and speech and language therapist. That is a whole task in itself. That takes time and requires professional competence. It is a drawn-out thing. There are territories there. That second layer is where we need to evolve towards. As for the question of whether there are particular members of the Dorset team who offer a distinct role, such as the nurses, we mentioned before that in France and Finland, they have nurses in schools. The nurse angle is a particularly interesting one that I would invite the committee to really scrutinise.
Paul Kehoe (Wexford, Fine Gael)
Link to this: Individually | In context | Oireachtas source
I thank Professor Downes, Dr. O'Reilly and Ms Stockham for coming before the committee. We look forward to spending some time with Ms Stockham on Thursday and Friday. It has been a very interesting conversation and a very productive one in the committee's ongoing work.
Rose Conway-Walsh (Mayo, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
Can I suggest that we take up the invitation, when our schedule allows, to go to Ballyfermot and look at the model there? I would be interested in that.
Paul Kehoe (Wexford, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Yes. No bother. We can do that.
Paul Kehoe (Wexford, Fine Gael)
Link to this: Individually | In context | Oireachtas source
On behalf of the committee, I welcome Professor Barbara Dooley, deputy president and acting registrar at UCD and chair of the IUA registrars group, representing the Irish Universities Association; Ms Treasa Fox, head of the student counselling service at the Athlone campus of the Technological University of the Shannon, TUS, representing the Technological Higher Education Association, THEA; and Ms Patricia O Sullivan, executive director, Higher Education Colleges Association, HECA.
I will invite our guests to make a brief opening statements starting with Professor Dooley, Ms Fox and finally Ms O'Sullivan. The opening statements will be followed by questions from the members of the committee. As everyone is probably aware, the committee will publish the opening statements on its website later.
I remind members of the long-standing parliamentary practice to the effect that they should not comment on, criticise or make charges against a person outside the House or an official, either by name or in such a way as to make him or her identifiable. I remind our witnesses of the long-standing parliamentary practice that they should not criticise or make charges against any person or entity, by name or in such a way as to make him or her identifiable or otherwise engage in speech that might be regarded as damaging to the good name of the person or entity. If their statements are potentially defamatory in relation to an identifiable person or entity, they will be directed to discontinue their remarks and it is imperative that they comply with such direction.
I invite Professor Dooley to begin. She will be followed by Ms Fox and Ms O'Sullivan. They have five minutes each.
Professor Barbara Dooley:
I thank the Chairman and I am here on behalf of students in Ireland.
Mental health issues begin to emerge in early adolescence and peak at around 18 to 20 years, which coincides with a large proportion of the undergraduate population in higher education in Ireland. Higher education is associated with several stressors and transitional events during a time at which common mental health problems are at their developmental peak. Globally, the prevalence, severity and complexity of mental health issues among students in higher education institutions have increased in the last decade. HEIs struggle to meet growing demands for mental health services. A World Health Organization report found that 35% of first-year university students screened positive for at least one psychological disorder, with anxiety and depression the most common conditions reported,
which are often associated with suicidality and self-harm.
Although higher education can offer opportunities for growth and maturation, it can expose individuals to stressors which can lead to psychological distress. This is problematic, not only because of the adverse psychological and socio-emotional outcomes associated with mental ill health, but also the negative influence that poor mental health has on course completion and academic performance.
Established risk factors for poor mental health include being female, younger such as first-year undergraduate students, an international student, being socioeconomically disadvantaged, having a disability or mental health difficulty and belonging to a sexual or gender minority group. Alcohol and drug use, and risky sexual behaviours such as unprotected sex, are also associated with poorer mental health outcomes. Peer risks include experiencing non-consensual touching or sex.
Less research has focused on protective factors among students, which are assets that can support an individual's capacity to respond successfully to life's stressors. However, resilience, optimism, life satisfaction and social support, for example, have been identified as protective factors. Help-seeking behaviour is also an important protective factor yet many students fail to disclose disabilities or mental health difficulties, and as many as half of students fail to seek help for their mental health concerns.
While many risk and protective factors have been identified, little research has investigated how these factors profile across different student cohorts. Given the diversification of the student profile in recent years due to national policies that endorse equity of access to higher education, it is important to document mental health across cohorts so that service provision can adequately address student mental health needs and target more at-risk groups.
Aligning with international research, findings in the My World Survey 2, which collected data on approximately 10,000 students, concur that many Irish students experience mental health difficulties, with about one fifth experiencing severe or very severe depression and anxiety, and over 10% reporting a suicide attempt. With regard to different cohorts, undergraduates, particular younger undergraduates, reported the highest level of anxiety and depression and lowest resilience and social support for example.
Students entering through HEAR and DARE pathways reported higher psychological distress, lower social support and life satisfaction. Nearly 40% of LGBAP students and 32% of female students were in the severe to very severe range for anxiety. Harmful alcohol use, financial stress, poor sleep and time spent online were linked to higher levels of anxiety and depression. Finances emerged as a top stressor, with nearly 40% stressed by the pressure to engage in paid work.
Approximately 47% of students were reported as being touched against their will and 20% reported being forced or pressured to have sex, which impacted the mental health of both males and females. Students are likely to seek support from friends indicating the importance of peer support in the college environment. Also, the support of one good adult was found to be protective. However, 40% of students report that they do not talk about their problems, furthermore those who do not talk reported higher levels of distress. To ensure the success of all students and to respond to their varied mental health needs which range from mild, to moderate to severe, universities endeavour to provide a whole-of-institution comprehensive response with a range of services and interventions focussed on mental health promotion for all students, prevention with targets specific to individuals or groups, treatment that focuses on those with mental health issues and illness which require specialised support and maintenance and aftercare for those with more significant and enduring mental health illness.
Universities also engage in peer mentoring programmes, collaboration and partnerships with all stakeholders, promotion of mental health and wellbeing and identifying students who need supports who do not present to college support staff. We also need to respond effectively to all students who need support and to have robust systems for those who are at risk and engage in research and evaluation.
Ms Treasa Fox:
I thank the Chair and members for this opportunity. In its excellent paper on future funding, this committee tellingly devoted a complete chapter to mental health. It stated:
Promoting positive mental health must be of paramount importance in higher education. All HEIs should be designated as places of sanctuary and actively support student health and well-being with a specific focus on vulnerable groups including displaced students seeking refuge in this country.
