Oireachtas Joint and Select Committees
Tuesday, 15 November 2022
Joint Oireachtas Committee on Education and Skills
Mental Health Supports in Schools and Tertiary Education
I remind members to ensure that their mobile phones are turned off for the duration of the meeting since they interfere with the broadcasting equipment, even when on silent mode. Are the minutes of the meeting of 8 November agreed? Agreed. Are the minutes of the meeting of 25 October agreed? Agreed.
We are meeting with psychological support organisations. On behalf of the committee, I welcome Mr. Derek Chambers, general manager of national mental health operations, HSE mental health services; Ms Maureen Murray, youth mental health promotion manager at Jigsaw; and Mr. Ian Power, CEO of SpunOut. I welcome Mr. Mark Smith, past president, in 2020, and current council member of the Psychological Society of Ireland; Ms Lisa Molloy, CEO of the Irish Association for Counselling and Psychotherapy, IACP; Ms Mary Logue, vice chair of the board of directors of the Irish Council for Psychotherapy; and Ms Fiona Jennings, senior policy and public affairs manager of the Irish Association for the Prevention of Cruelty to Children.
I welcome the visitors from the IACP in the Public Gallery, Séamus Sheedy, chairperson, Jade Lawless, vice chairperson, Iwona Blasi, innovation and development manager, and Nicole Mac Dermott, communications supervisor. I welcome Ms Fiona Hughes, clinical manager of Jigsaw, and Mr. Poul Walsh Olesen, senior project manager, HSE mental health operations, who are also in the Public Gallery.
Witnesses are here to discuss mental health supports in schools and tertiary education. I will invite witnesses to make a brief opening statement in the following order: Mr. Chambers, Ms Murray, Mr. Power, Mr. Smith, Ms Molloy, Ms Logue and Ms Jennings. This will be followed by questions from members of the committee. There are five minutes in each slot for members to ask questions and witnesses to reply. As people are probably aware, the committee will publish opening statements on its website following the meeting.
Before I 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.
Witnesses are reminded of the long-standing parliamentary practice to the effect 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. Therefore, if their statements are potentially defamatory in relation to an identifiable person or entity, they will be directed by the chair to discontinue their remarks and it is imperative to comply with such direction from the chair.
Mr. Derek Chambers:
Good morning to the Chair, members and colleagues. I thank the committee for the invitation to contribute to this important discussion on student mental health. Our mental health is influenced by many different factors. While the continued enhancement of specialist mental health services is important, the mental health of our young people depends on a broad public health approach that builds on collaboration across the health services, the education sector, statutory and voluntary bodies, and within our communities. The age of onset of mental health difficulties typically falls around the late teenage years and early twenties, and adverse early childhood experiences can be a significant predictor of serious mental health difficulties in later life. In the development of youth mental health services, it is therefore critical that we prioritise the promotion of good mental health, intervene early when problems develop, and ensure clear pathways to community-based mental health services for those who need extra supports.
The continued development of all mental health services across Ireland is directed by Sharing the Vision, our national mental health policy, with a focus on ensuring that people have access to the right care at the right time when they experience mental health difficulties.
Reflecting this approach, the range of mental health supports provided by or on behalf of the HSE through our funded partners is broad and covers mental health information and self-help resources, community-based supports, primary care services and specialist mental health services. At a general population level the HSE continues to deliver trusted mental health information through yourmentalhealth.ie or from the Your Mental Health information line. For young people, the HSE works closely with SpunOut.ieto provide engaging online mental health content and signposting. Both yourmentalhealth.ieand Spunout.ieattracted well over 1.5 million site visits in 2021.
Recognising the importance of inter-agency collaboration, we also arrange webinars and online workshops to connect with stakeholder groups and to increase awareness of mental health supports. To this end, HSE mental health recently collaborated with the Irish National Teachers’ Organisation to deliver a webinar to their members highlighting the available supports to teachers who are concerned about the mental health of students. We will build on that initial engagement over the lifetime of Sharing the Vision and beyond.
In order to promote positive mental health and resilience in our children and young people, the HSE supports a number of school-based mental health promotion programmes, including Zippy’s Friends for primary school children and MindOut for students in post-primary schools, by providing teacher training and implementation support across the country. Both programmes are evidence based and have been independently evaluated. The HSE is also working with the Department of Education on the development of junior and senior cycle social, personal and health education, SPHE, curriculum resources. For children and young people who experience mild or moderate difficulties, supports are available through GPs, primary care and through our HSE-funded partner. These include primary care psychology services, Jigsaw and counselling in primary care, CiPC.
Services provided by our funded partners range from peer support, counselling, telephone helplines, online or text support to advocacy services. In addition to the services represented here today, the HSE recently partnered with the Professional Counsellors in Higher Education in Ireland to launch Togetherall, which is a clinically governed online peer support service that has gained significant traction internationally. This service can become a very important first step towards supports for young people in colleges across Ireland. Other services that have had particular traction recently include online counselling through MyMind, which has averaged 1,000 free to access sessions per month, and guided online cognitive behavioural therapy through Silvercloud, which has been provided to more than 7,000 people since April 2021 and has reported significant improvement in mental health outcomes for clients.
In addition to these community based supports and primary care services, a relatively small number of children and young people will require specialist mental health service treatment with the input of a multi-disciplinary child and adolescent mental health services, CAMHS, team. There has been a significant investment in CAMHS over a number of years to meet increased demand and to improve services for children and young people. Within the past six years, €22.6 million of development funding has been directed to enhance CAMHS services. Since 2013, an additional 18 CAMHS teams have been established and close to 300 additional whole-time equivalent posts added to our workforce. There are currently 73 multi-disciplinary CAMHS teams in place providing assessment and treatment services. Between 2020 and 2021 the number of new cases seen has increased by 21%.
Alongside these targeted enhancements of capacity in CAMHS teams, we have invested in tele-health, eating disorder teams and inpatient care. Importantly, we have also invested in services such as Jigsaw and primary care psychology for children and young people with mild to moderate mental health difficulties who do not need to access the specialist mental health services that CAMHS provide. The improvement of youth mental health services will continue to be a key priority for the HSE and will be guided by the Sharing the Vision Implementation Plan 2022 – 2024. Published in March 2022, this implementation plan provides a three-year roadmap for the continued development of mental health services. The HSE's work to deliver Sharing the Vision will be driven by a strong outcomes focus and a commitment to report on progress in an open way through, among other things, the online publication of quarterly status reports.
In summary, the supports and services offered by the HSE and partners for young people are broad in range to respond to the varying needs arising among this population. Effective collaboration, clear pathways between services and the ability to provide shared care will be crucial over the coming months and years in ensuring these supports are effective.
Ms Maureen Murray:
I thank the Chair and committee members for this opportunity to contribute to the committee's important work in the area of mental health supports in education settings. By way of brief introduction, Jigsaw is Ireland’s primary youth mental health charity. It is supported by the HSE mental health and wellbeing and other funders. Jigsaw has, for over 16 years, established a track record in achieving better mental health outcomes for young people by providing a range of primary care therapeutic services for those aged between 12 and 25 years. We have previously made submissions and participated in committee deliberations.
Our submissions and participation have focused on mental health supports in higher education. We will focus today specifically on mental health in post-primary and further education and training settings. There is a growing body of evidence that implementing whole-school interventions has a positive impact on student well-being and mental health and has been shown to reduce mental health difficulties; improve social skills and social and emotional well-being; and improve learning in young people.
The My World Survey 2 research published by Jigsaw in association with the School of Psychology, UCD, in 2019 shows that there has been a significant increase in the levels of anxiety and depression among adolescents in Ireland over the past decade. At Jigsaw, we have experienced more and more young people seeking our services across the country and online. The most common concerns among young people aged between 12 and 17 attending our brief intervention services were anxiety, at 65%; low mood, at 45%; and sleep changes, at 34%.
We acknowledge the work of the Department of Education and other key stakeholders in supporting the well-being agenda in post-primary schools, particularly the role of the National Educational Psychological Service, NEPS, and others in implementing the well-being policy and framework for practice. Jigsaw has a significant contribution to make in supporting the mental health and well-being of the whole school community through our One Good School initiative. One Good School, which is endorsed by the National Association of Principals and Deputy Principals, NAPD, and the second-level students' union, ISSU, is a whole-school initiative which supports the mental health and well-being of young people and those around them, developing a shared responsibility across the whole school community. The programme is funded through significant fundraising and is currently being implemented in 147 post-primary schools in Ireland.
We have developed infrastructure to deliver a range of supports to schools at local, regional and national level, which supports the schools to promote and support student mental health. Jigsaw also launched a new online schools hub in March 2021, which provides a range of resources, materials and supports to teachers and school staff across the 26 counties which enables them to deliver meaningful well-being lessons in the classroom at both junior certificate and senior cycle. Jigsaw recently established a specific team to focus on supporting mental health and well-being in further education and training and higher education settings. We have a particular interest in Youthreach and further education and training; our detailed submission points to the significant mental health difficulties experienced by young people in these settings. Our One Good School programme has the capacity to provide all schools in Ireland with a universal, whole-school structure for supporting the mental health of students, teachers, parents and school leadership. However, the expansion of the programme requires significant mainstream funding, which should be supported by the Department of Education. Additionally, it is crucial that a range of targeted mental health support services are provided to effectively meet the needs of students who may be considered more at risk.
We recommend that student voices and engagement are central to and integrated into all collaboration, planning, development and delivery of health supports. We also recommend that specific funding be allocated to the development of comprehensive mental health promotion at further education and training and Youthreach settings. We all need to work collaboratively to provide a more comprehensive and co-ordinated approach to mental health and supports to students across all education settings in order to avoid duplication and ensure equitable access to an integrated mental health system which meets the needs of all. State investment is now required.
The students of today are our future professionals, parents, politicians and "One Good" adults, who, in turn, can support the mental health of future generations. I thank the committee for this opportunity to speak. I look forward to members' questions.
Mr. Ian Power:
I thank members for the invitation to speak today. I do not think there has ever been a more important moment to talk about mental health and our education systems and we in SpunOut welcome this opportunity to discuss these matters. Before we begin, I will give a quick outline of who we are. SpunOut is Ireland's youth information service, run by young people for young people. Through our platforms, we provide young people in Ireland with access to quality, non-judgmental information services, with more than 150,000 readers availing of our information resources every month and thousands more engaging with our content on social media channels such as Instagram and TikTok. We also provide a round-the-clock crisis support service through our 50808 text helpline, funded by the HSE.
