Maureen O'Sullivan (Dublin Central, Independent) | Oireachtas source

The phrase "child and adolescent mental health services" sounds fine. It sounds promising, as though a service is being provided for young people with mental health issues. We know the mental health issues that young people face. The Minister of State knows it from his own experience and I know it from my teaching and voluntary youth work.

I know the difference a service of support and an individual in a supported setting can make.

The issues I would have seen at second level up to the time I left teaching ten years ago are those that are presenting now at a much younger age. The mental health issues I would have been dealing with at second level are being seen in primary schools now. I am talking particularly about self-harming, suicide ideation, aggressive behaviour, violent behaviour and serious threatening of classmates. That is happening at a time when teachers and principals are snowed under with bureaucracy and endless amounts of paperwork. I would say it is senseless paperwork in many cases in that it is not adding to the quality of the teaching or to the quality of the relationship between the student and the teacher, which is paramount when it comes to mental health issues. It is the principal, the teachers, the guidance counsellor and the chaplain who will be responding to these issues initially, and for quite some time also, while they are waiting on services like CAMHS.

Before speaking on this issue I asked two teacher friends - one at primary level and one at second level - for their reaction to the acronym "CAMHS". From one I was told that the waiting lists are far too long and that CAMHS is more reactive than preventive. They asked what a child needs to do to be guaranteed to see someone in CAMHS in a swift manner. They said that communication with schools leaves a lot to be desired and as the referral is made by the GP the school can be left behind in the paper trail. The other teacher said that CAMHS is very good when the child can be assessed but it looks as if it is over-burdened with every mental health issue. That teacher made the point, which I am aware of also, that there is a gap in services in terms of the hard-to-find services for those between the teenage years and early adulthood. That is the reality.

Another reality is the statistics on the numbers waiting for an appointment. The statistics from August 2018 show 2,453 waiting for an appointment, 169 waiting more than three months, and 313 waiting more than 12 months. Do we have statistics on the presenting issues behind all those figures? I wonder, and perhaps this does happen, if there is a type of triage service that indicates the different levels of urgency behind those particular cases. I acknowledge the target of 72% being seen within 12 weeks.

I saw the report from the National Youth Mental Health Task Force. Its recommendations were sound in looking for a detailed assessment of services and supports currently available to identify gaps and to scope the improvements, but we know about the gaps. Any school or youth project could tell the Minister of State at this moment what those gaps are and can also advise on what exactly is needed.

We hear of the so-called normal mental health issues, and I use that word "normal" very loosely, for young people. We also know the very negative mental health effects on those who are homeless. However, we now have children who are homeless and the normal mental health issues of anxiety and stress are compounded for those young people who are living in hotels and bed and breakfast accommodation. We are shoring up massive problems for CAMHS in the future.

Returning to the point about CAMHS being reactive rather than preventive, I would point to the range of programmes for primary and second levels in the past such as Walk Tall and On My Own Two Feet but they are very relevant today because of the material and the skills they sought to build. I would also point to social, personal and health education, SPHE, and today we are moving into the Wellbeing programme. Those programmes are all worthwhile and effective if the time allocated to them is sacrosanct and the teachers have the skills to deliver them.

I agree with the Wellbeing programme but it must take account of the local area and local issues because there are areas of greater need and greater difficulty. I know what children in the north inner city have been facing, including the violence and the murders they have seen in their community. They see active addiction, people smoking, shooting up and injecting. They see the paraphernalia of drug addiction. Some of them are being intimidated into dealing drugs and some of them have family members who are dealing. Families are being intimidated also over drug debt. The Wellbeing programme must be cognisant of that, recognise the issues in an area or a community and be specific to those areas.

Wellbeing is a preventive programme. I know the demands on the school curriculum. We saw the committee report on relationship and sexuality education the other day but what is needed is a programme in critical thinking that can be applied to any situation or any mental health, relationships or sexuality issue. Wellbeing is also about physical health and physical education and games are important in that respect. None of the preventive measures could help with delays in accessing CAMHS but they could prevent some people having to access CAMHS. The schools and youth projects are picking up the pieces while young people are waiting on CAMHS. They were the youth projects that suffered so many cuts in the past.

Substance abuse service specific to youth, SASSY, is an organisation where children and young people can self refer. Parents and teachers can refer also for those who have addiction issues. I believe we could examine that model and support it even more.

It is about joined-up thinking in terms of mental health issues of young people. I refer to the Departments of Health, Children and Youth Affairs, Justice and Equality, Education and Skills and now Communications, Climate Action and Environment also because of social media.

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