The Covid-19 pandemic bequeathed many lessons. It cast a spotlight on the inequities within the educational system and instilled a determination to address these. The HEA’s new access plan, which was published in August 2022, extends our notion of enabling entry to a more inclusive and diverse structure to encompass access, participation and success in higher education. The State and its institutions commit not just to widening participation but to supporting all learners through the system. The pivotal role that mental health and wellbeing supports play in sustaining our higher education student population has become increasingly recognised and prioritised. We have welcomed the recommendations that this committee has made in that context. As a professional of long standing, I work with a community of practitioners across higher education and advice based on our direct experience and expertise is key to ensuring that supports are targeted appropriately and effectively.
To give some context, mental health student counselling services are the dedicated mental health support service available across higher education institutions. The work is best described by the comprehensive student counselling service model which identifies four foundational pillars, namely, clinical services; consultation and collaborative services; outreach, prevention and early intervention; and training and education. Evidence points to a dramatic increase in the demand for student counselling services in recent years and also a consistent rise in self-reported self-harm and suicidal ideation among the student population.
In Ireland, in the academic year 2019-20, 12,852 students attended approximately 65,000 counselling appointments. In 2020-21, this rose to 14,386 students attending some 69,000 counselling appointments, a figure which represents attendance at student counselling services of 6% of the total number of students in higher education in those years. What can we expect if student counselling services are not adequately resourced? International evidence shows diluted treatment, limits of eligibility for care and other limitations lead to poor outcomes with less symptom reduction.
This recent research has been examining the clinical load and its impact on counselling service delivery and outcomes. The clinical load index, CLI, is a standardised and comparable score that describes the standardised caseload of a student counselling service. The CLI can be thought of as clients per standardised counsellor per year or, in simple terms, the demand-supply balance or imbalance in a student counselling service. The research shows that working with a high clinical load index means services provided fewer appointments that were scheduled further apart and produced less improvement in symptoms. Additionally, high CLI services require clinicians to absorb clients in their schedules regardless of available openings in an effort to serve more students. The results demonstrate that services with lower annual counsellor caseloads have increased capacity to provide more treatment, on average, to students across all presenting concerns and identities, including those with critical needs, for example, students with suicidality, sexual assault survivors, students with a registered disability and first-generation students. Conversely, services with higher caseloads will likely struggle to offer more care to students with safety concerns and high intensity needs.
Diluted treatment, which includes spreading appointments out, limiting the number of appointments, shortening appointment lengths, limits on eligibility for care and other scope-of-service limitations will be common. Those at the high end of this zone may need to focus almost entirely on rapid access, crisis stabilisation and external referrals. Work stress in this zone will likely be focused on a near constant level of excessive demand for services by students in high levels of distress paired with the inability to provide treatment on site.
This research has particular relevance to the data in the recently published student survey 2022. A new question was introduced to the survey in 2022 which asked, “Have you ever seriously considered withdrawing from your degree programme?” Results indicate that over one in three first year respondents, or 36.6%, have. The rate is particularly high for final-year undergraduate respondents, with more than two in five indicating that they have seriously considered withdrawing from their programme. The most common reason provided was personal or family reasons, which was given by 13.3% of all respondents. This was followed by financial reasons, which was given by 9.8% of respondents. In qualitative responses, 10% specifically called out their mental health as reason for withdrawing. The challenges of balancing personal life, work and study; loneliness and difficulty making friends; and lack of support from the HEI all featured significantly in consideration of withdrawal. Without access to appropriately resourced, timely and adequate counselling services many students, because of personal or mental health reasons, will inevitably withdraw.
On our call to action, we warmly welcome the post-Covid-19 increases in mental health funding, but our advice is that there is a clear need for multi-annual core funding, ring-fenced for student counselling services, to ensure continuity of improved services. This will embed the enhancements arising from the lessons of the pandemic. We also strongly recommend adhering to internationally recommended ratios and the clinical load index. Specifically, we repeat our call for increased multi-annual ring-fenced core funding to support higher education institutions to meet international standards of one counsellor to 1,000 students.
It has become increasingly difficult to recruit qualified and experienced counsellors, psychotherapists and psychologists offering the short-term contracts that have been necessary due to the once-off nature of the recent funding allocations. Student counselling should be identified and promoted as a viable and attractive career path for such professionals and will only be so with guaranteed core funding in order to support long-term, permanent posts which are not possible to offer based on the current ad hocfunding model.
Ms Patricia O'Sullivan:
The Higher Education Colleges Association would like to express our gratitude to the Chair and members of the committee for the opportunity to address it today on this important issue. We have provided the committee with a detailed submission so I will limit my comments to some key points, primarily on mental health supports for higher education students.
To begin with, I would like to echo some of the points highlighted by my fellow colleagues and joint committee members over the last number of roundtable discussions. First, while it evident that Ireland has several positive initiatives to support students’ mental health, for example, the anti-bullying initiative, we are still struggling to cope with a national mental health crisis. Second, in general, we need greater focus and support for mental health promotion and preventative measures as well as more timely access and interventions for students in need of mental health services across the education cycle. Third, schools have the potential to identify young people who are experiencing emotional distress and to provide opportunities for early intervention in school settings which have the potential to reduce later mental health vulnerabilities. Fourth, teachers should not be positioned as replacements for mental health professionals. However, they should have appropriate resources, time and training to assist in promoting a culture of well-being for students as well as timely access to a joined-up system with services across health and education working locally together. Fifth, several studies have reported an increase in higher education student mental health problems, including anxiety, stress and depression. Nearly a decade ago, the Royal College of Surgeons in Ireland, RCSI, report highlighted that young Irish people may have higher rates of mental ill-health in comparison with similarly aged young people in other countries. We also know that a third of young people of college entry age are reported to have experienced a mental health difficulty.
Without a doubt, the current generation of students are facing many challenges, including financial concerns, the cost-of-living crisis, the effects of the Covid-19 pandemic and a national accommodation crisis, all of which can have negative effects on students’ mental health.
For students, unresolved or unsupported mental health problems are associated with several negative outcomes such as academic underperformance, increased risk of dropping out of education, poorer career prospects and, in the worst cases, suicide. International evidence indicates the importance of mental health supports in higher education in terms of responding to students who experience vulnerabilities and in promoting mental well-being in the student population. Therefore, it is extremely important that access to intervention resources designed to alleviate mental health issues in the student population is available across the higher education landscape.
Independent colleges provide quality assured programmes to more than 10% of the higher education student population and provide a variety of mental health and well-being services for their students. Our members support the wider body of legislation and good practice which places a responsibility on all education institutions, public and independent, to take steps to provide a supportive student environment on a range of issues, including health, welfare, disability, equal opportunity and discrimination. This recognises that students, irrespective of what institution they attend, may experience mental health challenges, can benefit from fostering well-being, and have a right to access appropriate, professional, evidence-based responses.