Around 4,000 young people reach out to us by texting 50808 every month, a significant number of whom are struggling with anxiety, depression, the urge to self-harm, body image issues and, in one in five cases, thoughts of suicide. One in five is a figure that has been remarkably stable over the past three years and it is showing no sign of reducing. It is easiest, when talking about the work that SpunOut and 50808 do for young people, to present our impact in their own words. One texter recently told us, when referring to volunteers, "they were the difference between me [self-harming] and not, me having a scar for the rest of my life and not, me going to bed feeling like I deserve to be here and be heard, and not." That is the service that incredibly talented staff and volunteers work so hard to provide. As a front-line, crisis service, we deal with people at one particular moment of acute need.
If we want to look at the systems that contribute to good or bad mental health outcomes more generally, then the role of our educational systems is simply inescapable, as drivers of stress and anxiety in their own right, as settings where young people live out much of their lives, and, when things work well, as real, invaluable sources of support. It is clear that the main stressors for school and college students tend to be local to their educational environment, so it stands to reason that most supports need to be local as well. Where supports are properly funded and well-integrated into the school or college system, we hear about their successes. When those services are not available, or not adequately resourced, we hear about their failings.
Young people want services that provide immediate support, that exist where they need them, and when such services are in place, they are not shy about telling us just how much they help. It is clear to us, for instance, that the National Educational Psychological Service needs to have a much wider role in our schools. It needs to be empowered to act as a co-ordinator for psychological supports across the school system. It needs to have a role in psychological education for students. Bluntly, NEPS needs to be better funded to carry out its purpose.
The question of better resourcing cannot be disentangled from the mental health crisis we are seeing among young people in Ireland. There are positive, cost-neutral reforms but, ultimately and crucially, there is no substitute for adequate funding. As of this moment, that funding is not in place. That funding has to be found because it is the only way we will begin to tackle the real and growing need for mental health supports, particularly in our secondary schools. We stress that it is not just the role of the Department of Health or HSE to fund mental health services but also the role of the Departments of Education and Children, Equality, Disability, Integration and Youth to resource the sector.
We know that the onset of mental illness peaks between the ages of 15 and 25, meaning students are at particular risk just as they enter into the uniquely stressful situation of the leaving certificate cycle. Mental illness is the number one health condition for young people. No physical illness or condition compares. As Ms Murray said, the invaluable My World Survey tells us that, in 2019, before any of the impacts of lockdowns and the pandemic, 40% of young people were experiencing depression and 49% were reporting anxiety levels outside the normal range.
I mentioned earlier that one in five young people we talk to through the 50808 text line mention thoughts of suicide. Unfortunately, the My World Survey results are just as stark, if not much starker. They tell us that 6% of young people surveyed had actually made a suicide attempt. Last year, the National Office for Suicide Prevention put the number of deaths by suicide at 399, which is 59 more people than in 2020, and the first reported increase in deaths by suicide since the trend was reversed in 2016.
Reliable and resourced in-school mental health supports are unquestionably part of the answer.
Schools-based services can act not only as front-line case workers but as indispensable links to outside services to help students and their families navigate the wider mental health system, often a difficult and alienating experience for people who are already at their most vulnerable.
These reforms are far from impossible. We only need to look at the real progress that has been made in higher education institutions in recent years. We are still a long way from a perfect system and there is much to do to safeguard student mental health supports at third level, but funding for student counselling has increased, which is very welcome and is going to change and saves lives. For our part, the 50808 service has been expanding our relationships with higher education institutions. We are key partners with every college and university and we believe the next step for mental health support in higher education is for the State to fund at least a part-time, if not full-time, psychiatrist in each and every higher education institution. This will be an immeasurable benefit to the students who will need it and will revolutionise each institution's ability to provide in-house support to young people where and when they need it most.
Recruitment of mental health professionals is, of course, a challenge right across the system but we believe that, with the right resources, this could be achieved. More broadly, we need to look at widening the pool from which we draw our mental healthcare workforce. We are up against a global shortage of trained mental health practitioners and we are well aware that there is no quick-fix solution, but that means it is all the more critical that we invest in those longer term solutions now. We need to create more training positions across all mental health discipline so we can meet the very real service needs that we will continue to face in the next few years and beyond. I thank members for their attention and look forward to the conversation with colleagues.
Mr. Mark Smyth:
On behalf of the Psychological Society of Ireland, PSI, I thank members for the opportunity to address the committee. One in three young people in Ireland is at risk of experiencing a mental disorder by the age of 13. This also coincides with when children make the often challenging transition from primary to secondary education and when their bodies are undergoing significant physiological and emotional changes.
Sharing the Vision recommends a stepped approach to care that would focus on promotion, prevention, early intervention, recovery and participation. Over time, this should reduce the need for more expensive acute and crisis response services. In this context, strategic investment in primary care services should be viewed as an investment rather than a cost. However, the current reality is that, as of August 2022, over 11,000 children were waiting for access to community primary care psychology services, with almost 4,000 children waiting more than a year for an appointment. That is 4,000 young lives prevented from accessing the supports that would see their difficulties reduced and overcome by spending over a year waiting for those supports. The additional investment in primary care psychology and mental health as part of the 2022 waiting list action plan was welcomed but there are not enough psychologists trained or available for sustained meaningful reductions in waiting lists.
The National Educational Psychological Service supports the personal, social and educational development of children in schools. This can be complex work that requires psychologists to become deeply involved in building trusting relationships with school communities. PSI welcomes the announcement in budget 2023 that NEPS will receive funding for an additional 54 psychologists to provide services to special schools and special classes. While this is a positive development, there will continue to be shortages of NEPS psychologists in schools due to there being no provision for cover for maternity leave. In a predominantly female-dominated profession, the impact of a lack of cover for maternity leave places additional unnecessary strains on psychological services to schools. In addition, inexplicably, the situation continues that trainee educational psychologists are expected to train for free for three years and pay thousands in fees each year. This is a direct impediment to attracting candidates to the profession as it is in direct contrast to other psychology professional training courses.
In contrast to the successful roll-out of the assistant psychologist, AP, grade in primary care psychology services, there is no current provision for employment of APs within NEPS. Employing APs could enhance NEPS service provision by freeing up qualified educational psychologists to complete the more complex work that they have been trained to do.
A clear causal line can be established between the oversubscribed specialist CAMHS and the failure to resource primary care psychology services to the extent required in providing evidence-based early intervention for children with mild to moderate mental health difficulties in school settings and in the community. Mental health support to staff, students and other members of the education community can help to reduce the frequency, length and impact of mental health difficulties that young people experience.
The successful adaptation and implementation of increased psychological supports within schools is constrained by several factors, with one factor predominating. Ireland does not have enough places on professional training programmes to meet current or future demands. Even if significant additional Government funding was to be provided to increase the numbers of psychologists in primary care psychology and NEPS posts, the reality is that we are not training enough psychologists to fill those posts.
The HSE report of the national psychological project team estimated a need for an additional 322 psychologists in mental health services alone. Each year, approximately 100 psychologists enter professional training programmes.
The key to the delivery of high-quality psychological services at primary care level, including in our schools, is the sufficient availability of skilled and trained personnel. There are significant shortfalls in the provision of psychological services due to inadequate staffing levels, which result in long waiting lists and significant difficulties in the recruitment and retention of trained staff.
One of the critical factors is the insufficient number of funded postgraduate training programmes. In 2000, the Department of Health, under the leadership of the then Minister for Health, the Taoiseach, Deputy Martin, responded swiftly to the requirement for the provision of extra training places by approving funding for a total of 30 additional trainee posts each year for three years. The PSI calls on the Government and the Taoiseach to show in budget 2023 the quality of leadership shown in 2000 and respond just as swiftly in 2023 to provide multi-annual funding to address the significant gaps in our psychological workforce. The PSI continues to call on the Government to fund an additional 50 trainee psychologist posts across the professional doctoral programme each year for a five-year period, which will necessitate an additional €2.45 million in funding per year or €12.25 million for the five years.
In psychology, there is the principle of Occam's razor. This posits that the simplest explanation is often the most correct. On why we have wholly unacceptable waiting lists for children and young people, the answer is that we have failed to train enough professional psychologists to meet previously predicted demand and this crisis in access will remain until additional funding for trainee place are provided.
Ms Lisa Molloy:
I am CEO of the Irish Association for Counselling and Psychotherapy, IACP. I thank the Chair and members for extending the invitation to participate in this roundtable discussion. I am honoured to be here today, alongside representatives from the HSE national mental health services, Jigsaw, SpunOut, PSI, ICP and the ISPCC.
The IACP represents more than 5,000 members in communities all over the country and is the largest counselling and psychotherapy association in Ireland. The IACP has called for the introduction of access to school counselling and psychotherapeutic supports for many years and we were delighted with the news of the allocation of €5 million for an in-school counselling pilot for primary schools. It is a great start.
School-based counselling programmes are established in over 60 countries worldwide and are mandatory in 40 of them. They have been operating in second level education very effectively in the UK for many years. The British Association for Counselling and Psychotherapy, our counterpart in the UK, has successfully collaborated with the UK Government in establishing school-based counselling in second level schools across the UK. Following the success of school-based counselling at second level, there is now a pilot under way in Northern Ireland, Healthy Happy Minds. It was launched in November 2021, with funding of £5 million, and was originally scheduled to run for a period of six months but has now been extended to March 2023. The evaluation report of the pilot will provide invaluable learning to the Government in determining the model for the primary school pilot here.
The bottom line is that having timely access to counselling and psychotherapeutic supports through professionally qualified counsellors and psychotherapists in schools has proven to be highly effective. Growing support for this was clearly captured in our latest nationally representative general public survey. The survey was conducted by Behaviour & Attitudes and commissioned by the IACP. It was carried out in April and May 2022 and has produced some very timely top line results, including a finding that 93% of Irish adults think counselling and psychotherapy should be made available for children and young people through schools. This is a 5% increase on the already high level of pre-pandemic support for this, which was 80% in 2019.
Growing international evidence for the benefits of school-based counselling highlights accessibility, destigmatisation and support for children, teachers, parents and caregivers. A study of more than 1,200 primary school principals carried out in 2017 by St. Patrick's mental health services in DCU offers robust results for consideration. It found a high level of interest expressed by school principals in having access to school-based counselling, in particular individual counselling and psychotherapy for children, as well as consultation for staff.
I have seen these findings borne out in the presentations by several school principals who recently appeared before the committee.
We know from the most recent large-scale research carried out in the UK, a study led by the University of Roehampton and published in The Lancet: Child & Adolescent Healthjournal in 2021, that school-based counselling is effective and should be considered as a viable treatment option for children suffering from mental health issues. This study found there were large increases in the levels of self-esteem of pupils, as well as large increases in their achievement of personal goals. It also found that parents and caregivers feel school counselling can play an important role in improving young people’s self-confidence, happiness, sense of self, relationships and academic performance.
