Oireachtas Joint and Select Committees
Wednesday, 28 January 2026
Joint Oireachtas Committee on Health
Child and Adolescent Mental Health Services: Discussion
2:00 am
Pádraig Rice (Cork South-Central, Social Democrats)
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We have not received any apologies. I advise members of the constitutional requirement that they must by physically present within the confines of the Leinster House complex in order to participate in public meetings. I will not permit a member to participate where they are not adhering to this constitutional requirement. Therefore, any member who attempts to participate from outside the precincts will be asked to leave the meeting. In this regard, I ask any member participating on Teams that, prior to making a contribution to the meeting, they confirm they are within the Leinster House complex. The minutes of the committee's meetings of 20 and 21 January 2026 have been circulated. Are they agreed? Agreed.
The purpose of this meeting is to consider issues relating to access to child and adolescent mental health services, CAMHS. We will hear from three organisations, namely Families for Reform of CAMHS, Spunout and Jigsaw. From Families for Reform of CAMHS we have, joining via Teams, Ms Hannah Ní Ghiolla Mhairtín and Ms Anne Holland. From Jigsaw, I welcome Dr. Joseph Duffy, CEO, Ms Sarah Cullinan and Mr. Jason Smith. From Spunout, I welcome Ms Sinéad Keane and Dr. Joseph Morning.
Report after report has identified serious issues in CAMHS. This includes the damning 2023 Mental Health Commission report and the consistent work done by the Families for Reform of CAMHS. Despite this, it seems the same problems persist around access, funding staffing, dual diagnosis, inconsistent practices and over-medication. None of these issues exist in isolation; they are interwoven - both influencing and resulting from each other. As with many of our other health services, families are being pushed into private systems on foot of these failings. People should not be forced to pay for health services; they should be a right, not least children's mental health services. Those who cannot afford to pay should not be left behind. These services should be readily available in the public system, including vital early intervention and prevention services. Parents should not have to fight for these or feel guilty for not being able to afford to go privately. The State is failing these children. For that reason, it is important we draw attention to these issues at the committee again today.
Members and witnesses are reminded of the long-standing parliamentary practice that they should not criticise or make charges against any person or entity by name or in such a way as to make him, her or it identifiable, or otherwise engage in speech that may 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 to discontinue their remarks. It is imperative that they comply with any such direction.
Some of our witnesses are joining us online via Teams. I invite Ms Ní Ghiolla Mhairtín to make her opening statement on behalf of Families for Reform of CAMHS.
Ms Hannah Ní Ghiolla Mhairtín:
We would like to start by thanking the committee for inviting us in to speak today. We were last before the committee two years ago when our group was newly formed. We have since doubled in size and are now made up of over 1,500 members from across the country. What remains the same, however, is our call for urgent reform of CAMHS. We are making that call on behalf of our children but also on behalf of children to come.
The year in which our group was formed was the year when the Inspector of Mental Health Services stated publicly that she could not provide assurance that children in Ireland had access to a safe mental health service. Rather than that stark warning acting as a much-needed catalyst for change, we are yet to see real reform.
We want to provide the committee with a small snapshot of what fighting to access CAMHS looks like from a family perspective. It is a fight that families have to take on at their most vulnerable times. Imagine promising your child you will get them help and keep them safe, only to have the door closed repeatedly in your face. Imagine seeing your child lose more of themselves each day and being unsure whether support will come too late. This is the reality for many families across Ireland and, as a parent, it can break your heart.
Eighteen months ago, we published a report based on the experiences of 736 families accessing CAMHS. The report illustrated the difficulties at every stage of the process. First was trying to get through the referral process, which for 44% of families takes multiple referrals before being accepted. It is worth noting that these referrals, which have to be made by GPs, are rejected by CAMHS without anyone ever meeting the child. We have families telling us that their child who has suicidal ideation or who is self-harming has been turned away without any discussion or without the child being met. All families can do is get another referral.
Once you make it onto the waiting list, the fight for services continues. Three quarters of our families said that their child’s mental health deteriorated while on the waiting list and 39% ended up having to go to accident and emergency. That is a frighteningly high percentage of children having to go to accident and emergency while they are waiting for support from CAMHS. That is almost four in ten of our children reaching such a critical emergency point before help is received. That is beyond cruel and involves avoidable pain and suffering.
We found that, once in the door of CAMHS, it could still prove hard to access support. Some 8% of children were discharged on their first appointment so, after all that waiting, support did not come. A further 10% of children were discharged after three appointments and 13% after six appointments. Of the families who stayed in the service for a longer period, almost 70% of children had been offered medication. Much smaller percentages were offered any therapeutic interventions.
Many families felt that there was a lack of accountability. Only 30% of families who had made a complaint were happy with how it was handled. Many were too worried to make a complaint in case it impacted their child’s care. This speaks to the vulnerable position families find themselves in. Families widely acknowledged the huge strain staff were under, the heavy workload they carried and that many teams simply did not have the time or capacity to offer appropriate care to their child. Individual staff members who went out of their way to help a family were highlighted and huge gratitude expressed. Being listened to, believed and validated made a huge difference. This should be the norm.
In terms of leaving CAMHS, 70% of families were not in agreement about their children being ready to be discharged. This led to a huge sense of distrust in the system. Families worried about what would happen if their children needed help again in the future because they knew how hard it would be to get back in the door.
It is worth mentioning the experiences of certain groups. Some 70% of families with an autistic child felt that being autistic negatively impacted their ability to access CAMHS or mental health supports in the service. Anxiety, depression and other mental health disorders are treatable conditions and autistic children should have equal opportunities for treatment and support. For children with intellectual disabilities, over three quarters had no access to a CAMHS ID and only 14% were being offered any interim support. That means 63% of children with intellectual disabilities had no access to any mental health service at all. That is not good enough. Families have nowhere to turn.
We continue to call for meaningful prioritisation of reform.
Pádraig Rice (Cork South-Central, Social Democrats)
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I thank Ms Ní Ghiolla Mhairtín. I now invite Dr. Joseph Duffy to make the opening remarks on behalf of Jigsaw.
Dr. Joseph Duffy:
Jigsaw warmly welcomes this opportunity to contribute to the vital work of the Oireachtas Joint Committee on Health relating to access to child and adolescent mental health services. I am joined this morning by my colleagues, Ms Sarah Cullinan, our director of services, and Mr. Jason Smith, clinical director.
Established in 2006, Jigsaw has, with the invaluable support of the HSE, philanthropy and other donors, established a track record in achieving better mental health outcomes for young people by providing a range of community-based primary care mental health services and supports. As an organisation at the forefront of understanding the mental health needs and experiences of young people, we believe we can add value to this discussion.
As the committee members will know only too well, Ireland's current youth mental health system is increasingly under pressure – overstretched, under-resourced and under the constant strain of demand. Funding is too low. Integrated care remains largely an aspiration and where you live can often dictate the care on offer, yet behind a discourse increasingly dominated by words such as "demand", "systems" and "funding" are young people struggling to cope and parents left to shoulder the pain.
Demand for our Jigsaw services across the country is at an all-time high. In 2025, we had the highest ever number of referrals to our services around Ireland. Over 11,000 young people were referred to us for support, an increase of 23% on the previous year.
The solutions to addressing the crisis we are facing are complex, but there are positive signs. At Jigsaw, we are seeing significant progress regarding wait times. The 2025 data shows the average time to get an appointment dropped from nine to three weeks. Through a large-scale change management process, we have introduced and seen huge benefit from a new electronic health record, we have rolled out our single session therapy model across the network and we have improved access to Jigsaw. The journey was not easy, but it has highlighted that change in how we deliver services is possible.
Alongside this, we warmly welcome the development and work of the HSE's child and youth mental health office, established by the Minister of State with responsibility for mental health, Deputy Butler, in September 2023. The office's child and youth mental health action plan points to a number of encouraging commitments, including the development of a single point of access, the implementation of an electronic health record and improved integration. Alongside the action plan, the updated CAMHS operational guidelines, launched in December 2025, put in place a clear commitment to improve consistency and an enhanced referral process.
Jigsaw has had links with CAMHS teams across the country over many years. We are an approved referral agent to CAMHS. Our experience of some CAMHS teams is that a close working relationship is possible, which offers young people smooth access across both services. However, our referrals have not always been accepted. An integrated approach to working is something we would like to see across all CAMHS teams, but if we are to address the crisis facing youth mental health, we need to look beyond CAMHS.
Jigsaw strongly believes, as is outlined in the national mental health policy, Sharing the Vision, that we need to augment the resources in primary care mental health so that there is better access, better information on where to access supports and better integration of primary care into secondary and specialist care. Core to the Jigsaw model are our early intervention primary care youth mental services, which are designed to be safe and compassionate spaces in and of the community that offer quality care to a young person when and where they need it most. We need mental health supports that are accessible, free and do not require a referral, and where people can move in and out of them based on their need. If more primary care supports existed, such as full national coverage of Jigsaw, it would facilitate earlier identification of mental health difficulties and earlier intervention. The more advanced our primary care supports are, the less the likelihood that inappropriate referrals will go to the secondary or specialist care, causing increased delays and further clogging up an already-stretched system.
We believe the central ingredient that would transform our youth mental health system is early intervention. If we can intervene as early as possible, we can help support young people and reduce distress and the increased demand that occurs on our acute services. More attention at policy and funding levels needs to be devoted to preventing mental ill health rather than intervening as it arises. As such, we must at a minimum increase mental health funding in line with the Sláintecare recommendation of 10% of the overall health budget.
While much remains unpredictable, what is crystal clear to us in Jigsaw is that increased investment, improved integration and a sharper focus on early intervention are now needed if we are to make a meaningful difference to the mental health and well-being of young people in Ireland. At Jigsaw, we are fully aware of the factors behind our increasingly stretched youth mental health system. Those factors are complex and multifactorial. However, we need to grasp the opportunities at hand to address these challenges.
I will conclude with three points. Addressing the challenges within CAMHS alone will not address the youth mental health crisis that we are in. Any conversation aimed at addressing the mental health needs of our young people needs a wider lens, looking at the role of the community and voluntary sector, primary care, inter-agency integration and increased funding. Jigsaw remains fully committed to strengthening the youth mental health system in Ireland and in supporting the important work of this committee to address the challenges that face young people in this important area.
I thank the committee members for their attention. We welcome any questions.
Pádraig Rice (Cork South-Central, Social Democrats)
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I thank Dr. Duffy. I now invite Ms Sinéad Keane to make the opening remarks on behalf of Spunout.
Ms Sinéad Keane:
We welcome the opportunity to contribute today to the committee's important work examining issues related to CAMHS. Spunout works with young people to support their mental health and well-being. We connect with over 1.4 million young people a year with high-quality youth information, a 24-7 messaging support service, e-learning courses and tools connecting young people to personalised mental health information, resources and support via Navigator.
