Ms Ber Grogan:

I thank the committee for inviting Mental Health Reform here today for this important session. I am the policy and research manager and I am joined by Neil Moore Ryan, mental health advocate and member of our grassroots forum. Myself and Neil will both contribute to this opening statement.

As I hope the members of the committee know, Mental Health Reform is Ireland’s leading national coalition on mental health, with over 80 member organisations, working for progressive reform of mental health services and supports in Ireland. According to the Central Statistics Office, CSO, in 2022, there were over 1.2 million young people under the age of 18 living in Ireland, which represents 23.6% of the total population. Ireland also had the highest estimated proportion of children in the European Union in 2021. Thus, the well-being of young people needs to be a central focus for the State.

Our mental health policy defines "dual diagnosis" as the term used when a person experiences both a substance misuse issue and a mental health difficulty such as depression, anxiety or psychosis. Treatment options must address both. Dual diagnosis may also refer to someone who has a mental health difficulty alongside an intellectual disability, autism or both. Key for Mental Health Reform and our members is not to focus on terminology but to move towards services that are tailored to, and revolve around, the needs of children and young people, rather than expecting them to conform to existing structures. Too often, young people end up slipping through the cracks, encountering service gaps that do not cater to their needs or find themselves stuck on lengthy waiting lists, only to discover they have been waiting in the wrong queue or knocking on the wrong door all along.

I will highlight three key areas. I will start with early intervention and prevention. Specialised services alone are not enough to support young people with mental health difficulties, including those with dual diagnosis. It is equally essential to scale up early intervention and prevention services, ensuring where possible that we are preventing the development of more complex and costly mental health difficulties. The voluntary and community sector plays a crucial role in the delivery of these services, including education, talk therapies, helplines and peer support. Appropriate investment in prevention and early intervention services is needed to support children in the community and reduce the need for specialist care. Our recommendation in this area is to invest in early intervention and prevention by providing sufficient funding to the vital voluntary and community mental health services.

Turning to accessing appropriate services, we know that CAMHS waiting lists have almost doubled since 2019. In summer 2023, the figure was around 4,400 children and young people. Concerns about CAMHS have been raised in the Mental Health Commission's independent review reports, as well as in the earlier Maskey report. In February 2023, the UN Committee on the Rights of the Child, which monitors the United Nations Convention on the Rights of the Child, UNCRC, expressed serious concerns about the inadequate and insufficient mental health services for young people in Ireland. The HSE has stated:

Substance misuse services are not provided by CAMHS. The HSE provides two CAMHS consultant psychiatrist-led teams in North Dublin and South Dublin which provide substance misuse services to young people. CAMHS can refer to these services and also receive referrals from them. The service encourages self-referral by the young people themselves.

Mental Health Reform acknowledges the recent announcement of funding for two dual-diagnosis hubs for adolescents with substance misuse issues, but we remain concerned about when these will be operational. Elements impacting on youth mental health span many Departments and, at a service level, a child can be working with several different agencies at once. As such, much improved strategic co-ordination of child and young person-centred care is needed both at policy level and at implementation level. This co-ordination is particularly important in light of the ongoing restructure from nine community health organisations, CHOs, to six HSE health regions. We understand that the aforementioned two dual diagnosis hubs are being funded separately through mental health and then also through the national drugs strategy. We would welcome more information on these points.

Our recommendations are to urgently implement the youth mental health pathfinder project, to develop child and young person-centred care pathways, and to develop a central referral system drawing from the learning from the current pilot in CHO 9.

I will now hand over to Neil Moore Ryan.