Mary Butler (Waterford, Fianna Fail) | Oireachtas source

I am pleased to have the opportunity to discuss child and youth mental health services and highlight the work that has been ongoing over the lifetime of this Government to bring improvements to mental health services. I assure the House that the Government is fully committed to the delivery of modern, high-quality, person-centred, recovery-orientated mental health services. As Minister of State with responsibility for mental health, it is very important to me that parents, guardians, children and young adults have confidence in the mental health services they access, including child and adolescent mental health services, CAMHS. I am proud of the work that has been accomplished to date in increasing funding, improving access to services, developing new models of care and developing legislation that is modern and person-centred. There is much more to do. We should always strive to make services better and ensure that all young people feel secure in the knowledge that they can access mental health supports if they need them.

Everyone in this Chamber, be it through constituency work or personal experience, has heard first-hand accounts from families who have struggled to access the care their children need. I am here today to emphasise that each of those individual experiences has been heard and that I, my Department and the HSE continue each and every day to work to improve capacity, increase staffing levels and make sure that every euro of investment in our mental health services is used to better the experience of all those accessing our services. This is why it is so unhelpful to characterise the provision of mental health services in a persistently negative light. It has an impact on whether staff want to work in the area and dissuades young people from training to work in the area. It suggests to parents that services are not available and that there is no benefit in even trying to seek help for their children and it risks causing vulnerable people not to come forward to seek the supports they need.

Around 12 months ago, I travelled to Kerry to attend an older persons' conference. Later in the day, while we were having a cup of tea, I asked a woman sitting beside me who she was representing and she said the HSE. She said she worked for CAMHS but did not tell anyone that. She just tells people she works for the HSE. That struck me. Every day I try to build confidence in what CAMHS does.

We have to recognise, although we are operating in the context of a fast-growing population and pent-up demand since the Covid-19 pandemic, that access should be faster. It is my job as Minister of State with responsibility for mental health to deliver on that. However, as part of today’s statements, it is important for parents, families and those seeking help to know that when they experience a mental health difficulty, there are services available to support them. They are staffed by a dedicated mental health workforce, who deserve to be acknowledged for the valuable work they do each day. These staff work with the most complex and sometimes most vulnerable people and very ill people with acute and enduring mental health illnesses.

Last week, the Children’s Rights Alliance published its report card and allocated an E rating to child and youth mental health, citing inappropriate placement of young people in adult psychiatric facilities. Consultant psychiatrists do not take the decision lightly to admit a young person under 18 to an adult mental health facility or approved centre. That decision is made using extensive clinical judgment and experience to determine what course of action will best serve and meet the young person’s needs at that immediate time. Such admissions only happen in exceptional circumstances, with appropriate safeguards in place. On the limited occasions that young people are admitted to an adult mental health facility, they are cared for on a continuous one-to-one basis and always in line with the Mental Health Commission’s code of practice. All admissions are notified both to the commission in line with the code and to a national CAMHS lead manager in the HSE.

Admissions have decreased significantly in recent years, as cited in the Children’s Rights Alliance 2024 report card. Work to end the admission of children to adult psychiatric units is a commitment in the programme for Government. In 2019, there were 54 admissions. The figure fell to 20 in 2022 and 12 in 2023. In 2023, the majority of young people admitted to an adult mental health facility were aged 17. They were admitted on a voluntary basis - that is important - and for periods of less than a week. In some cases, the young people turned 18 and automatically entered adult services during their stay. Those who remain under 18 stay for short periods and move, as appropriate, back home to a CAMHS facility or community-based CAMHS team.

I accept other criticisms in the latest Children’s Rights Alliance report card, especially in relation to lengthy CAMHS waiting lists which I will address shortly. I disagree, however, that a clinical decision made in real time by a consultant psychiatrist should prompt an E grade. It simply does not reflect the on-the-ground experience of the clinicians delivering care to young people enduring severe mental health difficulties. Young people are admitted to adult mental health facilities only after all efforts to place them in a CAMHS facility have been exhausted.  A range of factors can influence the clinical decision, including crises, suicidal ideation, immediately available capacity or distance. We need to reflect on that because it is too simple to say we will give you a fail or an E score because consultant psychiatrists took decisions, more than likely to save a young person's life. If we continue to hammer consultants for taking a decision to save a child's life, I worry where we will end up.

There are currently 51 fully staffed inpatient beds available for CAMHS. A total of 31 young people are inpatients in these approved centres. We also contract and use private providers as needed. As in much of the rest of the health sector, we are actively recruiting more specialist staff for increased services and beds. There is no young patient on a waiting list today for an inpatient bed, and I am updated weekly on the level of demand for CAMHS-approved centre beds.

Regarding CAMHS community supports, we now have 75 CAMHS teams across the country. Between 2020 and 2021, the rate of referral to CAMHS increased by 33%, while the number of new cases seen increased by 21% in that same period. Provisional figures made available to me this week indicate that nationally in 2023 there was a decrease of 480 children on the waiting list for CAMHS community mental health services, down from 4,239 in December 2022 to 3,759 a year later.

Provisional data provided to me by the HSE shows 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. Thirteen thousand one hundred and fifty-five new and re-referred appointments were offered last year. Of these, 12,338 were seen. Eight hundred and seventeen appointments were not attended. I accept that some young people might have aged out at the time. There are 820 staff working across the country in CAMHS. While we stand here today, they are busy working in their offices and clinics supporting young people.

I acknowledge that there are challenges in meeting the growing demand for CAMHS. I thank the Mental Health Commission for the work it undertook over the last 18 months to review all services provided by CAMHS to ensure there are no failings in the standard of care that our children and young people across the country receive. All of our CAMHS teams have worked closely with the Mental Health Commission over the past year and more to develop and implement improvement plans following the interim and final reports of the commission's review of services provided by CAMHS nationally, and their work continues.