Everything we do at Spunout is achieved through continuous youth engagement, consultation and co-production. Over the past 20 years, we have built trust and created spaces where young people feel safe enough to share many aspects of their mental health journeys. In 2022, as a member of the Sharing the Vision youth mental health transitions specialist group, Spunout carried out consultations with 1,391 young people who had first-hand experience of CAMHS. Many highlighted shortcomings in the support they received: 67% told us they were not kept well informed on the treatments they received in CAMHS; 63% did not feel supported by CAMHS staff; and 77% did not feel they received the treatment they needed from CAMHS. Some expressed frustrations related to staff shortages and disrupted care, poor communication from staff, and a lack of appropriate knowledge on topics such as neurodiversity and gender identity.
We followed up with an in-person consultation event, where 53 young people shared their experience of CAMHS and their insights on how youth mental health services in Ireland could be improved. During this consultation, we heard about a service marked by gaps and barriers to accessing support: excessive waiting lists, cumbersome screening procedures and a lack of communication between different youth mental health services. They spoke of an inefficient referral process, where initial GP referrals to CAMHS were rejected, a geographic variation in the quality of supports available, and especially the challenge of accessing physical CAMHS locations in rural areas.
Young people identified a lack of supports surrounding CAMHS, meaning it was CAMHS or nothing. They did not feel like they had appropriate interim supports while on CAMHS waiting lists or effective primary care supports that could prevent the need for CAMHS altogether. Instead, some young people described a waiting game as their symptoms increased in severity. Some with more complex presentations were passed from one service to another instead of those services working together to meet their needs in a cohesive way.
These findings were uncomfortable and distressing to process, but they represent an opportunity for reform. Since 2023, the rate of progress has been encouraging. We welcome at Spunout the establishment of the HSE child and youth mental health office and corresponding action plan, which prioritises early intervention and clear pathways to community-based mental health services. We also welcome the development of national standards for child and adolescent mental health services by the Mental Health Commission and were encouraged by the centring of voices of service users and advocates in this process. Spunout is proud to sit on the expert advisory group for this body of work.
It is essential that the momentum is not lost. We are calling for increased investment in the mental health in budget 2027, particularly for early intervention youth mental health services. While we have welcomed an increase in the budget in recent years, further investment is needed to turn the tide of the youth mental health crisis in Ireland. We ask for the timely implementation of the HSE child and youth mental health office action plan. The single point of access action must receive the resourcing, partnership and collaboration needed to improve access to integrated mental health services. We ask that the national standards for CAMHS be published in a timely manner and that there be a move to regulation once published. CAMHS teams must be provided with the funding, staffing and training necessary to meet these new standards.
We encourage the committee today to advocate for full delivery of the commitments in the 2025 programme for Government related to child and youth mental health, including the development of a new care model for HSE primary care psychology to expedite services for young people with less complex issues, and focusing on smoother transitions from CAMHS to adult mental health services.
Finally, we ask that a permanent and continuous consultation process be put in place so that service users' voices continue to shape the supports they access. While I focus on CAMHS today, we must remember that the service does not exist in isolation. CAMHS is just one part of the ecosystem of youth mental health in Ireland. We must do better in reforming CAMHS but we must also widen our lens to focus on prevention and early intervention. In this way, we cannot only ease the pressure on CAMHS but significantly improve the range and quality of support available to those who so desperately need it at all levels of mental health care.
Pádraig Rice (Cork South-Central, Social Democrats)
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We will now move to questions from members. Deputy Daly is substituting for Deputy Clarke. I will have to leave at 10.30 a.m. to attend the Dáil and Deputy Burke will step in as Chair at that point.
David Cullinane (Waterford, Sinn Fein)
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I welcome the witnesses and acknowledge the opening statements that have been made. There seems to be consistency across two, if not three, of the opening statements, where concerns have been raised about referral pathways, inconsistencies in referral thresholds, that is, when somebody is referred whether they meet the threshold for a CAMHS referral in the first place, repeated referrals, in some instances, and children being turned away without even being seen in some cases, which I can certainly attest to. Unfortunately, I have had far too many conversations with the parents of children who have experienced that. Worst of all, the biggest failure is children ending up in accident and emergency departments because services have failed them. As we debated in the Dáil last night, even at that, when they attend accident and emergency departments we do not have crisis intervention rooms available on a 24-7 basis or the staff available in emergency departments to deal with those challenges. Ending up in a busy accident and emergency department is not the best place for any child. In some cases, they are being turned away.
I will start with an obvious question. I will come to Spunout first. In any area of healthcare, first of all, as the witness said, we have to consider prevention and then early intervention. What pieces are we missing at primary and community care level? We have to make sure that at the earliest possible time when somebody reaches out they get the supports and care they need and are not waiting until it gets to an acute episode where they end up in CAMHS or an emergency department. From the experience of the witnesses, what gaps exist in that space at primary and community care level?
Ms Sinéad Keane:
That gap is being worked on at the moment by the HSE child and youth mental health office and involves a single point of access. It is a no wrong door model, ensuring that every referral, regardless of entry point, will receive the appropriate care. It involves working with statutory organisations and the community and voluntary sector, including us, Jigsaw and a number of other organisations, to ensure that we properly identify where the right intervention is. That will be crucial to ensuring a stepped care approach, which includes everything from mental health promotion and prevention right up to CAMHS.
As we and Jigsaw mentioned, it involves looking at the early prevention piece. We had a consultation with some young people about CAMHS two weeks ago. One young person shared with me that they did not know that they were feeling unwell. They had no idea that there was something wrong with them until it was almost too late and too severe. There is definitely a need for the education piece in both the education system and in alternative education models across youth services and online through our digital information and mental health promotion at Spunout in order to help young people become aware of their well-being and how to ask for help when mental health challenges arise.
Dr. Joseph Morning:
I will add to that. A lot of really good work is happening already in the prevention and early intervention space. We were part of the children and young people's mental health project run by Mental Health Reform. It published two reports last year on the level of need and the level of service provision in the early intervention space. It found that the level of need is high. What is required to provide the necessary level of support involves scaling up existing services. The only way to achieve that is through investment.
We published two reports. One was an economic evaluation of the benefit that would come from increased investment. That examined what an increase of €15 million per year would do-----
David Cullinane (Waterford, Sinn Fein)
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More investment, resources and staffing and scaling up what is already there is essentially-----
David Cullinane (Waterford, Sinn Fein)
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The opening statement from Families for Reform is really good. It carried out a survey of families and listened to people's experiences . It has given us examples of some of the failures in the system. Could the witnesses elaborate on the impact on a child and family when a child is referred by a GP to CAMHS and then sent home without being seen in some instances? How prevalent is that?
Ms Hannah Ní Ghiolla Mhairtín:
I thank the Deputy. Our families are used to fighting for access to services. In the media, a lot of attention is given to the numbers on the waiting list. We wanted to highlight the instances where families cannot even get onto a waiting list, the frustration and upset that causes and how it can take over a person's whole life if they cannot get support when they need it. There are children who are not able to go to school and parents who are not able to go to work because they are looking after their children. There is a sense of distrust in the system because a child desperately needs help but cannot get it.
We examined the updated CAMHS operational guidelines from December and the number of referrals that have been accepted. However, no information is given on how many were rejected. We know that is a high percentage because that has been reported on previously. The HSE also does not collect data on why referrals have been rejected. We are working in the unknown. Many families come to us with children who have suicidal ideation, which one would think is the most serious thing a child can experience, but have been turned away. Their referrals have been refused and they are not being given answers as to why. It creates fear in families. I do not know whether Ms Holland has anything she wishes to add.
David Cullinane (Waterford, Sinn Fein)
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I have to come to the last witness. Apologies for that. We have a very short amount of time. I have a minute and a half left. I thank Ms Ní Ghiolla Mhairtín very much for the response. On the data point raised, we should take up with the HSE the point that we need accurate data capturing exactly what is happening. If people are being turned away and referrals are not being accepted by GPs, we need to understand how often and why that is happening and better understand it.
I have a final question for Jigsaw. It is a parochial and local question, as the witnesses can imagine. I will ask about Waterford. It is one of the largest cities in the State but still does not have a Jigsaw service. It has been promised, announced, re-announced and re-announced again. Can Dr. Duffy give us an update on the Waterford service? I know how important the Jigsaw service is. I have seen it operate in other areas. I want to acknowledge the work done by every group which has come before the committee. Jigsaw plays an important role in mental health for young people. I ask Dr. Duffy to give me and the committee an update on the possibility of a service roll out for Waterford.
Dr. Joseph Duffy:
I can indeed. It is a key issue for Jigsaw. As the Deputy knows, support and funding was provided in the last budget for Waterford, the wider south east and County Clare. We have identified a premises and are working to negotiate with a landlord at the moment around that. Once we have secured that, we will start recruitment. It is hoped the service would be up and running by the middle of the year, but there are a lot of contingencies around that. Once that has been developed, we hope to extend the service to the wider south east.
Peter Roche (Galway East, Fine Gael)
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The witnesses are most welcome. From the bottom of my heart, I want to thank them for what they do. Had it not been for the intervention and support they provide to families, in particular children, we would be in a very different space. I have had reason in the past to visit Jigsaw in Galway, out of curiosity.
I have read up on what Spunout and all the other support services do. Dr. Duffy mentioned the good work going on. It is thanks to him and we welcome that. A lot of good work is going on in a system that is failing overall. I say that in the context of the challenge of getting early interventions such as assessments of need.
I recently dealt with a case where the principal of a national school - I will not mention the school - made contact with me. The case related to a Ukrainian child whose single parent was pleading for an assessment of need to be done in order that the child could get treatment. I did what I could only to be told that it would be a year and a half or two years before an assessment would be carried out. I thought, "Mother of God". That child and his family from Ukraine are most welcome here. We have failed that child because we are leaving him stuck without early intervention. That is a killer for the school, which wants to do the best for the child and for the parent. For us, as a nation, it is wrong. That is one problem.
We hear a great deal about what CAMHS does, but we do not hear about how it will improve the situation with regard to intervention. There is a consistency across the statements we have heard, which is the lack of early intervention and funding and the need for more and better services. There is a common theme. The witnesses identified quite clearly where the deficits lie. It beggars belief that the Department would not want to start by way of investment. I am pretty certain that one of the issues is a lack of psychologists. I could be wrong, but I imagine that is probably one of the issues. If that is the case, why do we not recruit more? This is a bit like the dental service in the past. We need to put a resource into a school to identify that a child who requires the assessment of need can have it done. It is a failure for anyone to suggest that it will take a year and a half or maybe more.
