Marc Ó Cathasaigh (Waterford, Green Party) | Oireachtas source

In common with probably every Deputy in the House, I have a reading list as long as my arm and I wish I had more time to devote to reading what comes across my desk every day. While this report does not strictly fall within my bailiwick as a party spokesperson, I felt compelled to read it. When I started reading the report I had to get to the end of it and having read through it, I felt compelled to speak on it. If it is a difficult read for me, I can only imagine how difficult it is to read for somebody who is working in CAMHS and experiencing the burnout referred to in the report and being burdened with overwork. I can only imagine how it must be to read it as the parent of a child who is struggling to access services.

I note that Mental Health Reform in its briefing note, for which I am very grateful, described the Mental Health Commission’s interim report into CAMHS as a damning indictment of a deepening crisis in our mental health services. It is difficult to read the report in any other way. I acknowledge the Minister's comment that the contents of the report are unacceptable.

Article 24 of the UN Convention on the Rights of the Child, which we ratified in 1992, states that all children have the right to enjoy the highest attainable standard of physical and mental health. We often hear trotted out on the floor of Dáil a famous line from the 1916 Proclamation which commits us to cherish “all the children of the nation equally”. Are we living up to the standard of that foundational document set out over a century ago?

We are seeing in this report that children with mental health difficulties are essentially prisoners of geography unless their parents have the means to transcend that geography and step outside the public system. The Minister was careful to say that we have to acknowledge that much of the care received by children in CAMHS is very good, and that is also acknowledged in the report. However, it should not be the case that the standard of care received should depend on where people live or how deep their pockets are. That is not vindicating our commitment under Article 24 or cherishing all of the children of the nation equally.

As I said, the report makes for difficult reading and demands a Government response. The Minister and the Minister of State, Deputy Butler, set out in detail some of what is being done to tackle the issue. I also acknowledge that the report is a result of research commissioned by the Minister of State, Deputy Butler, to get a better understanding of what we need to do. The very fact that the Inspector of Mental Health Services, Dr. Susan Finnerty, felt she had to issue an interim report is a measure of how seriously and urgently she views the situation.

As I said, it is important to acknowledge the work of the 770 people who are working in CAMHS and how difficult this report must have been for them to read. I know each and every one of them strives to provide the best possible service to the people in his or her care. It must feel like the task of Sisyphus for them every day when they go back into work and the boulder, again, is at the bottom of the hill.

I also acknowledge that 21,000 children are accessing CAMHS and also Dr. Finnerty's explicit statement that, for the most part, the quality of care received by those children is excellent. That is also important. We must highlight the deficiencies and prioritise those areas in which we can drive improvement but we should depict the service as a complete failure. That would not be an accurate picture.

The Government and Oireachtas have an obligation not just to identify the problem but to begin to set out solutions as we see them. As Deputy Gannon and other Deputies noted, we have to look at workforce planning and benchmark the staffing levels we require within CAMHS. We know this cannot be solved immediately but we need to do so in the medium term. There is a role for the Department of Further and Higher Education, Research, Innovation and Science in ensuring we deliver the people who will fill those roles into the future. We need to recruit more people into CAMHS.

On a related matter, we also have the children's disability network teams, CDNTs, in which there is also a major issue with recruitment. That is also part of the picture. Services must connect better and I include primary care in that picture. It, too, is identified in the report. We have to ensure the communications between the different strands of the health system are better connected and speak to each other. As we know, that will take time but we can refine that planning now.

Dr. Finnerty pointed out that there is no ring-fenced funding for CAMHS. With regard to my earlier point about workforce planning, unless we have a ring-fenced budget and benchmarked staffing levels, I am not sure how we can engage in workforce planning. Perhaps the HSE can address that.

I also mentioned that the integration of children’s mental health services is not where it should be. We need CAMHS to talk to the CDNTs, primary care and GPs for the benefit of the child. Services should be child-centred and follow the person and we need to ensure communication streams are better. On digital infrastructure, it should not be the case, as highlighted in the report, that some records are held in physical format, with pieces of paper often added as the file is developing.

The type of recordkeeping for CAMHS that exists in each of the CHOs has to to streamlined and standardised. It should be the same across all our CAMHS. That is something Government focus can help resolve.

Deputy Gannon referred to the wider matter of the digitalisation of health records, which was discussed at the Oireachtas Joint Committee on Health yesterday. Let us expedite that. The Chief Whip is present. I know the health information Bill is priority legislation. Let us make that happen so that, for example, somebody's PPS number can be used to hang health records onto in order that digitisation can begin in a meaningful way. Procurement is a matter that the Minister of State at the Department of Public Expenditure and Reform, Deputy Ossian Smyth, might look at. If there is no standardised approach to the digitisation of records across CHOs, should the State not enter into a process of consultation with the CHOs, ask them what they need from the digitisation of records, go ahead and procure that, provide it to them, provide the necessary training and make sure there is consistency across the board?

On the supervision of medication, which was referenced by some Deputies, there is a network of pharmacists. Is there a role these people can play in the supervision of medication? They are highly trained, competent, and the network exists within our communities. Is that something that can be activated in response to this issue?

I would not claim to be any sort of specialist on this matter. The Minister and his Department are far closer to it. As I mentioned, it commissioned research to better understand the picture in front of us. I am responding to this issue as a parent and in empathy with the parents who have to navigate that torturous and labyrinthine pathway to getting the mental health supports they need for their children. If you are a parent, and your child is struggling and you reach out to the State for help, it is so important that the State is there. We have to live up to that obligation. As I said, this is something we have committed to in ratifying the UN Convention on the Rights of the Child in 1992. This matter sits at the heart of that cornerstone document and the foundation of our State. It is something I feel strongly about. The Minister and the Ministers of State have outlined the many ways this Government intends to respond to this report. It is incumbent on all of us to engage with that so we push that agenda forward in a constructive manner for the good of all the children in the State.

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