Dr. Niall Muldoon:

That was a particularly harrowing case study. No one would like to think of it happening to any child and particularly one who we had taken into care and tried to support through the foster parent.

We expect the final report from the Mental Health Commission on CAMHS very soon. It has not improved. The Deputy will have seen the interim report since the last time I was here. It came out in January and was scathing. At that stage, the commission had only gone to five of the nine CAMHS services and felt it was important to bring out an interim report because it was so concerned about it. That has not changed. I am not sure what might come out from the final report but even if nothing changes and the commission stands by what it said in January, that is a damning indictment of the system. The HSE has been scrambling around to try to show what is working. There was a report this morning that the Minister of State, Deputy Butler, is teasing us with an outcome from the HSE's own review of medication and prescription around the country. She said there is nothing to be concerned about and that Kerry was an outlier. That is good to hear but it only took a 10% sample from around the country so I take it with a pinch of salt when it comes to being sure. The review by the Mental Health Commission will also be of 10% of files. The review by Dr. Susan Finnerty, the inspector, was of 10% of five areas and she was so concerned that she had to write an interim report. We are now waiting for the final report to come along. CAMHS has a lot of work to do. My concerns about CAMHS are on the record. We need different leadership, better governance and oversight. There are 73 teams and the Minister of State said there are now 75. Each one has individual autonomy, which will always be a recipe for danger if there is no standing operating procedure. As each CAMHS team can work independently, there are opportunities for flaws, gaps and mismanagement and for mistakes to be made. It is also led by psychiatrists. We cannot and will never get enough psychiatrists to run those teams. We know that. I am on the record that we need to change the clinical leads and have the opportunity for other professionals to be clinical leads, where appropriate and necessary. Finally, there is a sense that oversight of the professional body, some of the things that were written in the reports of both the Mental Health Commission and the Maskey one in Kerry show poor professional performance but I have never seen anyone brought before professional boards. It would enhance trust again if we knew that if someone stepped out of line and was not doing his or her job properly that the professional body would step in and do something. That would reinstate trust for parents.

I made a recommendation before, and saw the Minister of State say it today, that if there was 75 teams and none are full, then we would bring all those staff together and create 40 or 50 teams that work and allow those teams to start to thrive. If those staff could be brought together, then it would start to make a better culture that is working, positive and in which parents can trust. That in turn would allow CAMHS to grow because people will want to be back working in that service again.

People will want to work there again. Professionals will return from other countries and it will start to become something positive. There are opportunities there as well.

As regards counselling for children in primary schools, my interpretation of the INTO's figure of €11 million is that the organisation wants the Government to provide that funding to offer a counselling service rather than the INTO providing it. We have got to start with the €5 million from the Minister for Education, Deputy Foley. I recommended last year that the €5 million should be matched by €5 million from the Department of Health so that the two organisations were working together to provide a mental health counselling service for children. We could use the same professionals and would not have to hire new people all of the time, although in some places we would have to hire new people. I am delighted the INTO is really supportive. It was involved in research in 2017 which found that two thirds of all school principals felt that 80% of their children needed therapy at some stage in primary school, which is really clear and scary at the same time.

The starting point, the pilot scheme the Minister is running, is fantastic but we really need to push it. For me, €10 million or €11 million would be the minimum. We have gotten it started and we have two different strands coming. One is where several counties have panels of therapists available and schools can draw on them. The second one is where clusters of schools get health professionals involved to help them with counselling as well as working with parents and teachers on a broader, preventative element. Those two strands are very important and the crucial element is that this is not just a one-off budgetary election promise. It has to be sustained and built into the system so that children in primary school have as much access as they need in that regard. The INTO is pushing it and I am delighted about that.

I congratulate the Deputy and the autism committee for the work they have done. I have not had a chance to read all of the report but I know there are over 100 recommendations in it. There is real clear-sightedness there. Oftentimes it feels like a statement of the obvious but we need to move forward. Future thinking, as the committee can see from my discussion on planning for places, is so important but even when we have all of the information we do not seem to follow through on the future planning. That is really concerning but hopefully the report of the autism committee will be taken on board.