Duncan Smith (Dublin Fingal, Labour) | Oireachtas source

I commend the motion. I also commend Deputy Ward, in particular, for his ongoing work in this area. He certainly does not just pop up when issues hit the news. He consistently raises the need for improvements to mental health services. Fair play to him.

Referrals to child and adolescent mental health services in Ireland increased by more than 40%, from approximately 12,800 in 2011 to 18,100 in 2019. Unfortunately, our services have not increased to match that. At any time, more than 3,000 children and young people are on waiting lists for CAMHS. The Minister of State with responsibility for mental health and older people confirmed that of the 18,000 children expected to be referred to CAMHS in 2020, only 11,000 were expected to be seen. That means we were unable to reach 7,000 people who were referred in 2020, a time when the pandemic hit and we all knew and could see the impact on young people and their mental health was becoming more severe and profound.

In replies I and my colleagues have received to parliamentary questions, the HSE has stated that waiting lists are due to a lack of availability of specialist CAMHS clinicians. Current vacancies and difficulties in recruiting in an international context can impact on waiting times in various areas. This is the root of it and we cannot get proper answers to the issue. Why are we unable to hire and retain clinicians at all levels in our psychiatric services to ensure we have a functioning service? Why are vacancies unfilled not only for months but sometimes for years? As I have asked in other parliamentary questions, why do we have competitions and interview panels for roles for which no one is successful, which means the HSE has to re-advertise the role? This is the fundamental question that needs to be answered and addressed. We all know many people who entered third level to study nursing, medicine or some sort of care degree. We have a vibrant third level sector in this area. Where are our graduates going? Are they staying in the service or are they leaving? If they are leaving, why are they leaving? Is it down to the cost of housing, the cost of living or the wages and salaries in our health service? Is it down to the work practices in our health service or a lack of confidence in our CAMHS? Do people who qualify and desperately want to work in mental health decide they will not work in CAMHS because they know what it is like? Perhaps those people think that some CAMHS are working and others are not but they are not going to be able to practise the type of clinical mental health service they want to practise in an Irish context. These are the fundamental questions. The answers can be painful for the institutions of our country, the Government, the HSE and our third level institutions but those questions need to be answered.

Having all these vacancies, year after year, is leading to these waiting lists. It means that children and young adolescents are left bereft of the support they need. We really need to get serious about recruitment and retention. We cannot just throw it out there. We need to get to the root of the problem. We need real answers to parliamentary questions. We need honesty from the Government and once we have that, we can look at the reasons. We feel we know the reasons but where are the numbers? Where are our graduates going? How many people are leaving midstream? How many are leaving because they are not getting the promotions they need? How many are leaving because they are whistleblowers? They may not have come to the Government, Opposition Deputies or their local politicians but may have gone to managers and been told to go away, that there is nothing to see here. We need the answers to these questions.

Most CAMHS still operate Monday to Friday, 9 a.m. to 5 p.m. or 5.30 p.m. That is outdated and must end. The only people who receive 24-7 mental healthcare in this country are the most profound, severe cases of young people who are being treated in the few inpatient residential beds we have. We do not want to see our young people having to be treated in long-stay inpatient residential care but some are there because they have to be. Some are there because they did not have early intervention care. They have been on waiting lists too long and their mental health has deteriorated because they have not received the care to which they are entitled, need and have asked for. We touched on this issue when we heard statements on young people's mental health in the Chamber last week. Part of the reason we have more presentations is not because people's mental health is worse now than it was ten or 20 years ago. It is because people are talking about it more and have the confidence to say to their parents, peer group or whoever it may be that they are struggling and need help. That is to be commended. However, if we keep going the way we are, with waiting lists like this and situations like the one that happened in south Kerry CAMHS, people will be less inclined to come forward. They will keep their problems to themselves because they cannot face being left outside and not getting the care they require or, worst of all, they cannot face opening themselves up, exposing their vulnerability and asking to be cared for only to get poor care that is ultimately going to damage them. That is why this is such a chronic failure. These young people got into the system. They were supposed to be cared for and were not. They were supposed to get the treatment they deserved and was their right but they did not.

Parents and carers were, and are, second guessing whether they can engage with the services now, debating whether they have the trust in the services. They must have that trust. We need to make it clear that advocacy on behalf of young people with mental health issues is more important than ever. Parents and carers need to have confidence. They must know that if they get their children into the service, they can ask every question under the sun of the person who is giving that care. It does not matter how senior the consultant or doctor. They must ask questions about medication and get second opinions. No question is too stupid; every one is vitally important. We need now, unfortunately, to hold to account all our professionals in this area. The days of blind trust in our medical professionals are gone because of cases such as the one in south Kerry CAMHS. It should not have to be that way but it is.

The Minister of State last week voiced her support for a national director of mental health. I would like to know if any progress has been made. What has the Minister said, if the Minister of State has had any conversations with him? Is he back from his trip and has the Minister of State put this issue to him? If we had a national director of mental health, it would not help every person going through the system or trying to get into the system at the moment but it would be a statement of intent from this Government as to how important are our mental health services. I believe the Minister of State in that regard. She speaks with real integrity and passion on the issue and I believe her when she says she wants such a role. She is the Minister of State with responsibility for mental health.

If this does not happen, we need to know why. If we get this role in place, we will have a figurehead and we can drive on and deliver the cultural and systemic change we need in our child and adult mental health services. I commend the motion again and thank Deputy Ward.

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