The IACP believes intervention is critical and access to counselling and psychotherapeutic services through schools, as research indicates, is highly successful and with positive outcomes not only for children but also for the wider community. We therefore urge the Government to establish access to counselling and psychotherapy in primary and second level schools. This will ensure that children and young people requiring mental health support can access this in a timely and seamless way via the school setting.
The IACP is here to offer its expertise and to assist in the establishment of school counselling and psychotherapeutic supports that are evidence-based and informed. I thank the members of the committee for their time and attention. I am happy to answer questions.
Ms Mary Logue:
I am confident all of us around the table want schools and third level institutions to be places where mental health is seen as central to the well-being of all students, teachers, lecturers and other staff, and indeed parents and other stakeholders. Right now, however, I regret to say, it is the view of the ICP that this is not the case. In schools and educational settings, high levels of anxiety are being experienced by students, their parents, teachers and school principals, school boards and third level leaders. The ICP represents over 1,700 psychotherapists across several modalities and is the national awarding organisation for the European certificate of psychotherapy. It is our view that it is essential that affordable and accessible psychotherapy services be available to all who need them and that these services are delivered by appropriately trained and qualified professionals.
At an everyday level, we all know that to have a healthy society we need to raise children and young people who can learn and play in safety. In their best iteration, schools and third level institutions can act as islands of safety in a chaotic world. In a school setting, many teachers learn from experience that it is impossible to teach if the classroom is filled with children who are unable to participate due to high levels of anxiety. Earlier this year, my colleague, Trish Murphy, director of the student counselling service in Trinity College Dublin, TCD, spoke here of the increase in demand from students in that institution. Student counselling services all over the country are having similar experiences.
ICP members working in and with schools have relayed shared experiences since the pandemic where there is a push to return to normal. This normal involves the pressure to return to teaching in the vital but narrow curriculum, rather than providing safe spaces where children and young people can learn. Speaking with a colleague who works with a Delivering Equality of Opportunity in Schools, DEIS, band 1 school in the west, I was told there were over 90 unexplained absences in a school of 500 pupils on one day last week. I think the committee members will all agree this tells us something regarding the mental health of our young people. Our teachers are not supported and trained to handle the level of trauma children are experiencing, trauma that has been exacerbated by the pandemic.
I would like to share with the committee an initiative that is working. The Joint Managerial Body, JMB, which provides assistance to voluntary secondary schools and training to school management, runs Balint groups, where a qualified psychotherapist jointly leads the group with a school principal. The task of the Balint group, made up of eight to 12 principals and meeting every six weeks, is to provide a confidential peer-based setting to reflect on the emotional experience of the work.
The workload and worry-load of school principals has increased significantly in the past decade. While they are often reminded "that principals need to create an environment of emotional support for staff, the emotional support is often missing for themselves". In one such group last week, where a principal spoke of a very complex case involving students, a family and teachers, the principal said, "This group is the only place I have to bring problems such as this."
I give these examples to illustrate that there are already mental health supports in schools being provided by psychotherapists working in the educational system. What is needed is more of them. When systems come under pressure - for example, when it comes to managing disturbing or disruptive behaviour in schools - a trauma-informed approach will help teachers understand that these behaviours start out as frustrated attempts to communicate distress. In the absence of this understanding, the misbehaving child is met with a return to traditional methods of managing disruptive behaviour such as detention and suspension. In those situations the school becomes yet another traumatic trigger.
By increasing resources, the support structures that are already in place in some schools can be replicated and improved. In addition to the bolstering of support structures within the school system, ICP also suggests that the resourcing of CAMHS teams with psychotherapists as well as specialist child and adolescent psychotherapists be prioritised. As another of our members remarked, "Child and Adolescent Psychotherapists are like Hen’s teeth in CAMHS." ICP supports as a priority the reinforcing and support of the work already taking place such as that in the education and training boards and the work being done by the JMB Balint groups as well as the increase in the number of specialist psychotherapists within CAMHS teams nationally. Our profession is ready to step up and to play its part. We look forward to working with all members of the committee in any way we can.
Ms Fiona Jennings:
I thank the committee members for inviting ISPCC today. Some of our key recommendations include promoting the use of helplines as important initial sources of support; championing supports and programmes that strengthen resilience and build coping capacity; upskilling on-site personnel in active listening skills; and, most important, the initiation of the youth mental health pathfinder project.
ISPCC has supported children, young people and families since its inception in 1956. Next February will see it mark 35 years of its flagship service, Childline. Childline, while once a telephone-only offering, is today a suite of multichannel services delivered both face-to-face and non-face-to-face, responding to the new routes in which children and young people access support. Most people are familiar with Childline's helpline, a universal service delivered via phone and online where professionally trained facilitators actively listen to children and young people, empower them to come up with solutions and signpost and refer on where appropriate. The provision of this type of non-face-to-face support affords a child or young person a sense of accessibility and autonomy.
Childline's therapeutic support service offers children and young people a more long-term, personalised individual plan of support depending on their level of need and the presenting issues. The aim of the service is to build resilience and increase the young person's coping skills. We can meet children and young people at a place where they are most comfortable. Digital mental health and well-being programmes aim to reduce anxiety for children and young people as well as enabling their parents or carers to manage their own anxiety while supporting their anxious child or teenager. These programmes, developed by SilverCloud, are based on the principles of cognitive behavioural therapy, incorporate mindfulness practices and are specifically designed to assist in managing anxiety. The aim is to empower participants to think and feel better and to apply the given techniques in their day-to-day lives. A trained member of our Childline team guides and supports each participant through his or her programme confidentially.
We developed our Shield anti-bullying programme as a direct response to the issue of bullying and how it was impacting the mental and emotional health and well-being of children. The Shield programme aims to support organisations in their efforts to proactively manage bullying and to protect children and young people from bullying through prevention and intervention strategies. Bullying is a complex social issue and can occur in many different settings. The self-evaluation tool is a key component of the programme and is designed for any organisation working with children and young people. There is now a large body of evidence in respect of effective approaches to bullying and what has been proven to work. ISPCC has distilled the latest research into ten Shield statements that are evidence-based.
By reflecting on each of the ten statements and associated questions, organisations will identify their areas of strength and those necessitating development in their approach to bullying. We were delighted to collaborate with DCU's anti-bullying centre and our Irish safer Internet centre partners, Webwise, on the revised Shield programme. Smart Moves is an evidence-based resilience programme specifically focused on the transition from primary school to post-primary school. The programme’s pre-developed session plans are delivered by the teachers to their class group. Smart Moves can be completed by both fifth- and sixth-class students and is currently available to schools across the country.
Best practice tells us that students need to be supported not just before they transition from primary school to post-primary school, but also during and after that. Our aim is to follow these students as they move into first year so they can continue to engage with the Smart Moves post-primary programme.We also recognise that parents and carers often need guidance during this time too. Therefore, we offer online tutorials to support them as their child transitions. The long-term vision for this programme is that all sixth-class and first-year students and their parents or carers will engage with and benefit from the programme, leading to more successful transitions into post-primary education.
All ISPCC services and programmes are available to children and young people and can be accessed within the school environment. Teaching personnel can refer to our Childline therapeutic support service and our digital mental health and well-being programmes on behalf of a child or young person with parental consent and can register to participate in our Shield and-or Smart Moves programmes. Teaching personnel can always signpost any child or young person to our Childline helpline where they can access mental health supports via phone or online or by extension on our Childline.iewebsite, which hosts multiple articles and resources on the issue, including a public notice board, Ask Alex, where readers can find support from responses to other children and young people’s queries.
Our mental-emotional health profile features consistently in the top two issues children and young people seek support on. We are pleased with the direction Government policy is taking to better support the mental and emotional health and well-being of children and young people and strongly feel that ISPCC can play an important role in supporting Government to fulfil these policy objectives. However, we remain convinced that without the immediate initiation of the youth mental health pathfinder project, the collaboration and co-operation that are required to deliver meaningfully on any policy will be stymied. I thank the committee for its attention and I look forward to engaging with members as the session proceeds.
I thank the witnesses for the presentations. I feel, as I am sure my colleagues do, that the presentations have been overwhelming. It feels like we face a tsunami of mental health challenges across the country. The witnesses made strong points about the lack of psychologists, the lack of funding and the issues that young people are having.
I will start on a positive note. Last week, I attended the Yellow Flag Programme awards, which were rolled out by the Irish Traveller Movement. A number of schools across the country have taken the initiative to go with that programme and speak about integration and anti-racism policies. They are seeing success. I was at a presentation from Scoil Chiaráin in Donnycarney last Thursday night. I think the programme is called "what he needs". There was a film that deals with toxic masculinity and how to respond to it positively in issues that young people come across. There are individual schools that are doing their best, notwithstanding the existing challenges. I have separated out some of the mental health challenges that young people can face. They can deal with issues outside school that are then brought into school. Individuals may be dealing with issues, such as health issues or sexual orientation issues. There may be school-based issues.
I am always interested in the wider context. We often talk about funding and strategies, which is absolutely right. What if the way in which we set up the education system is exacerbating these problems? We expect 12- and 13-year-olds to transition to a new stage of their education at a point when they are becoming more self-aware. That can become a traumatic change. We have an exam-focused second level education system which has to be more stressful than other education systems across Europe. We are constantly talking about examination reform. We seem to be ill-equipped to challenge the patronage model of schools and how we separate children by gender, income and in other ways.
I will focus these questions on Ms Murray and Mr. Power. What percentage of these issues are we dealing with which are caused by schools? What percentage of them are being brought into school from the outside? Do we have to have a conversation about how equipped or ill-equipped the entire system is for what we ask young people to go through to deal with their lives and the individual mental health stress they may have?
Ms Maureen Murray:
I agree totally with the Deputy that the system puts barriers in the way of young people progressing from primary and into secondary and further on. The first barrier they come across is the issue of leaving their safe and secure primary school and moving into a totally complex second level system. My background is in education and I have seen a lot of this first hand. That is one area we need to look at. The Deputy mentioned the exam system. There is no doubt the exam system has been shown to add immense stress to young people and it totally stressed them out throughout Covid. One of the good things we saw during Covid was the voice of young people coming out to say they were finding it stressful and difficult. Schools find things very difficult insofar as they are very isolated and alone in dealing with these problems and issues, that is, trauma of young people coming into the school and family difficulties and violence coming into the school.