Placing these institutional responses in a HEA policy framework, such as the national student mental health prevention framework, has the potential to increase capacity and efficiency through knowledge and data sharing. I say "potential" because at present the independent sector is omitted from such sharing and excluded from national mental health resources, campaigns, funding, knowledge and data gathering. There is hope and evidence of change. For example, our members can now participate, and very much welcome our involvement, in the Department of Health and HSE funded national healthy campus initiative. This supports higher education institutions to embed health and well-being into campus life for staff and students. To be honest, it is difficult to see a rationale for the exclusion of one in ten of the higher education student population from national student mental health initiatives. How can this be a student-centred practice or even led by evidence-based outcomes when one in ten are left out? To add to the challenge, students at our colleges were excluded from the recent student cost-of-living financial supports as well as funds for students with disabilities, the student assistant fund, SUSI, the Covid-19 supports and the €5 million allocated to publicly funded higher education institutions to support mental health and well-being in 2020 and 2021.
The myth that students at independent colleges are somewhat immune to financial challenges that can, as we know, worsen mental health issues should also be challenged. There are students and potential students who study or wish to study QQI validated programmes at independent colleges from many under-represented groups, such as mature students, single parents, students with disabilities and students from disadvantaged socioeconomic backgrounds, who would greatly benefit from these supports. These supports are readily available to their fellow students in publicly funded colleges. We consider this approach discriminatory, inequitable and inherently unfair.
Independent higher education institutions are significant partners in fostering the mental health of students in Ireland and share a desire to support their student populations and help them to succeed. It is important that we have policies and data-driven decision making that supports a safe, healthy and inclusive environment for all students, whether in publicly funded or independent higher education institutions, regardless of their social background, race, self-identity or learning needs. There is also a need to recognise the various challenges that underpin mental health in the education cycle. I thank the committee.
Rose Conway-Walsh (Mayo, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
I thank the witnesses for their presentations. My first question is for the IUA. In her opening statement Professor Dooley said that students from less well-off backgrounds are more likely to suffer from mental health issues and that financial pressure is a leading contributing factor to mental health issues. We all know that rent is now one of the biggest barriers to third level education. It is also one of the greatest causes of financial difficulty and not only for students. Does Professor Dooley agree that the housing crisis in general and the student accommodation crisis are contributing to mental health issues among students? Is there any sign that those who have to travel to college are more likely to suffer from mental health issues? I have been contacted by many students and parents from smaller towns and rural areas who are struggling. I know the pressure this puts on them. What is the experience of Professor Dooley? Are we measuring it?
I am very concerned about a number of students who have contacted me. They wanted to defer because they could not get accommodation at their colleges. Blocks have been put in the way of deferral and the students have been told they have to go ahead. There are financial implications in terms of SUSI and perhaps not qualifying the following year. There is a huge crisis and a problem. The system is set up in a way that further exacerbates what is happening to the particular students I am speaking about.
Professor Barbara Dooley:
Deputy Conway-Walsh has raised some very important questions that are somewhat embedded in one another. The core question is to what extent the accommodation crisis and its financial impact are playing into mental health issues in our students. We have not measured this but I am sure that if we did we would see that those who are struggling with accommodation, and particularly with commuting, do not benefit from the education experience to the same extent as those who live closer and can get to the campus more easily or those who can afford to live on campus or close by. Deputy Conway-Walsh is right that it is a crisis nationally at present. We need the Government to begin to tackle the issue of accommodation where possible for those who are commuting. It is one of the big drivers in considering how we invest in our campuses to provide accommodation for those who must travel distances.
When students must commute issues are raised not only regarding mental health but also social development. Students who live close to the campus and get there easily and those who live on campus are able to engage in everything offered by our higher education institutions, whether publicly funded or otherwise. This is with regard to the development of an individual. I firmly believe that the academic classroom is only one point of the college experience. The broader college experience involves developing as a person so that when the students leave they have gained many resources other than an academic qualification. The qualification in itself may be just a starting point for many of our students who may change career multiple times. It is about the development they get when on campus. The issue is how we balance these. Certainly from speaking to the registrars in the IUA group most universities are trying to see what we can put in place for those students who commute. What are the issues we can alleviate or mitigate for someone who commutes for quite a length of time? Can we open the campuses earlier to support them? Do we have places to relax? Perhaps there should be better access to showering facilities. These do not alleviate the crisis but perhaps they will help us to mitigate in the short term.
Rose Conway-Walsh (Mayo, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
I hear about people dropping out. This is with regard to apprenticeships also. What does it say to people if they are forced to drop out because of their financial circumstances and having to commute due to not having accommodation? We are telling the students they have failed at this. How are we picking up and looking after these students and young people? They have not failed. Certainly they are in the situation through no fault of their own. How do we encourage them to look at the outside factors and see it is not their fault they are caught up in this crisis? This will have a mental health impact on them.
Professor Barbara Dooley:
The higher education institutions have supports in place. If they know students are going to drop out generally they try to support them. The primary issue is to keep them. The question is how we support students to stay connected and continue to progress with their programmes. This is the number one priority. Most institutions where they can, if they have student assistance funds or welfare funds, endeavour to support students as best they can. Again it is about resources. There is a limited pool of resources given to institutions. During the pandemic many of these resources increased significantly. They were significantly reduced this year. The amount of funding to support students in need was dramatically reduced. A greater number of them are probably having to pull out due to economic circumstances. We may have been in a better position to support them last year.
Rose Conway-Walsh (Mayo, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
Yes, I agree. Sometimes the figures are played about with because we have the student assistance fund that would have been increased by a certain amount, which it has, but not to the extent that is presented and the expectation is there for students. There are also students at college now from families who never thought they would have to access a student assistance fund. We have a smaller fund and we have to make it stretch much further than it can at the moment. I am very glad to hear Professor Dooley's contribution today. Everybody needs to work together but it is a matter of resources. I have not got to my question and I do not have time in this slot. The answer to all of this is multi-annual core funding, not bits and pieces of money, in order that we can engage and employ proper people, not that there are not proper people there now, on a long-term basis, on proper contracts, to be able to provide the supports we need. It is completely a resource issue that needs to be dealt with - an investment issue, I would say.
Professor Barbara Dooley:
Just to add, the counsellors are one piece of this but all our institutions have other support networks across the system to identify a student who may be struggling and to see how to step in. Again, that is a resource issue, so we are back to funding and how we adequately resource. We know globally that the number one reason for lost economic output is due to mental health difficulties. If we are able actually to do something to support students at a time of need so that they can potentially contribute to society afterwards, that is a game not just for the institutions and people working with them, but also for society. We have an imperative to invest properly in this.