The HSE continues to progress three national audits concerning CAMHS arising from the Maskey report on south Kerry. Included are the national review of CAMHS prescribing practice and the national audit of compliance with the 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, University College Cork is undertaking a qualitative review of service-user experiences.

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. This will also receive my full attention, and its implementation will bring about valuable improvements.

This year, I allocated nearly €150 million to CAMHS in dedicated funding, in addition to €110 million to community-based mental health organisations and NGOs, such as Jigsaw, Pieta, spunout and Belong To. The list is endless. A significant proportion of the funding is dedicated to supporting young people. In addition, I recently announced a further €10 million in funding from the Revised Estimate volume for youth mental health. I am placing a dedicated geographical focus on the allocation of this funding to address what is often postcode-lottery access to services.

Budget 2024 also provided for 68 additional posts. Together they will strengthen CAMHS teams nationwide, enhance CAMHS hub teams and develop key clinical care programmes such as programmes concerning early-intervention psychosis, eating disorders and dual diagnosis. The HSE increased staffing in community CAMHS from 659 in December 2021 to around 820 posts. This staffing figure will increase to nearly 900 by the year's end on the back of 2024 investment and recruitment plans.

Examples of service initiatives for mental health under budget 2024 also include the development of a central referral mechanism or "no wrong door" for services for children. This service will ensure that those children who require services receive the care that 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, as well as external agencies across the education, childcare and youth justice fields, are also important.

The additional €10 million in funding will also provide additional staff for CAMHS hubs, CAMHS crisis cafés, CAMHS out-of-hours services, investment in a new single point of access to children's services, investment in an electronic health record, and additional funding to allow Foróige and Jigsaw to develop upstream mental health services in primary care and community services. Specialist clinical care programmes, such as the national clinical programme for ADHD, will also be enhanced, as will recovery-oriented services.

I must also point out that for the first time in the history of the State, we now have a dedicated national office for child and youth mental health in the HSE. This is a very significant development that I delivered, and it will improve leadership, operational oversight and management of service delivery. A new HSE national clinical lead for child and youth mental health and a new HSE assistant national director for child and youth mental health have taken up post. They have been in post for six months and I meet them regularly.

The HSE must also be commended on fully utilising opportunities offered by telehealth technologies to mitigate recruitment challenges and modernise delivery of mental health care. This includes a new multidisciplinary model of care for CAMHS hubs, which I launched last September in Cork, with pilots across five sites in CHOs 2, 3, 4, 6 and 8. Support from these hubs is designed to be over a short period as they provide targeted and intensive interventions with flexibility to respond to different young people's needs, or parent or carer needs.

Ensuring that mental health legislation is modern and person-centred and that the human rights of anyone, child or adult, receiving care in an approved centre are respected is at the core of the new mental health Bill. I will introduce the Bill to the Oireachtas shortly, and this will completely overhaul and modernise the existing legislation and provide comprehensive regulation of all mental health services, including community CAMHS.

I acknowledge that the development of the Bill has taken longer than expected. Many of the issues addressed in the Bill are legally and ethically complex and require consultation with key stakeholders and extensive legal advice. Furthermore, it is a very lengthy Bill and will have in excess of 130 sections. Despite the length and complexity of the Bill, I am very happy to say it is now in the final months of drafting and will be published in the next Dáil session, which begins in April.

The regulation of community CAMHS under the new Bill will bring a high level of scrutiny to this sector for the first time, with a significant percentage of private service providers in the sector. Children and young people accessing community services, and the service providers delivering these services, deserve a regulatory system backed by a clearly defined, robust legal framework. I would, therefore, like to emphasise how much I support the regulation of community CAMHS. My colleagues in government and I all recognise the importance of ensuring all mental health services, including both inpatient and community and both adult and child and adolescent, are fully registered, regulated and inspected by the Mental Health Commission in its role as the independent regulator of mental health services. It is a matter my officials have been carefully considering in the drafting of the Bill.

The Bill will comprehensively address the expansion of the commission's regulatory remit to include all community mental health residences and services, including all community CAMHS. The provisions in the Bill have been subject to ongoing and lengthy consideration by officials in my Department. A Part of the Bill is devoted to the regulation of all mental health services and will provide very strong legal underpinning to regulate community CAMHS.

In addition to expanded regulation, the Bill will overhaul the involuntary admission and detention process, modernise provisions related to consent to treatment, provide enhanced safeguards for people accessing inpatient treatment, and provide a new, discrete Part that relates exclusively to the care and treatment of children and young people in inpatient settings.

Last week, when listening to a radio interview, I was struck by the choice of language used in relation to suicide.

It is crucial that all of us use sensitive and non-stigmatising language when engaging in a conversation, talking or writing about mental health, in particular suicide, and in the media. Using language and words that are helpful and respectful will encourage open and safe conversations about suicide and its prevention. In particular, using the term "commit suicide" can imply a sin, criminal offence or act, and, can, therefore, be stigmatising, of the person who has died or of people who have been bereaved. We have come so far as a country in opening up about our mental health and working actively to remove the stigma of mental health challenges. The act of suicide was decriminalised in Ireland in 1993 and the terms "commit"or "committed suicide" should always be avoided.

To conclude, parents and their children have the right to have confidence in being able to access mental health supports across the country where they need it and to meet their needs. I am committed to a no wrong door policy and the core concept that there is no health without mental health.

I thank all Deputies for the opportunity to speak to this Government's commitment on child and youth mental health services and I look forward to hearing all the contributions throughout the afternoon.

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