Schools are very much on their own and isolated which is why they are afraid to do anything. I mentioned our One Good School initiative to the Deputy. We hope it will be rolled out in every school in the country because it brings the school together as a unit to respond to the needs of young people in the first instance. Our programme helps to support the young people, parents, teachers and school leadership. We heard earlier reference to how difficult school leaders are finding things at present and, yes, it is exceptionally difficult for school leaders at present. The One Good School programme starts with school leaders to support and train them and then invites school staff to be trained and included.
When I talk about training, I am talking about moving away from the absolute fear there has been in schools over the years to even mention mental health. Every school was afraid of opening a can of worms and whether they would open up something it could not deal with. We need to look at mental health and, in the first instance, destigmatise it. Every single one of us sitting around the table this morning has mental health. Sometimes it is good and other times it is not so good. One of the first things we need to do with the system is to destigmatise the concept of mental health being bad. We all have mental health and we have to deal with it.
When schools are complex organisations, it is very important for parents to be included and on board. Our programme ensures that parents are included in all decisions about the school. I am quite passionate about the voice of young people being in everything that we do. Young people have to be at the centre of all our planning and consultations moving forward.
Ms Maureen Murray:
The programme we are suggesting should be rolled out nationally. It builds confidence and capacity in schools to talk about mental health and related concerns openly and honestly with everybody in the community. Everybody in the community is made responsible for supporting and promoting mental health. It is a village issue rather than an individual issue.
Mr. Ian Power:
I thank the Deputy for the question. It is a really important one in that we often talk about symptoms and issues experienced by young people but we do not get to the root cause of why those emotions are manifesting. There is a fundamental issue with the structure, particularly in our post-primary system, in that it is designed for one learning style. Students who find that learning style difficult because it is not their natural style of learning are stigmatised and made to feel as though they are failing in the system rather than the system failing them. Talking to young people in Youthreach centres around the country, the reasons they give for having left formal education involve not feeling that the curriculum is designed for their learning style. They will also describe the mental health issues that stemmed from that were not supported in the school environment either. We need to look at how we introduce vocational education opportunities for young people earlier. They do it in the UK. I welcome the move towards more continuous assessment. That is really helpful for lots of students. There are also really good examples of how young people can get involved in vocational education opportunities that will see them earn while they learn and really thrive.
The other piece for me is basic needs, which was touched on by the Deputy. If we consider the numbers of young people who are living in poverty or at risk of poverty, programmes like the free school meals are extremely important when it comes to providing an opportunity for young people to have their needs met in a school environment. There is also an issue relating to those young people's identity. They are different in some way. Perhaps they are struggling with their sexuality or coming from a community that is new to Ireland. We need to do more in school environments to create a culture of celebration of difference rather than focusing on elimination of discrimination. When we talk to young people - they will often reach out to our texting service and we also hear from them in Spunout action panels - the bullying, othering and ostracisation that can happen really affect their identities and experiences, not just in the 13 to 17 age range but into young adulthood and often into adulthood. While we are all talking about services that can intervene and support young people and build them back up, which is incredibly important, the fundamental causes of all of these issues need to be addressed and the education system is uniquely positioned to do that.
Gabhaim buíochas le gach duine as teacht os ár gcomhair agus fianaise a thabhairt. Tá sé an-tromchúiseach agus is léir go bhfuil go leor constaicí ann chun é a réiteach do na scoláirí go léir. I agree very much with what Mr. Power said about schools being well placed. Not all of the issues facing young people are related to schools but every child does attend school and there are opportunities there. The scale of this problem is very significant because we must try to resolve the root causes of it and as Deputy Ó Ríordáin, Mr. Power and Ms Murray have just discussed, some of those are rooted in education or schools. I have just come from the launch of the BeLonGTo Irish school climate survey, which found that 76% of LGBTQ+ students feel unsafe in school and one in three reported other students not being accepting of LGBTQ+ identity. That is just one example. The scale of the problem is so significant because many of the issues that are causing mental ill-health are societal but it also concerns trying to ensure that people who have difficulties and crises are responded to, so there are two sides to it.
My first question relates to how we do treat young people in those situations. My question is for Mr. Chambers but perhaps Mr. Smyth or somebody else would like to respond as well.
The situation in CAMHS is challenging. All present are aware of the waiting lists for the service. If we were to take a single area, Cork is probably one with which both Mr. Chambers and I are familiar. What is the current threshold for a child to be admitted to CAMHS?
Mr. Derek Chambers:
In terms of the threshold for admission to CAMHS, as the Deputy is aware, that goes through the person’s general practitioner, GP. All referrals to specialist mental health services such as CAMHS go via a GP. That is the practicality of how a referral is made. In terms of how it is guided, the 2019 CAMHS operating guidelines set out clearly the overall approach in terms of how a child’s journey into and through CAMHS should be managed. Adherence to those operating guidelines is now under scrutiny. That has been focused on in light of the Maskey report.
I hope Mr. Chambers does not mind me interrupting. I am under time constraints. To drill down into it, obviously there has to be a triaging when resources are short but am I right in saying that, at the moment, a child who is self-harming but not considered to be suicidal would not necessarily be able to access CAMHS?
Mr. Derek Chambers:
I do not think that would be applied in that black-and-white manner. The full circumstances of the young person’s environment and what is happening in his or her life would be taken into account. There is no hard and fast rule in respect of self-harming as the primary cause. There will always be other underlying factors to accompany any behaviour such as that, so-----
Mr. Derek Chambers:
Self-harm alone requires a particular response. In the first instance, that would be to make sure the young person is physically being looked after. Thereafter, CAMHS may not be the best or most appropriate service for that young person. We heard presentations from colleagues in respect of the prevalence of self-harm, and we have known for a long time that the prevalence is very high. The specialist mental health services may not be the best place for a young person who is self-harming to present. We have to get the entire range and suite of services working well together to ensure the appropriate response to a young person in that kind of scenario. It is often the case that a young person would be better off with services elsewhere in the health services, whether that is in primary care or through one of our funded agencies, such as Jigsaw. Jigsaw has its own criteria relating to presentations around self-harm. We also work with Pieta in that space specifically. It depends on the needs of the young person.
I acknowledge that there is complexity to this but my understanding of the situation on the ground is that the under-resourcing is so severe – I know Mr. Chambers is one of the people trying to resolve that and it is not necessarily his fault or anything like that; it is people working with him – that children and others in serious circumstances are referred to primary care teams that themselves are under significant pressure.
My final question, which is related to that, is that part of the problem is there are not enough mental health professionals, such as psychologists and psychiatrists. That is probably also true in other countries. In the view of the witnesses who are here as representatives of psychologists, psychiatrists and other mental health professionals, what more can be done to recruit and retain mental health professionals? Does it relate to the cost of getting clinical experience?
Ms Mary Logue:
One point is that there needs to be a pathway into services. We have been speaking about CAMHS. In the view of the Irish Council for Psychotherapy, there need to be more places for psychotherapists, particularly specialist child and adolescent psychotherapists, to be working within the CAMHS sector. It is more about having a pathway to allow people to work in those areas.
Ms Lisa Molloy:
From the perspective of the IACP, I support what Ms Logue said about pathways. A ready-made workforce is available. It is about how it is harnessed. It is important to acknowledge that we have qualified professional counsellors and psychotherapists in the country. We also have a throughput of students all the time so there is a workforce there. What is important is how they can be brought in to provide those supports. The important point is that there is a ready-made workforce.
Mr. Mark Smyth:
There are two barriers. One relates to counselling. There is some move from Government to try to support that. Our educational psychologists continue to be left out in terms of opportunities to do that. They must go through three years of a doctorate unfunded while paying €14,000 in fees. Irrespective of whether it is counselling, clinical psychologists or educational psychologists, we just do not have enough of them. Again, we are only training approximately 100 per year. Not everybody on those training programmes wants to work in our public service so we need to incentivise our psychologists to want to work in the public service by reducing those barriers and giving them opportunities. The reality is that there is a limited pool moving between different areas because there is an oversupply of jobs and an undersupply of psychologists. This will continue until we get more people training. If the Government allocated more funding next year to provide more places, it would be three years before those students came out as fully qualified psychologists. We have been highlighting this for a couple of years. We had a disability capacity review that indicated that we need 110% more people working in child disability services by 2033. There has still been no increase in attempts to recruit more people and create more places to fund that. We know where the gaps are and what the solutions are but we do not yet have the training places to meet that demand so we need better workforce planning. Our view is that this has not yet begun so we are on the clock.
Mr. Smyth said there approximately 100 students in training programmes every year but far more than that come through psychology degrees. Obviously, there is a significant difference but it seems that between the two stages, we are losing a lot of people who might be fit to help. What is the reason for this? Where are these people going? What are they doing if they are not going into psychology?
Mr. Mark Smyth:
Hundreds of undergraduate psychology graduates come through. Not all of them want to enter psychology. Some wish to go into research or other branches of psychology. The bottleneck starts at the assistant psychologist level. To be fair, the HSE did formalise the grade of assistant psychologist early last year at 114 places. There is room to increase that number. We mentioned that. We also noted that there is room to increase capacity for assistant psychologists in NEPS services because there is none at the moment. Even if we increase the number of assistant psychologists, the bottleneck at professional training programmes will remain. The Government did that in 2000 and there is room to do so again but it needs the political will to make it happen.
To continue Deputy Ó Laoghaire's point about educational psychologists, there are three avenues people can take with PhDs. The reason so few are going into educational psychology is that it is unfunded or not funded to the same level. The same kind of training is given and the same number of hours are worked across all three PhDs. I feel very strongly that this is not just up to the schools to deal with. We must look at what skills we need and once we identify them, that is where we need to put the money.
I do not think our schools mirror society. We are putting young people through a system that does not mirror the society in which they eventually end up. I was looking for statistics and because they are down in the dungeons, I could not get access to the Internet. The numbers of people who go to counsellors as adults have shot up. As Mr. Chambers rightly noted, the mental health of young people is what determines the mental health of adults. That makes complete sense so this is the time to invest in the area.
I was delighted to hear Ms Murray talk about the engagement with the Irish Second-Level Students' Union, ISSU, because it relates to one of the really good things that happened during the pandemic. One of the bad things was that it affected young people's health but one of the good things was much more emphasis on the voice of young people. Everybody knows about the ISSU, which has been running for years, because of its great work.
