James Browne (Wexford, Fianna Fail)
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My Topical Issue matter relates to the need for the Minister for Public Expenditure and Reform to address the delays in approving the pathfinder programme for young people with mental health problems. Elaine Loughlin, writing in the Irish Examineron 16 June, reported:

A scheme to help young people deal with mental health issues is being “blocked” by the Department of Public Expenditure, it can be revealed.

Four departments have agreed on how to fund and run a new coordinated “pathfinder” programme for young people with mental health problems. However, it is being held up by Public Expenditure Minister Paschal Donohoe’s department.

The Minister of State at the Department of Health, Deputy Jim Daly, is quoted as saying, “A timeline to full implementation cannot yet be agreed as the participating departments have not received final approval from [the Department of Public Expenditure and Reform]”.

I received word today that the Minister for Public Expenditure and Reform, Deputy Donohoe, was not going to take this question and had passed it back to the Department of Health. I do not understand that as the question is very clear and concise. It is directed towards the Department of Public Expenditure and Reform and asks why it is not approving the programme. I do not understand the rationale for the Minister and his Department deciding they were not going to deal with it. I do not understand how the Department of Health can answer the question on behalf of the Department of Public Expenditure and Reform and I note that the Minister of State with responsibility for mental health is also not present.

Pathfinder is a hugely important programme but it is sitting there, undelivered. Did the Department of Public Expenditure and Reform explain to the Minister of State who is present today why it was not taking the question? Has it decided that mental health is not important enough for it? Did it even read the question or did its officials just see an issue dealing with health and decide to kick it back? It is the Department of Public Expenditure and Reform which needs to answer the question as to why this programme is being held up. Is it that the Department is too embarrassed at the Government's failure to protect children and young people by making these programmes available? It appears as though the bean counters in the Department of Public Expenditure and Reform are saying that children and young people are simply not a priority.

We have seen the consequences of Departments failing to work together in the past. The pathfinder programme sets out a clear way the Departments will work together as they want to. There is a clear plan and structure but it is not being given the funding necessary to deliver. Why is that? We have over 6,000 children on primary care psychology appointment waiting lists and 2,500 children waiting for the child and adolescent mental health services, CAMHS. In the south east, as indicated by the Ombudsman for Children at a meeting of the Joint Committee on the Future of Mental Health Care last week, CAMHS is imploding because its psychiatrists are all resigning. We have more than 4,000 children with disabilities waiting for their statutory entitlement to an assessment under the Disability Act and almost 6,000 children and adolescents have been waiting for more than a year for occupational therapy assessment. We have more than 10,000 waiting for more than 18 months for hospital outpatients appointments and we are heading towards 4,000 homeless children.

It appears that the Government has an issue in prioritising children and young people and the pathfinder programme is a clear example of that. Good policies are being put in place, including by the Minister of State present, but it appears that the Department of Public Expenditure and Reform is not putting the proper funding behind many of them. The Department and the Minister, Deputy Donohoe, should have been here to address this issue today as it is that Department which is holding up the pathfinder programme, not the Department of Health or the Minister of State at the Department of Health, Deputy Finian McGrath.

Finian McGrath (Dublin Bay North, Independent)
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I thank Deputy Browne for raising this important issue and for his question on the progress of establishing the youth mental health pathfinder unit. Following Civil Service Management Board and ministerial approval, the establishment of the pathfinder unit is a mental health priority for 2018 for the Department of Health. The motivation for the model comes from an analysis that no single Department or Government agency has the key to all of the policy responses required to address the issues around youth mental health in Ireland. The remit of the pathfinder unit is to identify youth mental health priorities and objectives, developing policy to give effect to those priorities and objectives and engaging with Departments, Government agencies and non-government organisations to achieve the most effective means of implementing these policies.

The proposed model has three key elements: a cross-governmental unit staffed through secondments from participating Departments to operate for an initial three-year period; a pooled budget to drive change; and shared accountability at Secretary General level across sponsoring Departments. Membership will be drawn from participating Departments including the Departments of Health, Education and Skills and Children and Youth Affairs, in collaboration with the Departments of Public Expenditure and Reform and the Taoiseach.

