Marie Sherlock (Dublin Central, Labour) | Oireachtas source

I genuinely wish the Minister of State well on her reappointment. We all need her to succeed in her role.

To many of us, the decline in the mental health of our young people in this country is one of the biggest health, social and economic challenges of our time. The research states that approximately 50% of us will experience mental health difficulties at a particular point in our lives, but for young people the figures are truly terrifying. I am struck by surveys undertaken by the RCSI in 2021, which found that a quarter of all adolescents described their mental health as bad or very bad, more than a third reported self-harming in their lifetime, and one in ten or 10% had attempted suicide. Some of these results are related to the Covid-19 pandemic, but we know from talking to teachers and mental health professionals that those impacts are still being felt in our classrooms and communities. When we add in the housing crisis, there is a devastating impact on thousands of families and a ticking time bomb in terms of the mental health of so many of our young people.

In 2019, the Royal College of Physicians of Ireland published research that showed that 40% of homeless children experience clinically significant mental health and behavioural difficulties, are more likely to need clinical care and are at greater risk of bullying. As we all know, the number of homeless children has gone up dramatically since then, not down. From talking to so many families in my constituency, Dublin Central, I know overcrowding, cramped conditions, fear of eviction and eviction itself all have a ravaging, long-term impact on so many children, despite the brilliant efforts of parents and their wider families to try to shield them from the anxiety of it all.

Unfortunately, it is up to the Minister of State, her Ministry and her Department to make proper provision to deal with the psychological impact of the failure of the previous Government and, indeed, some of its predecessors to provide adequate housing and put services in place to deal with the overall deterioration of mental health services. Unfortunately, we currently have a system that is under-resourced, overstretched and, to my mind, in need of immediate reform. The waiting times are scandalously long. The Minister of State referred to a figure of over 600. I did a quick tot. The figures we had available for the period up to August last year show 941 children were waiting 12 months or more for a CAMHS appointment. The eligibility criteria for CAMHS are often too narrow. We see that interagency integration and co-operation are piecemeal. I have encountered families whose children's needs are too great for primary care but they do not meet the criteria for CAMHS. They are left with nowhere to go. The Minister of State knows this as well as we do. Behind all this is a model of care that fails to adequately recognise the value and potential of early intervention. We all very much recognise the need for better functioning and much better resourced CAMHS. I absolutely understand that we have to fix the parts of the broken system in parts of the country; however, the eye has been taken off the ball in recent years in ensuring a more comprehensive system of early interventions. While I hear what the Minister of State said about more funding, the reality is that we are still very far from where we need to be with early interventions across every county and community. Consequently, we are condemning young people and their families to unnecessary mental distress and, of course, preventable mental health circumstances that become crises. This requires more investment in mental health in schools, communities and higher education settings. We absolutely need more investment in community-based mental health services.

I pay tribute to Jigsaw and Spunout, in particular, and the other community-based mental health services, which are doing brilliant work across this country. However, we need more of this work in our communities. When I examine the breakdown of the mental health budget – I am the new spokesperson on health for the Labour Party and am still trying to find my way around it – and when it appears that 12.2% or so is spent on CAMHS, I conclude we do not seem to have any great clarity as to how the rest of the budget is being spent. That needs to change.

With regard to CAMHS itself and its regulation, I want to put on record our very firm and clear support for the mental health bill and its necessity and urgency. We urge the Minister of State to press on with it as fast as possible. We all know the existing legislation is badly in need of reform. It is 24 years old and in need of updating, so we will not be found wanting in trying to progress it through the Houses. However, as we all know, the legislative reform will have very limited meaningful impact if our mental health services are not properly staffed.

I sincerely welcome the introduction of the mental health clinical programmes over recent years, but the reality, certainly from late last year – I do not know whether my figures are as up to date as they should be – is that we know we were about 40 teams short across mental health clinical programmes, ADHD, dual diagnosis, early intervention for psychosis, and eating disorders. That points to a series of major issues with regard to how professionals in this area are recruited and retained. It is an issue the Government has failed on right across the health sector. I am thinking, in particular, of a psychologist I met about six months ago who works in one of the biggest mental health providers in the State. She is 55 and has considerable experience but is burnt out because of the massive waiting lists and the enormous toll and strain of knowing, day in, day out, that she cannot meet the demand that exists because she operates in a service that is under-resourced. She loves her job and is totally committed to doing what she has done for the past 30 years. She wants to work part-time so she can sustainably continue working, but she has been refused this. She has been denied because the reality of the HSE pay and numbers strategy it that it has imposed an appalling chill effect on any type of flexibility and innovation with regard to managing existing staff.

I am aware that the recruitment restrictions have been lifted, in theory, but we are not seeing the results in practice. We know that about 700 psychiatric nurse vacancies were effectively wiped out or disappeared because of the pay and numbers strategy. That is wrong. It is wrong in a sector in which we know there are major shortages. Let me give a specific example. Linn Dara, which operates out of Cherry Orchard, Ballyfermot, got a derogation in May 2024 for 14 posts. A significant number of those posts have been filled but there are no contracts forthcoming. What is happening? We are being told publicly by the HSE that the recruitment freeze has been lifted, and on the ground we are hearing about a very different context.

The second key issue I want to raise with regard to recruitment concerns the section 39 workers. We know that the backbone of mental health services in this country is comprised of section 39 organisations. They feel a real sense of disrespect because of the lack of pay parity between them and workers doing the exact same job in section 38 organisations. I very much welcome that the pay negotiations are going to recommence but there is concern over whether the Government will really push for pay parity. We had a very clear statement in Fianna Fáil's manifesto that it would pursue pay parity. Fine Gael did the same but the concept disappeared from the programme for Government. I asked the Taoiseach about it earlier and asked him whether he was committed to pay parity. He said he was, but section 39 workers need to be convinced of that. We need to ensure the pay rates of section 39 workers are tied to those of section 38 workers, such that we do not have the nonsense that happens every few years whereby a pay negotiation must happen to let section 39 workers catch up. The reality is that care workers who do overnight shifts earn less than the minimum wage. I ask the Minister of State to put her political heft behind ensuring section 39 workers are given the dignity and respect they deserve for the crucial work they undertake, because we need every single mental health worker to stay in his or her job and to be looked after. With regard to recruitment and retention, we cannot afford the exodus we are seeing in so many parts of our health sector.

See this speech in context