Mark Ward (Dublin Mid West, Sinn Fein) | Oireachtas source

I move:

That Dáil Éireann:

notes that:

— under the United Nations Convention on the Rights of the Child, every child has the right to the highest attainable standard of physical and mental health;

— there were 3,065 children on Child and Adolescent Mental Health Services (CAMHS) waiting lists as of October 2021, including 863 waiting greater than six months and 202 waiting greaqter than 12 months;

— there are particularly long CAMHS waiting lists in Community Healthcare Organisation (CHO) 4 (Kerry, North Cork, North Lee, South Lee, West Cork) and CHO 8 (Laois/Offaly, Longford/Westmeath, Louth/Meath), which accounted for 48 per cent of those waiting in Ireland in March 2021;

— in 2020, 4,905 children referred into CAMHS requiring specialist mental health care were turned away after consultation, with the referrals deemed inappropriate;

— one-in-five consultant psychiatrist posts are vacant or filled on a temporary basis, which results in a large gap in clinical oversight and quality control, with notable resignations over several years due to the unsafe conditions which understaffing has placed patients and staff in;

— there are 9,554 children on Primary Care Psychology waiting lists as of October 2021, including 6,029 waiting greater than six months and 4,272 waiting greater than 12 months;

— over 71,000 children are waiting for life changing treatment, including 19,000 waiting greater than 12 months, across occupational therapy, physiotherapy, ophthalmology, speech and language therapy, dietetics, psychology, and mental health services, which are all vital to the mental health and well-being of children; and

— the World Health Organization recommends that 12-14 per cent of health and social care expenditure is directed towards mental health services and that the agreed Sláintecare minimum target is 10 per cent, yet expenditure on mental health services remains lower than 6 per cent of the healthcare budget, with expenditure on children's mental health services as low as 1 per cent;

further notes:

— the shocking and highly troubling findings of the Maskey Look-back Review into the malpractice and substandard treatment of children under South Kerry CAMHS, which put more than 200 children at significant risk of harm and resulted in significant harm to at least 46 children who were prescribed inappropriate medications without proper follow-up and oversight;

— that the individual who uncovered this malpractice and ensured it was brought to light has since left the Health Service Executive (HSE) and claims to have been undermined and side-lined;

— the Government's commitment to an audit of prescription practices and adherence to clinical guidelines across CAMHS State-wide;

— that more than 50 children were inappropriately placed in adult psychiatric facilities over the last two years; and

— that the outgoing Children's Ombudsman regarded this practice as "lazy" further commenting that "we have let the idea that we do not have the resources in place rule the fact that the best interest of the child is being overrun"; and

calls on the Government to:

— protect our children's mental health and fix our children's mental health services;

— immediately put in place supports for the children and families affected by the malpractice in South Kerry CAMHS;

— broaden the CAMHS review to include capacity deficiencies and geographic inequalities, to examine whether persistent consultant vacancies have contributed to substandard care, and to review the excessive amount of referrals which are deemed inappropriate;

— immediately conduct a review, to be published, into the treatment of the South Kerry CAMHS whistleblower and the circumstances around their change in duties which led to their resignation from the service;

— tackle extreme waiting lists and clinical oversight deficiencies in children and adolescent health services by addressing the two-tier consultant contract issues which prevent the filling of consultant vacancies;

— put in place a proactive strategy for the recruitment and retention of psychologists across CAMHS;

— immediately re-appoint a National Director of Mental Health in the HSE;

— legislate to end the practice of placing children into adult psychiatric facilities;

— deliver 24/7 access to mental health services and a consistent 7-day week outpatient model for CAMHS; and

— set out a plan for achieving a minimum of 10 per cent of healthcare expenditure being directed to mental health services as agreed under Sláintecare.

We need to fix our children's mental health services to protect our children. The shocking report into malpractice and the substandard treatment of children in south Kerry's Child and Adolescent Mental Health Service, CAMHS, found that more than 200 children were put at significant risk of harm. At least 46 children were prescribed inappropriate medication without proper governance and suffered significant harm.

You only have to listen to the heartbreaking testimony of parents whose kids were wrongly medicated about how they lost their personalities and their smiles.

The first thing the Government must do is immediately put in place supports for children and families effected by the malpractice in south Kerry. It needs to put in place a comprehensive care plan so that these children can get back on the road to recovery and be given the chance to reach their full potential.

Public confidence in youth mental health is at an all-time low. The Government has announced an audit of all CAMHS services across the State. I called for that audit to be carried out last April but my call fell on deaf ears. The Government has wasted eight months. The national audit must have independent oversight and it needs to be broadened. It must look at how twin deficiencies in staffing and working conditions, especially the lack of supporting multidisciplinary teams and the two-tier consultant contract, have contributed to substandard care and to vacancies across CAMHS. The audit must also answer why over 3,000 children are on waiting lists for CAMHS services, including 200 children who have been waiting for more than a year. It must answer why the quality of treatment available to a child is based on where they live and why some CHO areas are performing better than others.

In 2020, almost 5,000 referrals to CAMHS by medical experts were deemed inappropriate. What happened to those 5,000 children? I have been inundated with messages from people across the State this week who have concerns about CAMHS and who feel they have been let down by the service. One young person contacted me to say that someone is finally doing something about it. They stated that they had waited three years to start their healing and then they was rejected by CAMHS because they was not taken seriously enough or believed. They said that they were not listened to and were pushed too far. They thought the only way out of was to take their life which they attempted. They wound up in hospital and only then were they diagnosed and put on another waiting list.

That is the real life experience of a young person who was deemed inappropriate for CAMHS. It is not just CAMHS that is failing children. The failure is right across children's healthcare. At the moment, more than 9,000 children are on primary care psychology lists, of whom 4,000 have been waiting more than a year. Early intervention is key. We all know that if some of these children had got the care they needed when they needed it, it would take the pressure off CAMHS for more acute cases. There are also 71,000 children waiting for life-changing treatment including 19,000 children who have been waiting for more than 12 months for services such as occupational therapy, physiotherapy and speech and language therapy. We can all get bogged down in statistics but behind each figure is a child with dreams and ambitions who has family and friends who are impacted by the lack of care being given to that child. It is a child who has a right to be given every chance in life to reach their full potential. Successive Governments have failed these children. I have no doubt that in her response, the Minister of State will mention the amount of money that has been spent on mental health but it is not enough. It is still way behind best international practice, which recommends that 12% to 14% of the overall health budget should be spent on mental health. Sláintecare recommends a minimum of 10%. Currently, the Government is spending less than 5.5%. The Ombudsman for Children told the joint sub-committee that children's mental health is 1%. That is nowhere near good enough.

There is very little accountability for governance at the top of the HSE. That is why Sinn Féin has consistently called for the reinstatement of the office of the national director for mental health. I welcome that the Minister of State has added her voice to this call but she needs to make sure that this happens. She should be running the show and calling the shots, not the HSE.

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