In terms of our capacity to deal with the challenges and to provide investment, whether it is human resources or financial resources, what is the greatest need across the sector? Is it personnel? Is it funding to employ personnel or what is it? I described it earlier as a failing system because if it fails people, the it is a failing system.
Dr. Joseph Duffy:
The greatest need is around implementation. We have the policy, and we have had a certain level of investment. What we need is speedy and clear implementation. There is a very good action plan in place. The overall mental health policy is very clear. It needs change and it needs urgency. The other element is that it needs to be child centred. When we think about broad mental health and about the systems in Ireland, it is obvious that there is too much focus on CAMHS. It is really important to focus on CAMHS. Particularly since the Maskey report, youth mental health has been synonymous with CAMHS. We know from our research and from the My World Survey conducted by UCD and Jigsaw that about 66% of young people are doing fairly well. They need some support in schools. We have worked with NEPS and the Department of Education and the NEART programme to do that.
We also know that about 2% of young people need the support of CAMHS. Sometimes that might be medication and a dedicated multidisciplinary team. About one third of young people need support in terms of primary care but insufficient resources are provided. For instance, in Dublin there are seven or eight CAMHS teams versus one Jigsaw service. There is a disproportionate level of resources. We need a much higher level of resources, and we need consistency in those resources. In the report, I mentioned that we have a very good relationship with some CAMHS teams across the country, but other CAMHS teams will not accept referrals from Jigsaw. The standard operating procedures highlight that referrals should be accepted. It is about how those standards are being reviewed, who is in charge of them and how we can ensure they are consistent.
As the representatives of Families for Reform of CAMHS and Spunout have said, we need to think about a young person at the centre of this. Children do not get a second chance at childhood, which is hugely important. We need urgency in that implementation.
Peter Roche (Galway East, Fine Gael)
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Assessment of need is an entitlement under the Disability Act 2005. Clearly, that is being breached because people are being left behind. Even if the assessment of need were to be done in a timely way, this does not necessarily mean someone will get on to CAMHS as soon as it happens. Until we have that improvement in access, a chronic problem will obviously remain. Mental health issues are not decreasing; in fact, with a growing population, they are increasing. We have to respond positively. Dr. Duffy mentioned speedy clear intervention. That is what I would be asking the Department to do. As I have stated many times previously, if we are carrying out a review in a year's time and are still in the same mess, it would be a shame on us.
Pádraig Rice (Cork South-Central, Social Democrats)
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I have a number of questions to ask. I will begin by expressing my frustration that time and again we have reports on failings in services. As I said at the outset, the State is failing children who are struggling to access services. People who should have services as a right should be able to access good-quality mental health services as part of the public health system. It is a real stain on the State's record that the State has been unable so far to provide these services. We come back time and again and rehearse the same debates on the same reports. Things are not changing, and they are not changing at sufficient speed.
My first question is for Families for Reform of CAMHS. It is really sad to hear its representatives say that their families have to fight for services. They should not have to continually fight to improve services that should be available. In the three years since their group was formed, have they seen any improvement in services?
Ms Hannah Ní Ghiolla Mhairtín:
It is very hard for us to tell. Since we were formed, we have consistently called for a commitment to the implementation of the Mental Health Commission's 49 recommendations and reporting on those recommendations, which has not been done. There is a lack of transparency as to what has been done.
Our first time coming into Leinster House was about two or three years ago. The waiting list numbers remain the same. From a data perspective, there has not been much change. We received a newsletter from the HSE last week about things that had been done. However, it seems like tinkering around the edges as opposed to really considering what is required for the service to supply a good standard of care to our children, including setting out the staffing and funding requirements and working backwards from that. Many of us have lost trust in the system and have lost trust in the reforms that are being progressed. Ms Holland may wish to add to that.
Ms Anne Holland:
The majority of people in our group are looking for change and would not feel that valid change has happened.
We would love see the CAMHS operational guidelines from 2025 implemented. They focus on care between the 9-to-5 hours. We would question what happens after 5 p.m if a child is in crisis. Unfortunately, some of our families have had situations that would completely contradict those guidelines. We are also aware that the guidelines are only implemented since 2025. Time has to be given to allow it a chance to change. However, on the ground our families do not feel enough is being done and the impact is not being felt within the homes.
Pádraig Rice (Cork South-Central, Social Democrats)
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It is a real sign of the state of services that families have lost trust in them. It is a real sign of how bad things are. On that point around transparency, what additional information would the witnesses like to see CAMHS providing to the organisations and publishing more widely so that we could have a better sense of how the services are currently and how they are improving? What kind of data do they think we need to have?
Ms Hannah Ní Ghiolla Mhairtín:
We need context for a lot of the figures given. In its newsletter, CAMHS stated that approximately 49 new staff had been put in place but without context for that and how many are needed, it does not mean that much to us. We do not know are they filling positions or are they new positions. There is a blueprint out there from the Mental Health Commission's 49 recommendations. Last year, the Oireachtas committee for children did a report with recommendations and the College of Psychiatrists Ireland did a really good report about governance changes that are needed within CAMHS but there is never any response to those. There is never any reporting back on what is being put in place. We received our first newsletter last week and it does not make any reference back to any of the recommendations. If CAMHS had a website even, with all of the reforms that are being looked at, that would be helpful. We were involved in the consultation process for its new action plan. I do not want to say too many negative things because there is good intention there. We are not convinced about the urgency with which it is being progressed. The consultation process involved putting up one slide of 16 coloured boxes with titles and asking us what we thought of the plan. We had not see the plan; we saw a slide of 16 coloured boxes with titles. I think sometimes there is a bit of a tick-box exercise going on. CAMS can say it did its consultation. When we look into that, it is very questionable.
Pádraig Rice (Cork South-Central, Social Democrats)
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I thank the witnesses. Just for Jigsaw, I am interested to note the witnesses' point around the lack of implementation of policy and that there are plans there. Something we see again and again is this implementation deficit disorder. The State puts together really good plans and policies but then fails to implement them. We have dusty reports sitting on the shelves of Departments time and again. I also note that, like Families for Reform of CAMHS, the witnesses from Jigsaw said that referrals to CAMHS are not always accepted. Why do they think that is happening?
Mr. Jason Smith:
I cannot be absolutely sure as to why. There may be a lack of appreciation around this very strong clinical governance framework to which Jigsaw operates. While I would say there have been occasions when this happened, it is very variable across the country as to which CAMHS services have not in the past accepted referrals from Jigsaw. We can point to some very good examples when referrals have always been accepted by CAMHS. There are some which have not. With the reintroduction of the CAMHS COG from early December 2025, there was certainly an re-emphasis of the nature of recognising trusted referral agents such as Jigsaw. I would hope that going forward they will be recognised. With regard to GPs, for example, who may have met with distressed families, they may be less than sure about the response they will get from a range of agencies and scattergun referrals can go on. Each and every service can receive a referral. The integrated way of working would support that.
Pádraig Rice (Cork South-Central, Social Democrats)
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Finally, as I am conscious of the time, have the witnesses from Spunout seen any progress since the HSE's action plan for child and youth mental health services was launched last year? Are they seeing progress?
Ms Sinéad Keane:
We were at a recent committee with the HSE in December where it shared some updates on the single point of access in terms of where it is at with demonstration sites and the implementation. That is heartening to see but as our colleagues in Jigsaw said what we really want to see is continued updates on that timely implementation. The action plan is there and it will be really impactful in supporting young people's mental health. The more resources we can put behind it the better.
Martin Daly (Roscommon-Galway, Fianna Fail)
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I thank all the witnesses for coming in. It is a hugely important topic and one in which the public has taken a big interest because it affects families all over the country. It has a ripple effect out into families because of the huge commitment of families 365 days a year, 24 hours a day. It is not simply the family unit; it is the extended families who are affected. That is why there has been such a response to the whole issues of CAMHS in the last while. I will pick out a few things. First, I recognise that the Minister of State, Deputy Mary Butler, has brought a focus to CAMHS and to mental health services but we are still playing catch-up. We are not putting in the resources that are internationally recognised. About 10% of our health budget should be invested in mental health services and we have not reached that level yet. There is no point in pretending that while we are waiting things are okay. They are not okay. I want to focus on the family voices today because these are the people who are living with these issues day in, day out, without answers, access or support. People say they are getting some support but as a GP on the ground, I see them not getting adequate or timely access and huge frustration and anger. They are being left in a situation where they are grappling with the most difficult situations. I can think of a mother this week who contacted me who has four children with autism. She is a professional woman. Her life is now changed forever. Two of the children are non-verbal and one is verbal. There is a dispute between CAMHS, which took a long time for her to access for one of the children, and a neurology service in Dublin over a diagnosis. The child waited for almost a year to get a neurology diagnosis and a ten-minute consultation which was not consultant-led. Now, there is no communication between CAMHS, other than letters going back and forth and a family in distress. I will focus on a number of things and will ask the families, which is more important. This fear of complaining, I understand this as a GP working on the ground. There is no choice in the system so you have to try to get on with the service that is there. There is a fear, even among general practitioners, therefore I can imagine what it feels like for families to complain about the service. There is a fear they will not get the service or they will get a different type of service. Will the witnesses comment on that please?
Ms Hannah Ní Ghiolla Mhairtín:
Families are very vulnerable. It is so hard to get access to CAMHS that once you are in the door you are worried that if you complain or raise an issue you will be discharged or your child's treatment in care will be impacted. There is a real lack of clarity. Even if you wanted a second opinion, we are not sure if that is possible. Different members have different experiences of that. Regarding raising complaints, a third of our members said they were too worried to make one even they wanted to because of the potential impact on their child's care. However, about 20% were not sure how to actually raise a complaint. That is important because in the updated CAMHS operational guidelines in December, complaint mechanisms are not mentioned at all. There is a dearth of information out there on what you do if you have a complaint or if you need a second opinion. If your referral is refused is there an option to repeal or do you just keep referring? There is no information out there on that. It is an awful position to be in, if you have an issue with the care your child is getting, not to be able to raise that.
Ms Anne Holland:
To follow on from that, while families are very vulnerable in this situation, it is the only public service that is also available and we have had many a family who had been refused a private service, assessment or option due to the age and diagnosis of their child. Therefore, they are faced then with CAMHS as their only option and when CAMHS is not meeting those needs, there is a very serious limbo for our families.
Martin Daly (Roscommon-Galway, Fianna Fail)
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I thank the witnesses. Ms Holland has just hit the nail on the head.
There is a very similar situation in that there are no alternative pathways being offered to families and their GPs for children who require an assessment. I can understand that there are very many good, committed staff working in CAMHS, probably in circumstances that are under capacity. However, the culture seems to involve the system serving the system. I also get the feeling that sometimes GPs and families are being gaslit. They are told that this is not their service, that the referral is not appropriate and that they should go somewhere else. I hope the commitment of the Minister and the CEO, Mr. Gloster, on the one-door policy will solve some of those issues.
