Mary Butler (Waterford, Fianna Fail)

I thank all the Deputies for their comments.

The reason why amendment No. 206 is not being accepted is because this amendment duplicates what is already in the Bill. There are 223 sections in the Bill. It is huge and very complex. There is a lot in it and it is hard to take every bit of it in, but that amendment is a duplication. That is the only reason why it is not being accepted.

I do not disagree with the Deputies regarding the upper age for CAMHS. Some of the Deputies might know Mark Smyth, who was head of the Psychological Society of Ireland for a long time. He chaired a committee under the national implementation and monitoring committee, NIMC, for the last number of years looking at the whole transition between CAMHS and general adult mental health services. When discussing increasing the transition to age 25, it is important to note that this would pertain to community supports. It would be much more difficult to do it with in-patient supports. We could not have a situation where in-patients supports for young people are extended to age 25. There might be a 13- or 14-year-old young girl with an eating disorder such as anorexia nervosa. There could not be a situation where they would be treated alongside a 22- or 23-year-old. We concentrated on the outpatients' perspective in that regard. We are looking for a more streamlined approach. Take the example of an 18-year-old in the care of CAMHS for a couple of years. The child is probably doing the leaving certificate and going to college for the first time and is being asked to leave the supports that are very good. A huge number of people have good supports and good outcomes in CAMHS. Asking them to move on to adult mental health services is difficult. That is an area is which we have done a huge body of work to try to make that transition more streamlined.

I agree with Deputy Clarke regarding safe staffing levels. They are really important. The problem we all have, as the Deputies know, is that the Mental Health Commission has a defined role within mental health services. It is responsible for the regulation of mental health services, of vindicating the rights of involuntarily admitted people through the operation of mental health review boards and setting of standards for best practice. It has a similar role to what HIQA does. We could not have a situation where the commission becomes responsible for implementing mental health services and policy and being responsible for allocating resources regarding funding and whole-time equivalents. As the Deputies know, that is a role in proper for the Minister for Health and the Government of the day. The Government is accountable to the Irish public and must be in control of the State's purse strings. The commission is a key partner in the delivery of mental health services, but the Government, any government, must be responsible for the allocation of services.

I take Deputy Quaide's point regarding A Vision for Change, but our policy since 2020 has been Sharing the Vision. What I like about Sharing the Vision is that it is person-centred. Second, what Sharing the Vision has that A Vision for Change never had was the national implementation and monitoring committee, which holds me, the HSE, service deliverers and the Department of Health to account. It meets regularly. We are now on our second iteration of it, with Catherine Brogan as its second chair. I set it up in November 2020. Every quarter without fail, a report is laid on its website, where people can read about the short-term, medium-term and long-term aspirations and where we are. It is a really important aspect because it shows us where we are on target and where we are not.

Deputy Clarke raised CAMHS waiting lists. I am not one bit happy about the waiting list. There are 4,544 people on it. I have been doing a couple of things. The budget for CAMHS in 2023 was €137 million. In 2025, the budget is €167 million, an additional €30 million in two years, which is a lot of money. I am not seeing the output for that additional money, however. Recently, I undertook a tour of CAMHS teams all over the country. I started in Cork and Kerry. Deputy Quaide would know well that they have the highest waiting list for CAMHS in the country of approximately 24%. I do not have the figures in front of me. I visited several CAMHS teams, some in the counties and some in the city. It was stark to look at the waiting lists and see where some teams are performing very well and others are not performing as well. I continued to Ashbourne, County Meath and Swords.

I visited there as well. The real contrast was with Monaghan and Cavan which have no waiting list for CAMHS. They had seven on the waiting list the day I was there, but Deputy Ó Murchú's area, and we have discussed it many times, is very challenged. There are 19 teams in that area and you would wonder how some teams can do so well and others do not. I travelled to Limerick a couple of weeks later, and Limerick is an exemplar at this stage. It has reduced its waiting list of more than 12 months by 90% and its waiting list under nine months by 59%, down to a total of 167.

The current challenge we have, and the Deputy will see this from the parliamentary question response, is three regional health areas in the country are carrying 70% of the entire waiting list for CAMHS. Dublin south east and my area, which is also that of Deputy McGuinness, are the only areas in the last quarter which showed a reduction in their waiting lists. I have asked that there not be anyone waiting more than 12 months. We have some waiting more than 18 months and some more than 12 months. I asked as a first step that this be reduced, and it was. I get the figures every week. What I am saying is that we have three areas carrying 70% of the waiting list. We have one area doing extremely well, which is Limerick, at about 4% of the waiting list, and we have a few other areas - the Galway area in the west, Dublin south east, and our area, the southeast of the country, carrying 7% to 8% of the waiting list.

I am trying to delve down into some of the issues because there are some areas where they have the most staff and a smaller catchment area but their waiting list is higher than what it should be. From what we have seen, the amount of referrals have grown exponentially in the past four to five years. We are also seeing young people and children presenting with much more complexity than they were previously. Young people who receive the support of CAMHS, if they meet the criteria, can often be in its support for three to four years. Once upon a time, when a child entered CAMHS, we had another child leaving, whereas now the situation is that for every three children coming into CAMHS, we have only one child leaving.

That is what I am currently at. I have visited four of the areas and have two more to do. As I said, an additional €30 million has been provided in the past two years plus a waiting list initiative. Just before the election last year, the waiting list was at 3,700. When I came back after my re-election and reappointment as Minister of State for Mental Health, the waiting list was at 4,200. I was not one bit happy. None of those children deserves to be on a waiting list. I have a complete focus on this at present and my officials know that. As I said, we are visiting these areas but I cannot understand how some of the country and teams can produce a really good outcome. We are delving down into how many referrals they get, how many are accepted and the standard operating procedures, but I am not seeing any output or improvement in output. I do not say this lightly but I have not seen any improvement in output of the number of children being seen with the additional €30 million provided in the past two years.

We have 81 CAMHS teams across the country now. I am pleased to see the Cork and Kerry region, where I met with the REO, Dr. Andy Phillips, has come back with a comprehensive plan to reduce its waiting list for anyone waiting more than 18 months and then for anyone waiting more than 12 months and to work this down. It has a good approach down there for ADHD - I think it is called SNAP-IV. The agreement is any young child or young person presenting with ADHD will be seen quickly by that particular team. They will then be referred back to their CAMHS team in the area, having a diagnosis and medication if appropriate.

We are taking the learnings from different areas to see if we can streamline it, but I must give all credit to Limerick. That area has seven CAMHS teams, and it must be complimented on having reduced its waiting lists by 90% for those waiting more than 12 months and reduced numbers for those under nine months by 59%. My point is that, if they can do it in some parts of the country, why can they not do it in all of them? I accept it is under my watch and that is why I am in the weeds of the teams to see if we can get more output.

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