It is proposed to utilise section 12 of the Public Service Management Act 1997 to enable a new collaborative model of working across Government. As this will be the first time this legislative provision has been used, a significant amount of work is required to design a robust and workable model for this new arrangement. Officials from the Department of Health, as the lead Department, have been working in co-operation with officials from the Department of Public Expenditure and Reform over a period to meet all the administrative, budgetary, governance and legal challenges that need to be addressed in developing this innovative model. I am informed that the next meeting of officials from both Departments is scheduled in the coming days. This model has been approved by the sponsoring Secretaries General and the Civil Service Management Board, which is made up of all Secretaries General and heads of offices.

It has also been approved to further some of the recommendations of the national task force on youth mental health, including taking a lead in formalising mechanisms to ensure that the voices of young people are fully considered in the development and implementation of legislation, policy and services for youth. The pathfinder team should develop mandatory protocols, which will work to safeguard young people against potential changes in policy that could negatively impact on youth mental health. It will also carry out a detailed assessment of the services and supports currently available in respect of youth mental health to identify gaps in service provision and to scope what improvements could be achieved through greater co-ordination.

In conclusion, the Departments of Health and Public Expenditure and Reform, together with other participating Departments, continue their ongoing collaboration in delivering this new, innovative and complex project and I look forward to following the development of this positive, interdepartmental proposal.

James Browne (Wexford, Fianna Fail)
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In its key message, the final report of the youth mental health pathfinder project states that urgent action is required on youth mental health in Ireland. It states that evidence shows the majority of children and young people in Ireland are highly resilient but suicide and self-harm rates among our children and young people are extremely high by international standards. The rate for young men is the third highest in the EU and the rate for young women is the highest in the EU. It states that Connecting for Life, the national suicide reduction strategy, prioritised young people but is insufficiently clear about how, when or where to take action and by whom and a sift of the evidence shows we are not serving children and young people well enough.

The Minister of State said the motivation for the model came from analysis that no single Department or Government agency has the key to all of the policy responses required to address the issues around youth mental health in Ireland. That is true and it is clear from the pathfinder report. The Minister of State also noted that the Departments of Health and Public Expenditure and Reform, together with other participating Departments, were continuing their ongoing collaboration in delivering this new innovative complex project. All the other Departments have done their job but the Department of Public Expenditure and Reform is not doing its job. The pathfinder report is dated March 2017 and I understand it was finalised last December but we are now coming into the second half of 2018. I reiterate the Minister of State with responsibility for mental health was reported as saying that a timeline for full implementation cannot yet be agreed as the participating Departments have not received final approval from the Department of Public Expenditure and Reform. It is the Department of Public Expenditure and Reform which is holding this up and which is not prioritising mental health. That Department and its Minister, Deputy Donohoe, should be here to answer this question today and not the Ministers of State at the Department of Health, Deputy Jim Daly or Deputy Finian McGrath. The Department of Public Expenditure and Reform needs to step up to the mark.

Finian McGrath (Dublin Bay North, Independent)
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I fully accept the Deputy's genuine concerns on the suicide figures and on youth mental health.

I also firmly believe that children have to be a priority. Funding is an issue and we must have and continue to have detailed consultation with young people. I also commit to bring the concerns expressed back to the Minister for Public Expenditure and Reform, Deputy Donohoe. The status at the moment, however, is that a cross-Government unit staffed through secondments from participating offices and agencies will operate for a three-year period. It is proposed to recruit a director for the unit. The Department of Health has agreed to fund this post, subject to the agreement of the Department of Public Expenditure and Reform. As approval to proceed is still awaited, I take the Deputy's point.

It has also been agreed that the participating Departments will cover the cost of their own seconded staff, subject to approval by the Department of Public Expenditure and Reform that Departments be allowed to backfill seconded posts. A draft job description for the director has also been prepared. It is also essential that we have a budget to drive change. It is proposed to utilise section 12 of the Public Service Management Act 1997 to create a pooled budget between participating Departments. A draft order, entitled the Public Service Management Act 1997 (section 12) (youth mental health) Order 2018, is in preparation, with an input from the Department of Health legal unit and the Office of Parliamentary Counsel, OPC. This is currently being reviewed before being resubmitted to the OPC.

The Department of Public Expenditure and Reform raised queries - and this is partly a response to the Deputy's concerns - on this approach in December 2017. The Department of Health responded to those queries in January 2018. Further queries were then received from the Department of Public Expenditure and Reform on 21 June 2018 and a meeting has been scheduled between the Department of Public Expenditure and Reform and officials from the Department of Health. We have to focus on this and I will bring these concerns back to the Minister for Health, Deputy Harris, the Minister of State, Deputy Jim Daly and, more importantly, to the Department of Public Expenditure and Reform.