Mary Butler (Waterford, Fianna Fail) | Oireachtas source

I want to thank everyone who has been here for over three hours. We have listened intently. That is one thing I always do whenever I sit on this side of the House. I listen and take notes.

It has been a really difficult week. There is no point in saying otherwise. Deputy Niamh Smyth summed it up when she said that you should not have to fight the system. We all see that you have to fight with the system even though we have really good people working within it. In that context, Deputies Ó Murchú and Munster referred to a particular case. That case was brought to my attention yesterday afternoon by Deputy Fitzpatrick. It relates to a young child in the midlands. There were an awful lot of difficulties involved. Thankfully, by yesterday evening, through my efforts and those of my staff, that child got an inpatient bed. It was the first I heard of it yesterday afternoon. There should not be a case where someone has to go to a politician to try to get access to a bed or the necessary supports that are needed.

There is something we must be cognisant of. Many comments were made today. I do not have a medical background of any sort, and nor do many people here. This is about dealing with the most complex, challenging and vulnerable people and consultant psychiatrists make a decision after many years of being trained and many years of experience. I will always accept and respect that decision because I do not have the medical wherewithal to challenge it. We hear a lot about young people who do not gain access to CAMHS. Only 2% of all young people with mental health difficulties need the support of CAMHS. That decision has to be taken by a multidisciplinary team. It determines whether the child meets the criteria or not. I am concerned that it varies widely from 38% to 81% depending on which CHO area a person lives in. That is something that I am looking closely at.

I have had many meetings this week with the Minister and the HSE. I had a meeting with the Taoiseach earlier today. We have to push so hard on the IT systems. It is not acceptable to still use paper files in 2023. That is really difficult. Another area in which I have zero tolerance relates to governance. There cannot be a situation where governance and standard operating procedures are not in place. The standard operating procedures were introduced in 2019. We dealt with Covid and a lot of other issues, but it is down to me now to push this as hard as I can. I will immediately seek to ensure that all CAMHS multidisciplinary teams have an acceptable level of staffing. We hired 90 people in December. Much of the hiring goes on towards the end of the year. There are an additional 85 people working in CAMHS in the last two and a half years since the Government came in. Yes, we need more. We have 280 staff under recruitment at the moment. Across the multidisciplinary teams, staffing sits at 64%. It varies higher or lower depending on location. That is an area where we are challenged.

There was much talk about children lost to follow-up. I do not agree with the choice of language used in this regard, and I will explain why. There was one team in CHO 3 which was identifiable. In that one team, 140 children who had open cases had been lost to follow-up. The children had not been lost; the case had been lost to follow-up. The team had already started the process of a desktop review of these cases and had informed the Mental Health Commission when it came in. A further 28 cases have been looked at. That is 168 cases in total. They are being actively followed up. Consultation has been held with most of the children in this case and their families.

I remind everyone that HSE live is available to support any children or families with concerns. The freefone number is 1800 700 700. We have 21,000 children who avail of the help of CAMHS. As of yesterday evening, just under 40 contacts had been made on that issue and eight had been escalated. I reassure people that the phone line is working and the supports are being put in place.

We have a lot more work to do on this. There will be another motion next Tuesday night and I will be in here to take it. I will also be in the Seanad next Wednesday. We will make every effort that we can to make sure that we will improve the system. I thought the Ceann Comhairle's words were very wise. Some 21,000 children receive support from CAMHS. They will have appointments again on Monday morning and their families will be listening. My job is to build confidence in the system because there is a lot of good work, really good work, going on. That was stated in the report.

CAMHS staff work extremely hard to try and provide a good service. That is stated in the report. We are aware that many young people and their families have received excellent care and treatment. It is stated on page 20 that: "We were pleased to note that, in the majority of the sample of files reviewed, the physical monitoring was completed for children and young people with ADHD on stimulant medication." My main concern in the context of children on stimulant medication was whether physical monitoring was taking place and whether such medication was being overprescribed. There was no evidence of that in the report. I thank all the Deputies for their time. I appreciate it.

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