Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

Go raibh maith agat a Cheann Comhairle and I am sharing time with the Minister of State, Deputy Butler. The Mental Health Commission's interim report is an important contribution to our objective of providing timely high-quality child and adolescent mental health services, CAMHS. The focus on service quality and patient safety is vital in developing and improving services. Following the Maskey report early last year, the Minister of State, Deputy Butler, contacted the Mental Health Commission to ask it if it would consider conducting a review such as this into CAMHS services. The Mental Health Commission is independent and ultimately chooses what it wants and both the Minister of State and I were glad that they decided to focus on CAMHS this year. The findings in this interim report are significant. The report makes for very sober reading and is being treated as a priority by the Minister of State, Deputy Butler, and me, by the Government, by the Department of Health and by the HSE.

The findings in the interim report are significant. It makes for very sober reading and is being treated as a priority by the Minister of State, Deputy Butler, and I, as well as the Government, the Department of Health and the HSE. The findings identify issues that are simply not acceptable to me, nor are they acceptable to our healthcare professionals providing these services. Many of the issues raised are being responded to by the HSE, and the Minister of State and I are engaging with the HSE and the Department of Health on what additional actions are warranted on the back of these findings. We are also hearing from front-line clinicians, from excellent groups such as Mental Health Reform, which are here with us this evening, and from professional bodies.

The report is one of several important pieces of work under way. These include an improvement plan, addressing issues identified in the Maskey report, many of which have been highlighted in the interim report. There is an audit ongoing on adherence to the agreed 2019 national guidelines. There is an audit on prescribing practices. There is a listening exercise, which is very important, that is focused on engaging directly with service users and their families. A look-back review into cases in north Kerry is being commenced and, critically, the HSE is commencing a review of all open child and adolescent cases that have not been monitored for six months or more. One of the issues highlighted in the interim report is the need for such a review. In fact, it was one of the main asks of the Mental Health Commission, and the HSE has immediately agreed to do that and is undertaking it. The HSE estimates there to be approximately 4,000 such cases. The interim report references 168 cases. The HSE has engaged with 140 of those already and is looking at the remaining 28 cases. I also look forward to the final report, which will come out later this year. Coupled with new national leadership positions in CAMHS, and guided by the national strategy for mental health, Sharing the Vision, these different areas of review are informing what additional actions are required to achieve what we all want which is consistently high-quality and accessible mental health services for young people.

As the programme for Government outlines, we are committed to a high-quality, safe and compassionate mental health service for children, women and men. In addition to ongoing and increased funding for mental health services, a focus on service improvement and reform is essential. It is important to say that in spite of the challenges we are discussing this evening, good progress is being made on many fronts, and the Minister of State, deserves great credit for her ongoing work and championing of changes and improvements that patients need to see.

I fully empathise with young people and their families who may be worried about receiving the care they deserve. This came to the fore with the publication of the Maskey report and was highlighted again this week. I thank Dr. Susan Finnerty and her team for their valuable contribution so far in both the interim report and final report that will come. I also recognise the important and good work done by CAMHS teams across the country. I thank them for their ongoing commitment to young people and their families. It is important to emphasise that many young people experience a positive outcome with the support of CAMHS.

It is important for us to reflect that the interim report quite rightly calls out the things that need to change, but it also makes important points about what is working. It states that 225,000 appointments took place last year under these services. Some 21,000 young people are being supported by CAMHS. Critically, the interim report states that many young people, and their families, have received "excellent care and treatment" and we must keep that in mind.

To the credit of the 73 CAMHS teams nationally, they have turned additional funding and supports from the Government into a 21% increase in the number of new patients being seen. Let us think about that for a second. In spite of all the challenges and difficulties that Covid caused for patients, their families and service providers, our CAMHS teams increased the number of new people being seen by 21% and that must be acknowledged. The problem is that demand for services rose by 33% during the same period. There is no health service in Ireland, and I dare say very few anywhere, that could absorb a 33% increase in demand in a short period and not come under significant pressure. It would not be any different with our CAMHS services.

While the work and reviews are ongoing, we must ensure that people are receiving appropriate care today. Acknowledging the serious concerns raised in the report, I remind all those using CAMHS, and their families, that HSE Live is available to support children, young people and families with concerns arising from the interim report. The telephone number is 1800 700 700 and lines are open Monday to Friday from 8 a.m. to 8 p.m. and Saturday to Sunday from 9 a.m. to 5 p.m.