I would like to hear about the experience of Families for the Reform of CAMHS of integration and communication. My experience as a GP is that it is extremely poor and sometimes disrespectful.
Ms Hannah Ní Ghiolla Mhairtín:
We probably agree with that. Again, it differs from service to service. We have many members who are happy with the service and who have very dedicated team members helping their children. However, it varies across teams and is not consistent. Many families do not have this experience. When we surveyed our members on basic things, we found only one quarter had both a key worker and a care plan. About one third had neither, and 20% did not know whether they had either. Basic things set out in the operational guidelines are your point of contact in CAMHS and the care and treatment plan. If you do not have those, you are operating with a serious lack of information. It is often hard to get in touch with CAMHS. Most CAMHS services do not have an email address, so parents must ring repeatedly. Many of us have resorted to writing letters to get responses. Some form of communication is needed. When families are on a waiting list, there is no update about where they are on that list and no checking in on how their children are doing. It is left up to parents to keep ringing.
Ms Anne Holland:
I reiterate that trying to get into the service and make contact with people can be one of the most frustrating aspects. About one quarter of families in our group have a key worker, which means 75% of those families have no point of contact. They have no person to reach out to when they are on the cusp of crisis. They have nobody to give them immediate advice.
Martin Daly (Roscommon-Galway, Fianna Fail)
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I am short on time and want to ask one more question to Families for Reform of CAMHS. One of the areas of concern I have, which I see in the report, is the lack of access to assessment for ADHD, and also the question of people going online seeking services. It appears to me, and I may be wrong and am open to correction, that there is an unregulated market for ADHD assessment. Many people are paying a lot of money to get assessments from people who are not qualified to conduct them.
Ms Hannah Ní Ghiolla Mhairtín:
We would agree with that. The youngest children being referred to CAMHS are those with ADHD, and they experience the longest waiting lists. Parents are turning to all sorts of options, including unregulated psychologists or psychiatrists, or going abroad. That places huge pressure on families.
There are also different experiences regarding whether diagnoses already received privately are accepted by CAMHS. In some cases, a child may have to come off ADHD medication in order to be reassessed by CAMHS. Again, that is very disruptive.
There are many issues in this area, especially if CAMHS is the only service offering treatment for ADHD in Ireland.
Martin Daly (Roscommon-Galway, Fianna Fail)
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I thank the guests.
Pádraig Rice (Cork South-Central, Social Democrats)
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Our next slot is for Sinn Féin. Deputy Pa Daly is substituting for Deputy Clarke. I ask Deputy Burke to take the Chair.
Pa Daly (Kerry, Sinn Fein)
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I thank all our guests for coming in. Yesterday marked four years to the day since the publication of the Maskey report. From Ms Ní Ghiolla Mhairtín’s opening statement, I see that children were overmedicated. Complaints were made. Reference is made to the huge strain on staff and the heavy workload, which may be leading to the early discharges. In counties such as Kerry, where significant harm was done to children according to the Maskey report, there was overmedication, sedation, cognitive impairment, considerable weight gain and galactorrhoea in boys due to overmedication.
I understand that more than €2 million has been spent on the Halpin investigation since it was initiated. I understand the report has been completed and submitted but the relevant Minister of State, Deputy Mary Butler, has said she has not received it. In the meantime, families are excluded from a compensation scheme and must pay for very expensive medical reports. They are being doubly punished as they must fork out up to €10,000 of their own money to get a case, even when an apology has been received arising from deficiencies in care. Is this Ms Ní Ghiolla Mhairtín’s experience of what is happening around the country? She mentioned the lack of, or slower, treatment for social anxiety and ADHD. The lack of alternative pathways has already been mentioned by Deputy Martin Daly. Does Ms Ní Ghiolla Mhairtín have any comment on this matter? Many children I met who had entered CAMHS were suffering from social anxiety but were placed on medication of the type referred to by Ms Ní Ghiolla Mhairtín in her opening statement. Could she comment on this, please?
Ms Hannah Ní Ghiolla Mhairtín:
When we surveyed our members, we found that 70% of children who had access to CAMHS had been offered medication. In many cases, medication may be required, so we are not necessarily disputing that. Our issue is the over-reliance on medication. Only about one fifth of children, or 20%, were offered therapeutic interventions. We know this is due to the lack of resources and capacity within CAMHS. We are emphasising the over-reliance on medication as opposed to other forms of support. We have members in our group who are from Kerry. What they have gone through over the past couple of years has really burnt them out. It has been such a prolonged process. I do not want to talk on the families’ behalf but I know it has been really hard for them.
Pa Daly (Kerry, Sinn Fein)
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Despite the Maskey report, is there still overmedication across the organisation’s membership?
Ms Anne Holland:
What we are trying to point out is that while there is a high number of children medicated, and that may be essential, there is nothing accompanying the medication. It is proven that medication can be a first protocol for ADHD but there are no services being offered to help the children learn regulation.
Pa Daly (Kerry, Sinn Fein)
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Therapeutic services?
Pa Daly (Kerry, Sinn Fein)
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I have a couple of questions for Dr. Duffy arising from his opening statement. In this regard, I noted what Deputy Cullinane mentioned about Waterford. Dr. Duffy, having regard to the lack of interventions, said there is a disproportionate level of services and that there has been investment only at a certain level. Could he expand on that? Is it putting a strain on rural services, in particular? Where is doing disproportionately poorly?
Dr. Joseph Duffy:
Jigsaw services have not developed in an overall planned way. We have had two or three developed, then maybe a gap, and then a number of others. We now have plans to develop a number of services this year. Their development will still leave about 25% of the country without a primary care youth mental health service. Ultimately, if there were full national coverage, there would be a very good entry system. That would couple with the HSE action plan and lead to further integration.
One of the difficulties we face is that even in areas where we have a Jigsaw service, the demand is huge. Dublin city is a prime example. We have had a 23% increase in demand but the size of the team has remained the same. We are asking for further investment in new services but also an increase in investment.
Pa Daly (Kerry, Sinn Fein)
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What extra investment or money is needed?
Dr. Joseph Duffy:
Essentially what we would be looking for are services that cover the whole country. We are talking about probably another €10 million or €15 million for Jigsaw alone. This, in the scheme of things, is not a huge amount of money but it would provide a significant plan. If this investment was agreed and planned over time, and if we went to the end of 2030 with full coverage, we would be able to provide really good support for many children.
Pa Daly (Kerry, Sinn Fein)
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There was a debate in the Dáil last night about mental health. One of the issues that came up was the lack of a suicide crisis assessment nursing service. There is no such service in 11 counties. It is in Dublin and Cork, for example, but it is not in Kerry. Particularly with regard to Travellers, young male Travellers have seven times the suicide rate of the general population. People speaking to me say they are slower to go to accident and emergency departments and there are clearly cultural differences. What is the experience of the witnesses and what is being done to support young male Travellers in particular given the shameful statistics that we see, with 11% of Traveller deaths being as a result of taking their own lives? What services are there and what should be there?
Mr. Jason Smith:
From Jigsaw's perspective we have open access. There should be equal and equitable access to services but what we do see is a reluctance and a lack of trust, perhaps, with services. That said, with regard to Jigsaw, having just read through a raft of service action plans a good number of the services from a mental health promotional perspective look to reach out and try to breach the stigma and the lack of understanding about how services can and should provide services to this particular homogenised group.
Pa Daly (Kerry, Sinn Fein)
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Jigsaw's services or services in general?
Mr. Jason Smith:
I am speaking from a Jigsaw perspective. I cannot speak to the plans that CAMHS has. Having read through the national youth mental health action plan, there is certainly one point that speaks to marginalised groups and the need to reach out to Traveller communities to support access. There is still a lot of work to be done on breaking the stigma attached to understanding mental health awareness and access to mainstream and more specialist services.
Pa Daly (Kerry, Sinn Fein)
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It is clear that services are inadequate, particularly for Travellers.
An Leas-Chathaoirleach:
A question I get from parents is about the lack of continuity with regard to the people they deal with. They deal with one person in May or June and a totally different person in October or November. Do the witnesses find this in their dealings with the State agencies, whether CAMHS, the HSE or support services? How do they deal with this? In a slightly different case from what we are speaking about this morning, one family has a four-year-old child in its care and so far they have gone through 13 different social care workers. How is this issue dealt with? Has it been identified as a problem? Especially when dealing with a child, whether aged four, five, ten or 11, this lack of continuity seems to be a problem. Have the witnesses dealt with this?
Dr. Joseph Morning:
I am pretty sure this comes up in our consultation work with young people who have experience of engaging with CAMHS. This lack of staff continuity has a big impact on their overall experience of the service. A lot of it comes down to issues with staff retention. Addressing this and being able to increase staff retention in the services will be very important. A certain level of staff turnover is inevitable, especially when in a multidisciplinary care team. These things will happen but having very solid handover procedures, where young people are not burdened with retelling their story every time they move from one member of staff to another-----
An Leas-Chathaoirleach:
Has there been a review of why there is such mobility of staff? In a school there is stability in the sense that the teachers are there every day and there is a far lower turnover from the point of view of teaching. Therefore, a pupil going in has this stability. We are speaking about very vulnerable people and there is a lack of the stability they need coming from the agencies that are supposed to be providing the service.
Dr. Joseph Morning:
It is a complex issue and there is a range of factors that probably go into it. One that I would point out is that if we look at the reports from the Mental Health Commission on the state of CAMHS, these are incredibly overstretched services from a staff member's point of view. It is a high-stress environment to work in. There is a staff well-being element to this and if this is addressed it could increase retention.
Ms Hannah Ní Ghiolla Mhairtín:
One of the main things that families experience is the fact that child psychiatrist registrars rotate every six months. This is why families end up having so many different staff members. It is not necessarily a retention issue; it is more how the system is set up. There is a new psychiatrist every six months, which is very difficult for children because, as mentioned, they have to keep retelling their story. They start from scratch every six months with a new staff member, some of whom the child connects really well with and others they do not. It is all a bit of a lottery. Children really do struggle with this huge turnover in staff.
Mr. Jason Smith:
Clearly continuity of care affects and impacts the outcomes for children and families accessing support. Another theme is the integration of care. Ireland has a system, the Meitheal framework, which is ostensibly for reporting to prevent safeguarding-based issues. It is a framework where we have an opportunity, on an interagency and cross-agency basis, to hear the story from the family at first hand, as it is at the centre of this, with all of the relevant agencies around the table to hear. This also offers accountability for these services to say what is their bag and their responsibility and that they will pick it up. Further and extended roll-out of something like Meitheal could go a long way to support everything the Leas-Chathaoirleach has discussed.
