Mary Butler (Waterford, Fianna Fail) | Oireachtas source

I thank Deputies for their constructive contributions, of which there were 51. It has been an excellent debate from that point of view. Fifty-one Deputies, which is a lot, came to speak about the important issue of youth mental health. I have listened closely to what has been said and taken copious notes. I will continue to work closely with all sides of the House to ensure developments and improvements in the delivery of our child and youth mental health services.

As I have indicated many times since becoming Minister of State, protecting the mental health of all our population, including young people, has never been more critical. To achieve this and effectively meet the mental health needs of all children and young people, fundamental reforms are needed in many areas of mental health service delivery. Unfortunately, the report published today shows that, despite the progress of recent years, our services failed our children and young people in Kerry, with serious impacts on them, their families and their communities. My thoughts are with those children, young people and their families. Through hearing each of the Deputies' contributions, I know that they all feel for these families, too.

The systematic failings in the young people's care is devastating and unacceptable. All measures will be taken to ensure that such an extreme failure, which occurred at multiple levels of the system over a protracted period, does not happen again. I take this opportunity to stress once again that any young person who has concerns should seek help without delay. Our wide range of care services provide help. They make a real difference to many young people day in and day out.

A couple of Deputies raised an issue concerning the 35 recommendations. I read the report on Sunday evening. I received a copy of it at around 6 o'clock that evening. I read the full report again on Monday and then read all of the subsequent shorter versions. There are 35 recommendations. To update the House, six of the recommendations are complete, 13 are in progress and 16 have yet to commence. Some of them are longer-term recommendations, for example, whether children and young people who receive support for mental illness should be able to remain in CAMHS up until 25 years of age as is the case with Jigsaw. The national implementation monitoring committee has put in place a sub-committee on CAMHS and this is one matter that we are examining. I am not convinced that it should be 25 years. We should look at all ages - 21, 23 and 25 years.

I am open to persuasion but I believe that for a young person of 18 who might be in the care of CAMHS for five or six years, at a time when they may be going on to college or doing their leaving certificate, the transfer over is very traumatic. At those ages, 18, 19 and 20, I would like to see people have the option of being able to stay within CAMHS. That is where we are in that regard.

Several people raised my call for the reinstatement of a HSE national director for mental health, in line with our programme for Government. This post is essential in driving the fundamental reforms needed across our mental health service, not least in our child and youth mental health services. To be frank and honest, to date I have been unsuccessful in reinstating this post, but I do have the support of the Minister, Deputy Donnelly, and the Taoiseach - I discussed the matter with them again last night - and I welcome that, across the House, everybody seems to be in agreement. I would appreciate any support Members can give me on this and in raising the issue. It is extremely important at a time when "mental health" has been probably one of the terms most used during the pandemic apart from the word "vaccine". I think "mental health" might have been the second most used words, especially in respect of young people. Having a national director for mental health would send out a clear signal, and now is the best time for us to do that.

I will not be able to touch on all the matters raised but I will try to touch on some of them. Eating disorders come up constantly. Our clinical programme for eating disorders was launched in 2018, but the rise in cases in recent years has been very significant, so I have put more funding into treatment of eating disorders in the past two years than any other clinical programme. By the end of this year we should have ten teams in place. We started from a very low base of three teams. I will not say there is no issue with recruitment because there is, but the funding is there and the posts are funded, and that is the important thing.

As for bed capacity for young people, we have Éist Linn, in Cork, where we have 16 beds; Merlin Park, in Galway, where we have 20 beds; Linn Dara, in west Dublin, where we have 24 beds, including two high observation beds; and St. Joseph's, Fairview, where we have 12 beds. I have visited all those locations. We therefore have 70 beds plus two high observation beds. In fairness, a lot of those beds are specifically for young people with eating disorders.

One of the issues that was raised quite a bit - Deputy Dillon raises it with me constantly - was the pathfinder project. The implementation of the project is a priority for me and I will continue to keep the matter under close review. It has stalled over the past few years because of Covid, but now is a really good time to put the pressure on. There is quite a bit involved with it because it comes under the Department of Health, the Department of Education and the Department of Children, Equality, Disability, Integration and Youth. Coupled with that, there is a significant budget involved, and significant administration, governance and legal arrangements will have to be put in place. You have to start someplace, however. In light of so many calls for the pathfinder project to be put in place, I think now is a really good time to start working on it.

As for the mental health legislation, about which a couple of issues were raised, no legislation, when it starts out, is perfect. That is why it goes for pre-legislative scrutiny and that is why that legislation will come before the Dáil, the Seanad and the committee and amendments will be tabled. I will be open to any amendments. This legislation is a long time in the making. I am delighted to say that, under the Office of the Attorney General, last week two drafters were put in place to draft the legislation. It is a priority of mine. It is unlikely I will get it in before Easter, but it will certainly be in in the next term. A huge amount of work is going into it.

I know that the issue of the admission of young people was raised in the health committee during the week. Sometimes you could have a male aged 17 and a half who might be suffering from psychosis. We had a case of a person up in Donegal, a very rural county. For his own safety, it was decided he would be admitted to an adult facility for 24 hours because he needed to sleep. Then he was brought to Merlin Park. Sometimes such clinical decisions are made because you cannot have an inpatient facility everywhere. We do have 56 departments of psychiatry throughout the country. We have four inpatient units for our under-18s. Sometimes, not always, there are capacity issues and the decision is taken purely from a medical or clinical point of view by the consultant psychiatrist. My fear is that if we close the gap completely, it might have a detrimental effect on people. I do not want to see any child, teenager or young person go into an adult mental health facility. I am happy we are going in the right direction. If, however, I were to be asked whether I could stand here and say that no young person or adolescent will ever be admitted into an adult mental health facility again, at the moment I could not say "no". I am not a clinician or a consultant psychiatrist. When a psychiatrist takes such a decision, I am not in a position to overrule that because it is done in the best interest of the patient. We will tease that out when the time comes and discuss it at the committee. We can discuss all that. A lot of work is being done on this.

Today has been something of a watershed as we have learned of the failures down in Kerry, and everybody is very upset and distressed, but this was a really good debate. Members were very respectful and open and they have all had their say. I have listened intently and I am happy to discuss any of the issues again.

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