What of the overall direction for mental health and youth mental health services? The HSE is essential in implementing the recommendations of Sharing the Vision and it sits on the national implementation monitoring committee for the implementation of the 100 policy recommendations. Progress is being made on the implementation plan. Sharing the Vision aims to enhance mental health services and supports up to 2030, from mental health promotion, prevention, and early intervention to acute and specialist mental health service. With improved links to youth mental health services in the widest sense, CAMHS is crucial to Sharing the Vision. As of the third quarter of 2022, some 88 of the 100 actions are in implementation stage, with 57 marked on track. I have no doubt we would all love to have the 100 actions marked as on track, but we must bear in mind that our health services providers, the people tasked with doing this, have been dealing with the most difficult health care crisis in 100 years at the same time. We must bear that in mind when we look at the level of implementation.

I acknowledge the broad support, co-operation and balanced understanding always shown in this House in respect of these policies and the support for Sharing the Vision. Funding is essential. Budget 2022 provided €1.149 billion for mental health, including specific funding to enhance CAMHS. It allowed for the provision of two new CAMHS telehubs and a dedicated €6 million to expand capacity within the community mental health teams. Further investment was made last year in the national clinical mental health programmes and new models of care, many of which benefit young people directly. One example is the national clinical programme on eating disorders. An additional €1.15 million was secured enabling the development of three new specialist eating disorder teams, bringing the total number of teams funded to nine. There are four fully-operational teams now and the other five are nearing full recruitment, expecting to be fully operational early this year. It is a very important and welcome development that has come about because of the political prioritisation from the Minister of State. The CAMHS eating disorder teams are operational in community healthcare organisations, CHOs, 4 and 7 with recruitment well under way in CHOs 2 and 9.

Another programme was the CAMHS intellectual disability model of service, which the Minister of State, Deputy Butler, launched last September. It was developed to enhance services for those with intellectual disability, advancing the development of specialist mental health services and standardising the care. Currently, there are 38 mental health intellectual disability staff working across five CHOs. That work is ongoing and is very important. I know from talking to service users and parents, that pathway is not fully there many people. If there is a combination of mental health and intellectual disability issues, the model of care is meant to be very clear and laid out. However, it is not being properly or fully implemented in all areas, and it is something we are looking at.

Funding in 2022 also included €10 million for mental health services relating to Covid. Our service providers kept 90% of the services going during the Covid pandemic, which was good to see.

This year, the Minister of State secured an extra €57 million in core funding for mental health bringing the total budget to €1.2 billion. That is an increase of almost €200 million.

We need to promote quality and safety in light of increasing demand and case complexity. It includes more integrated care between CAMHS and primary care and disability services, which is so important. Yes, we need to focus on CAMHS. There are many excellent things happening in it but there are also many serious issues that have been identified in this and other reports. However, we really need to be talking about youth mental health, of which CAMHS is one part. We have primary care psychology and amazing community-based teams like Jigsaw and others and we need to maximise prevention, early intervention, low-complexity treatment where that is appropriate and make sure CAMHS is available for all those who need it. We are not there yet and because of that, there are referrals to CAMHS that would be better suited to fully functioning primary care psychology services and other community-based services as well.

However, an extra 500 people are working in mental health services since the Government took office. There is a workforce of 10,500 healthcare professionals and 97% of those roles are filled. The Minister of State is working with the HSE on the remaining 320. We have 73 CAMHS teams with clinical governance from 80 psychiatrists. Very substantial resources are in place.

The report is entirely on the money with regard to ICT systems. It is not good enough that community services across the country, not just mental health services, are still using paper files instead of IT systems. It is something we are prioritising and we need to roll that out quickly.

Two new roles are coming in to which the Minister of State will speak. One is a clinical leadership role while the other is an administrator of leadership role to make sure the changes that need to happen are championed and co-ordinated with broader healthcare supports in hospitals and the community.

I will finish where I started, which is by acknowledging the work of the Mental Health Commission and the very serious nature of the issues it has raised. They are issues the Minister of State sought to have raised. It is one important piece of work in several reviews that are ongoing to make we have the best possible services.

We get into very robust debates in this House, as we should. I was in the Seanad earlier. Some of the language used would lead one to believe there is not a nurse, doctor or health and social care professional in the country providing a decent service to any patient. Some of the language was around total systems failure, which we know is not true and it is not true of CAMHS either. A lot of people will be watching this debate. A total of 21,000 young people use CAMHS. Can we bear that in mind and bear in mind that the interim report explicitly states that many people are receiving excellent care and treatment as we discuss this over the next few hours?

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