Mr. Jason Smith:
I can speak on the UK experience. The continuity and integration of care is a very common theme. In the UK particularly, in recognition of the crisis, and this speaks to my experience 15 or so years ago, it rolled out the common assessment framework. This is very much based on the Meitheal model. It brought all agencies together to hear the stories of the challenges and struggles that families were experiencing. It made the agencies accountable to the families they served. We see it on occasion across Ireland and I wonder whether it could go a little further.
Mr. Jason Smith:
I would say "Yes". Beyond the UK, Jigsaw is part of a global network with similar services in Canada and Australia in particular. Integrated youth services aim to bring together a cohort of services to offer a range of services, such as drug and alcohol support, family support and youth work support alongside mental health support.
With those types of models, we can go a long way to support increased and better integration and delivery of the holistic care that children and families need.
Ms Sarah Cullinan:
I would probably echo some of the points made earlier about the policy being in place, but implementation being required. In recent months a strategy has been published on the workforce in health and social care. There are some really important points in it. Jigsaw and every other service delivery agent in Ireland is struggling with the availability of clinical workforce and retention issues. There is a lot in that recently published policy around increasing the numbers in training and increasing placements. Ultimately, that impacts on the quality of care that is delivered to young people when there are gaps in staffing and turnover. The families have very clearly expressed the impact that has on them. Again, the policy is there but there is an urgency with the implementation so that we all have the available workforce.
Michael Cahill (Kerry, Fianna Fail)
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I welcome the guests who are physically present and those online this morning. Yet again, I wish to raise the CAMHS scandal in Kerry, both north and south. A number of years ago I was invited by south Kerry representatives and families and parents to Leinster House and subsequently with Davin Godfrey from Listowel, a victim and spokesperson on behalf of families in Kerry. Lives were ruined. Children were misdiagnosed and mismedicated. I know many of these individuals and their families. I deal with them all the time. Thankfully, some have excelled but some are in a lost world, to be fair. We must get the diagnosis right.
We met the Minister of State, Deputy Butler, on a number of occasions here in Leinster House. I am going back a number of years now. Many of the children are young adults today. Are they finally getting the supports they deserve? Have they been compensated? Where is that actually at? What is the total cost of the various reports - the Maskey report and the look-back review? Hundreds were initially affected in south Kerry. Then it was realised that it was equally bad if not worse in north Kerry. What are the actual numbers in both north and south Kerry? Are they available today?
Will the north Kerry CAMHS look-back review ever be published? It seems to be going on for ever and ever. We were promised dates in the past. We need to give some bit of relief to the individuals and their families. I try to choose my words carefully when I speak about it. Obviously this can never again be allowed to happen. I made a call in the past and I want to do it again today. I have spoken to the Taoiseach about it as well. I believe these individuals and their families deserve a public apology. I would be most grateful if, as a committee, we could agree to write to the Taoiseach requesting such an apology.
Michael Cahill (Kerry, Fianna Fail)
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Could we do it as a committee?
An Leas-Chathaoirleach:
That is another issue. In fairness to the panel who are in here today, they are giving evidence on the challenges they are dealing with. I do not know whether anyone wants to comment on it. It is not really within the jurisdiction of the invited guests to be involved in that issue. That is a HSE issue. Does Deputy Cahill want to ask questions of the people who are here?
Michael Cahill (Kerry, Fianna Fail)
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Okay.
Teresa Costello (Fianna Fail)
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Perhaps I could come in now.
Teresa Costello (Fianna Fail)
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Yes, then I can come in.
Nicole Ryan (Sinn Fein)
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I welcome everybody. It is good to have them here this morning. It is lovely to have them. One of the big themes we are hearing from them is implementation. Time and again we have seen that there are so many different plans. For example, the plan for dual diagnosis is fantastic but the implementation has not really begun. We see it in loads of different areas. Sometimes the Government comes up with these big plans and it kind of gives the Government a clean slate before it has to implement it. It is like it is saying it has this really great policy that is going to work but then there is no real urgency to actually implement it.
Currently in the Seanad we are debating the Mental Health Bill. It is a broader look at mental health. We have found out two things, the first of which is that Ireland has signed up to the UN Convention on the Rights of the Child but we have not implemented it. It is another thing that we have signed up to that is not being implemented. The second point highlights the failure of CAMHS, which is that children are still being detained in adult units. Do the witnesses think what is being done at present is acceptable? I accept the Minister has brought the numbers down, but it is still happening. What is their opinion on that? The question is open to all the witnesses.
Dr. Joseph Duffy:
Senator Ryan talked about implementation. There is a real need for urgency in looking at the issue of children being detained. It is not an area on which Jigsaw focuses, as it deals with early intervention. When we speak to families about policy, we hear that what is needed overall is to have more services available locally. It is also about having the right standards in those services. If a child needs to be provided with support that is in an adult service, it must be done in a very clear and structured way. The broader issue is how we are going to effect change and do so in a timely way. As I said earlier, children do not get a second chance at a childhood. There is a sense of absolute urgency. There is a real deficit between having policies and having a will. It is about how we change the course of that ship. How do we move that and increase the level of urgency? It is partly about investment, but it is also about leadership and having clear standards and making sure those standards are implemented. Who is in charge and where is the accountability? As my colleague Jason mentioned earlier, it is about the sense overall as to whether the children and families are at the centre of this and how we organise it. If the families are told time and again that we are not the service for them, then what is the service for them? That is the important question to ask.
We often get phone calls from families in absolute distress. We make a big effort in Jigsaw to get a clinician to ring back a mother or father, usually a mother, and have a conversation. The feedback they give to me is that those parents are often really relieved because they understand a bit more about the system. They understand why they might have been told "No", but they also understand where they might be told "Yes". It is that human contact. We have realised that we needed to record that indirect way of working, because we needed to show that this is a really important element of the work. A lot of our work was measured in terms of when we saw a young person sitting opposite us, but the support is for families, sometimes teachers or grandparents, and it is that level of contact that is needed. Hannah mentioned trying to find a contact for the CAMHS service. If there was a human at the end of the line and people were able to have that conversation, which is done in many cases but needs to be done in all cases, that would make a huge difference.
Ms Hannah Ní Ghiolla Mhairtín:
I just want to make a quick point about inpatient care. There was a recent report by some senior paediatricians and clinical child psychiatrists in which they called for an increase in psychiatrists connected to paediatric units. At present, only three out of 18 paediatric units have psychiatrists supporting them, so children are not getting the appropriate care. They are just going into general paediatric units. That is for children under 16. As rightly raised, children between 16 and 18 are being admitted to adult inpatient units, which is not appropriate. I think everyone will agree about that. Work is going on to reduce those numbers, but it is still happening and these children are vulnerable. It is not an appropriate place for them.
On the second question, last year the College of Psychiatrists of Ireland did a model of care report outlining governance changes that needed to happen in CAMHS. These are management and structural changes. It would be good to get the HSE's position on those recommendations because it is not possible to have an effectively operating service without those structures in place.
Nicole Ryan (Sinn Fein)
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My second question is about the urban-rural divide in services, access to services and the barriers faced in accessing services. I am thinking about my constituency of Cork North-West. For instance, Charleville has a big issue around mental health and access to supports. In recent years, there have been numerous deaths, including of young people under 18. As the witnesses will be aware, when people turn 18, they are almost thrown out and they have to access and navigate the adult system, in which services are also quite poor in some places. One thing people find is that everything is concentrated in the city, which is fair enough because Cork city is Cork city. However, when they try to access services, there are such barriers as travel, access to timely care, trying to get into the city to access services and all that kind of stuff that happens. It does not only happen in Charleville. It happens in Newmarket and all the rural areas. What would the witnesses like to see in rural services? The services in the cities need to be expanded because the populations are growing, but rural Ireland often just gets the last few little bits of services, if there are any and if not, they get services from people, such as voluntary groups or community groups, who are trying to do their absolute best and to respond to a crisis or urgent need. Those services are not ad hoc but sometimes they do not last long because they do not have access to funding.
Ms Sarah Cullinan:
Maybe I can speak about that. The Senator raised an important point about the accessibility of services as close to home as possible for young people. We very much listen to young people in that regard. I will take our Cork service as an example. While our hub, the main service location, is in Cork city centre, there are number of ways in which young people from outside the city can access our service. One is online; young people have the option if they wish to attend their appointments online and that is an option that suits some young people due to college and work commitments or travel. We also offer our services in many of our rural areas on an outreach basis. We have a presence, for example, in Youghal and one in Mallow, which is a lot closer to Charleville, to use the example the Senator gave. The same is true of our services in Kerry, Donegal and so on. In addition to our central hub, we partner with local organisations. For example, we sometimes have a presence in a family resource centre in a local community, which means there is a presence during the working week and we can offer appointments more locally to young people. The online option is also there, but I should say, in addition to our community-based services, Jigsaw offers a live chat service, which is available across the Twenty-six Counties, so even where we do not have a physical presence, young people aged between 12 and 25 can have online contact with the clinicians.
Pádraig Rice (Cork South-Central, Social Democrats)
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We will now take a five-minute break. Is that agreed? Agreed.
Pádraig Rice (Cork South-Central, Social Democrats)
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We will resume the committee's consideration of the issues relating to access to child and adolescent mental health services.
Manus Boyle (Fine Gael)
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I thank the guests for coming in and talking about their experience. It is people like them who have stepped up to help children cope and deal with life. That is what it is all about. The organisations must be commended for all they are doing because when a child has a mental health issue it is a crisis that affects the whole family. I know from personal friends how hard that can be and, as Ms Ní Ghiolla Mhairtín said earlier, it is heartbreaking. Trying to get into the system at the start is heartbreaking because, from what I have been told, when a person turns up at an accident and emergency unit in a hospital there is no designated person there right away. As Deputy Pa Daly said earlier, there is a lack of urgency. When a child and a parent make a decision that they need help then the help needs to be there. It cannot be prevented. If a person turns up at a hospital with his or her arm hanging off then he or she needs to be seen right away. We need to move to a service where people can be seen right away and I totally agree with what the organisations are trying to do. CAMHS works for many people but a lot more people need to be brought into it. What I get from people at home in Donegal is that when a person reaches the threshold of 18 years of age he or she is passed over to somebody else and a lot of people fall between the systems. Last week, we talked about this issue. Four or five people reached out to me over the weekend to tell me that the biggest problem is that when they reached 18 they were passed on to somebody else and it is not a natural pass as people must start the fight all over again. Families who are dealing with these issues have enough to be doing without trying to fight the system to get their child into the system.
I totally agree that more money needs to be spent on this service. To me, early intervention is key. Prompt action is required when a child decides that something needs to be done. Am I correct that one of the witnesses said that people must wait between six and seven months to get seen in some places?
Manus Boyle (Fine Gael)
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Sorry, I picked it up wrong.