Rose Conway-Walsh (Mayo, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
For sure. Thank you.
Aisling Dolan (Fine Gael)
Link to this: Individually | In context | Oireachtas source
I thank all the guests from all the institutions who have come in to show that mental health is so crucial. It is fantastic. I am on the mental health committee, which is a subcommittee of the health committee in the Oireachtas, and it is the first time this committee has been put in place. We have had an opportunity to hear from the educational side.
I appreciate that the bullying report by the education committee has been mentioned. That was one of the first reports it did. It is crucial to tackle the behaviours and attitudes around bullying. We know DCU has the UNESCO chair, which has been phenomenal, and it is rolling out courses for secondary schools, but we need more around that, in all walks of life. Bullying does not just happen in one part of life. It happens at all times and in all areas.
I have a number of points from the presentations on some of the things that came across me. First, on anxiety and stress, students who have come in to third level education, who may not have had the normal last year or two years of secondary school and who may not have had to do a proper exam, particularly with the Covid-19 lockdown, may feel immense stress having to deal with an exam situation they have never had to deal with or did not deal with because of the way everything happened in the past two years. I am very conscious that the way in which exams happen in colleges could be and probably is one of the key issues we need to understand for that cohort who have started college in the past year to two years. I am also very conscious that students may also have had to deal with the loss of older family members or any sort of family loss over that time.
One of the few things we have mentioned in terms of the impact of mental health is student dropouts. One of the key things on which the Minister, Deputy Harris, and I want to see more is around the technological universities, and this would be Ms Fox's area in particular. The technological universities and campuses that are being rolled out are crucial to getting access in regional areas to third level but also to encouraging access to apprenticeships as another model and way for students to reach degree or PhD level. We are now going to see the apprenticeships as well as the traditional courses into third level on the CAO forms and they are even looking at including placements this year. Students and parents will have more choice when they look at those forms, but we need to speak more about students themselves understanding the options that are available. There is much to said about the practical experience combined with the academic that may suit certain students more and still benefit them. When I think of apprenticeships, I think of people nearly running their own businesses a couple of years after doing those types of courses.
I believe it was Professor Dooley who mentioned the HEAR and DARE programmes. I am especially interested in these in terms of delivering equality of opportunity. One in four DEIS schools have access to those programmes, and even in my own area, primary and secondary schools do as well. I thank Ms Fox for the details she provided, particularly around student counsellors and the three or four pillars there. I very much appreciate that. She mentioned in her survey the fear of dropping out that one in three students have. Obviously this relates to personal, family and financial concerns, but does she have any more detail on that? I thank Ms O'Sullivan as well, who spoke about the promotion, anti-bullying and the efforts that needs to be put into that.
The other thing I wanted to mention was the Togetherall platform, the 24-7 access to community support that has been implemented this year, along with the 50808 24-hour textline number. Will Ms Fox speak about that because it has just been launched? Do any of the other guests wish to comment on how third level institutions or students are promoting that in universities or colleges?
Ms Treasa Fox:
I thank the Senator for her questions. The four pillars describe a comprehensive model if we were resourced to provide such a model. The most obvious one is the clinical services or the direct service we provide in terms of one-to-one and group supports for students who attend with mental health difficulties, but there are others that are as important. We mentioned the national student mental health and suicide prevention framework, and within that we talk about a whole-campus approach. One of the nine themes, which I was involved in the development of, is around how we resource and support other people in the university structure to be able to identify students in need, maybe students at risk of dropout, and to resource and skill them to confidently and competently-----
Aisling Dolan (Fine Gael)
Link to this: Individually | In context | Oireachtas source
And staff as well. Dublin City University is rolling out the FUSE programme to secondary schools. Is there some type of equivalent of this programme that could be implemented for third level or for staffing at third level?
Ms Treasa Fox:
The Psychological Counsellors in Higher Education Ireland, of which I am chair, held training on identifying and responding to stress and the at-risk student, and that was delivered by clinicians in person to university staff. I think it has run in UCD for a number of years. The pandemic, of course, required us to go online and we were lucky to receive some funding from the Higher Education Authority, HEA, to develop that. That is in development at the moment, so there would be a version online open for all staff that would be hosted on the virtual learning environment, and the level 3 of that training is an in-person module and does a much deeper dive into asking questions about risk and suicide.
Aisling Dolan (Fine Gael)
Link to this: Individually | In context | Oireachtas source
Very good. On Togetherall, an additional budget has been allocated for student counsellors within university and third level structures, along with psychologists and assistant psychologists. How is the roll-out of that going? Is it being promoted centrally through the Department or are universities taking a lead in how to promote that? It was mentioned that students sometimes do not feel comfortable in speaking. It is a different environment. They are going from an environment in secondary school where there is maybe more handholding to third level where they are supposed to be independent and out on their own and in these big lectures if they are studying arts or something like that, like I would have done. How do we encourage students? Maybe this textline service or online services are ways to reach students at third level.
Ms Treasa Fox:
That is exactly why we scoped this out last year in response to what we were seeing as practitioners on the ground, which was the identification of loneliness and isolation that students were experiencing post pandemic. Many of them did not have that integrated experience on campus the Senator has mentioned and-----
Aisling Dolan (Fine Gael)
Link to this: Individually | In context | Oireachtas source
Sorry for interrupting, because I want to catch the others as well. How is it being done or promoted in the institutions Ms Fox represents?
Ms Treasa Fox:
Yesterday, we launched the programme in Technological University of the Shannon: Midlands Midwest, TUS. Different colleges have had internal launches, but the national launch was on mental health day on 10 October and was endorsed by the Minister, Deputy Harris. Each college or university is launching it at a time they consider most effective. We are engaging with student unions-----
Aisling Dolan (Fine Gael)
Link to this: Individually | In context | Oireachtas source
Will it happen by the end of November or December for the Technological Higher Education Association, THEA, colleges which Ms Fox represents?
Aisling Dolan (Fine Gael)
Link to this: Individually | In context | Oireachtas source
Great. I thank Ms. Fox. I apologise to Professor Dooley and may have an opportunity to come in again at the end to allow her to respond.
Professor Barbara Dooley:
I will respond very quickly. First, about examinations. All higher education institutions look to diversified assessment strategies. It is not just always exams. We understand that students do not always go into an exam hall, so to speak, and we have different strategies to help students transition and to have different styles of examining.
