Joan Collins (Dublin South Central, Independents 4 Change) | Oireachtas source

I thank Dr. Susan Finnerty for producing the interim report. It should be noted that in every Mental Health Commission annual report, she always has a section on CAMHS and always makes the point that the situation is dire. This interim report has shown once again a total breakdown in our health services. We see again some of the most vulnerable people in our State being let down again and again by the services that are supposed to look after and care for them and be their safety net when they are ill. We see children lost in the system; children left on medication for years without any sort of review; children waiting for days in emergency departments; some reaching 18 without transfer to adult services; chaotic paper-based record keeping; and staff not properly trained, not properly supervised, overworked and overwhelmed. Everybody knows that this is not an attack on those workers. They are putting their full time into their work with children who need support. All this is from a sample of just 10% of the 6,000 children in CAMHS. We know from the Maskey report that there were 240 children with serious shortcomings in their care in south Kerry alone. These are the children who were lucky enough to get into CAMHS in the first place. The report found acceptance rates of referrals range between 38% to 81% in different CHOs without any clear reason why. How many more children have been lost and let down by this system? How many cannot even get into it?

Mental Health Reform, MHR, has said that 4,043 children were on the CAMHS waiting list as of October 2022 and 741 children with mental health difficulties attended emergency departments last year. As of last October, only 37.1% of the Maskey report's recommendations had been completed. The HSE audits of CAMHS promised by the end of last year have not yet been published. No agreements are in place with private providers for children and adolescents attending CAMHS despite the lack of public beds Around half of the €24 million allocated for new mental health services in the 2022 budget has not even been spent. There were over 700 mental health nurse staff vacancies in mental health services as of last November.

We knew already from the Maskey report and the Mental Health Commission's 2021 annual report that this system has been failing. The Government has known this system was failing yet clearly not enough has not been done to help these children and their families.

MHR has said the Government's approach is not working. Professor Matthew Sadlier from the IMO says the Government has implemented unfunded and under-resourced structural changes with no consultation with those on the ground. Funding for CAMHS is not ring-fenced and must compete with other services. We know we are facing a shortage of hundreds of child psychiatrists by 2030. People working in these services are warning that this situation will just get worse. I hope that from today, the situation will get better for those workers.

The report found that only one CHO provided excellent services. This was the only CHO with electronic records and it was not run by the HSE. This was actually put to the Government at the United Nations Committee on the Rights of the Child on Tuesday. How can this country be the location for the offices of all the big global tech companies and still run paper-based records for the care of some of its most vulnerable children?

This system is clearly not working. It is clearly letting down thousands of children in this country. The Mental Health (Amendment) Bill 2023 needs to be brought forward immediately. I heard the Minister of State say this will happen. She will not find this side of House wanting when it comes to pushing the legislation through very quickly if necessary. We must legislate full rights for everyone receiving mental health services in this country and set out clear responsibility when those services fail them.

The next budget needs to properly increase our mental health spending as a percentage of total health spending. The World Health Organization recommends 12%, the UK has 13% and we have 5.5%. This needs to be in the form of spending increases. It needs to be put towards developing new services and needs to be properly planned, allocated and ring fenced for different services. The post of national director for mental health in the HSE needs to be immediately reinstated. Having an assistant national director is not good enough. The national director needs to report directly to the CEO of the HSE and needs actual funding to develop new services and a new administrative system to take pressure off the existing system.

This crisis is not acceptable, it never was acceptable and it should never have got this far. We need immediate action to protect these children and we need a system with proper planning, oversight, transparency and funding to make sure these failings never happen again.

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