Ms Sarah Cullinan:
No. I am glad to say that the longest wait time we have at the moment is five weeks, which is a significant improvement. Last year, we did a lot of work on that and have managed to significantly reduce wait times. In Donegal, for example, if a young person presents today he or she will be seen within three weeks. That is what the wait time currently stands at.
Manus Boyle (Fine Gael)
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Is there a problem with the rate of staff turnover? Are there not enough staff? When children need help it is probably very hard to have enough staff. If someone starts off with Ms Cullinan then that assistance should follow straight through. According to some of the correspondence that I have received it could be Ms Cullinan one day and somebody else the next day which, as somebody said earlier, means people must repeat their whole story again. If children tell their story to Ms Cullinan at the start and she moves on then they move forward themselves but if they have to go back into the system again and start the whole thing over they find it really hard. Perhaps the witnesses could come back to me on that.
Ms Sinéad Keane:
The continuity of care is an issue that came up in our consultation with young people when we talked about CAMHS with them. There is that retelling the story piece. Like the Senator has said, once people overcome that incredibly hard stigma to be able to even acknowledge that you need help and ask for it, to then be met with different healthcare professionals and not have the same trust as you might have had with the first person that you met, it could be incredibly challenging for young people and children. In addition, the transition by young people from CAMHS to the adult mental health service is an aspect that was raised as incredibly frustrating for young people and challenging in terms of even things like their files not being transferred over. Through consultation by Spunout, young people suggested that there would be a dedicated person responsible in CAMHS and the adult mental health services to improve that transition to support them going through that time.
Manus Boyle (Fine Gael)
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It is a crucial time and more staff are needed. What are the criteria if somebody is refused or declined by CAMHS? Where can they go? I know they can go to Jigsaw, etc. How can we speed up the process of getting people to where they need to be? From all that I have heard from people in Donegal, it is like pulling teeth. It takes so long to get into the system and once that happens then the service is very good up to 18 years but, then the whole lot slows down again.
Pádraig Rice (Cork South-Central, Social Democrats)
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One of our witnesses online would like to comment.
Ms Hannah Ní Ghiolla Mhairtín:
On the point made about the waiting list, Jigsaw has very good waiting times. It is worth noting that a person will not access CAMHS in five to six weeks after the referral process and could easily wait over a year.
In terms of the transfer to adult services, half of our members who went on to join adult services got in quite easily but the other half were either put on another waiting list or there was no transfer pathway. It is worth noting that this happens when the child turns 18 which means a lot of those children are in their leaving certificate year, so it causes huge disruption to their life in general.
On the question about being refused by CAMHS, that is a really difficult position for people. There is no set process for knowing whether an appeal can be lodged or whether to send in additional referrals. Children who have suicidal ideation are being refused by CAMHS. Children who are autistic are being refused. Not all of them are being refused but there is enough of a cohort that they are joining our group because parents are so worried. They are being pushed from service to service. CAMHS is saying a child is too autistic, the disability services are saying this child is too anxious and it is a lose-lose situation for families.
Manus Boyle (Fine Gael)
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One of the parents who reached out to me said that once his or her child reached 18 he or she did not get as much information then. When a young person starts off then the family is involved the whole way up to 18. Once the child is over 18 years then the information is very limited and families do not get the feedback that they need. Am I right?
Ms Hannah Ní Ghiolla Mhairtín:
We have definitely heard that from families. Obviously the child should have a right to decide how much information is provided to his or her family but I know a lot of children and families want their family to still be involved. The young people are going through a very hard time at that moment so communication is still key and needs to continue.
Manus Boyle (Fine Gael)
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As one woman said to me, the team that supports children needs to do so the whole way through and not have one side left at home. Parents are trying to help their home life and work with their son or daughter who is now an adult so parents need information fed back to help their child move forward.
Ms Sarah Cullinan:
We understand that is part of the plan but we would really like to see it implemented. We know that the transition from adolescence into early adulthood is a time when continuity is needed and certainly the young people with whom we work with day in and day out would say that period is critical. Jigsaw would really like to see that across the board.
Teresa Costello (Fianna Fail)
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I thank all the witnesses for coming in. I want to refer to an earlier statement about children being detained in adult services. As far as I am aware, it was fewer than five children in the previous year.
Two were definitely 17 years of age, and I know the Minister has spoken on this. I felt that she would prefer that rather than a child not get the emergency immediate assistance they need at that time with 24-7 care, that is why that happened. I just feel the statement was slightly inflated. It sounded as though - and this is my interpretation - lots of children were just being detained in adult services, which is not the situation.
I thank the witnesses very much for coming in today. I have had personal experience with Jigsaw. I found the waiting times to be very short. Jigsaw is very on the ball and the service it provides is invaluable. It has an office in Tallaght. I know that during Covid Jigsaw offered online services in a very quick timeframe. I would say the waiting times were less than five weeks. I just wanted to acknowledge that and thank the staff.
With Spunout, having young people advocate for themselves and having their voices heard is so important. We have a young girl in Tallaght who has created a magazine called Sonder. I have been chatting with her and it is brilliant to hear because my own son has ADHD so I do have experience with CAMHS and my experience has not all been negative. For parents who may be looking in, from listening to some of the conversation here today, if I was just starting out, I do not think I would bring my son anywhere because he is just not going to get the help. There is help out there. I think there should be a huge increase in parenting courses as well. I think parents need them. We are handed these bundles and we are all only learning. I have made mistakes as a parent. I did the positive parenting course through ADHD Ireland and I found that really good because I know that there were things I needed help with. I have spoken on ADHD before and I think everybody needs more education on ADHD. Children are pigeonholed as being bold or misbehaving or they are just not understood and it such a complex diagnosis that it is very hard for teachers to understand behaviours. An awful lot of work needs to be done with that and I agree with Jigsaw's opinion on the 12 years of age to 25 years of age. When my son transitioned into adult services - and I know he will not mind me sharing this - he was unsure if he would even attend when he got a notification because he did not think he would be organised enough. We have to acknowledge the role of parents and that is why I go back to parenting courses because in society the role of parents is so important and we are shying away from the conversation. If parents are not fulfilling their role effectively, there is a knock-back on society and children are suffering. What do the witnesses think is actually working? Anybody can take this question.
Ms Hannah Ní Ghiolla Mhairtín:
We can jump in. When we went out to our members and asked them what was the top support they received from CAMHS, it was by far individual staff members and that is really worth noting. Individual staff members who go out their way to help a child make such a difference in families' lives. I would echo the Senator's point that when we are campaigning for things we are not trying to put families off from seeking help from CAMHS. What we are trying to highlight is where things can and do go seriously wrong. That is not across the board. It is different across all teams but highlighting those staff members who are trying to do their best for our children is important. They often do so despite the system rather than because of it. They are not getting the adequate support. On the Senator's point about parenting courses, these are a little bit of a bone of contention. A lot of our parents who were not offered support through CAMHS or were not offered support through disability services were offered parenting courses. This can sometimes be a little bit triggering for parents because there is sometimes a sense of blame being placed on parents as opposed to the actual support the child needs for a serious mental health issue.
Teresa Costello (Fianna Fail)
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It is right to advocate and I welcome all conversations around this. I do not want Ms Ní Ghiolla Mhairtín to think I thought she was putting a negative spin on things. It is right to advocate and that is how change happens. Regarding the parenting course, I did not feel triggered when I was offered it. I grabbed it with both hands because I was delighted to get a bit of extra help.
Dr. Joseph Morning:
The Senator makes a really interesting point about the benefit of training. Young people exist within networks of support, some informal, some formal, and every point in that network can benefit from increased support. At Spunout, we provide training directly for young people on tools to empower them, to help them manage their own mental health and understand it better. The benefit of training does not stop in informal spaces. Whenever we consulted young people, increased training for CAMHS staff was requested, especially around topics like neurodiversity and gender identity. Sometimes these can be overlooked because we think the people in CAMHS are the experts and they already know everything. However, the staff in CAMHS can still be provided with extra support on these issues that are becoming more relevant to young people's lives now.
Teresa Costello (Fianna Fail)
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They are more spoken about because people are more open.
Dr. Joseph Duffy:
On the Senator's question on what is working well, I would rephrase that and ask what has changed. In my experience what has changed has been the service user voice and service user involvement. We can see this here today in terms of families being represented. It is really important to encourage and support that. Everybody has a voice and it is about how that voice is amplified but also about how that voice is listened to. That will lead us much more in terms of youth-centred services and children-centred services, and encouraging that but also being encouraging in terms of the service-user forums. I am part of one where there is a very clear, good panel, which looks at national policy and makes a real difference to it. It is hugely important for the members of the committee to be encouraging that and to have a balance in that. For so long in mental health services and health services there was a predominance of the professional voice and it is hugely important that this balance is changed and shifted.
Teresa Costello (Fianna Fail)
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I totally agree. There was another statement today about the Government looking for a clean slate. I am a member of a Government party and I am a parent and I want the best for our children and our children's mental health. Forums like this one are helpful in us all understanding better what is needed and where improvements need to take place.
Maria Byrne (Fine Gael)
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I had to speak in the Seanad Chamber and go to the disability committee in between, so apologies if any of my questions were asked already. I will go to Families for Reform of CAMHS first. One of the things that struck me in the opening statement was that 70% of the children were not ready for discharge. I believe that 18 years of age is too young to leave the services. Even though children become an adult at 18 years of age, some of them with different diagnoses will still need support going into their adult lives. Will Ms Ní Ghiolla Mhairtín comment on those two points to start?
Ms Hannah Ní Ghiolla Mhairtín:
We were actually surprised as well by the statistic that 70% were not happy with being discharged. The resources are not there and there are waiting lists. I do not know if CAMHS teams are sometimes under pressure to discharge children to take on new children. In our survey we found that 30% of the children on the waiting list had previously been with CAMHS so they are obviously trying to get back in again. It causes huge concern among families because once they have been through the process once and then discharged, they how hard it is to get back in when they need to. For children with intellectual disabilities it is also worth mentioning that the percentage jumps to 90% of families not being in agreement that their child should be discharged. This is very specific to that cohort who really have trouble accessing mental health supports. We also very much agree that the age should be extended to 25 years of age because 18 years of age is too young. Children are in their leaving certificate year and extending transfer to adult services to 25 years of age would be very beneficial.
Maria Byrne (Fine Gael)
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I see other heads nodding in agreement. I visited Jigsaw's services in Limerick on a number of occasions. I know from dealing with families who have access to its services that it is a positive experience, so well done. One thing that struck me in its statement was that addressing the challenges with CAMHS alone would not address the youth mental health crisis we were in. That was a stark statement. I would love to hear the witnesses’ thoughts on how it can be addressed. I believe they are right about looking with a wider lens, with community and family involvement. Youth involvement is also important. Will they expand on that comment?
