Dr. Joseph Duffy:

I thank the Chair and members for the opportunity to contribute to and support the committee's important work in the area of mental health. Jigsaw was established as a charity in 2006. Over the past 17 years, we have gained a track record of achieving better mental health outcomes for young people and developing supportive communities by providing a range of primary care services and supports. Throughout this time, we have been able to support over 60,000 young people. This has been achieved through a range of direct one-to-one mental health interventions as well as indirectly by developing and rolling out innovative and effective solutions for young people and those around them in settings where they live, learn, work and play. With the support of public and private funds, and particularly the HSE, our current model sees us deliver a range of free primary care mental health services and supports to young people and adults, including delivering one-to-one services across 14 sites around the country; offering community-based programmes aimed at better informing, supporting, educating and empowering young people and those around them; undertaking pioneering research; and providing a wide range of online mental health supports through jigsaw.ie. We also have a comprehensive post-primary schools programme, One Good School, which is being rolled out with 147 schools across the country. There is an online schools hub that provides information on well-being and support and comprehensive information for all school staff. We also have a specific team that focuses on supporting mental health and well-being in further education and training, FET, and higher education settings.

Ireland’s youth mental health system is increasingly under pressure. It is overstretched, underresourced and, in large parts, inadequate. Demand continues to outstrip the system’s ability to cope. Funding, overall, is insufficient and integrated joined-up thinking remains an aspiration in many areas. Yet, behind a discourse that is increasingly dominated by demand, systems and integration, there are young people struggling to cope and parents left to shoulder much pain. Ultimately, something has to change. We know from the My World Survey 2, which Jigsaw conducted in conjunction with UCD, that there has been a significant increase in the levels of anxiety and depression among young people in Ireland over the past decade. While Covid-19 has contributed significantly to a deterioration in young people’s mental health, long before Covid the indicators were not good. Internationally, we see from large-scale studies increasing mental health difficulties among young people. At Jigsaw, we have experienced this first hand, with more and more young people seeking the services and supports we offer across the country. Last year alone, we had over 8,500 referrals for young people, the second highest number of referrals we have ever had in a single year. Over 36,000 individual appointments were offered to young people. Online, we provided nearly 1,500 live chats, which are anonymous supports for young people. Over 32,000 people participated in workshops and training. I previously mentioned our One Good School programme. Last year, significantly, there were nearly 20,000 users of our online schools hub, which has provided support across a lot of schools.

Many of our services continue to experience significant demand, resulting in the time between first contact and first appointment in Jigsaw services remaining too long. This is particularly concerning as we aim to provide early intervention services for young people. While we are encouraged to see that Jigsaw is recognised as a high-quality, youth-friendly and impactful service, and that young people are continuing to reach out for support, we are aware that much more needs to be done.

We are making five key recommendations to support the better development of youth mental health.

We firmly believe the current funding model must change. As members are aware, funding for mental health in Ireland is just over 5% of the total health budget. This compares with a Sláintecare recommendation of 10%. There is higher funding for mental health throughout the European community.

We must prioritise community-based primary care services and supports that are preventive and early interventionist in approach. This is very much in line with the Sharing the Vision policy. Much more attention should be paid at funding level to support this area. We must listen to young people. With a recognised and established history of youth engagement and participation, Jigsaw is aware of young people’s ability and right to be involved in the decision-making that supports them. This needs to be further extended across all areas of policy development on youth mental health. We also need to develop a workforce strategy. As a country, we simply do not have enough mental health professionals to deliver vital care. A shortage of trained mental health professionals, not only in Jigsaw but in the wider mental health services, continues to stretch the limited resources that we have.

We must strive for better integration of services that support young people’s mental health and offer smoother care pathways in the mental health and social care arenas. We believe increased shared ownership, leadership and accountability need to be in place throughout the voluntary and statutory services as a matter of urgency. As such, we must accelerate the appointment of a director of mental health services in the HSE to lead reform of our mental health system of care. While we welcome the recent recruitment of a youth mental health lead, a director of mental health services will ensure increased accountability, better integration of services, a strong strategic focus and, ultimately, will ensure better mental health outcomes for all young people. In line with this integration, and in line with Sharing the Vision, areas of immediate focus should include addressing how interagency referrals are made and managed, the funding model, data-sharing across services, the extension of the age range in the child and adolescent mental health services, CAMHS, from those aged between 12 and 18 to those aged between 12 and 25, as included in Sharing the Vision, and a more consistent application of the referral guidelines.

While much remains unpredictable, what is clear to us in Jigsaw is that increased investment, improved integration and strong political will are now needed if we are to make a meaningful difference to the mental health and well-being of Ireland’s young people, and to give them the best possible chance at a full and healthy future. At Jigsaw, we understand that the solutions are not always easy. However, we are adopting a wide range of strategies to improve efficiency, maximise clinical activity and enhance the timeliness of our services.

Our work outside the session room is also very important. Prevention and intervention must go hand in hand. As such, we are investing in our digital offerings and we are seeing a significant appetite for these. We continue to support communities to promote positive well-being with a range of offerings, including One Good School, One Good Club, Jigsaw hubs and more. In short, we are actively seeking solutions. State investment in this area is now required. The young people of today are our future professionals, parents and politicians, and our One Good Adults, who, in turn, can go on to support the mental health of future generations of young people. I thank members for this opportunity and I look forward to their comments and questions.