Mary Butler (Waterford, Fianna Fail) | Oireachtas source

I thank Deputy Ward, once again, for initiating the Bill. I also thank my colleague, the Minister of State, Deputy Naughton, for opening the debate.

We are talking about youth mental health tonight and regulation of CAMHS. However, the contribution from Deputy O'Donoghue was so telling, and it especially appealed to males to reach out and ask for support. In 2022, we lost 411 people in this country to suicide, and 331 of them were male. It is a huge issue that men especially do not reach out for help. We know that of those who receive support from CIPC, the counselling services through the HSE, and who access supports from Pieta House, two-thirds are female and one-third are male. We have to do more on this issue. I want to put that on the record. Deputy O'Donoghue's intervention was so powerful at a time of huge distress for Deputy Collins and his family. We all stand with him.

I start by reiterating the Government’s commitment to further improvements in our CAMHS service and our recognition of the importance of ensuring all mental health services, both inpatient and community, and both adult and children and adolescent, are fully registered, regulated, and inspected by the Mental Health Commission in its role as the independent regulator of mental health services. All CAMHS teams have worked closely with the Mental Health Commission over the past year or so to develop and implement improvement plans, as needed, following the interim and final reports of the Commission on CAMHS nationally. The HSE continues to progress three national audits relating to CAMHS arising from the Maskey report on south Kerry. These were the national review of CAMHS prescribing practice and the national audit of compliance with CAMHS operational guidelines, both of which were recently published. Both published reports are being given full and proper consideration by me, the Department of Health and the HSE. In addition, a review of service user experiences is currently being undertaken by UCC.

It is important that everyone recognises there continues to be a substantial and growing demand for CAMHS services. Between 2020 and 2021, referral rates into CAMHS increased by 33%, while the number of new cases seen increased by 21% over the same time. The 75 community teams nationally are currently delivering approximately 225,000 appointments for children and young people every year. There are 820 staff working across the country in CAMHS services. I understand, based on provisional data received today from the HSE, that in 2023 there were 12% more appointments offered to children through CAMHS than in 2022. This highlights how the HSE is working hard to deliver more activity in the face of growing demand for CAMHS services. Some 13,155 new and re-referred appointments were offered last year. Of these, 12,338 were seen, while 817 or 6.2% of appointments were not attended.

At the end of last year, provisional figures show that there were 3,759 children on the CAMHS waiting list. In 2023 there was a decrease nationally of 480 children on the waiting list for CAMHS services, down from 4,239 in December 2022 to 3,759 a year later. I welcome this reduction, but my focus is to keep reducing this waiting list week on week, month on month. Improving access to modern mental health services requires that the waiting lists for CAMHS services be addressed. Targeted waiting list activity in 2024 will focus on those children who have been waiting the longest to ensure they get the care they need. There are currently waiting list initiatives underway across six Community Health Organisations.

The severity of presenting symptoms as well as a clinical assessment of risk is always taken into account in terms of waiting times. Every effort is made to prioritise urgent cases so that the referrals of young people with high-risk presentations are addressed as soon as possible. Some 92.8% of urgent referrals to CAMHS nationally were responded to within three working days, while 91% of new or re-referred cases were seen within 12 months in community CAMHS services in 2023. I also acknowledge there is a variation of referral acceptance across CAMHS teams, and this is an area being prioritised by the HSE to help improve access to CAMHS and to address CAMHS waiting lists. CAMHS canaccept children or adolescents only where there is evidence of a moderate to severe mental health difficulty present. The HSE is taking account of the recent Maskey and Mental Health Commission reports on CAMHS, and is currently finalising a youth mental health service improvement plan, which will set out agreed actions for focused service improvement through identified, timely, and measurable actions. I will announce the details of this improvement plan shortly.

CAMHS is receiving more than €150 million in dedicated funding this year. In addition, approximately €110 million in funding is provided by the Government to community-based mental health organisations and NGOs. Much of this is focused on supports for children and young people from an overall mental health budget of €1.3 billion. The new child and youth mental health office in the HSE is now in full operation, and I work closely with it. The Minister, Deputy Donnelly, and I have had several recent meetings with the office.

At my request, the HSE developed proposals for 2024 funding. The latter will provide much-needed CAMHS investment to meet demand. This includes the 68 posts to strengthen CAMHS teams nationwide that I announced on budget day. In January, I also announced a further €10 million that will allow for further targeted funding in the area of youth mental health. As already stated, I will be announcing details in this regard shortly.

Evidence shows that approximately 2% of young people may need the support of dedicated CAMHS teams. It is important that we also focus on positive youth mental health supports and early intervention in communities for young people who will not need intensive supports. I am particularly focused on the further development and delivery of the no wrong door approach to ensure that those children who may require various services receive the care they need in the most appropriate setting regardless of the complexity of need or source of referral. Improved links to primary care and disability services, particularly such as autism, as well as external agencies across the education, childcare and youth justice fields, is also important.

I welcome the focus on youth mental health. In the context of the provisions of the Bill before us, my reason for seeking this timed amendment is twofold. First, I believe that the Bill as drafted will not provide for the regulation of community CAMHS. Second, I will introduce a mental health Bill in the summer session that will comprehensively update and overhaul our current mental health legislation. I appreciate that the Deputies’ intention with this Bill is to grant additional regulatory functions to the commission. It is my opinion, however, that the intent behind the Bill is not what the text of the Bill reflects. I have been working closely with my officials in the Department of Health in relation to the Government's new mental health Bill over several years. It is important that this complex and lengthy legislation accurately reflects and supports the delivery of person-centred, modern mental healthcare which supports the rights of each individual and puts the service user front and centre. It is important that all voices will be reflected in the forthcoming Government legislation, including those who use the service and those who deliver it.

We continue to invest heavily in and to develop our youth and child mental health services. That is why it is unhelpful to characterise the provision of mental health services in a persistently negative light. This impacts on staff who want to work in the area and take pride in the valuable work they do. It suggests to parents that services are not available and risks vulnerable people not coming forward to access services that they need. I would like to take this opportunity to thank all those who work in mental health services, whether public, private or voluntary. The Government's mental health Bill is in the final stages of drafting and will move to publication in the summer term that begins in April. I look forward to bringing this Bill before the House and to engaging with colleagues on it.

See this speech in context