Róisín Shortall (Dublin North West, Social Democrats) | Oireachtas source

I will start by thanking Deputies Ward and Cullinane for their work in producing this legislation. The Social Democrats are very happy to support it. Yesterday marked seven months since the damning report by the inspector of mental health services into CAMHS was published.

That report revealed a level of dysfunction that went very far beyond what was first feared and spelt out in the starkest terms the most serious shortcomings in service provision but these revelations came as no surprise to the many families who have been dealing with CAMHS over many years. They are all too familiar with the State's failure to provide an appropriately staffed and governed service. Last July when the Mental Health Commission's report was published, the Minister of State with responsibility for mental health and older people, Deputy Mary Butler, issued a statement welcoming that report. The Minister of State, however, stopped very far short of committing to implementing the 49 recommendations in that report.

The first and highest priority recommendation called for the immediate and independent regulation of CAMHS by the Mental Health Commission. At the very least, that primary recommendation should have been a priority for this Government but, clearly and unfortunately, that is not the case. Given the condition of children's mental health services in this country, there can be no excuse for continued inaction. There have been problems with children's mental health services for well over 20 years and the story is the same every year. Money is provided in the budget but the money does not get spent and the excuse is, "We cannot get the staff". Why can CAMHS not get the staff? Why has the Minister of State not dealt with this long ago? Why has there not been proper workforce planning in this area so we know the necessary therapists and specialists needed for recruitment in this area are trained and available? This has not been the case and of course it is then a vicious cycle because the more vacancies there are, the more scandal there is in the service, the less likely it is that people want to be part of CAMHS. This is why it needs a complete root-and-branch change and needs to come under the remit of the Mental Health Commission.

We have to bear in mind that when the recommendation was made last summer, that was not the first time it was made. When Dr. Susan Finnerty took on the job of looking at CAMHS and producing this report, she was so concerned about the major shortcomings in the service that she issued an interim report. That interim report reflected her serious concerns and the urgency with which she believed the issue needed to be dealt with. She published the interim report in January 2023 recommending the immediate regulation of CAMHS. This is the only way we are going to get any kind of transparency and any kind of action in bringing CAMHS up to an acceptable level. We have had enough obfuscation in this regard. We have had enough cover up and lack of frank reporting from the HSE about the serious problems that exist there. We cannot continue with the situation where there is, essentially, self-regulation of CAMHS by the HSE. It is absolutely critical that the primary recommendation by the Mental Health Commission for the independent regulation of CAMHS is implemented as a matter of urgency.

At this point, it is very difficult to come to any conclusion other than the HSE and the Department of Health cannot be relied upon to be upfront and transparent in respect of the nature of the problems within CAMHS. I am very slow to make that allegation but I cannot come to any conclusion other than there are cover-ups going on and there have been for some time. There is an incredible lack of transparency around the reality of the problems within CAMHS. We must not forget that the sorry state of this service only came to light because of a whistleblower, Dr. Ankur Sharma, who was brave enough to speak out about the problems in County Kerry. Rather than encouraging an open culture - and this is a huge mark against the culture within the HSE - we again see those who speak being ostracised. This is why, along with the immediate regulation of CAMHS, cultural change is essential.

We are led to believe that the regulatory functions of the Mental Health Commission will be dealt with in the long-awaited Mental Health (Amendment) Bill 2023. There is a strong view that giving responsibility to the commission to regulate CAMHS is possible under existing legislation. The Minister of State seems to be nodding her head. I do not know if she agrees with that. If there was a political will to do it, this could be done under the existing Mental Health Act. Regulating of CAMHS can be done by that route, or under this legislation. It is short and concise legislation to make an amendment to the Mental Health Act. Has the Minister of State received legal advice on the ability to do that without primary legislation? At the very least it can be done by a very small amendment to that Act.

The repercussions of not acting quickly are far too serious. We have seen major problems and we have seen children utterly failed by the existing service. There is a responsibility on the Minister of State to take on board the very clear and concise recommendation from the Mental Health Commission, which is to have independent, outside regulation of CAMHS so that standards can be driven.

There is no doubt that wide-ranging reform of the Mental Health Act is clearly required but the Government has not even published that Bill. It is still only on the priority drafting list of the spring legislative programme, as was also the case this time last year. People cannot be blamed for being very sceptical of what the Government is proposing to do. We are led to believe that this Bill will be published in the summer legislative session but one would be forgiven for not believing that promise yet again. Reform of the 2001 Act is a programme for Government commitment but one and a half years after the mental health sub-committee's pre-legislative scrutiny report, we are still waiting for the Bill to be published. This does not fill anyone with confidence, not least when at most there is one year left in the term of this Government. The failure to progress a new mental health Bill in a timely manner is just further proof that reform of mental health services is simply not a priority for the Government.

Reform of this Act has been on the table for more than a decade. How many more governments will it take? The 2001 Act is not compliant with the European Convention on Human Rights or, indeed, the UN Convention on the Rights of Persons with Disabilities. In February 2023, the Committee on the Rights of the Child highlighted serious concerns with practices in our children's mental health services. It is deeply disappointing that the practice of refusing access to CAMHS for children who have autism has been allowed to continue. The parents who formed the group, Families for Reform of CAMHS representing 800 families, many of whom are in the Visitors' Gallery tonight, highlighted this issue. Children with autism and mental health difficulties are being left with no service whatsoever. Again, the Minister of State does need legislation to deal with this. At the stroke of a pen, the Minister of State could deal with this tomorrow. This is the minimum we expect her to do. I urge the Government to stop this nonsense about waiting nine months. It should deal with it now. It is an urgent matter.

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