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

I welcome these statements on youth mental health and the renewed focus on the need to improve services in that area, but after Tuesday's debate, I am still unclear about the Government’s position on CAMHS regulation. The Minister still has not committed to acting on the Inspector of Mental Health Services' primary recommendation out of 49 recommendations in total that CAMHS should be regulated by the Mental Health Commission. This is a measure the Government could take that would be transformative. How long will the Government go on listening to excuses and reasons for things not being done by the HSE? How long will the Government continue with a situation where the HSE is effectively regulating itself in an area that has been massively problematic for years? There is a strong view, one that I put to the Government on Tuesday, that it could bring CAMHS under the remit of the Mental Health Commission by using a statutory instrument under the existing legislation. I appeal to the Minister of State to check this view out legally. At the very least, it could be done through a minor amendment to the Mental Health Act, as was proposed on Tuesday. This would be a major contribution for her to make to child and youth mental health services. It would put the responsibility on the experts to oversee CAMHS, call out problems when they see them and start the implementation of important recommendations to bring the model to the point where it is fit for purpose. That is certainly not the case at the moment.

The Government's vague commitment to regulate via the long-promised mental health Bill just does not cut it. The Minister of State knows as well as I do that an election is coming, casting major doubts over the Government’s supposed commitment to reforming the 2001 Act within its lifetime. After all, neither the Department nor the HSE is known for its ability to stick to timelines. For example, completion of the first phase of the north Kerry CAMHS look-back is well overdue. That was supposed to be completed by the end of 2023. This ongoing delay is extremely distressing for families engaged in the process, especially as many of the cases in the so-called look-back are actually current cases.

Can the Minister please provide an update on this?

The discrimination of certain patients, outlined in a recent survey by Families for Reform of CAMHS, is also deeply concerning. According to the survey, 59% of their members have an autistic child. Of those, 85% said that an autism diagnosis negatively impacted the service and support they received from CAMHS. Some members said that services were withdrawn once an autism diagnosis was disclosed, and that anxiety and depression was explained away as just being part of autism spectrum disorder, ASD. The survey also found cases of autistic children presenting with suicidal ideation being turned away from CAMHS. One parent was told that their child’s suicidal thoughts and plans were "not really mental health issues and just their autism".

Children with intellectual disabilities are also being severely mistreated. I pick those words carefully. The survey found that 81% of their members who have children with intellectual disabilities have absolutely no access to mental health services. Under the CAMHS-ID model of service, children with intellectual disabilities are no longer accepted into CAMHS. Instead, they are to be seen by specialist CAMHS-ID teams. However, there are only four or five partial teams in the country, when there should be 16 full teams. This means that in some parts of the country, children with intellectual disabilities are being discharged from CAMHS without any team to care for them. That is completely indefensible.

If this inequality in service provision is to be addressed, children’s health services must be integrated, and the needs of each child must be put at the centre of any package of care. That is a fairly modest expectation of a modern health service, yet the sad reality is that we are nowhere near providing that.

Another major deficiency in youth mental health services is the lack of early intervention and prevention services. CAMHS may be the headline grabber, and there is no doubt that it is in need of major reform, but fixing it is not a panacea for youth mental health services. According to the Mental Health Commission, only 2% of young people experiencing mental health difficulties require the specialist support of CAMHS. However, due to the deficit in multidisciplinary teams and community-based services, such as talk therapy, more and more children are being pushed into CAMHS. This, in turn, is pushing more and more extremely vulnerable children into adult services which are entirely inappropriate. That is why, alongside reform of CAMHS, there needs to be a major scaling up of early intervention services. Research has shown that 75% of mental health conditions are established before a person reaches the age of 25. This is why early and targeted intervention is essential.

However, the reality is that community therapies are at breaking point. Last year, there was almost 16,000 children on a waiting list for community psychology. Almost 6,000 of those were waiting more than a year. It is very hard to contemplate the impact of those kinds of waiting times. I am putting it to the Minister of State to do one thing and to do it now, that is, bring CAMHS under the remit of the Mental Health Commission. That would make a huge difference and would be transformative. She can do it now. I ask her to please act.

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