My next point concerns getting into services. I recently visited Barnahus, a sexual assault unit in Galway with which Ms Jennings will be familiar. When I was there, the lack of access directly from Barnahus to counselling services was raised. Children come forward with sexual abuse and sexual assault claims. They can also speak directly to the courts through that facility and this would be replicated around the country. People are raising an issue - I presume the same is true in schools - but there is no direct counselling service afterwards so they could be on a waiting list, which seems shocking. There are areas where we need a straight path. If someone raises an issue that is so severe, there needs to be somebody next door with whom he or she can speak. Notwithstanding all the issues around educational psychologists or whoever the staff are, some areas need to be prioritised.
Ms Fiona Jennings:
I will speak about the tiered approach and low to moderate anxiety. The committee will have heard a lot during the past couple of sessions about the all, the some and the few. If the all is neglected, they become the some and if they then are neglected, they become the few. The Senator's observation about Barnahus is correct. It is a fantastic project set up in Galway that will be established in Cork and Dublin. However, it does not have enough services it can access to refer on. It does some therapeutic support itself.
Many agencies and organisations do fantastic work. I will bring it back to the pathfinder project. This must be initiated without further delay. Then and only then will we be able to truly identify. I know Mr. Smyth spoke about gaps pertaining to psychology but there are gaps in every cohort and at every level of support as well. If that pathfinder project was initiated, we would be able to get an idea of what those gaps are and address the challenges that would inform better service delivery, better service alignment and, ultimately, better service outcomes.
I often raise the Meitheal model because it works well. This model involves getting all relevant services around the table, the child or young person is at the heart of it and it is the service with the best ability to serve their needs that works with them. Amazing pockets of good work are being done. They are being done in silos, however, and there is no collaboration or co-ordination. That is the crux of it. To have any kind of meaningful impact, that foundation must first be laid.
Mr. Ian Power:
Regarding the availability of a workforce, there is a reluctance in certain areas to fund training places. Disability, social inclusion, primary care and mental health are competing for a shrinking workforce and a low number of people who are available to join their teams. If there is a small pool of resources you need to direct to the most appropriate and urgent need, you might not invest in a training place where you do not know that this person is actually going to end up in your system and contribute to the need you have. This is why it is really important that the Department of Further and Higher Education, Research, Innovation and Science takes that leadership role around skills, planning and what we need for our future mental health care workforce so that it is the one directing the resources. If we had an easier system whereby everyone could chip in and the vote system was such that it was easier, you could do it that way but you cannot so it must be the Department creating the resource allocation for all different programmes to expand the number of places. As Mr. Smyth said, every year we do not do it, we prolong this issue because in some cases it is three years, while in the case of psychiatry, it is five, six or seven years, which is too long for us to wait to start really tackling the problem.
I urge committee members to really take on this issue because, while we can all talk about moving the deck chairs around in the interim, until we increase the number of people working in the system and create space for psychotherapy in the different services, we are ultimately on a hiding to nothing because the demand is always increasing.
Mr. Mark Smyth:
One of the things that has come up quite a lot is the impact of schools. However, we are also very mindful of the impact on the teachers and principals of carrying all of these mental health difficulties. They are under immense stress. They worry about things happening to their pupils and being unable to get access or communicate. I will echo what our colleagues in Jigsaw have been emphasising for many years regarding the importance of one good adult. For these children, we should be supporting those teachers, year heads and guidance counsellors so that they can be that one good adult but we are expecting them to be teachers, educators and mental health support workers without support. We need to move away from a model that emphasises the psychologist doing one-on-one therapy with the child. We need to support the environment and support teachers so that they can get timely access, know how to respond and feel safe and supported in doing the work when a child comes forward looking for that help.
With the indulgence of the Chair, I will note that this was raised as a point across the board in our session before the last one. The point was well raised that the first point of contact is the teacher. On the fear that teachers might have that service might not be available, it is similar to raising an issue regarding sexual assault. If a teacher feels that there is nowhere to send a person, I can understand why he or she might be really concerned about opening the floodgates if he or she does not have a background in that area or the education required to deal with it.
Ms Maureen Murray:
I totally agree. The fear among staff in schools is about opening the floodgates because they feel they may be regarded as the counsellor or the person who should be the professional providing support to students. We in Jigsaw reiterate over and over again that staff in schools are not trained professionals or counsellors. They can promote and support mental health on an ongoing basis for all in the school, as Ms Jennings said earlier on, but when we move up to issues affecting some and few, school staff are not the people to deal with those issues. We need more direct resources in school to support young people who are more at risk and have more difficulties.
Ms Lisa Molloy:
I will just speak in support of that. There have been many studies carried out in the UK, not only on the effectiveness of counselling and psychotherapeutic supports based in schools, but also on support for teachers and the wider school community. In 2013, a scoping review was carried out across studies in England and Scotland and 90% of school staff were extremely satisfied with the supports they were receiving. We have a lot of evidence to support the point being made.
I thank all of our guests for coming before the committee this morning, for their opening statements and for the excellent work they and their organisations do on behalf of young people. I hear what they have said about resources loud and clear. That will very much be reflected in the report of the committee. I also hear what Ms Murray has said about the need to recognise that teachers have limitations and how we cannot expect teachers to fulfil roles for which they are not qualified and which it would not be fair to ask them to fulfil.
I will start with Ms Murray. In her statement, she mentioned that there has been a significant increase in the incidence of anxiety and depression over the past decade. We are consistently hearing the theme that the incidence of anxiety and mental health challenges among adolescents is increasing. Is it the case that people just feel more comfortable talking about it or does Ms Murray believe there is an empirical increase in the incidence of these conditions? If there is, what is causing it?
Ms Maureen Murray:
There has been an increase in the incidence of anxiety. That was clearly demonstrated in our second My World Survey, which was published in 2019, before the pandemic, so we could see this increase growing and building at that time. On the Deputy's question regarding whether it is real or whether it is just that we are talking about it more, I was a principal until 2018 and, in my experience, it was very real.
The experiences young people have to suffer, if I may say, are so much more complex and difficult than the Deputy or I, or any of us could ever have imagined. For example, on the issue of mobile phones and bullying through them, when the Deputy and I were going to school, we might have had a tough time, but we went home to the safety and security of our home. These children are going home, they have their mobile phone, this computer under their pillow, and it is pinging at 2, 3, and 4 in the morning. That is a very significant pressure.
There is also a very significant pressure of body image and the image that is in the media, of which young people are the focus, which is also very significant.
I am saying this more in a personal capacity but there are also many stresses in families and in family life for a great many reasons. These are impacting on young people. I know of one young person who lost his door key and was terrified and stressed in school because he could not ask his parents to replace it because they did not have the money to pay for the door key for him to get in home. The levels of stress have definitely increased.
Mr. Ian Power:
Issues of bullying and of body image are perennial. They have been manifest in different ways for people of different ages, but the issue now is that it is very hard as a young person to self-realise and factualise fully who the person is as a person today. That is much more difficult than it was before. It is harder for young people to find their tribe and put their roots down in their community. This is multifactorial and there is no easy answer to all these things. Young people are more open to talking about their emotions, which is great, but they are still not being resourced with the coping skills to deal with those emotions that might be difficult.
Anxiety is the number one issue which comes through for young people who also text with us. Around 30% of all texters talk to us about anxiety. Another 20% talk to us about stress. This is because we have not equipped the young people with the skills to deal with those emotions. There is a great deal of evidence to suggest there are many things you can do to be protected around your mental health with which, perhaps, we have lost connection. These are things like nature, exercise and other things which we hear from young people.
The issues are probably perennial but the way in which they are experienced are probably much more nuanced, invasive and insidious, as has been described by Ms Murray. Previously it was body-shaming on the front of magazines. Now it is looking at Instagram today-----
Ms Fiona Jennings:
Social media certainly play a role and we are always going between the good angel and the bad devil. As Mr. Power said, where children and young people have particular vulnerabilities or where there is something there already, those can be exacerbated by social media.
I want to touch on what the Deputy said about the anxiety. I spoke to our clinical lead in preparation for this meeting in respect of what is coming in on the digital mental health and well-being programme that is on the silver cloud platform. She said that separation anxiety is coming up, probably for younger children. We support parents of children from five to 18 on the programme, and the children themselves can do a programme from 14 to 18. Parents are saying the children have concerns about the parent being safe and are constantly phoning them to see where they are. Some of that is the impact of Covid-19. School avoidance, in particular around separation anxiety, is where the mindset before was that they had no choice, but Covid-19 has given them a choice somewhat as to whether they go to school.
There is social anxiety and struggling to engage offline, which touches on what the Deputy mentioned.
The message around health anxiety for the last two years has been to keep safe and do not make others sick, especially those who are more vulnerable. Other stuff that is coming through is around obsessive-compulsive disorder, OCD,-type behaviours, such as excessive hand washing, use of sanitiser, fear of vomiting in public etc. All those levels of anxiety are exacerbated.
Ms Mary Logue:
They might be receptive but one of the issues is where do they go in that case. If we look at things starting in the family, everything originates in the family, if parents can not afford to replace the key, can they receive the ill health? I think it is a really systemic piece. One is connected to the other and so on. It is difficult to answer that in any short way.
In terms of adolescents who require serious mental health intervention, the attendance before psychiatrists, can Mr. Chambers indicate what is the availability of psychiatrists from the HSE in south Dublin, for example, for children who are experiencing mental health challenges?
Mr. Derek Chambers:
If I could address the wider point as well, we have been talking about mental health in this country from the first public mental health campaign in 2007. Since then the most important thing for us in generating that conversation around mental health is to have places where people can go if they are concerned about their mental health. If there is an increased awareness of anxiety or depression, where does someone go? Through yourmentalhealth.ieand organisations like SpunOut, we are working off a layered care model of support which in the first instance provides people with information and signposting. That is about increasing people's mental health literacy in order that they know where they can go for support. It is really important that we provide support relevant to the need of that young person or anyone in society. From that information and signposting and the public messaging, we also promote some self-help resources such as the Minding Your Wellbeing and Stress Control programmes on the HSE website. From there, things like person-to-person supports have become really important. We can not overstate the importance of these supports because early intervention is so much better for any human being in terms of their journey with mental health.
There are much data around the uptake of services like TEXT 50808 but I know the question was about psychiatry and mental health services. For us, the critical point is to ensure resourcing of primary care and community based supports before anyone ever needs to transition to that next step. However, when they do, we need to make sure that specialist mental health services are resourced. Mr. Smyth has said that the work has not really started and we need to ramp up our efforts in terms of retention of mental health professionals. There is a new HSE recruitment strategy and the implementation plan for that is being developed. In the first instance, it is really important to get it right at every level of the layered care pyramid of support. We also need to ensure that people are able to move between those different layers. It really is part of the bigger picture to ensure that people get the support they need when they need it. Most of us here will agree that the sooner a problem is addressed, the better, so that it does not escalate into a crisis
I have a couple of questions for the witnesses from Jigsaw and SpunOut. Reference was made to interference and bullying, particularly with mobile phones and technology. Impersonating is gone absolutely out of control and no one is doing nearly enough in this regard. Is there a quick fix for this issue? If the witnesses had the powers to implement something quickly what would it be?
