Gary Gannon (Dublin Central, Social Democrats) | Oireachtas source

I cannot help but despair when listening to this debate. It is a year to the day since the publication of the Maskey review into South Kerry CAMHS and the situation remains dire. Vulnerable children are being utterly failed on this Government's watch and the Minister’s colleagues’ chorus of concern is of little help. I note in particular that the Taoiseach and Tánaiste described the report as "concerning" and "unacceptable". I would agree, but it is almost like they are surprised. We would be forgiven for forgetting that both are former Ministers for Health.

This Government is just playing to the gallery. They have known about this crisis for years. How many more children have to suffer because of Government inaction, which the Minister today described as “unacceptable”? How many more reports do they need before they take meaningful action? This is a service which treats some of the most vulnerable children in our society but it remains poorly resourced. It is a postcode lottery, and if you find yourself in the wrong CHO area, your child could languish on a waiting list for months, even years, or become one of those "lost" cases.

Is there a more harrowing description than a “lost” case? These "lost" cases were cited in this week's damning report and they are particularly concerning. These are children and young adults with open cases who have been lost to follow-up. In some cases, children who should have had follow-up appointments for review of prescriptions or monitoring of medication did not have an appointment for two years. As if that was not bad enough, we also know that when some young people reach their 18th birthday, even if they have not completed the leaving certificate, they simply fall off a cliff. There is no planning, no discharge and no transition to adult services, and no advice about medication, simply abandonment.

This brings me to a related issue which impacts the whole health service but the crisis in CAMHS has brought it into sharp focus. That is our IT infrastructure, or the lack thereof. Yesterday, officials from the Department of Health appeared before the Committee on Health regarding electronic records, and they did not inspire much confidence. The e-heaIth strategy is now eight years old yet we heard that the project is "only at the starting line". That is scandalous. How are we still talking about starting lines eight years later? Why are we so far off course? We will never make progress on integrated care without the implementation of electronic records. In fact, why are we talking about the implementation of electronic records in 2023?

The Government’s failure to modernise our IT infrastructure has major implications for CAMHS. The interim report revealed that four out of the five CHOs visited used paper-based files. The report said these paper-based clinical files were frequently disordered, incomplete, sometimes illegible and devoid of logical filing systems. In 2023, it is completely unacceptable that most CAMHS teams are still reliant on paper and pen. Aside from making us an outlier internationally and a joke by any sort of modern metric, this outdated system of filing makes it difficult, if not impossible, to follow the care and treatment pathways delivered by CAMHS. This may seem like a peripheral issue in the grand scheme of things but it is at the very heart of the problem.

Another factor in this crisis is a lack of accountability and local decision making. The centralised nature of the HSE is totally flawed. When scandals come to light, everyone is to blame but, most importantly, nobody is held responsible. Last year, we learned that a junior doctor was effectively running CAMHS on his own in south Kerry, with little or no supervision. That junior doctor should not have been scapegoated for the entire scandal. There has to be accountability for this stunning failure of the senior management and those with ministerial responsibility, but without serious restructuring of the HSE, that will never happen.

We are still waiting for the Minister for Health to implement the new regional HSE structures mandated by Sláintecare. Under those reformed structures, there would be legally enforceable accountability among senior management teams for failures in clinical care.

This radical restructuring will completely shift the balance of power in the HSE, devolving power to local regional bodies. Aside from the clear benefits in accountability, it will provide for more patient-focused services and improved health outcomes, something desperately needed not just in CAMHS but across the entire health service. This is a key recommendation in the Sláintecare report but, like so much of the plan, implementation is proceeding at a snail’s pace or still at the starting line. As we have seen with countless reports, it is a case of all talk and no follow-through.

It is 17 years since A Vision for Change was published. This report detailed a number of deficiencies in youth mental health services, yet the system remains in disarray. As matters stand, staffing equates to just 56% of what was outlined under A Vision for Change guidance on staffing levels. That is a shameful indictment of successive Governments. This chronic understaffing of CAMHS is having a detrimental impact on the mental health of so many children. It is time the Government stopped wringing its hands about dysfunction in CAMHS and did something about it.

As well as seriously scaling up recruitment, the Department and HSE need to engage in proper workforce planning and move away from centralised recruitment. Due to this model, local services have serious difficulty hiring the staff they need at the time they need them. These measures should have been taken years ago. I urge the Minister to immediately progress them to address this historical and horrific understaffing.

While I welcome the announcement that a national clinical lead for youth mental health will be appointed, this process, which was promised in budget 2023, must be a prioritised. It essential that the recruitment process beings immediately. However, this is not the only new appointment needed. There has been no national director for mental health since 2016. The Government committed to reinstating this post in the programme for Government but I have yet to see proof of any progress beyond that.

Ultimately, we need to know that the Minister has the political will to overhaul mental health services. Behind every CAMHS waiting list figure is a child in need and a child who is being left behind. Almost 600 children were waiting over a year for a CAMHS appointment last November, an increase of 168% since June 2020. I appreciate that Covid-19 has exacerbated the problem but the need is great and the will must match it. We should be treating mental health just like physical health and not allowing conditions to worsen to a point where emergency interventions are needed more often. On every level it makes sense to fund these services.

This chronic under-investment cannot continue. Our piecemeal system needs root and branch reform because too many children are falling between the cracks. This resistance to change has to stop. The children who are being failed by CAMHS will not get their childhoods back. The Mental Health Commission's report may have been interim but the Minister’s response must be immediate.

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