Anne Rabbitte (Galway East, Fianna Fail)
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RTÉ programmes broadcast on three nights last week showed how children were being failed in this state. The programmes in question covered the issues of gambling and foster care and troubled young people, the latter of which is being raised by five Deputies by way of a Topical Issue. Although I can only talk about my own area, CHO area 2, I can empathise clearly with what the young people on the programme said about child and adolescent mental health services and facilities in general. It is shocking to think that at the end of January, some 6,181 children were waiting for a primary care psychological appointment. Most of the 1,200 high priority cases within that cohort have been waiting for approximately 12 months. I cannot understand why we have to wait for children to become acute before there can be an intervention. Why do we have to wait until they are in sixth class before there is an intervention? Why do we always have to wait until they are nearly on the brink of self-harm before there is an intervention? As we know, child and adolescent mental health teams are not completely filled. While we have the teams, we do not have the full complement of staff. I wonder what the Minister of State and the Department of Health are doing to recruit to fill the teams. To be honest, we do not have a functioning child and adolescent mental health service or functioning child and adolescent mental health teams. When one of the 11 components needed is missing, it can be a key driver that spreads throughout many other services. I wonder how the Minister of State intends to address the issues raised last Thursday night.

James Browne (Wexford, Fianna Fail)
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I thank the Leas-Cheann Comhairle for giving me an opportunity to speak about serious mental health cases among young people. On RTÉ's "The Big Picture - Young and Troubled" broadcast last Thursday we witnessed some heart-rending examples of the distress being experienced by young people with mental health issues and their families as they tried to access child and adolescent mental health services. Unfortunately, the stories we heard from these brave families on RTÉ last Thursday night are reflected across the country. The Government consistently states it is doing all it can, but the facts speak for themselves and I will provide some recent examples. A significant number of children are still being placed in adult units, some for up to six weeks. Some of them have to sleep on chairs or in hallways. At the end of January, over 6,000 children were waiting for a primary care psychology appointment. Over 1,500 of them had been waiting for more than one year. There is a similar situation in child and adolescent mental health services, with over 2,500 children on the waiting list, of whom 351 are on the list for over one year. Barely over half of the number of staff needed to provide a basic child and adolescent mental health service are in place throughout the country. When we engage in early identification and integrated intervention, we can help to reduce significantly the burden of mental ill-health on young people. We do this by identifying symptoms and warning signs at an early stage and, having done so, providing expedient and suitable care. Mental illness is particularly receptive and responsive to early intervention. The mental health system for young people seems to be geared towards triage and crisis intervention. When will the Government provide access to the timely and appropriate early intervention that is desperately needed by young people with mental illnesses?

Pat Buckley (Cork East, Sinn Fein)
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I have loads of notes, as Deputies can see, but much of what is in them has been covered. I do not think enough time has been provided to debate this utter travesty and absolute emergency. I compliment RTÉ and, more importantly, those who took part in the documentary. How many more documentaries will we have to watch before the country wakes up? I got angry last week when I was told by one of two witnesses who had to appear without prejudice at the Joint Committee on the Future of Mental Health Care that they had been threatened by management for coming here to tell us the truth. We are trying to get to the truth and the root of this issue to stop people from dying. It was reported at the joint committee that 70 schoolgoing kids had died by suicide last year.

If it was a school bus full of kids, it would be on the front page of every newspaper in the country. It excludes 16 to 18 year olds not turning up for school who are more vulnerable.

There is a crisis in CAMHS and I know that the Minister of State will mention staffing and recruitment, but he will have to come to reality. No matter what must be done, I ask him to sit down with nurses, staff, unions and whoever else to get this right. I am dealing with children aged six, eight, 11 and 13 years and can read what is written on their legs. They are going to doctors who cannot refer them to CAMHS. They are told that they are not sick. A number of weeks ago we had the awful case of young Elisha Gault, of which Members are well aware. I would upset the public if I was to relate what had happened to that young girl before she went for help. The system is failing and we should be absolutely ashamed of ourselves. I am very interested in the Minister of State's reply, but we must do something.

