Anne Rabbitte (Galway East, Fianna Fail) | Oireachtas source

I start by welcoming Valerie and the visitors to the Gallery for this evening's debate.

I thank Deputies for the opportunity to discuss the very important topic of CAMHS and the recent Mental Health Commission's interim report on the service. All of us on the Government side have listened closely to the views and contributions expressed and will continue to listen, including to the views of the non-governmental organisations in the Gallery. The motion is not being opposed as the Government recognises the challenges that CAMHS currently face and the value of the findings highlighted by the Mental Health Commission's interim report on CAMHS. The findings of the interim report highlight important areas where services can be improved and act as a point from which proactive activity can benefit CAMHS throughout the system.

This Government remains fully committed to the delivery of a high-quality, safe and compassionate mental health service for all, reflected through delivering our programme for Government commitments on mental health. I therefore welcome the opportunity to highlight the services and supports that are available for young people and their families experiencing mental health difficulties. It is important to me, my colleagues, the Minister of State, Deputy Butler, the Minister, Deputy Donnelly, and the Government as a whole that young people are aware of the services that are available to them, as well as the work that is ongoing to improve CAMHS.

The Mental Health Commission's interim report is one of a number of ongoing reports and audits into CAMHS. Between them, the reports and audits arising from the Maskey report, as well as the final report from the commission, will serve to provide important information on how mental health services in this country can be improved. They will also provide an opportunity to highlight good practice throughout the system and provide the occasion to share best practice. Nonetheless, as the Minister and Minister of State, Deputy Butler, clearly indicated last Thursday evening, the findings in this interim report identify several issues which are simply not acceptable to anyone, including those providing CAMHS. Importantly, the Minister and Minister of State supported the commission in carrying out its annual thematic report into CAMHS. As they indicated in the Dáil statements last Thursday, the Government has accepted in full the recommendations of the commission's interim report. We await the final report on all nine CHOs and welcome the role the commission plays in ensuring high standards of service provision in our mental health services.

All areas of concern identified by the commission in carrying out its interim report were escalated immediately to the HSE for immediate action and resolution, including the review of open patient cases which the HSE is undertaking. This will initially consist of a review of all open cases where the patients have been prescribed medication by their CAMHS consultant or doctor and who have not been seen in the last six months by their CAMHS team. In addition, the Department of Health will work with the HSE to immediately develop a model of care for prescribing practices in CAMHS. This review of open cases will provide assurances that these children and young people are receiving appropriate care, reflective of their current and future needs. The review will include a focus on physical health monitoring of those who are on medication.

On the interim report's recommendation for the regulation of CAMHS, it should be recognised that the need to regulate CAMHS was previously identified by the Department of Health and it is built into the provisions of the upcoming revised mental health Bill. It will empathise with young people and their families who may be worried about them receiving the care they deserve. Much good work is being done by our CAMHS health professionals across the country and, as is raised in the motion, it is appropriate to recognise their strong commitment to vulnerable young people and their families. While we recognise the challenges and concerns regarding service provision in this area, it is important to note that the majority of young people who experience mental health difficulties have access to a variety of services and supports. Of those who seek care from CAMHS teams, the vast majority also experience a positive outcome from CAMHS relating to care and recovery.

CAMHS teams receive and triage nearly 21,000 referrals annually and deliver 225,000 appointments for children and young people requiring assessment and intervention each year. Between 2020 and 2021, child and adolescent mental health services experienced a 33% increase in demand, while concurrently increasing their activity levels, seeing 21% more cases during the same period. There are currently 80 consultant psychiatrists in post working across the 73 teams. The HSE is continually working to ensure all funded positions are filled and staff are available to provide this important service. The HSE has a specific focus on supporting the recruitment and retention of staff, with a focus on optimising team capacity.

To this end, a new recruitment operating model is being implemented under the direction of the national director of human resources in the HSE.

On Thursday night, Deputies referred to staffing levels against recommendations in A Vision for Change. A Vision for Change was published in 2006. Sharing the Vision sought to build on this experience and set out a more flexible approach to team development and staffing. This approach was taken to ensure that local CAMHS teams could be developed and staffed to best meet local circumstances and local service pressures. As not every CAMHS team is identical, resources are put in place to make each team appropriate for its setting and to best meet patients' needs. I reiterate that a new post of youth mental health lead at assistant national director level in the HSE and a new post of national clinical lead for child and youth mental health have been announced, with recruitment under way this week.

We had a very intense and passionate debate in the Chamber last Thursday night, with what were overall positive contributions from all sides of the House. I remind everyone of the apt and welcome comments of the Ceann Comhairle during that debate which reflected a key point the Minister of State, Deputy Butler, has always made in her role as Minister of State with responsibility for mental health and older people, namely, that while any deficiencies in CAMHS need to be acknowledged, and addressed insofar as possible, we must always be conscious of the sensitivities and needs of those using the service. While the Government and we, as Ministers, accept constructive criticism, at the same time we must all offer reassurance to the public and instil confidence in the strong and important health services that operate here every day. A balanced and evidence-based approach is always the best way we can collectively analyse concerns and find the solutions we all seek.

At this point, it is important to correct the record. In CHO 5, the total number of persons waiting is 314, while the number who have been waiting longer than 52 weeks is 14. It is not the case that 314 people have been waiting for more than 52 weeks, as was stated earlier.

Real change in mental health has been under way in recent years and will continue through implementation of the current widely agreed policy, Sharing the Vision. There is a record €1.2 billion allocation in 2023. This means the Government has provided a significant increase in investment of some €220 million since June 2020. Importantly, dedicated funding for CAMHS is administered as part of the overall HSE mental health allocation each year. In addition, funding has been provided for two new CAMHS telehubs and a dedicated €6 million to expand the capacity of community mental health teams nationally, with a particular emphasis on CAMHS. The motion does not appropriately reflect the significant investment in our mental health services that I have outlined.

I highlight the emphasis the Government has placed on improving accessibility to mental health services for young people. Continued investment in community services continues to be prioritised. Over €80 million in funding was provided to community-based organisations in 2022. These organisations also provide important early intervention services. These services are a strong staple of mental health services for young people and provide an essential point of access to supports for those in distress or experiencing mental health difficulties. This €80 million in funding is provided to a wide array of service providers, often funded through the HSE. However, for those who do not need access to the specialist supports and services that CAMHS provides, it is acknowledged that children and their families can experience varying waiting times. Some 93% of urgent referrals to CAMHS are responded to within three days. Steps are also being taken to actively reduce waiting times. The Minister of State, Deputy Butler, will speak later.

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