In terms of the HEAR and DARE programmes, the pathways into university are acknowledged as a success if you come in through a pathway but also you need to be supported as you transition in through those different pathways for continued success. It is not enough to come in through an access pathway; once a student is in then supports need to be put in place in order that the person continues and transitions really well. That is something that universities have done really well. The other thing they are doing is embedding universal design principles into the curriculum and the design of our buildings and how we operate. In this way, we can ensure success for all sorts of different students, not just those from the HEAR and DARE programmes. Students come from different pathways and design needs to be considered in that way.
Aisling Dolan (Fine Gael)
Link to this: Individually | In context | Oireachtas source
Are IUA colleges also launching Togetherall or how has that been managed in the universities?
Aisling Dolan (Fine Gael)
Link to this: Individually | In context | Oireachtas source
I think that is a very important measure.
Professor Barbara Dooley:
Yes. In UCD we are engaging with that. Togetherall is a really positive thing because a lot of students want to engage in things online first before they actually take the step to seek support by reaching out. This is a peer-led platform that allows them to gain that support.
Aisling Dolan (Fine Gael)
Link to this: Individually | In context | Oireachtas source
Would the witnesses be able to provide an update on the timelines for the colleges to launch that strategy? That may be through the student counsellors or how it might be done in each of those universities.
Ms Patricia O'Sullivan:
In relation to examinations, we would be the same, we would not concentrate on the terminal exam. There is a lot of research showing that cortisol levels are high and other levels are low. The elephant in the room is also the Leaving Certificate. That is a terminal examination that is causing many mental health problems. It is also affecting students' choice of where they want to go, whether it is further and higher education. It is great that the apprenticeship and more work-based learning is coming in. In relation to the HEAR and DARE programmes, if we have students that want to come through these programmes to our colleges, they are not entitled to State funds, so that is another barrier for them. They may have enough CAO points to do law for example, in Griffith College, but not have enough points to do it in Trinity or one of the other colleges.
Aisling Dolan (Fine Gael)
Link to this: Individually | In context | Oireachtas source
In the publicly funded colleges?
Carol Nolan (Laois-Offaly, Independent)
Link to this: Individually | In context | Oireachtas source
There are several points with which I fully agree. The cost of living and accommodation crises undoubtedly are putting extra mental strain on third level students. Are there any programmes that are currently in place that are working well and that could be rolled out to a greater degree, maybe across all colleges? Has there been a case study done on a particular programme that has worked well that could be applied elsewhere as a template?
I know from meeting Union of Students in Ireland, USI, representatives every year that mental health is a massive issue. The union is very much involved with the students in doing what it can to fill gaps. Is there much collaboration between the witnesses and the USI and student unions? That would be key in terms of improving things and putting preventative measures in place. Collaboration can yield results.
My final point is that we need an awareness campaign. Many students still feel there is a stigma associated with mental health. While progress has been made, unfortunately that stigma is still there. Is there a national campaign in which the witnesses are involved that is trying to raise more awareness and take away that stigma?
Professor Barbara Dooley:
I will speak first on the co-design. I will start with the involvement of students. For anything to be successful in the area of student mental health requires working with students to see what supports they would like to see. We can provide professional services through our counselling services but we also need to understand from the students. We need to talk to them and find out what are the types of services they need. There will be some students who will struggle and will need short interventions. Then there will be other students who have more significant needs and then there will be others with psychiatric diagnosis. The Deputy asked whether we have a programme that we could universally roll out. In my view, that is probably not likely because students differ. It goes from mild to moderate to severe to very severe. What will work for one person may be very different to somebody who is presenting with a mild issue. This person may simply need a very short intervention or perhaps the support of somebody back near his or her college or school where he or she is doing his or her programme. Having a universal solution is probably not likely because each person is unique.
Raising awareness is very important and is probably best done working with students, the students' unions and USI and talking to them about co-producing something that has resonance. If students are to be reached, they need to be engaged in what one is trying to provide for them. There is no point in us being prescriptive about this. We need to ask them what do they need, when do they need it and how best can we do that.
Ms Treasa Fox:
There is a lot of collaboration with psychological counsellors. We meet USI regularly and we work on the HEA Connecting for Life working group. This oversees a lot of the sector-wide funding and delivery. In terms of programmes, Togetherall is an evidence-based, anonymous, peer support platform. That was created on the back of six months research into what could be a really beneficial service that would augment and work alongside the counselling services. As Professor Dooley mentioned, there are different levels of intervention. For some students it might just those normative transitional stresses and strains, as well as finance and things like that, but it also caters for those with more severe mental health difficulties in that it is clinically moderated. There are 24-hour mental health professionals on that platform. They are trained to escalate to emergency services when the need arises and then also action with the counselling services the further resources and treatment that somebody might need.
As for working with the USI and delivery of other programmes that have been of benefit, the text support service, 50808, was launched in September 2020 and is a key work partnership with the higher education institutions, whereby we can get high-level data at the end of each year about the usage of that service. That started pre-pandemic but we were very happy to have it when we all went into lockdown and isolation. That was in response to the USI survey launched in 2020, which indicated that around 26% of students wanted a text-based support service provided by the institution. Just under 27% wanted a text-based support service provided by an external service. Our identification of 50808, because it is a HSE service that we promote and endorse, spoke to both of them at the time.
The other sector-wide programme that has been really beneficial has been specific suicide intervention training. It is called the collaborative assessment and management of suicidality. This is on the back of joint funding from the HEA and the HSE. We were able to train 235 counsellors across the country in student counselling services in terms of that specific focus on how to reduce suicidal risk and work with suicidal students on campus.
Ms Patricia O'Sullivan:
In our colleges we have dedicated student support officers and counsellors. We have noticed a huge increase since before Covid. One of our colleges had a 157% increase in the demand for counselling services from their institution.
Engagement with students is very important in order to see what they need and want. We regularly do surveys to find that out and we do a lot of mental health promotion. We are not included in the initial Togetherall pilot but we have touched base with Ms. Fox and are discussing it to see how we can be part of these initiatives in future. At the moment, we seem to be excluded from a lot of the really brilliant national campaigns. We want to put our hand up and say we would like to be involved in those.
Paul Kehoe (Wexford, Fine Gael)
Link to this: Individually | In context | Oireachtas source
I have a couple of questions for Professor Dooley. She spoke about how mental issues often emerge in early adolescence and peak between the ages of 18 and 20. It is a big step for a student to go from second level education to third level education. Can she identify supports for students who are at risk during that transition that could be of help and assistance? We spoke about counselling services for primary and post-primary education and the Minister has identified some for primary education. Home school liaison and other supports that are available in secondary schools are not available in primary schools. Moving away from home and into the world of third level is a huge change for anybody who is mild-mannered and quiet.
