Catherine Connolly (Galway West, Independent) | Oireachtas source

I thank the Minister of State, who is accepting that. I will not waste my time praising the Minister of State, Deputy Butler, but it is beyond endurance that the senior Minister is not here.

I thank Sinn Féin for using its Private Members' time but I asked the Government to put it on the agenda. This report has implications for all of the CAMHS throughout the country and if we cannot see fit to discuss that, of itself, as a subject, and to look at the findings of this report and see what we are learning from it, as I stated on the previous occasion, we might as well resign.

I have only been here since 2016 and I have been given to serious moments of despair, not at the problems we face but at our failure to take action, and report after report. I am old enough to know about Planning for the Future, which was in the 1980s. Then we had A Vision for Change and then Sharing the Vision. Of course, we had the update on the legislation. All of the time, we have the most serious difficulties on the ground.

The Minister of State might update us tonight on the monitoring because I never had any faith, even in myself not to mention all other politicians, in the implementation of reports. That is why we need an independent outside organisation to monitor and tell us about Sharing the Vision. I am still stuck with A Vision for Change because to me it was a perfect document. Where the imperfection came was in the failure to implement it. As I said, the implementation body sat for two to tree years and then was disbanded; it did such a good job. Hopefully, this implementation body will do the same.

I looked to the Mental Health Commission to see what it said. In 2017, it expressed concerns about CAMHS in inpatient units. The commission has regulatory power over that. It also pointed out that CAMHS has had to provide services for mild and moderate mental distress due to the lack of primary care psychology facilities. Of course, a primary care strategy was rolled out 20 years ago but never implemented. It would have taken some of the pressure off. Children are inappropriately being referred to the CAMHS units and then, when they are there, amongst many other things, they are being inappropriately treated.

While I have a few minutes, I will go back to the report's findings. I have difficulty with the words "essentially independent", but the effects were so bad that they transcend my problems with "essentially independent". I have no idea why the following statement of finding is included, "No extreme or catastrophic harm had occurred in the 1,332 cases considered between July ... and April". This is catastrophic harm, as set out at findings 2, 3 and 4, but yet we are being told that. To me, that is Health Service Executive speak. I have never seen it in it. The Health Service Executive was instrumental in producing this report, notwithstanding the sterling work of the independent chair.

The report goes on to tell us that:

227 children managed by ... [a non-consultant doctor] where the diagnosis and/or treatment exposed them to the risk of significant harm by way of one or more of the following: sedation, emotional and cognitive blunting, growth disturbance and serious weight changes, metabolic and endocrine disturbance, and psychological distress. ...

3. 13 other children were found to have been unnecessarily exposed to a risk of harm under the care of other doctors in the service.

4. There was clear evidence of significant harm [but they feel obliged to tell us it was not catastrophic] ... to 46 children in the files that were reviewed.

They gave out a list of them and various things have been said.

That is a review following an internal audit. I am not sure why the triggers did not take off at that point to do an audit of all the CAMHS throughout the country, both community and inpatient services. Surely that would have been an obvious thing to do.

If we look at that report - I will work backwards in the time I have - we see three consultants left in the past year. This independent review tells us, "It is of concern that we have learnt that three consultants in the County MHS Area A have tended their resignation in the last year."

I had so many points marked out to go through methodically but I will not get the chance to do that. A governance group was set up in 2019. They raised concerns. Concerns were raised as long ago as 2016. There was diagnostic concerns and treatment concerns. There was the role of the private agencies in providing temporary doctors. There were family queries. The very concerned families did their best to raise their concerns, and were ignored. Phone calls were ignored etc. All that is set out. The maximum risk was set out, when they did a risk assessment, in relation to the vacancy. The risk was 25 out of 25.

What jumps out at me here is that there were good staff on the ground, who tried to bring concerns to the attention of management and nothing was acted on. We have one specific whistleblower and I would like the Minister of State to tell me tonight what review has been done in relation to how he was treated. If we are utterly reliant on a whistleblower, be it he or she, and we treat him or her so badly, it is impossible to have faith in the system.

I have to say publicly I am not one bit impressed with the comments from the CEO of the Health Service Executive in relation to this matter. National managers were aware that there were problems in south Kerry. That means the CEO, Mr. Reid, had to be aware as well. If he was not, then he should be asking how he is not being alerted to it. Then we have a Minister of State being repeatedly sent in here to face all of this. It is totally unacceptable to deal with us like that.

In relation to the language being used, there is a particular method that they use - I forget the four letters of it. The independent chairperson finds useful the analogy of traffic congestion and cars being backed up on a road and on a motorway in relation to the analysis of clinical cases and a backlog with clinical cases. I picked that out specifically because, to me, that is what has happened with language. Language, when I look at this and all of the governance documents, means nothing.

When a courageous person comes forward, his or her life is made a misery. I had the privilege in a previous life of working as a psychologist for the health board, and I must say, the service even in the bad times was 40 times better because at least language used to mean something.

Let us turn to the Mental Health Commission and the themed reports produced by Dr. Finnerty. I understand she is now undertaking an examination of south Kerry as well. She has repeatedly highlighted for all Deputies to see the difficulties in respect of mental health generally, and specifically in regard to Covid, the badly designed buildings about which we need to take action as a Dáil. In regard to mental health and the drugs that are prescribed, the physical health of the person suffering from mental health issues is utterly neglected. She has highlighted year after year in themed reports that physical health is utterly neglected and that people suffering from mental health problems die 15 to 20 years before their time. Year after year, this has been pointed out to us. I do not blame the Ministers of State. My point is we know all this information, so my sense of frustration is intensified with each session of statements in the House. I thank Sinn Féin for tabling this debate but it should be the Ministers of State, or the Minister for Health, laying out this report before us and inviting us to examine what will happen as a result of it, as opposed to us being grateful to Sinn Féin for using its Private Members' time for it.

How many draft reports are sitting in the various offices of Tusla and the Health Service Executive throughout the country as we speak, where whistleblowers have bravely come forward, a report has been produced and the word "draft" remains on it ad nauseam? Are the Ministers of State aware of how many there are? If they could check, that would be helpful. I refer to brave and courageous people coming forward, some of them managers and others doctors and nurses. They go to all this trouble and then the draft report remains with Tusla at its board or somewhere within the HSE, and Ministers of State have to come to the House and face the fire, as opposed to there being a proactive system that highlights problems and learns from them, not in a punitive fashion but before we get to the punitive stage. Someone should be held responsible for this.

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