Dr. Joseph Duffy:
I thank the Senator for her comments about Limerick. When Jigsaw was established, we looked at the young person at the centre. We looked at how young people had a voice and how you could amplify that voice. We also looked at supporting young people where they lived, learned, worked and played. Essentially, we know there are lot of different drivers for mental health. Traditionally in Ireland, we have had a medical system, which results in medication and hospitalisation. When I train staff members, I show them a picture. That picture is of what was St. Columba's Hospital in Sligo. What is fascinating is that hospital is now part of a hotel chain. When younger people start work in Jigsaw, they do not see that hospital. They do not know what it is. What we can see, however, is that the remnants of that system are strong in Ireland, even within the structure and funding of the health system.
The Senator spoke about that wider lens. The change we are looking at is about how we invest. The case is made that we need to have more investment in mental health. However, Jigsaw and I would argue that that investment needs to be in early intervention and on the prevention side. The work we are beginning to do, and that has happened with the Department of education and the National Education Psychology Service through the NEART programme has really looked at supporting young people's well-being in schools. That is a huge change for a Department of education to not just look at teaching a subject, but educating the person. That wider lens is a brilliant thing that is happening. We have the national policy, Sharing the Vision. Eighty of its recommendations fall within the HSE, but 20 fall across all the Government Departments. There is now a real movement to look at that, which is the change that is needed. However, thinking about our mental health system is about community. Meitheal was mentioned, and I am thinking about various groups in the community. We know young people will thrive if they are connected to their communities. It is not just connected to the family. It is the sense that it takes a village. It is about looking at how we resource all of that. The work we have done in Jigsaw in terms of one good adult, one good school, one good community and one good club is thinking about the whole concept of having a group of people who are there to support a young person and how the State is supporting that. The difficulty at the moment is that a lot of those resources go into acute or chronic services, which are absolutely needed. However, we need more resources and to put those resources in other places.
Maria Byrne (Fine Gael)
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Ms Keane can correct me if I am wrong, but I think Spunout referred to a new care model. Maybe it was one of the other organisations. I would love to hear her thoughts on that. We are hearing that some of the areas are working while others are not. What would a new model look like and what are her thoughts on that whole area?
Ms Sinéad Keane:
That is really part of the commitment in the programme for Government relating to a new HSE primary care psychology system to expedite services for young people with less complex issues. This also speaks to what Jigsaw said. It is about broadening the lens so that we are not just looking at CAMHS as the only solution for youth mental health, but at other ways so as to reduce the pressure on CAMHS. For example, we in Spunout have a 24-7 messaging service. It is text support, so we are there to meet people in moments of distress and crisis. We noticed in 2025 that we had 53,000 conversations across that text line. It is busiest between 8 p.m. and 2 a.m. It is also busiest when services like CAMHS are closed. When we see summer breaks and Christmas holidays, the number of people coming to us for support increases.
Similar to what Jigsaw said, we are advocating for investment in mental health promotion, and not just in schools, given that not all young people engage with schools. We are looking across youth services and digital platforms like our own. It is also about investing in early intervention.
Maria Byrne (Fine Gael)
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I am hearing that services need to be extended longer, but support also needs to be available for longer. I turn to early assessment because I know it is difficult to get an assessment. There is frustration in families that, where they get a private assessment, it is not accepted or whatever. How can that whole process be reformed? Does anyone have comments on that?
Dr. Joseph Morning:
One point might be relevant if you are looking at the mental health system. The mental health needs of any one young person can change over time, so the most appropriate service for them can change. You can be going through a period of really severe mental health issues where CAMHS is the best place for you. Your symptoms might ease through treatment to a point where CAMHS is no longer the best service for you. That should not mean a discharge with no thought of what is next, though. It might be that you still need support while being stepped down into a different service. It is this kind of interconnection and having stepped care where we have some services that are preventative and for all, others that are for many and others that are only for a few. People should be able to move through these seamlessly. On the inside, we know these are separate services and it is a complex mental health support system for young people, but it should not feel like that to an individual moving through these systems.
Conor McGuinness (Waterford, Sinn Fein)
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It is welcome news that Jigsaw services will finally be rolled out in Waterford. I commend it for all it does, and I commend all who have advocated for that service to come to the south east. It is something my colleague David Cullinane and I have highlighted, as have many others like Comhairle na nÓg and Councillor Donnchadh Mulcahy. As a region, the south east was left without such a service for a long time, so this is good. I understand an appropriate premises has been identified and there is some work to do to get that ready. I hope that work continues apace.
My question is twofold. The first part is about personnel to staff that service. Has recruitment begun? What will the total complement be when the service is stood up? The other part is about what engagement has taken place with existing mental health service providers and advocacy organisations. I am thinking of Laochas, West Waterford Mental Health and Awareness and Re-A-Suir. There are others around Waterford and the wider south east. What engagement has taken place? What engagement has taken place with the local CAMHS service so that, from the instant the service is stood up, there will be that good relationship in terms of referrals and troubleshooting issues that might occur in individual cases?
Ms Sarah Cullinan:
I am happy to respond. I thank the Deputy for the question. As he has said, the focus at the moment is on securing the premises. Obviously, we have plans in train in terms of recruitment of the team. We have some expressions of interest from within our existing network, from people who are interested in a lateral move to a new service in Waterford, which would be amazing, because there are people who already have experience working within Jigsaw. The plan is that, as soon as we have line of sight on a timeline for the premises, we will be ready to press "Go" with the recruitment campaign. I am hopeful that, as a population centre, we will be successful recruiting a full team to cover Waterford, south Wexford and south Kilkenny. It will give us that footprint in the south east, which the Deputy has pointed out has long been a gap in the Jigsaw map.
Engagement with other services is very much the plan in advance of the doors opening. We have reached out to the local HSE contact. We are hoping to have a meeting soon, and also to have meetings with CAMHS and adult mental health services, AMHS, teams ahead of time so that we are clear on our scope of practice and how we would like to work with them in an integrated way. As my colleague Mr. Smith pointed out earlier, we have good examples of where that integrated working has happened. We have done that ahead of time in other places such as Wicklow where we have gone in before the doors opened at all to meet those other services to work out some plans as to how we will continue to communicate and how best we might work together so young people get a soft and easy point of access to the right service.
If, for example, they present to Jigsaw and we believe their needs are different or that another service is better placed to meet them, it would be a case of us having that working relationship with those other services.
In terms of the staff complement, it will mirror a number of our other Jigsaw services in terms of local leads. We will also have a member of our administrative staff, a youth and community engagement worker, who will do a lot of the work we have talked about in terms of working with parents, other adults and young people in the community settings, and then we will have a team of clinicians, Jigsaw recruits and employed clinicians across a range of different disciplines. Psychology, social work, occupational therapy, mental health nursing and psychotherapy are the disciplines that we recruit from. We operate in a trans-disciplinary way so the teams will be made up of a combination of those different disciplines.
Conor McGuinness (Waterford, Sinn Fein)
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I have a follow-on question and it relates to something my colleague Senator Ryan mentioned earlier. I live in the west of County Waterford in Dungarvan and I understand the outreach model that Spunout has. What plans are in place at this stage to look at how that outreach might work in County Waterford and in south Tipperary and south Wexford?
In response to another member's question, Ms Cullinan spoke about engagement with family resource centres and the like. We do not have a family resource centre in mid- or west Waterford. It is another glaring gap in the service provision, of which there are many. How does Ms Cullinan see that working out? What will the nature of that service be?
Ms Sarah Cullinan:
It is our intention to have an outreach presence in Dungarvan. Our plan is to establish the service in Waterford city to start with and get the team in to get the service up and running. As part of our engagement that we have already referred to with local services, we will be keen to put out the feelers to see what space might be available to us. Family resource centres are just one of the models we have operated in. We have also co-located with other community and voluntary organisations, potentially in primary care settings. There are lots of avenues that we will explore. We will certainly be open to any local contacts that the Deputy or others might have that we could open conversations with. What that looks like is our clinicians will travel a number of days a week to an outreach location and offer the appointments in person from there. Access to a number of session rooms is what we need, but we will explore any and all available opportunities in Dungarvan.
Conor McGuinness (Waterford, Sinn Fein)
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I commend Ms Cullinan and her team for all their work on this and getting it to this stage. I have a number of moments left and I have a question for Families for Reform of CAMHS. In her opening statement, Ms Ní Ghiolla Mhairtín mentioned the difficulty faced by young people and their parents in being seen on foot of a referral if the child is autistic. I have also encountered some cases in my constituency where a child is not autistic or has no diagnosis of ASD, but perhaps they have a sibling who is autistic and maybe to the clinician or in some of the referral notes there is something that gives the clue that perhaps they may have a diagnosis at some point in the future and, on that basis, they refuse the referral. How common is that in Ms Ní Ghiolla Mhairtín's experience?
With regard to the burden this puts on parents, guardians and family members, the fact that parents and family members have to fight, to advocate and become activists and experts when really they should be nurturing and parenting their children rather than fighting the State for service provision, which I see across the board, whether it is in the lack of physical help or in terms of family support or special education provision, that obviously comes at a cost: burn-out, depression and mental health concerns of their own. What supports has Families for Reform of CAMHS found are available? Are there any supports available for parents and family members?
Ms Hannah Ní Ghiolla Mhairtín:
The issue around autistic children accessing CAMHS is one we have highlighted a number of times and it continues to be a major concern of our group. I think 70% of our members said that having an autistic child impacted the supports they received or felt that they received. We have families telling us they get into CAMHS and CAMHS says that it cannot accept them and that they need to get an assessment of need. That obviously takes a few years. They end up back in CAMHS and CAMHS turns them away and tells them they should go to disability services.
It is really important to remember that being autistic does not inherently mean you have a mental health issue. Mental health issues are separate and treatable. We are very concerned that there is diagnostic overshadowing taking place.
In the revised CAMHS operational guidelines from December, we welcomed that there was an inclusion of groups that are particularly vulnerable for mental health issues and how they should be given special consideration, but very notable was the fact that autistic children were not included, despite the fact that 70% of autistic children will have a co-occurring psychiatric disorder and are much more likely to consider suicide. We cannot emphasise this point enough. It was raised earlier that there is a need for neurodivergence training among CAMHS staff and tailored treatment for kids.
In terms of the burden this places upon children, specifically for parents of autistic children, it places an extra burden of proof trying to prove to CAMHS that this is not your child's normal behaviour, that your child is not inherently distressed and that the family needs help. That is a huge burden to put on parents. More generally for all parents of kids, we have spoken to so many parents, and obviously having a child experiencing difficulties is in itself distressing, but the bit that wears you down and burns you out is the fight for services. Having that extra on top of what you are already going through is so disheartening and it does impact a carer's mental health itself.