Professor Barbara Dooley:
The Chair is absolutely right that one of the biggest transition phases is moving from second level into third level or post second level education. As he pointed out, it is the age where the issues come to a peak. We have evidence globally, not just in Ireland, that it is in and around the age of 20. What all of the institutions need to do at that time is make sure robust peer support programmes are in place. That is not to substitute for all the other professional things we can do but identifying with a peer who has transitioned successfully can serve as a role model. There are different types of peer-led transition programmes across the country but that is one of the key things that can be successful. Unfortunately, that has been disrupted for the past couple of years because of the delayed leaving certificate results. Normally, what we have done collectively in our institutions was bring our incoming first years to campus before other students returned. It would been a time where they could be in that space themselves navigating, meeting people, seeing the size of the campus, particularly somewhere like UCD which is a large campus, and orientating themselves to that. With the delayed leaving certificate, our peer mentoring programmes began three weeks in for the other students who had started and they are trying to navigate their own work. That is my phone ringing; I apologise.
Paul Kehoe (Wexford, Fine Gael)
Link to this: Individually | In context | Oireachtas source
We all make mistakes. Take a deep breath.
Professor Barbara Dooley:
For peer led programmes, the delayed leaving certificate has been one of the issues and that needs to be looked at. One of the key pillars of transitioning successfully into university is feeling connected to the institution early and having a successful transition in the first few weeks. Years ago, the peer support programmes would start in weeks one and two and would then drop off. We all know that much longer is needed. It needs to be re-focused in the first six weeks or even longer. The first trimester is a key point to support people, particularly those who may find it more difficult to make friendships when they transition in.
Paul Kehoe (Wexford, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Professor Dooley also spoke about sexual consent and the potential it has to cause severe mental health issues for students. A previous group spoke to the committee on this issue. Can more be done in that area in second level to educate people going into third level, including, for those in their mid to late teens, how they manage their sexual orientation? I know time has moved on fantastically in the last five to ten years and it is very welcome that people can now express themselves more comfortably. However, a large number of students do not have the confidence around that. Ms O'Sullivan spoke about suicide and this issue can often lead to suicide. What are Professor Dooley's and Ms O'Sullivan's views on that? Could Professor Dooley answer first?
Professor Barbara Dooley:
I thank the Chair for that question. The first issue he asked about was sexual consent and respect for people. It is really important that we are doing this in the universities and there is a major campaign in UCD at the moment about sexual harassment, positive culture, respect, saying "No", active consent and also bystander training. Many universities and colleges are doing that. That behaviour may have started much earlier in a young person's life in school. There was a lot of reporting over the weekend about young people having access to pornography, the sexualising of women and seeing this content from a much earlier age. We need to think about how we educate young people at a much earlier age about respect, consent, valuing people and valuing difference and diversity. The Chair spoke about young people who may not identify as being heterosexual. Whatever it is they identify, whether it is their sexual identity or their sexual orientation, it is important that there is that respect. We need to have those conversations and have them earlier at second level so it becomes a thing that all people and all diversity are valued.
Paul Kehoe (Wexford, Fine Gael)
Link to this: Individually | In context | Oireachtas source
On sexual orientation, people find it to be a big issue with males being comfortable coming out, as I think we would all recognise. I think the supports they have at home, not from their friends but from their families, is a huge issue that we are often afraid to speak about. It is something that must be met head on. I am not sure what the witnesses' views are on that but perhaps Ms O'Sullivan will address it since she mentioned it in her opening remarks.
Ms Patricia O'Sullivan:
What we need is one early intervention. When we talk about sexual orientation I would go back to primary school. The conversation needs to be normal. Professor Dooley made the point with regard to pornography and respect for women that students may have encountered these issues even before secondary school. We need to counter-challenge it and have normal conversations that sexual orientation is their business as long as they are not harming anybody else. We need mentors, ambassadors and people in the primary and secondary schools showing that sexual orientation is the students' preference. Consent and respect should be part of all levels of the education cycle. It does not leave us when we finish formal education, whether at school or in tertiary education. It is lifelong and that is the message and that is where it should be. That will support mental health.
The Chair made a comment about how we have come a long way in the last few decades. We can go a lot further.
Paul Kehoe (Wexford, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Absolutely.
Ms Patricia O'Sullivan:
We can make things normal so that people who are in the outlier groups now that are not part of mainstream become mainstream. Our lives have changed. I was born in the 1960s and when we think of what was regarded as normal then and what is regarded as accepted now, we are a better society. We are leading the world in this and we can continue to do so. That is my belief.
Paul Kehoe (Wexford, Fine Gael)
Link to this: Individually | In context | Oireachtas source
On suicide rates in third level among males and females, I presume male suicide rates are higher than female rates. Is that correct?
Ms Patricia O'Sullivan:
Per se, that reflects society generally even outside the education part. Tertiary and higher education is stressful. There are two key points, namely, the first year when a student starts and the final semester. Students struggle. There is a lot of research showing the levels of cortisol at that time and how students' circadian rhythms are imbalanced. All of these things make people more vulnerable to mental health issues and if someone already has that vulnerability and feels he or she does not connect, that adds to it.
On the point about inductions, the challenge of the late leaving certificate has been horrendous, coming on the back of two years of Covid-19. It is a very challenging time for kids these days.
Paul Kehoe (Wexford, Fine Gael)
Link to this: Individually | In context | Oireachtas source
I have a question on that.
I presume I speak for other public representative as well but when a student transitions from second to third level education, one issue I often come across is that students often come to us looking for college accommodation because it helps them to settle in the first year. They feel much safer in college accommodation rather than going into general accommodation. Is people wanting college accommodation an issue Professor Dooley comes across or a statistic she often hears about?
Professor Barbara Dooley:
I can certainly speak from UCD's perspective. We survey students who reside on campus every year and one of the top reasons they give for choosing to be on campus - I acknowledge it might not be something everyone can afford - is the safety of being on campus. Feeling safe on campus is one of the things they list as an important driver.
Ms Patricia O'Sullivan:
May I say one thing in that regard? It relates to a point Professor Dooley made earlier. It is also about social development. The fact that they are together for that first year and all singing from the same hymn sheet, is important. It is great for connection, which is another important matter for mental health.
Paul Kehoe (Wexford, Fine Gael)
Link to this: Individually | In context | Oireachtas source
What supports does Ms Fox believe we can give parents of students going into third level?