Mr. Ian Power:
In respect of online safety, the Online Safety and Media Regulation Bill 2022 that is currently working its way through the Houses is a really important step to grapple with some of these issues.
We support it fully and we really welcome in particular the Minister's recent proposed amendment to the Bill to include an individual complaints mechanism for people. We saw yesterday at a meeting of international online safety regulators that the Australian online safety regulator talking about an issue that is coming up more and more for us. That is young men who have been contacted online by another young person, whether a man or woman, and they exchange images which are used to extort that young man. Unfortunately, we have lots of experience recently of young men across Ireland reaching out to both our live chat and texting services in that scenario, where they are embarrassed and worried and just do not know what to do. We need a resource like the online safety regulator for young people to go to that would require an immediate take down of that type of content, particularly where platforms do not respond. We are particularly worried obviously about Twitter where there have been lots of lay offs in the last two weeks, not only of its own staff, but 4,500 of the 5,500 moderators were let go at the weekend. Issues like that may seem ethereal and removed but there are young people in rural areas across the country experiencing those issues, and that is something that really needs to be addressed quickly.
The next thing is for young people to have access to supports to navigate those issues. Again, it is about emphasising the need for in-school supports so they have someone to talk to when those issues come up for young people.
Ms Maureen Murray:
I 100% agree with everything Mr. Power said. This issue is far bigger than we can conceive. If there were one thing I would love to see happen rapidly, it is that we would have the capacity to immediately take down information when it is put up. Very often the process of trying to get information and photographs removed is absolutely tortuous. The second point is that we need to upskill our staff and our young people in their knowledge and understanding of the use of technology, and the use of that computer in their hand and pocket all day. I would take away the words "mobile phone". It is a misnomer. It is a life-size computer, with world access in your pocket.
Ms Maureen Murray:
I could not give a figure at this moment. However, quite a lot of schools ban phones altogether. The reality is that you cannot ban phones. That is not a realistic approach. The reality is that young people will have them in their pockets and their schoolbags and they will have them on whenever they can. Helping them understand what they have in their hand and helping them analyse what is going on with this worldwide computer is far more significant, as is giving them the skills to be able to critique what is in front of them and seek help in this area as well.
The committee visited Dorset in the UK in regard to psychological services for children and counselling in schools. I am not sure if he is aware of a proposed pilot scheme to roll out counsellors in primary schools. Has the Department of Education been in contact with the HSE regarding the roll out of counsellors in primary schools?
I think it is really important that the HSE is very much involved in that. On our visit last week, it was the Department for Education and the NHS that were very much involved in the roll-out of this measure. I wish to ask about a proposal for a pilot scheme of the roll-out of counsellors in primary schools. What are the witnesses' views on that? I have changed my view on it, in that I am still in favour of it but not perhaps counsellors per se. I am not sure if any of the witnesses are aware of the Dorset model in the UK, which we visited last week. Would the witnesses like to see a similar model being rolled out in Ireland, where the workers are called practitioners rather than counsellors? If young people need counselling they are brought up to the next level.
Mr. Mark Smyth:
To echo what a lot of colleagues here have said, if we are to make successes of counselling within schools the pathfinder project has to be initiated. That came from the youth mental health task force recommendations from many years ago. It is the key that is going to ensure that we have cross departmental co-operation to make this a success. From our perspective, we are not really sure what the delays are or why it has been held up. That is essential to make this work. I think that everyone here wants to ensure that young people get the best care they can. We all come from disparate organisations but we all share the same values of early intervention and supporting. I do not think we should get into our own specific silos as counsellors or psychologists or psychotherapists, because we all want the same thing. In reality, we can all work together. We will bring different skill sets to it. The model referred to in Dorset has a range of people on the team, including educators who have expertise in particular aspects of education and interaction with mental health, counsellors and mental health leads. We need to look at a model similar to that, which encompasses a range of skills and expertise. It is very similar to what Sharing the Vision has talked about. It is not about professional silos any more where you have to have one of these, one of those and one of the other. It is about what skill set is needed within the school environment to support the young people, the teachers and the principals in the intersection between education and mental health. I am guessing that we all would be on the same page. There is room for psychologists, counsellors, occupational therapists and speech and language therapists because we all have something that we can bring to it. If we are all working together like that Dorset team does, there will be much better outcomes for kids than just having individual disciplines
Ms Lisa Molloy:
I echo what Mr. Smyth has said. It is fantastic that we are all here today and we all want the same outcome. In relation to the Dorset model, I am familiar with it but not in a very in-depth way. There are other models in the UK. I have spoken in the Irish Council for Psychotherapy submission about the school-based counselling model that is currently in every school in Wales. Every school in Wales and Northern Ireland has a school counsellor funded by the Government. There has been commitment from the Scottish Government for one in every school in Scotland and there are school counsellors in 60% of the schools in England. In relation to the primary schools pilot, the Minister has announced that she will be looking at various models as part of the pilot. There is a wealth of information and data that we can look to in relation to school-based counselling. We have very strong links with the British Association for Counselling and Psychotherapy, BACP. We have also been collaborating with the Irish Primary Principals' Network over the past number of months in putting forward a proposal in relation to a pilot for school- based counselling in primary schools. There is a lot that we can learn if we look to the Welsh experience. Ninety percent of the 11,753 children and young people who attended school-based counselling between 2018 and 2019 in Wales did not need onward referral after completing their sessions. There are models available that can show the efficacy of school counselling as an early intervention tool. It indicates a lessening of pressure on an overburdened CAMHS.
We often talk about adult mental health awareness in media etc. It often does not permeate down into primary and post-primary education. Do the witnesses feel that we are doing enough to educate the younger people about bullying, be it IT, mobile phones and all of that?
Some of these social media platforms are lethally dangerous. Are we doing enough against the social media companies themselves? Should we be doing more? What should we be doing? Often we talk to those aged 17 and 18 or older, but we have to get to the younger age group as well, like those in fifth and sixth class, and in first, second and third years. What are the witnesses' views on that?
Ms Fiona Jennings:
Categorically, we need to have online safety, digital literacy and digital competency embedded into the education system. There have been fantastic strides with different initiatives, but they really do not go far enough. I would push it further. Professor Geoffrey Shannon, the former special rapporteur for child protection, would have said we even need age appropriate messages at preschool level. This is something that is not going away. We need to prepare our workforce for the jobs of tomorrow, some of which have not even been created yet. They need to be able to live and succeed in this environment. Webwise has fantastic resources in terms of its online safety programmes. Unfortunately, not every school takes them up. That is something we would certainly champion. Bullying and cyberbullying were mentioned. The Harassment, Harmful Communications and Related Offences Act 2020 was passed, and again it is about creating awareness of these things. Mr. Power mentioned the much-fought-for individual complaints mechanism amendment to the Online Safety and Media Regulation Bill. We very much hope that gets passed. It would certainly be a safety net for children and young people as well. It is great having all of those things there, but we need to create better awareness of them for those who need them most. However, online safety really does need to be embedded into the education system.
Something I feel very strongly about is online safety and cyberbullying. I remember doing a ten or 15-page booklet a number of years ago, expecting that maybe I would print 500 copies. I was absolutely blown away by the number of copies parents and schools came looking for, because they had nowhere to go for this information themselves. These people would not be media savvy; they would not be googling. They are just ordinary parents who did not have the expertise about where to look for this. I was blown away not only by their awareness of it but also by their willingness to educate their children and themselves in looking out for that kind of bullying.
Ms Maureen Murray:
The question asked was whether we are doing enough. Absolutely we are not doing enough. We come back to the model of for all, for some and for few. For all students we need to increase their mental health literacy. We need to increase their understanding of relationships and what constitute good relationships and poor relationships. We need to develop their concept of self-care, and obviously we need to develop their sense of physical health as well. All of that needs to be done at a very primary level. However, even doing all of that, we will still need to refer students. There is no doubt that having counsellors or therapists on the ground in schools will prevent a huge number of more complex, more difficult and more tragic situations occurring in the later teens and early 20s.
Mr. Ian Power:
I want to continue on the point around whether having counsellors in school is the right idea. We are unique when compared with many countries. Unlike the UK, Australia or New Zealand, we do not use key workers and case workers, folks who are not specialised clinicians, to help, hold and support young people as they navigate the system. It would be of great benefit, and not just to clinicians who might be based in schools, to have that first level of support. Sometimes for students and young people it is a listening ear they need in a local environment. They may not necessarily need counselling, but rather that there is someone there who can interact with that. It is even more important in the school environment where guidance counsellors are wholly burdened with the responsibility for the emotional well-being of students in school communities and they have so many things they are supposed to be trying to do in addition to their own role.
Teachers feel really burdened with the responsibility for not only the education outcomes, but also the mental health outcomes of children and young people in schools. While we expand the clinical workforce, we need to start thinking creatively about what other types of roles we can have in both the school system and the mental health system to support and hold young people and manage their journey through the system.
This point was made to me last week during our UK visit in the context of a model that is based in specific primary schools. Those involved spoke about the importance of teachers being at the gates when children were entering and leaving school. They said it is the best way of getting information. The teachers can see from a child's face, from their facial expressions, the burden on that child and they can follow it up through the home school liaison officer or whatever.
Ms Maureen Murray:
That is why schools are such crucial places. They are the places where young people and young children, live and work and play. They are the places where teacher can wisely observe, notice, help and support children. They can not do it on their own, however. They can do it within programmes but they cannot do it on their own. They need all the additional help.
They need the backup. It was easy for the people we spoke last to last week to do it because they know the backup and support is there. Four weeks is the waiting time for CAMHS. I know the HSE think that it is good being down to four weeks but they were very open and honest. Four weeks is the waiting time if a child is referred to CAMHS. They are seen within four weeks.
Mr. Mark Smyth:
There is a public misperception about CAMHS, particularly regarding waiting lists and access to it. When HSE colleagues talk about the length of the waiting list, that does not represent everybody. There are three different types of referral to CAMHS. There is a routine one, a priority one and an urgent one. Children get access to CAMHS in a very timely way when there is very significant need. Obviously, we would like to reduce that to make sure everyone gets equitable access, but it is important that it is publicly acknowledged that children in acute crisis get access very quickly and get responded to. It is just that not everybody gets that same timely access and they should deserve that.
