Marie Sherlock (Dublin Central, Labour)

I welcome the opportunity to speak on World Mental Health Day. Enormous work is being done across the country by many groups, both informal and formal. Progress has been made on breaking the stigma in our communities in recent years. However, it is important to say that stigma is alive and well in workplaces and in the medical profession when people present with a long history of mental health conditions and then seek assistance for physical health conditions but are effectively not afforded the seriousness and consideration they should be. There has been progress but, by God, we still have a long road to travel.

I acknowledge the Minister of State's commitment to her role in recent years. We sharply differ on some issues but there is no doubting her commitment. I also want to acknowledge the presence of Deputy Roche, who has spoken so powerfully about his own family. When people speak out, particularly public representatives or others in positions of influence, that can be a wake-up call to services and as to the reality of mental health in this country. We know from research that 42% of all adults in this country have experienced a mental health illness. Just under half of the population will experience a mental health crisis or illness at some point in their lives. That is enormous.

The Minister of State spoke of the structural factors and it is important to speak of those here. Homelessness, the lack of affordable housing and, in some cases I know very well, the lack of access to disability services, particularly for children, can have a devastating impact on the mental health of parents, children and families. It should harrow us all to know one in ten adults in Ireland has at some point attempted suicide.

The Minister of State referenced the significant challenges for adolescents since the pandemic. We know from research by the RCSI that one quarter of adolescents have described their mental health as bad or very bad and one in ten reported attempting suicide following the pandemic.

The critical point is that our mental health services were very much in the dark ages. There has been some improvement but there is a long road to travel.

It has already been said that heart attacks, strokes and falls are not nine-to-five issues and for a long time our health services have recognised that with 24-7 availability of care. For mental health, it is a very different story. I was glad to hear this week's announcement of the specialist nurses or advanced nurse practitioners who would operate in emergency departments. I hope there will now be a separate pathway. The Mental Health Commission made clear last year how inappropriate it was, and how out of step Ireland was, that those presenting with a mental health crisis were filtered to an ED. They are first filtered for their physical health and then referred for mental health. We all know the long hours people spend in emergency departments and to think that people spend hours on end waiting for the appropriate care, particularly when it is a mental health crisis, is horrendous. We know 51,000 people annually access mental health services for the first time through emergency departments, so the lack of out-of-hours services and appropriate spaces is critical.

I welcome this week's announcement but I have two questions. First, it is important to have the advanced nurse practitioners or specialist nurses providing that service, but where is the referral to the consultant psychiatrist in the hospital on a 24-hour basis? Second, will the Minister of State clarify what "out of hours" truly means? Many of us would expect it to be 24-7 but I hear today the service is until 2 a.m. That is better than 5 p.m. or 6 p.m. but it is still not on a 24-7 basis.

Nor is it clear whether that is for Saturday and Sunday. We need to have that clarity. In my constituency we have had children in adult emergency departments waiting for days for a service to become available. It points to the lack of inpatient mental health services for children.

In regard to CAMHS, the announcement this week is to be welcomed. We have not seen the clear commitment on funding. Only when we see that will we be sure that is going to be there. The 300 additional staff is to be welcomed. However, in the context of now having 248 fewer staff compared with December 2023, it is really a case of running to stand still in CAMHS.

In regard to the length of the waiting list, I hear what the Minister of State said. Some regions have upped their game for a variety of reasons and other areas have not. There are 4,554 children waiting to be seen. Deputy Clarke referred to the more than 23,000 people waiting on the psychology waiting list with over 11,000 waiting more than a year. Last week we heard from the Minister for Health that there will now be special interventions with regard to occupational therapy, speech and language therapy and physiotherapy for children's disability services. We did not hear anything with regard to psychology. To my mind, any child waiting 12 months or longer or any period of time is utterly unacceptable. I am told it is complex and that it is difficult to recruit psychologists, but something dramatic has to be done.

Outsourcing is the unspoken piece of the mental health funding story. In 2018, €46 million was spent on private providers for psychiatric and mental health care. That figure was €80 million last year and we are spending an additional €13 million sending people to the UK for care. As the HSE has itself acknowledged, mental health expenditure on private placements is contributing significantly to the overall mental health expenditure. That level of outsourcing is unacceptable and reflects the deep and structural failings within our system. Earlier this year we spoke about eating disorders and the number of people who have to travel. Again, we have differed in terms of the words being used here but saying that people are choosing to travel seems inaccurate. Those families do not believe that they are choosing to travel. They feel they have no service available to them here. The reality is that in this country, according to the Health Research Board, 76% of inpatient admissions for eating disorders are to private facilities or private charity providers. That is simply not good enough.

I note the commitment in the budget this week but we have a long road to travel to ensure there is sufficient provision for those suffering one of the most difficult mental health conditions. Of all mental health conditions in this country, eating disorders actually have the longest of inpatient stays.

The lesser-spoken part of the mental health piece is mental health clubs. Regarding the piece about prevention, support and assistance to those who got a prevention from additional hospitalisation, for those who have long-standing mental health conditions that is important. In my constituency, two mental health clubs were closed down in the past number of years, Shines on Mountjoy Square and the 245 Club in Drumcondra. I met four men earlier this year who have a long history of suffering from schizophrenia and want to set up a mental health club. They came looking for help. They have worked it all out. They have a business plan. They themselves need this service but they recognise the need in everybody else as well. We do not have enough of these mental health clubs, which are vital yet simple service provisions that are effective in keeping people out of hospital and ensuring there is the support and framework around them.

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