Ms Treasa Fox:
That is an interesting question. We have to walk a thin line in understanding that our students are adults when they come to us. Almost all are 18 or over and only a small percentage of students are under 18. Our contract as organisations is with the students as adults. There is interesting stuff coming from some court cases in the UK about students experiencing poor mental health and suicidal risk. Some challenges were brought against the institutions because they did not involve the carers, the guardians or next-of-kin at an early enough point that they could have prevented tragedies. It is something we are still negotiating. Professor Dooley and I have had conversations about how institutions lean into that duty of care and set some boundaries. We must allow students to have their adulthood and be self-directed but we must also fulfil a duty of care where we contact family members or primary supporters when we are concerned about students. Different interventions are possible. For example we have a section on our website of advice for parents about how to support their sons and daughters. The biggest thing is communication. They must keep communication open all the time. The other thing we suggest frequently is students might want their parents to come and see their new world. We advise parents to be open and be prepared to do that, especially in the first semesters around the transition points. It is about being curious and showing interest in the students' new world and their exploration of it. However, within counselling services, except where risk is indicated, our contract is with the student and not so much with the parents. We will certainly listen and take on board some concerns and advise them how to get students into whatever services are needed. We can give that sort of advice but we cannot enter into discussions because of confidentiality.
Paul Kehoe (Wexford, Fine Gael)
Link to this: Individually | In context | Oireachtas source
I will finish with a question I would like one of our guests to answer briefly. One of the biggest challenges for us as a society, and it is a major challenge, is drugs and substance misuse. I do not think we take it seriously enough from every side, whether it be justice or education on the effects it can have on mental health and mental illness. Do the witnesses see that as an increasing challenge or have they heard about it from third level colleges?
Professor Barbara Dooley:
Certainly the link between alcohol, drug use and mental health is pretty clear but which comes first is the more difficult matter to disaggregate. It is important that we are mindful that these two issues may go together. If we are working with young people or our students who are struggling, we must try to understand to what extent they are engaging in risky behaviours. Mental illnesses, for example anxiety or depression, present themselves as how the student is feeling but we must ask what triggers have led to that feeling. Those are the types of things we need to understand. Triggers may be alcohol, drug use or other environmental issues such as if students are struggling with relationships. The complexity of mental health is what makes this work difficult and is the reason there is no perfect solution. It is because of the complexity of the lives of young people and of how they are living. It is incumbent on us when they present to try to unpick some of those things and perhaps put the right supports in place at that time. Certainly from our work there is evidence to link those two things and they are pretty strongly linked. People who have dangerous levels of alcohol-related behaviour or whatever are more likely to report depression, anxiety and suicide attempts.
Paul Kehoe (Wexford, Fine Gael)
Link to this: Individually | In context | Oireachtas source
I will allow Deputy Conway-Walsh and Senator Dolan five minutes each. I will go to Senator Dolan first this time because Deputy Conway-Walsh was before her the last time and she was first on the questions list.
Aisling Dolan (Fine Gael)
Link to this: Individually | In context | Oireachtas source
I will follow up on one of the Chair's points about the act of consent as it is important. It is true. We are hearing stories now that were probably hidden before on our campuses. It is shocking and it should never be accepted. Like all things, it should be a zero policy. We have to manage this as best we can. The University of Galway, through Dr. Pádraig McNeela, is rolling out the consenthub.iewebsite and it was launched at an event last year. Students at second level can access the website as well. There are elements for people aged under 17, as well as for young people in college. It is probably linked in because I assume they are working with THEA, IUA and all the colleges about how to roll this out. It is available online for all. Perhaps the witnesses will comment on how this is managed in colleges. I might be interested in that.
Regarding the colleges under HECA, we passed the Higher Education Authority Act, which is landmark legislation that looks at our third level landscape as we move into the future. There are opportunities for independent colleges to be designated. Designation is something colleges can consider, working with the Government on how to access other types of services. Will Ms O'Sullivan comment on the designation status and how colleges that she represents might be able to engage in that process and with the supports that may come from it, such as the student supports she has mentioned for mental health?
The reason I am focusing on text and online services is that students sometimes do not feel able to speak to a trusted adult or person. It can be a difficult transition. On the transitional piece, will Ms O'Sullivan provide an example, perhaps from one of the HECA colleges, of how student counsellors engage with first, second and third years? Are there different examples of engagement? Also will she speak about clubs and societies? That is a fantastic part of college, is it not, where students learn about music and all kinds of things? I remember that colleges used to promote that engagement and encourage students to take part in that as part of their full college experience. How is that going in universities now that everything has opened up again? There are a few comments in that, in how universities can take a lead. Are any supports available to help students and parents to see that type of life exists at third level?
If there is time, will each of the witnesses answer? Will Ms Fox answer first?
Ms Treasa Fox:
I thank the Senator. I will reflect on the Senator's question about Togetherall and how it is being rolled out so far. One of the issues goes back to what I spoke about earlier. The delivery, launch, roll-out and promotion of these things on campuses require resources and right now we are in waitlist territory with students who will not be seen before Christmas. Every institution has to balance that with a growing list of students looking for counselling.
Aisling Dolan (Fine Gael)
Link to this: Individually | In context | Oireachtas source
Promotion of the online supports is not possible. Is that what Ms Fox is saying?
Ms Treasa Fox:
I am saying it is a challenge when our resources are thin on the ground. For the launch-----
That is a partnership that the Minister for Further and Higher Education, Research, Innovation and Science has set up, particularly around Togetherall, active consent and making sure that those online supports are available to students, staff and so on.
Aisling Dolan (Fine Gael)
Link to this: Individually | In context | Oireachtas source
Is Ms Fox stating that there is a challenge in rolling those out to institutions?
Aisling Dolan (Fine Gael)
Link to this: Individually | In context | Oireachtas source
Can Ms Fox provide a proactive example of how a student counsellor would deal with a first year, as opposed to the latter coming directly to the counsellor? How does the counselling network in THEA colleges engage with students proactively?
Aisling Dolan (Fine Gael)
Link to this: Individually | In context | Oireachtas source
It is online. Will Ms Fox provide an example of a student who goes to a particular college?
Aisling Dolan (Fine Gael)
Link to this: Individually | In context | Oireachtas source
Can that not happen in person?
Ms Treasa Fox:
It is the practicalities of several different faculties having induction. It goes back to the fact that our first year students are coming on campus when our second and subsequent years are already there. Even in terms of facilities, rooms and lecture theatres, we might not have the space to accommodate 600 first-year students for in-person induction because second-year and other students are already on campus when the first years arrive. This is the problem with the leaving certificate at present. Professor Dooley referenced this. In ordinary times, first-year students would have come on campus for induction before those in second and subsequent years..
