Dan Neville (Limerick West, Fine Gael)

I thank the Ceann Comhairle for the opportunity to raise the issue of A Better Future Now, a position statement on the psychiatric services for children and adolescents in Ireland, which was published in September by the Irish College of Psychiatrists. I congratulate the Irish College of Psychiatrists, especially its sub-group, Dr. Brendan Doody, Dr. Amanda Burke, Dr. Brenda Dowling, Dr. Finbarr O'Leary, Dr. Philip Tyndall and Dr. Sarah Buckley, for the excellent work they have done.

In excess of 200,000 children have a mental or behavioural problem at any one time. In excess of 100,000 will have a mild disorder, 80,000 will have a moderate to severe disorder and 20,000 will have a disabling disorder. According to the Irish College of Psychiatry, which drew its information from reports in the Minister's possession — this document is based on reports to the Minister — to effectively deal with this serious problem would require 236 inpatient psychiatric beds. Currently there are 20 beds in two units based in Galway and Dublin.

To effectively respond to the psychiatric needs of these children requires 150 consultant child and adolescent psychiatric posts. Currently there are 62 psychiatrists in this field of the profession. The lack of psychotherapists, family therapists, clinical psychologists, occupational therapists and other key staff seriously inhibits the internationally acknowledged best practice for the provision of child and adolescent psychiatry services through multidisciplinary teams.

There is currently no capacity in child and adolescent psychiatric services to provide for children in the 16 and 17 age group. There is an urgent need to establish a specialist outpatient team providing a regional service with an inpatient facility to specialise in eating disorders. The report points out that there is no dedicated facility for those suffering from eating disorders.

The World Health Organisation states: "The lack of attention to the mental health of children and adolescents may lead to mental disorders with lifelong consequences, undermines compliance with health regiments and reduces the capacity of societies to be safe and productive".

Given the level of mental illness in children, the provision of adequate and sufficient children's mental health services should be a priority. For children who require mental health interventions, services and supports are seriously out of step with need. There is limited availability of the appropriate range of services, including those in primary care, community care, inpatient services, day centres, rehabilitation services and outreach services to provide support in the home and school.

The frequent need for urgent responses to problems presented by adolescents leads services to deal disproportionately with adolescents at the expense of their work with young children, thereby preventing useful early intervention which has a secondary preventative value.

I am struck by the international comparisons of the ratio of the number of child and adolescent consultant psychiatrists to the child and adolescent population. Having some knowledge of the Finnish system and its pioneering work in the area of suicide prevention in the early 1990s, I note that Finland has a ratio of one child psychiatrist to 6,000 children. In Ireland, the figure is one psychiatrist to 16,150 children.

In 2003, 11,200 children and adults, mostly adolescents, presented at accident and emergency departments in our hospitals having attempted suicide. We do not know the true figures, however, and there is no information on those who were treated at general practitioner level or the many who, because of stigma, did not seek help. It was indicated to us yesterday that the figure is probably double the 11,500, approximately 20,000, as stated in the Joint Committee on Health and Children. Over 40% of suicides are preceded by a previous attempt. Suicide is nearly always related to mental and behavioural disorder and the availability of accessible mental health services is of vital importance in any suicide prevention programme.

The report outlines that the recommended service level for children up to the age of 18 years would require an extra annual expenditure of approximately €80 million and a capital investment of approximately €180 million. I draw the Minister's attention to the fact that the €180 million is similar to the amount spent on PPARS and the €80 million is similar to the amount spent on consultants for PPARS. What happened in that case would fund the total capital investment and the ongoing investment for one year. Since 1997, the proportion of the health budget has dropped substantially and we would like the Minister to address that in the budget.

Having closely worked with Amnesty International in drawing up its report, Mental Illness: The Neglected Quarter, I will conclude by quoting from the report. It states: "Amnesty International is concerned that Ireland does not comply with its international obligations in the treatment of children with or at risk of mental illness".

See this speech in context