The people I spoke to last week told me that those priority lists are shorter than four weeks in the UK as well. We do have to open our minds and be open to the experiences of other countries in this regard. There is no perfect model, as they would acknowledge themselves, but I think it is a much better model than what we have here in Ireland. It is something we can learn from. There is no doubt it takes investment, but the early investment would produce huge savings later.
I appreciate the witnesses' input and their very clear commitment to the very important work they are doing. Getting to the crux of it, establishing the links between all the services and education settings is very important. How we do that and support young people in school, families, community and social settings and how we marry all of that is very important. Non-formal and informal education have a big role to play in this regard. Sometimes that is where young people might open up that little bit more because they tend to be in smaller groups than they might be in a big classroom. Reference has been made to the difficulties that exist for teachers in terms of trying to give that extra support where it is needed.
I know that "the right care at the right time" is a phrase that has been used. I think that is the core of it.
Mr. Chambers was talking about links between the HSE services and on-site support in schools, which may also go back to Mr. Smyth's contributions. In terms of shared care treatment between CAMHS and schools, having that continuity is hugely important. He and another witness also mentioned telehealth in the context of using online supports. I know there has been a trend to go down that road, and that happened particularly during Covid. However, is there any research showing the advantages and the disadvantages? I appreciate it might be easier for a young person, rather than saying they have an appointment, if they can go into a bedroom and go online. They do not have to make a big deal if they do not want to share it. Do we have that research?
Mr. Power spoke about widening the pool in terms of all the different support networks, and Ms Molloy and Mr. Smyth came in very strongly on that. We have excellently trained psychotherapists and counsellors who unfortunately are not recognised by the HSE because of the registration process. They are fully accredited and trained. I believe there is a case and it is important while we have a lack of personnel to have a pathway for trained counsellors and psychotherapists to be able to support the need that is there. I would appreciate comments in relation to that.
Mr. Power also spoke about Zippy's Friends and Mindout. I was really impressed by a programme put in place in schools to effectively weed out bullying and check in and see where young people are at. Young people at the start of a class can say they are between one and ten on a scale. I thought that was incredibly useful for teachers and peers to pick up on where someone might be and be able to have support. In terms of Spunout being run by young people for young people, that peer support is really important.
Toxic stress and stress in young people's lives, which they may be carrying from home into school, was mentioned. We know from research that has been done, particularly in America, that young people really pick up on stress at home. It strikes me that many parents may not realise the effect of talking about challenges they are having, even in terms of the cost of living, etc. Ms Murray gave an example about the key being cut and the child being very stressed. While acknowledging that these stresses exist in homes, I think we need to raise awareness among parents and guardians of how that stress impacts on young people in their pathway through life. One of the submission papers stated that 60% of children have experienced a traumatic event. What is traumatic to one child may not be traumatic to another, for example, when we think of Covid or bereavement. A figure of 60% is massive. A lady from a cancer support group recently told me about much of the work the group has done on the impact of bereavement. We need to do more of that in a preventative way, rather than dealing with it when a child goes through bereavement. We need to normalise the whole grief and death process in as positive a way as we can during school and the education process.
Finally, Ms Molloy was talking about the whole school initiative and the schools-based counselling. We are delighted to see a pilot scheme here, but she was saying that it is in 60 countries, and is mandatory in 40 of them. I am interested in quickly hearing her view on that.
Mr. Derek Chambers:
I am happy to pick up on a couple of things the Senator mentioned at the outset. Regarding evidence for online and digital mental health supports and telehealth, some things that have already been referenced include mobile phones and the impact they can potentially have on young people. However, with respect to our initial signposting to supports and creating awareness of different mental health issues, the volume of traffic to spunout.ieand yourmentalhealth.iehas been mentioned already. Some 75% of that traffic is coming from mobile phones so it is really important to acknowledge that the first instinct of young people, and all of us, if we are concerned about anxiety or depression is to go online. We have really good and trusted online mental health information in this country, and that is tailored for different age groups. I do not want to speak for another organisation, but through that, the person-to-person supports have really scaled up in the last couple of years. Text 50808 is a really fantastic example of a service that has scaled up. I think it averages 4,000 conversations per month. That is really important for somebody who is nervous about taking the first step but finally goes and does it. We have seen fantastic success. The last thing I will mention in terms of telehealth or digital mental health supports is the scaling up of online cognitive behavioural therapy, CBT. The platform is used by Childline and the Irish Society for the Prevention of Cruelty to Children, ISPCC, as well. However, since April 2021, we have been providing guided online CBT through SilverCloud. Over that period it has really ramped up and is now at around 600 activations per month, which means more than 7,000 people since April 2021 have benefited from that service. The mental health outcomes are demonstrated as well. The information on a person pre and post is measured, and we know it is having a good impact. That service will be ramped up further next year. We recently completed procurement around the provision of online CBT. I am not saying it is a panacea. It is certainly not for everybody, but it definitely has a role to play. Approximately 85% of referrals to online CBT are coming from GPs. Again, it paints a picture that when somebody is presenting to the GP, it is so important for us to provide that GP with different options.
The members also asked questions about the interaction between education and health and that is an area in which we have a lot of room for improvement. I have been speaking to colleagues from the higher education sector working in the delivery of mental health services specifically. I know there are issues around student mobility. For example, if somebody is attending college in one area but going back to their local area at the weekend or during holidays, sharing of care across those services is something we should be looking at more closely. We have a lot of room to work around. However, there are good linkages between the higher education sector and health services that we can build on. We have demonstrated that we can work effectively together. By ensuring those collaborations across sectors we will serve people better and improve those linkages across education and health.
Ms Mary Logue:
I was struck by the Senator's question because it was like she was talking about systems in a sense, and about the link between adults accessing psychotherapy and children. We have been talking a lot about youth in schools and in third level education.
The Senator mentioned how people find it difficult to talk about grief and that maybe adults do too. In a sense, we can also destigmatise the availability of psychotherapy generally so that people are able to access services. At the moment, access to counselling and psychotherapy is a private thing for many people in terms of affordability. I spoke to a colleague in Germany in the summer where citizens have access to psychotherapy as part of their health system. They can attend a psychotherapist and it gets paid for because it is seen as something valuable. I was thinking about how if we want to encourage children to access mental health services, we also need to be thinking of the family, where parents are also encouraged not to carry serious mental health issues. When I say serious mental health issues, I mean just the stress, anxiety and pressure that people feel. One of the ways to do that is perhaps by looking at health insurance, where at the moment, some of the health insurance providers do not cover psychotherapy and counselling. They are all areas to be looked at as well.
Ms Fiona Jennings:
I have two things to add. Mr. Chambers covered a lot about how we deliver on the SilverCloud programme. The Senator asked about the comparison between online and offline cognitive behavioural therapy. Again, it is not for everybody and it is one type of therapy. However, a US case study reported that for mild to moderate depression and anxiety, SilverCloud's iCBT-based digital mental health platform was able to generate up to a 65% plus reduction in clinically significant symptom scores. For the children and young people we have been supporting on it, they are supported over eight to 12 weeks with weekly check-ins and reviews. When they complete the programme they still have access to it and to the tools for up to a year after registering.
Mr. Ian Power:
I want to pick up the last point around video. We have seen clearly that even post-pandemic young people from rural areas really like being able to access their support immediately rather than having to wait. Rural public transport is a huge issue so in terms of accessing support, it is a means to do that. There is an element of choice for the young person as well. Obviously there are issues around confidentiality and making sure the young person is alone and all of those things. However, it is a really important element of our service provision that we allow young people that choice. Turning to the structural issues, the Senator started talking about the link between education and health, but I think the Departments responsible for children and housing need to be part of this discussion, as do other Departments to be honest. In 2018 the Civil Service Management Board , that is, the group of Secretaries General, decided it would be a great idea to create a unit called the youth mental health pathfinder unit. In a similar vein to the Criminal Assets Bureau this would be a multi-departmental unit where a director is recruited through the Public Appointments Service. Principal officers would be seconded from each of those three Departments to more comprehensively tackle the issues around children's and young people's mental health. Unfortunately in our spare time we have been trying to follow up on that initiative, given that it is an initiative of the Civil Service itself and had sponsorship from the Government. However, every time we write to the Department of Public Expenditure and Reform and every time we write to Health they say that the other one is currently responsible. I think the committee is potentially in a position to ask representatives from both Departments to come in and really say. In many ways it may have consequences for the NGO sector in streamlining resources and things like that, because I think the sector really wants that to happen in a way where leadership is shown across multiple Departments with responsibility. We have talked about online safety, so potentially that is another Department that should be involved.
I finally want to come back to the point around stresses and the cost of living etc. In 50808 we are funded by the HSE to have conversations that listen to young people, that validate their feelings and their experiences. A lot of their anxieties come about by their basic needs not being met. These are things like poverty, not having access to quality housing, and young people living in hotels with their family. We also see the impact of social anxiety, which was there before, but has been compounded by the pandemic for lots of young people. We see that society has huge expectations of young people and their anxieties are heightened by trying to live up to that.
We are concerned by the talk of recession. There were lots of column inches in the papers on Sunday about the possibility of that next year. We saw the link between suicide and economic depression in 2010 to 2015. We need to make sure the fundamental supports are put in place. There is no point in us talking about therapy if someone is not able to access food or housing. We need to be clear that there is more we can do to be more joined up between health, education and children. We have to meet peoples' basic needs before we can ever talk about therapy.
I thank all the witnesses. There is a wide range of expertise before the committee. Regarding young people's mental health, we hear it the whole time in our schools that children are not communicating the way they used to pre-Covid. We are hearing from teachers, principals and parents that there is an impact. It is great that we have a lot of our school activities back and people are going back out to clubs. Parents are giving time and volunteering in areas all around. I am in a rural myself. I am representing Roscommon - Galway but am from Ballinasloe, so I know some of the groups.
As Senator O'Loughlin has said, the online supports are crucial, particularly in rural areas where one can not travel two or three hours to get to a city centre location to speak to someone face to face. Being able to access online supports has been a game changer in many ways. I am very supportive of that.
I very much welcomed Together All. I know that is being rolled out under the Department of Further and Higher Education, Research, Innovation and Science and that funding was allocated to have access for students at third level. I know it is a UK programme but it is evidence based and it is run by professionals. When we had our universities and colleges before the committee my question was around how was that being promoted. I ask the witnesses to comment on that. We have all these services. How are the services being promoted at a local level or within colleges and universities around access to initiatives like Together for All?