Pádraig Rice (Cork South-Central, Social Democrats)
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We have some time for additional questions if any members want to come back in.
Martin Daly (Roscommon-Galway, Fianna Fail)
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As a practising GP, one of the biggest reasons for a refusal of a referral to CAMHS is because you might have identified the idea that there is neurodivergence - maybe autism or ADHD - or that another member of the family has it or you describe symptoms of anxiety and anxiety-triggering situations in which an assessment is made on your referral letter and the door is closed. I want to reinforce that point about what both Deputy McGuinness's experience and the families' experiences were. They are the people we need to listen to because they have that lived experience. I hope that the one-door referral system would take the pressure off families, general practitioners and perhaps Jigsaw, where a referral is made into the system and a decision is made on the best place for that assessment to be done and which service is the most appropriate and timely for that person.
I take the point that CAMHS is not a catch-all for everything, but one of the witnesses made the point very correctly that while we closed down all these institutions, we just moved that infrastructure into the community. Some of it was good, but the resources did not follow. We have a lot of people falling through the gaps, not just in child and adolescence but also in adult mental health services, which I have pointed out at this committee before. I think the point one of the witnesses made about the ecosystem is a really good idea in that a person gets into the system, and I hope this one-door system does that, people with more severe illness will be looked after by CAMHS at particular times in their life, and there is access, not simply a door closing and a mirror held back to the GP, saying the person should be somewhere else, or the GP being given a list of groups to refer to, he or she making more referrals and it being repeatedly sent back to the GP, with all of these services not available to a lot of people. Will the witnesses expand on that idea about an ecosystem? It will take integration and communication, not just within the mental health services but also, as I pointed out earlier, in associated services like neurology services where there are assessments required and paediatric services. That is where I feel the communication is simply not good enough.
Dr. Joseph Morning:
I think it is the route to reform. With this idea of the single point of access and a dedicated triage team where all of the relevant people are in the same space and are having these conversations, one of the things that can come from this as well is that it can really serve young people who have more complex presentations and who might need support from multiple services at the same time.
It is not like people are just getting support from CAMHS and are not getting anything else. It just means that if people have these kinds of co-occurring needs, they can be met together in partnership between multiple organisations. That will really help because what we have seen from our consultation work is that people who had more complex presentations were really being left out.
Martin Daly (Roscommon-Galway, Fianna Fail)
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My time is gone, so I will just make the point about the idea of having a psychologist in schools. It might not be in every school. It could be a shared psychologist between a number of schools depending on numbers, not just for mental illness but for mental health well-being so that there is early intervention when things are beginning to build and students have a resource, which is in their school, on how to cope with exam pressure, the pressures of life, social media and so forth. There is an accessible psychological service to schools around clinical psychology. I thank the witnesses for coming here today.
Peter Roche (Galway East, Fine Gael)
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I will go back a little to what I said earlier about how an assessment of needs without timely access to CAMHS is not support; it is a report. That is the way I look at it. I like the concept of one single point of access or what I would like to describe as a one-stop shop where that person would get into the system and stay in the system and be monitored throughout until he or she came out the far side in a far better place at whatever age that would be, whether it is 18, 25 or 95.
What we need to do as a Department, and I say this now almost against my colleagues who are in government, is stop the posturing on what is required. We have enough reports. What we now know, from the witnesses and others, is that there are clear deficits, and they need to be managed. Every attempt should be made to avoid people, parents especially, having to go to the cost of getting private care and private support. That in itself is an act of desperation because they know they cannot get it waiting on the public scheme. In my opinion, there are a few non-negotiable asks. I ask that we, as a committee, engage further on this topic. The non-negotiables are adequately staffed resources and facilities to go with that; speedy, clear intervention; direction for the person who needs the support of the access; and monitoring. If we had that model, we would definitely be in a very good place. If we continue to avoid managing those items and continue to do the posturing and not invest enough, we will continue to be back here again and again, clearly, with the same or similar messages. I would like us to avoid that if at all possible because as I said earlier, mental health issues are not getting any less. In fact, more and more people are presenting, sadly and regrettably, and that is as a consequence of societal issues and, of course, the increase in population. That is really just a comment.
I thank the witnesses again sincerely. I am much more enlightened. However, I am going away again from this committee meeting today knowing full well that there are people out there who are desperate to get access and, regrettably, that is not just months; sometimes it is years. It is not good enough.
Teresa Costello (Fianna Fail)
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This question is for Families for Reform of CAMHS. What sort of medication was frequently prescribed to children in lieu of behavioural or other forms of therapy? Ms Ní Ghiolla Mhairtín mentioned it in her statement. Have these medications shown successful outcomes? Did Families for Reform get reports back that they did? Did they prove to be ineffective to these families and their children?
Teresa Costello (Fianna Fail)
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It just highlights the importance of behavioural therapy and how important alternatives are.
Jigsaw mentioned that it would like to see an integrated approach to working across all CAMHS teams following an acknowledgment that some Jigsaw referrals in the past had been rejected. What might that integrated working approach entail?
Mr. Jason Smith:
The single point of access is obviously a very good starting point, but of equal priority and also listed within the youth mental health action plan is what is described as an integrated care pathway. The descriptor of that notes a recognition of the continuum of mental health care needs that might be in place. That speaks to both a multi-agency and inter-agency approach to make sure there is not a wrong front door. If that model can be enacted, and if in the build-up to its formation and implementation appropriate levels of consultation can happen with families and young people themselves and with youth and voluntary and community sector partners like us to support an understanding about what that continuum and smooth clinical care pathway might look like, that would go a long way. Clearly, there are some obstacles around appropriate data sharing, data governance, etc., but it is not insurmountable. I would suggest, therefore, that of equal need is the integrated care pathway across a spectrum of services.
Teresa Costello (Fianna Fail)
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Spunout deals with so many young people as well. What impact does Ms Keane think social media is having on their mental health? I scrolled through Facebook last night, and I was reading about Ireland's ruin and this and that. People might make these statements. I could actually feel myself getting lower. How does that impact? Politicians have to be careful with the words and language they use around things as well to not heighten situations because it does actually resonate with children. How do the witnesses feel about the impact of social media?
Ms Sinéad Keane:
We have actually been in here on two occasions quite recently speaking about that. We are a digital service, and we know the positive power of online connection. Saying that, however, in terms of the algorithm recommenders, they are creating this stream of information and disinformation for young people and sending them down a rabbit hole. We have seen research from both Dublin City University, DCU, and the Ombudsman for Children in relation to the harms and the way it can send young men looking at really challenging gender norms. For young women, it is around sending them down rabbit holes around eating disorders. There is so much work we need to do there to regulate. There is no silver bullet for it. There is regulation needed. There is education. Definitely, however, the one thing we would really be calling for in that area in terms of reducing some of the harm, not just for young people but for all of us who can find ourselves scrolling on our phones for hours, is turning off the algorithm recommenders. That is something we can really push for here in Ireland in the privileged position we are in because a lot of the platforms are actually housed here in the country.
Pádraig Rice (Cork South-Central, Social Democrats)
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I thank everyone very much. I have one additional question for each of the witnesses. I echo that call in relation to the algorithms. It is a really good call. It would make a significant difference in terms of mental health but also well-being and the operation of social media.
My first question is for Families for Reform of CAMHS. In her opening statement, Ms Ní Ghiolla Mhairtín said that referrals have been rejected by CAMHS without them even meeting the child. I also note that Families for Reform's 2024 report found that 44% of families needed multiple referrals before being accepted by CAMHS. Why does Ms Ní Ghiolla Mhairtín think so many referrals are being rejected? Does she think this is down to capacity or what is the issue?
Ms Hannah Ní Ghiolla Mhairtín:
It is very hard for us to say, to be honest, because the HSE does not report on why referrals are rejected. We just have information that they are increasing. We are trying to highlight the issue because a lot of the focus goes on the waiting lists, but the referral aspect is just as disheartening, and it can add significant periods of time on to families' wait for support. It would be a good question to maybe raise with the HSE.
Pádraig Rice (Cork South-Central, Social Democrats)
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It is quite alarming that a number of people require multiple referrals before they ever get seen.
I want to touch on one item from Jigsaw's opening statement. Dr. Duffy mentioned the introduction of the electronic health records in Jigsaw. Was this part of the HSE's action plan for child and youth mental health or is it a stand-alone project that Jigsaw has progressed?
Ms Sarah Cullinan:
The electronic health record the Cathaoirleach is referring to is the newest iteration. Jigsaw has always had an electronic health record, but with the support of philanthropic funding, we have taken on a new system in recent years, which has generated a huge amount of data and insights into what young people are presenting with and how much impact our interventions have had. Jigsaw felt that was critical to our model of care, being able to report on the impact of the work and the successful outcomes for young people.
Pádraig Rice (Cork South-Central, Social Democrats)
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There are potential lessons for the HSE in that. One of the sessions we held previously was around ehealth. There is a massive gap across the health services. It is great to see organisations moving ahead in the absence of the health service doing it.
My final question is for Spunout. In its opening statement, it called for the national standards for CAMHS to be published in a timely manner and for there to be a move to regulation after they have been published. Does Spunout anticipate there will be a delay in regulating when the Mental Health Bill has been passed? Has it had any engagement with the Minister of State, Deputy Butler, on the importance and urgency of regulating community CAMHS?
Ms Sinéad Keane:
We are on the steering group for the national standards for CAMHS. We attended our first meeting in the fourth quarter of 2025. There is a desire and intention within the group to have them published in a timely manner, so we have not engaged as an organisation with Deputy Butler on that. However, we welcome the progress on the Mental Health Bill in recent weeks and we are heartened to see it moving through the process at the moment.
Pádraig Rice (Cork South-Central, Social Democrats)
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I hope it will not lead to more delays and that the Bill will be enacted because it has been a long time coming.
That concludes this morning's meeting. I thank Families for Reform of CAMHS, Jigsaw and Spunout for their engagement on this matter. A number of serious issues were highlighted in this morning's session. The committee will continue to engage with the HSE, the Department of Health and other stakeholders on this. Perhaps as a follow-up to this morning's meeting, the committee will write to the HSE and the Department about some of the key issues that emerged from it. No doubt we will engage with them directly. We have ongoing engagement with the CEO of the HSE and the Minister for Health and we will raise some of the issues that were highlighted today. There is real interest across the committee in the area of mental health. It is a priority area for us and we will continue to engage on these issues, to raise the concerns and to echo the calls the witnesses made. I thank them for all their work and advocacy and the support they provide to children, young people and families. It is valuable work.
The meeting is now adjourned until 9.30 a.m. on Wednesday, 4 February when we will meet in committee room 2 to consider the HSE service plan for 2026.