Aisling Dolan (Fine Gael)
Link to this: Individually | In context | Oireachtas source
Now back to in-person teaching, the in-person nature of student counselling, and the proactive part of that, even with clubs and societies, is important. It is crucial.
Professor Barbara Dooley:
The point about clubs and societies is really well made. We had in-person induction this year for all of our incoming students. It coincided with our freshers week, which had all of our different societies and clubs display their stands. There was huge engagement. All day long, students were coming to induction and going over to the areas where all of the societies were looking for members. There was major participation. From talking to the registrars' group within the IUA and international colleagues, I am aware that there has been a huge uptake in the context of students coming back to campus. This is despite the accommodation crisis, which I acknowledge is there. Our campuses are really alive this year for the first time. Students felt they could come to campus and see the value of being there, of coming to class, learning in person, working with their fellow students, developing and joining clubs and societies. That connection was taken away during Covid. There has been an appetite to come back this year. From talking to college principals and others in the universities, I know that has been the case. As a university management team, we engaged earlier in the year regarding the strategies we would put in place in order to get people to come back. We thought we would need to work harder; we did not realise that students were going to vote with their feet. They wanted to be with us. It was then up to us to provide them with a high-quality experience in the context of why they should be there with us.
Paul Kehoe (Wexford, Fine Gael)
Link to this: Individually | In context | Oireachtas source
I call Deputy Rose Conway-Walsh. The Deputy has have five minutes.
Rose Conway-Walsh (Mayo, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
The IUA highlighted how international students are likely to experience particular mental health difficulties. What would be the average percentage of international students in publicly funded universities and colleges? That question is for Professor Dooley. What would be the percentage be of international students in private colleges? That one is for Ms O'Sullivan.
Professor Barbara Dooley:
Between 25% and 28% of our students are international. A large proportion of those will be at graduate level. Our biggest cohort of international students in UCD will be coming to do taught programmes in university. A smaller proportion come for four-year programmes. We also have quite a number who come for a study-abroad semester. They are often from North America. We also have Erasmus students. There will be a blend of different students who come here for different reasons. They may come to do a one-year taught programme. They may come to do a four-year undergraduate course. They may be Erasmus exchange students, they may coming from study-abroad programmes or they may be coming from North America. They come from almost 140 countries.
Rose Conway-Walsh (Mayo, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
Does the 28% capture all of those students?
Professor Barbara Dooley:
Pretty much all of them. It is a huge number. We prioritise our international students for access to accommodation on campus as well. When we are looking at how we allocate our resources, which are limited, the number one group comprises those coming through the CAO. They are our most vulnerable group - they are transitioning from second level and coming to UCD for the first time and they are younger. The others are those international students who are coming to UCD for the first time. It is our priority to make sure they transition well when they come onto our campus.
Rose Conway-Walsh (Mayo, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
What is the percentage in terms of the private colleges?
Ms Patricia O'Sullivan:
Approximately 15% of our students come from the international sector. Isolation, especially during Covid, was a huge issue for their mental health. Supports were very much needed. We arranged a lot of online activities at that time, such as coffee houses, group work, etc. I am sorry, what was the question?
Rose Conway-Walsh (Mayo, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
I was just trying to get the percentage of international students coming here in order to get a picture of the particular challenges around mental health for those students. We have 28% in the HEAs and for private colleges it is just 15%.
Rose Conway-Walsh (Mayo, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
As a follow on from that, how much is allocated for mental health supports and services by the private colleges?
Rose Conway-Walsh (Mayo, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
Overall, is there a ballpark figure?
Rose Conway-Walsh (Mayo, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
I would not expect Ms O'Sullivan to have the information today. Perhaps she could let the committee know how much is allocated.
Rose Conway-Walsh (Mayo, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
Will Professor Dooley indicate how far away we are from having proper core funding?
Professor Barbara Dooley:
Ms Fox is probably best to speak to that because she is the Chair of Psychological Counsellors in Higher Education Ireland, which is the umbrella group. There are two elements to that. It is the core through the counselling services, but we also need to embed services more broadly into our system, whether it is student advisers in UCD or whatever. There are supports that are not necessarily provided by counsellors. These also need to be embedded in the system. We also need to get lecturers to think about how we embed principles of good curriculum design into the system. They are lots things we can do.
Rose Conway-Walsh (Mayo, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
There are so many announcements, programmes and so forth, that the real issue is sometimes camouflaged in terms of having sustainability in the context of mental health services within colleges.
Rose Conway-Walsh (Mayo, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
We need to look under the bonnet there.
Ms Treasa Fox:
I am nodding in agreement. I will be honest. From where we were in 2019 and 2020 in terms of resourcing, the additional announcements of €5 million between 2019 and 2021 were really welcome. However, they have only been short-term contracts, so it is really difficult to say how far away we are, particularly in view of the tenuous nature of those contracts. In a couple of institutions those contracts will be finishing this month, next month and in January and February. If we are counting right now, we have those additional posts. In two months, we will not have them. Just to give an estimate, over the past couple of years, the authorities in Scotland allocated £11 million to recruit 80 counsellors to augment student counselling services there. I say estimated because we really cannot say categorically until we do a root-and-branch evaluation in each institution. There is wide variation across institutions as well.
Rose Conway-Walsh (Mayo, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
How many contracts will be coming to an end in the next two months?
Rose Conway-Walsh (Mayo, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
Is there a possibility of those being renewed at this stage?
Rose Conway-Walsh (Mayo, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
The resources are not there at the moment. That is an extremely worrying situation. We are coming up to examination time. Inflation is becoming more and more embedded. The financial crisis is deepening in terms of the pressures on families and students. We are going to have a drop-off in that regard. I would be deeply concerned about the consequences of that happening. It is something I am sure the committee will take up with the Minister.
Ms Patricia O'Sullivan:
If I may come in here, I want to give an example from some of our colleges. CCT College Dublin provides mental health counselling that is delivered by professional registered counsellors. Hibernia College does the same. It has a dedicated student counsellor. They are all noting that while their students can access these services quite quickly, there has been a marked increase in demand in recent times. The Deputy mentioned sustainability. How sustainable is it for any college? The publicly funded colleges are already highlighting that it is a challenge in the context of their resources. It is also challenging for our resources. I stated earlier that there is a mental health crisis. That is what we are experiencing, along with crises in respect of accommodation and the cost of living. It is hard to be sustainable.
Paul Kehoe (Wexford, Fine Gael)
Link to this: Individually | In context | Oireachtas source
I thank the witnesses for attending. The discussion has been very beneficial for committee members in the context of the work that is ongoing. I thank our guests for sharing their insights, expertise and knowledge in such an important area and on such an important issue. I thank the members also.