Donnchadh Ó Laoghaire (Cork South Central, Sinn Fein)
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This has often been described as a crisis and it is no longer in any way a controversial statement. The state of mental health services is very clearly a crisis and an emergency. Last week we saw the RTÉ programme "The Big Picture - Young and Troubled"; it was an excellent piece of public service broadcasting. The matter enters the heart of the public debate every so often, but for the young people affected, in particular, it is an ongoing and daily issue. Day in and day out, they wait for appointments. The Minister of State is aware of the particular interest in this issue in Cork as there has been much concern expressed in the past 12 to 18 months as the suicide rates in the city and county are above the national average in recent years. The Cork and Kerry area accounts for a substantial part of the mental health waiting list, making up 29% of the total. Last year there were approximately 120 people waiting for more than 18 months and that pattern is replicated nationally. There are approximately 250 young people waiting for longer than 12 months for an appointment with CAMHS at this time, which is scandalous. These young people find themselves portrayed as statistics, but the reality is that day after day they go about trying to live fulfilling lives by attending school or work and trying to find satisfaction or hope in life and all the while they wait months for appointments. Some of them could be in crisis. As there are not enough mental health professionals available, they are in the difficult position where they have to try to triage in what is a most severe crisis. As many of the young people who are waiting are in a very severe crisis, mental health professionals must try to establish whose cases are the most urgent. It is a fish and loaves job, as there are not enough professionals to go around. Young people are suffering as a consequence.

Jim Daly (Cork South West, Fine Gael)
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I thank the Deputies who spoke and took the time to ensure we could raise this matter on the floor of the Dáil following last Thursday's programme which highlighted many of the issues debated in this House in recent times in protecting youth mental health and particular issues surrounding the specialist Child and Adolescent Mental Health Service, CAMHS. Overall, the programme adopted a balanced approach, showing both the positive and negative aspects of the system. It referenced the increasing demands, good practice and the service improvements required.

I stressed on the programme that youth mental health had to be viewed in its widest sense and seen as more than just the specialist CAMHS. A priority for the Government is improving all aspects of prevention and early intervention, including progressing implementation of the 2017 report of the national youth mental health task force. Our aim is to improve access to services by examining options such as seven-day cover, 24-hour cover, developing a national telephone and text helpline and other digital information and supports, as access to early intervention and the signposting to services clearly need improvement for service users.

Mental health remains a priority for the Government. This is reflected by the additional €35 million we gave in the last budget, bringing total HSE funding in the area to over €910 million. The HSE service plan for 2018 is developing CAMHS against a background where the population of children is growing and the demand for CAMHS saw a 26% increase between 2012 and 2017. Approximately 18,800 referrals are expected to CAMHS this year, with approximately 14,300 being seen by this specialist service. A particular issue that came through strongly on the RTÉ programme was that of service variation around the country, particularly in accessing services, addressing urgent cases and tackling waiting lists. The HSE launched a standard operating procedure in 2015 for both inpatient and community CAMHS. The executive is reviewing its operational procedure and this review is expected to be completed by mid year. We expect it to reinforce the message that services must be delivered equitably across the country.

Other CAMHS-specific measures included in the HSE service plan for 2018 include increasing the number of CAMHS referrals to be seen this year by 27% compared to the number in 2017. The measures will also seek to provide a seven-day per week service for CAMHS to ensure supports for young people in line with Connecting for Life. They will also improve day hospital services within CAMHS and develop eating disorder specialist community teams for young people, with a range of "talking therapies" such as dialectical behaviour therapy. The executive is also enhancing access by older adolescents to specialist mental health services, with continued appropriate placement and care in CAMHS-specific settings.

There have been widely acknowledged difficulties in recruiting and retaining specialist CAMHS staff, while recruitment efforts have been ongoing, notwithstanding a serious shortage of suitably qualified CAMHS consultants at both national and European level. A key approach to reducing pressures on CAMHS is the decision by the Government to increase access to counselling services in HSE primary care services. The recent appointment of 114 assistant psychologists and 20 psychologists will go some way towards developing such a service for teenagers and young people. The genuine and serious issues raised on the recent RTÉ programme will receive full and proper consideration by the Department of Health and the HSE in the context of our collective efforts to improve all aspects of mental health services for young people.

Pat Gallagher (Donegal, Fianna Fail)
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Each Member will have one minute in which to reply. I ask all of them to observe this time limite as we have a long night ahead.

Anne Rabbitte (Galway East, Fianna Fail)
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I thank the Minister of State for his response and take on board everything he has said, but I must return to the programme, "The Big Picture - Young and Troubled", in which young people identified solutions and where they and their families needed help. Only a number of weeks ago in Galway the Youth Work Ireland counselling service applied for funding from the HSE to provide a service for 220 children, ranging in age from 16 to 21 years, but its request was turned down. It was only awarded €15,000. The service was to provide support for an entire county - the second biggest in Ireland - but seemingly it did not meet the needs threshold. The needs had been identified by teachers, schools and Tusla as being met by this very good and working early intervention group. I cannot understand how, with an extra allocation of funding, we are not reaching out to groups such as this which have a proven record and good statistics.