I appreciate the counselling and primary care. I only discovered that recently. I know it is through the GPs and perhaps the witnesses can talk about GPS who refer this. The Health Care and Day Hospital in Ballinasloe gave me a ton of leaflets on CIPC and explained how this was an amazing service that is done through a GP. In rural areas, more than likely the GP is the first port of call for someone who is going through an episode. Likewise, if a person wants to talk about a loved one or family member, the GP is the first port of call. I think the promotion of this service is very important. People are aware when they go to the GP they can be put in referral to the counselling and primary care.
It is great that there are 73 CAMHS teams. Eating disorders are a major issue. Community Health Care West has an eating disorders team. I do not know if Mr. Chambers wants to mention anything else on that. I thank him for his presentation.
I thank Ms Molloy from IACP. It represents 5,000 members. That is absolutely phenomenal. We have one in four schools now with access to DEIS. I know a lot of those services particularly around school completion and HSCL have moved from Tusla back into the Department of Education. All our schools need access to supports but in particular our DEIS schools might have particularly vulnerable cohorts. That is a point that I would not mind a bit of focus on. The IACP might have comments on that.
SPHE was also mentioned. How much time is been allocated, realistically, in examination years to SPHE when students are perhaps going through really pressurised times? Are we delivering these counselling supports and is it being done through SPHE? I am sure if it was in Ms Molloy's statement. Apologies if not and if anyone else wants to comment, please do.
I thank Ms Logue for contributing on the psychotherapy side. I think she mentioned absences in schools. In those DEIS schools there is a home school community liaison officer. I would be looking to see what the HSCL co-ordinator in those schools is reporting when it comes to absences in schools.
I thank Ms Jennings from the ISPCC. It is great about the helplines. The organisation and all its volunteers do a phenomenal job. It is great to hear about Smart Moves and any comments on it would be appreciated. Transition from primary to post-primary and from secondary into third level are difficult periods.
Can Ms Jennings indicate how many schools participate in Smart Moves? There are 4,000 schools. How many of them are doing the programme. How many have engaged? Is it an online process? It is great to hear that it is for parents and guardians as well.
Well done to Mr Power from Spunout. I knew one of the members of the team in a previous existence. I sing the 50808 song and I have been doing so for the past year and a half. I mention it whenever I can. It is a phenomenal text line service that anyone can access 24-7. Well do to everyone who works at Spunout in terms of the 4,000 calls fielded per month. Spunout has made a difference to a lot of people's lives at a really difficult time over the past two or three years. All of the witnesses do great work in their roles. It is great to hear about the engagement on Instagram and TikTok. I probably need to do that myself. Any other comments on these matters would be very welcome.
On SilverCloud and cognitive behavioural therapy, I am such an advocate of seeing more of this online. From what I can see, it is crucial in the context of early intervention. It is important in terms of people being able to engage and then accelerating matters to make sure that there is access, in a timely way, to one-to-one supports. We have to realise that there are long waiting lists. If we can get to people with early intervention, that is crucial.
I would like to say well done to Jigsaw on Innovate Together and One Good School. How many schools are participating in the One Good School initiative?
I apologise for asking so many questions. Perhaps they will allow the witnesses to promote the programmes they are doing and help us understand the situation that obtains at primary, secondary and third level.
Mr. Derek Chambers:
Together All was a HEA-HSE joint initiative. We provided matched funding for that.
Mr. Derek Chambers:
The importance of mentioning that relates to our commitment to work with the education sector and demonstrate that we can do so effectively. Our colleagues in the National Office for Suicide Prevention within the HSE have been doing that for a number of years in the context of the strategic framework around suicide prevention for students in higher education settings. There is a lot of collaboration happening in that sector already. We were delighted to join-----
Mr. Derek Chambers:
It launched on 11 October. I was speaking to Ms Treasa Fox, my colleague from the Psychological Counsellors in Higher Education. She appeared before the committee recently. We do not have statistics yet, but they are on the way. The service started in the UK . They have a very good track record internationally, so we are looking forward to that. It is one part of the overall solution that will hopefully take pressure off the counsellors and other service providers. That also fits into our overall plans around digital mental health. It slots in within the layered care model of support. That is one thing to mention, particularly as it is relevant to the work of the committee.
Counselling and primary care became part of the remit of the national counselling service in 2013. It is receiving around 19,000 referrals per annum, which is 365 referrals per week. There are capacity issues. There are waiting lists and there is variance across the country in relation to the counselling and primary care service. We are aware of that. It is an area that is a priority for us under Sharing the Vision. Recommendation 16 under Sharing the Vision refers to talk therapies and their availability. Currently, the service is only available to people who are 18 years of age and older and medical card holders. We need to further enhance and increase the capacity of this service.
That is crucial. Action is also required in the context of addiction supports. Say for example, in Ballinasloe we have a Day Hospital but our addiction supports only apply if a person has alcohol addiction with mental health issues. I know we are speaking about mental health but we also have many young people who have addiction as their primary issue. If a person is diagnosed and their addiction is primary as opposed to their mental health, he or she does not get to access those supports. There are pilot addiction and alcohol programmes in Galway. It would be great to see those rolled out more in other towns.
Mr. Derek Chambers:
The eating disorders model of care was launched in 2018.
The overall aim is for there to be 16 teams; eight CAMHS and eight adult. Currently, there are two CAMHS teams - one in the Cork-Kerry area and one in CHO 7, through the Linn Dara community eating disorder service. Funding was released for 20 additional whole-time equivalents in 2021 to establish three new teams. One of those is a CAMHS team based in CHO 2-----
Mr. Derek Chambers:
That is in progress.
I know that the question was directed to Ms Jennings, but I just want to state that the partnership between HSE mental health and SilverCloud will be part of a launch event on 30 November. We are planning to ramp up service provision next year.
Ms Lisa Molloy:
I do not have specific data on DEIS schools. Anecdotally, from speaking with a number of our members who work in DEIS schools, I am aware of the importance of the service. Many DEIS schools are already providing counselling based. The service is there because there is an obvious demand for it. We need to do this in a co-ordinated, comprehensive way so all schools get equal access to this essential service.
Ms Mary Logue:
I mentioned DEIS schools in my opening statement. I spoke to a colleague who said that in a DEIS school in the west, there had been over 90 unexplained absences in a school population of 500. There are home school liaison people and psychotherapists working in that school. My point was about the volume of such absences in the school. That is a lot for any home school liaison teacher to be working on.
Ms Fiona Jennings:
I thank the Senator for her kind comments and recognition of our helpline. Our volunteers and facilitators do fantastic work.
On SPHE, the time allocated for the junior cycle course is 100 hours over three years. The average is about one hour per week, which is not great.
Smart Moves is a whole classroom-based and evidence-based programme which the ISPCC has the rights to use in Ireland. Current uptake is 333 primary schools and 15 post-primary schools. The plan for this year is to target more post-primary schools in order to get further uptake. The unique selling point of the programme is that it is based on strengthening emotional resilience and coping ability and giving children smart moves they can develop as lessons proceed. It aligns with Government policies and the HSE Stronger Together plan under growing and learning well. Evidence has shown that in these types of programmes, outcomes are better when delivered within the classroom setting by the classroom teacher who the children have a relationship with. In terms of next steps, we are trying to translate the programme into Irish in order that our colleagues in Gaelscoils can access it, as well as further development of parent and carer support materials and securing funding to upscale. I am happy to send the outline of the programme.
SilverCloud is a digital health programme that parents of anxious children and young people can access. It is an adult programme that supports parents of anxious children or teenagers from ages five to 18. Parents avail of the programme to develop skills and techniques to support their anxious child or young person. There are modules they can do themselves and there are others they can do together. There is a separate programme for children and young people aged 14 to 18. They can log on and do the programme at their own pace and learn different things. It is cognitive behavioural therapy-based. They learn about understanding thoughts and behaviours and the relationships between them. On evaluation, there are two questionnaires, pre- and post-use and sometimes in the interim. There are strength and difficulties questionnaires, skill-testing questions, STQs, and general anxiety disorder assessment, or GAD-7.
They help to determine the starting point for the child or young person. It can be looked at in the interim and then also at the end. It runs over approximately eight to 12 weeks and the child or young person has the autonomy to dip in and out of it.
Ms Maureen Murray:
Jigsaw also has an online service, which was launched recently. We have a whole new department. We provide a live webchat, which is super. We have group chats once a week in which various topics are discussed and also an email service. Therefore, we have moved into that domain and it is proving very useful.
The Senator asked about the number of schools. We have 147 schools currently engaged in the One Good School programme. Those 147 schools are all in Jigsaw service areas. We have 14 service areas, one of which I am glad to say is in County Roscommon, and we have one in County Galway.
Ms Maureen Murray:
We have 14 throughout the country and this programme is only available in those areas. By the way, the services we have currently in the 14 areas are all delivered therapeutic services by a variety of clinicians from different disciplines.
One of the things about the One Good School programme is that we need to see it go national. It is so unfair that this programme is only available to schools within our service areas. In order for it to go national, we need funding because it is currently totally funded by fundraising. There is no State support for it.
I will finish on this point. We have heard about various social and emotional learning programmes that are in place. Our One Good School programme can incorporate them and give a structure in which schools can use those programmes. We know that coming in and doing once-off events or programmes that are then allowed to fall away has less use than, let us say, the One Good School programme in which we offer a very solid, defined structure. These programmes can very much fit into our own programme.
Mr. Ian Power:
I thank Senator Dolan for her question. I should point out in respect of DEIS - I think the Senator made this point as well - that a high proportion of the children and young people who meet the deprivation threshold actually go to schools that are not categorised as DEIS. As such, the point about making sure supports are available in all schools is really well made.
In terms of SpunOut, it is really important that we are providing mental health literacy information to places where young people are, for example, Instagram and TikTok. Advertising on those platforms is really expensive. We have been trying to get the platforms to help us out in terms of making that information available to their users in Ireland. I will pass on the Senator's thanks to the 50808 volunteers. Hundreds of people around the country log in on their laptops from their couches every evening to support other people, which is amazing.
Mr. Ian Power:
It is an amazing thing they do. We had a volunteers' celebration in Dublin last night. It was wonderful to thank them in person for what they do for their peers. We will soon be launching that service on WhatsApp so it will be available to young people who live in rural areas where the SMS signal is not great but who may have access to a broadband connection. That will increase accessibility for them. There are lots of things we could be doing. It would be great if some of the platforms that are headquartered here could support us more to reach people.
I thank the Senator and also the witnesses for coming today. The discussion has been varied, wide and productive. It is not often that we have seven witnesses at one meeting. I think everybody had an opportunity to put questions to each of the witnesses. I commend them on the work they do daily with various different organisations and within their own organisations for the good of young people.