James Browne (Wexford, Fianna Fail)
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I was struck by the comments made by one young person on the RTÉ programme who said people felt abandoned and lost in the system. That probably sums up the experience of many young people and their families in trying to access mental health services.

The second interim report of the Joint Committee on the Future of Mental Health Care was published last week and one of the most notable aspects was that €400 million was being spent on psychotropic drugs but only €10 million was being spent on counselling in primary care settings. That goes to part of the problem to which I alluded in that we seem to triage and deal with crisis interventions instead of dealing with people when they first show early signs of having a mental illness or difficulty. The HSE launched a standard operating procedure in 2015, but it is ineffective when there are not enough staff in place to operate or implement it. Everything is being funnelled into CAMHS and GPs are in a desperate position because they either send people to emergency departments or must prescribe drugs for them. We must provide for earlier intervention and more primary care supports for young people.

Pat Buckley (Cork East, Sinn Fein)
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I know recruitment is a massive problem. We know that the Minister of State, Deputy Jim Daly, sees this and he is trying to do his best. I ask him to use his and the Government's power to try to solve this. No amount of money is too much to ensure that services can finally be put in place. It is more than 12 years since A Vision for Change. As I mentioned, 70 schoolchildren died last year. How many have attempted to take their lives? How many have self-harmed or abused drugs or alcohol? We do not know. We surely cannot allow this to continue. It is a national emergency. These are children. They are people's sisters, brothers, mothers and fathers. We said all this before. On the future of mental health care, I ask the Minister of State to listen to the recommendations of the Oireachtas Joint Committee on the Future of Mental Health Care. Listen to our proposals, talk to the unions and please make the changes that we need so that we can get this right. I do not care what it takes. Prevention is better than cure. I appeal to the Minister of State to take everything on board.

Donnchadh Ó Laoghaire (Cork South Central, Sinn Fein)
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I know the Minister of State is sincere and that problems predate his appointment by some distance. There is a lot of discussion about prevention, and rightly so. It is vitally important to resolve this crisis and prevention has to be at the fore. It is going to take many years to build this system properly. There will be prevention in schools and in the wider community. That is going to take some time to work through the system. Meanwhile, we have people in crisis and people who require urgent healthcare. Sometimes a distinction is drawn between physical health and mental health that is not helpful. These are people who are often in bad health and require urgent attention. Often, they are not able to get it, not because the staff are not up to it but because they are overstretched. They need much more support. A Vision for Change is 12 years old. We have only two thirds of the staffing level or a little more than that. That badly needs to be addressed to ensure people get the service they deserve.

Jim Daly (Cork South West, Fine Gael)
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I thank each of the Deputies. I know the sincerity every Deputy raising this issue brings to the table. It is not just today that I have seen that.

I have a few responses. On the Youth Work Ireland counselling service in Galway, I have undertaken to look at that for Deputy Rabbitte. There are issues with governance etc. in respect of some organisations that have received money. While I am not suggesting for a second that Youth Work Ireland is involved, the Deputy will appreciate that I can not give her detail now, but I will talk to her again.

We continue to try to fill staff vacancies and to build training. There have been a number of people coming in. The 114 assistant psychologists that have been taken on in primary care will make a big impact. They are supported by 20 full-time psychologists. That will be another level underneath CAMHS. That has been badly needed for years. That is the biggest help we can give to deal with the lists and the numbers that are piling in at the top of the CAMHS list.

On intervention, I appreciate what Deputy Ó Laoghaire is saying about not neglecting the upper level of the pyramid. We will continue to keep resources there. Deputy Ferris mentioned individual cases. He will appreciate I cannot go over those. Deputy Buckley spoke of 70 children. As I understand it, the CSO would dispute that number.

Jim Daly (Cork South West, Fine Gael)
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I do not think it is correct, but it does not matter whether it was one child or more. It is neither here nor there. If one child died by suicide, that is one child too many. I am not going to argue the toss over the numbers. People have a responsibility when they supply information to ensure that it is accurate. I am not suggesting the Deputy in this regard but the people who came before the committee.

People know my views on the CAMHS system and what we need to do. I refer to early intervention and rolling out things like the STEPS programme in schools and ensuring we have a more proactive system rather than one that is reactive. For too long too much of it was management. That was highlighted by that show. Different CAMHS teams operated very differently and had much longer waiting lists despite having a similar number of referrals to other CAMHS teams that had no waiting lists. We have challenges within the management of these systems that we have to look at. I reiterate that we take it very seriously.