James Browne (Wexford, Fianna Fail)
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My matter is focused on the general issues and the lack of services for child mental health throughout the country. For example, more than 6,500 children were waiting for a primary care psychology appointment at the end of May 2018. Some 1,700 of them had been waiting for more than a year to be seen.

Demand for child and adolescent mental health services, CAMHS, is increasing; almost 3,000 children are now waiting for a first appointment. In excess of 300 of them have been waiting more than a year for a first assessment. This is an intolerable wait for children to see a specialist. The psychology services and CAMHS, which is our acute mental health service, are sister services. Delays in community psychology services are leading to increased pressure on the acute services offered by CAMHS.

Unfortunately, it gets worse. The number of children who are being admitted to adult units increased by 20% in the past year. Children who should not be in those units are being admitted to them, which is contrary to Government policy. Doctors and families are left with a Hobson's choice of either getting the services in an appropriate setting or not getting them. That is totally inappropriate.

There are no multidisciplinary teams to support parents and children when they need help. In my county of Wexford, for example, there should be three consultant child psychiatrists but there is none. There are only two approved but there is none for an entire county of 150,000 people. There is a 34-month waiting list for child psychology services in County Wexford, and urgent cases cannot be taken. Last October, the Minister promised a new site to replace the inappropriate facilities that specialists are working out of currently The site was promised for this summer. Now it is September and what I am being told locally is that the building is being rented.

Pat Buckley (Cork East, Sinn Fein)
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More than 700 children with mental health difficulties are on a waiting list for specialist treatment services in the Cork and Kerry region, including 200 who are waiting more than a year. Delays in accessing CAMHS worsened recently in Cork North Lee, which closed to new referrals last month following the departure of a consultant psychiatrist. The HSE said referral rates among under 18s in the Cork-Kerry area have risen by 26% since 2011, including a 10% increase between January and June this year versus the same period in 2017. As of March this year, 2,691 children and young adults were waiting for the HSE to provide them with an appointment. The HSE mental health services disclosed that 1,369 were waiting for up to three months, 470 up to six months, 241 up to nine months, 225 up to 12 months, a staggering 178 up to 15 months and 80 up to and over 18 months. It goes on and on.

We all know that CAMHS staffing is only at 56%. I do not mean to be disrespectful but we are probably going to get a lot of generic answers on this and we are well aware of it. Cork, Kerry, Wexford and Tipperary services are understaffed. We now have problems in Waterford and Sligo. I can tell the Minister of State how bad it is within 16 seconds. A 13 year old was in CAMHS but somebody in his or her wisdom decided that she may not have Asperger's, so she was discharged from CAMHS. She needed an assessment which still has not happened, and that child is doing her leaving certificate this year.

Catherine Byrne (Dublin South Central, Fine Gael)
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On behalf of the Minister of State, Deputy Daly, I thank the Deputies for raising this matter. He apologises that he cannot be present.

One of the Government’s priorities is ensuring appropriate and accessible mental health services for children who need them. This is reflected by a budget 2018 allocation of an additional €35 million for new developments, bringing total HSE mental health funding this year to more than €910 million. The HSE service plan 2018 commits to further development of CAMHS against a background where the population of children is expected to increase and where the demand for CAMHS has seen a significant increase in recent years. Approximately 18,800 referrals are expected for HSE CAMHS this year, with 14,300 being seen by this specialist service. Additional resources and facilities means there are now 69 CAMHS teams and three paediatric liaison teams, supported by 68 operational CAMHS beds nationally, with further beds planned to come onstream in the near future. Since 2012, more than 1,300 health professionals have been recruited across mental health to modernise and improve services. However, there are widely acknowledged difficulties in recruiting and retaining specialist CAMHS staff, particularly consultant psychiatrists. The HSE acknowledges that the lack of consultant cover can impact on access to services locally. It is working to explore all avenues for the recruitment of qualified staff to fill vacancies, particularly in areas such as consultant, psychologist and nursing posts. The HSE is working to provide the best CAMHS service within available staffing resources.

A key approach to developing wider services for young people, and thereby reducing pressures on CAMHS, is the decision by Government to increase access to counselling services in primary care, with the appointment of 114 assistant psychologists and 20 psychologists nationally.

In addition, the Minister of State, Deputy Jim Daly, recently approved ten new posts for advanced nurse practitioners who will be specifically directed to CAMHS. Other CAMHS-specific measures included in the HSE service plan include increasing the number of CAMHS referrals to be seen this year by 27% compared with 2017, providing for a seven-day per week service for CAMHS to ensure supports for young people in line with the Connecting for Life strategy, improving CAMHS day hospital services and developing eating disorder specialist community teams for young people. The Minister of State has set as a priority with the HSE the development of a 24-hour helpline, as well as digital support services. These will enhance access to supports and, where appropriate, facilitate early and urgent interventions using innovative digital technologies.

The Cork Kerry Community Healthcare organisation has approximately 168,000 young people under the age of 18, in line with the national average of 25% of the population. A CAMHS enhancement project commenced in September 2017 given local and national concerns about the growing demand for CAMHS services in the area. As a priority, the initial focus has been on reducing waiting times in excess of 12 months in Cork and Kerry. However, in the longer term, the project aspires to address both system and culture practice changes to improve access to CAMHS.

James Browne (Wexford, Fianna Fail)
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The Minister of State mentioned the number of CAMHS teams but the vast majority of these are understaffed. She spoke about the difficulty in recruiting psychiatrists. This year, the College of Psychiatrists of Ireland sought a 10% increase in the number of training places from the HSE but the executive would only approve a 5% increase. The Government refuses to extend the National Treatment Purchase Fund to cover mental health services and refuses to appoint a digital safety commissioner, who would be critical in addressing the concerns young people experience online. Due to infighting between Departments, Pathfinder, a crucial programme set up by the Government, is not being financed in order that it can implement necessary supports for young people. Dr. Kieran Moore, a consultant psychiatrist, left Wexford because Slaney House is not fit for purpose. He left after having been there for 13 years. We were promised a new building last October but it has still not been delivered. Children and parents are distraught and it is simply not acceptable. Not enough is being done.

Pat Buckley (Cork East, Sinn Fein)
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I thank the Minister of State for her answer. I am not surprised that it is more of a generic one. I am happy that Cork was mentioned in the answer because normally when one asks about a pen in this House, it is not in the answer. It does not mention any solutions. It mentions 168,000 young people under the age of 18 who are waiting for this or that. There does not seem to be a plan. The plan was to reduce waiting times to under 12 months. A total of 631 people in Cork have been waiting for more than 12 months. The Minister of State mentioned 69 CAMHS teams, four of which are staffed. We will not be having a premier league of 60 or 70 teams. We cannot set up a premier league because we do not have fully staffed teams. It is disgraceful. Regarding the difficulties in recruitment, if we paid the staff, we might get them and this generic answer is desperate.

In the brief time available to me, I will talk about what is happening. I want the Minister of State to get to grips with this. I got permission from a mother just before I came in here to tell the following story. It is about a 15 year old teenager who has been bullied, has been moved from school to school and has struggled to stay in St. Michael's unit in Cork. She has attempted suicide and cut all her hair off. Her father has stage 4 cancer, the family is being pushed from pillar to post and the Minister of State is telling us that there is a big push on in Cork and Kerry. The Minister of State heard Deputy Browne talk about how Wexford is falling apart, as is Tipperary. I am fed up with coming in here and talking. It is verbal diarrhoea. These people are struggling. The Minister of State should visit that family and see the hurt on the mother's face. The Minister of State should not come in here with generic answers because it is an insult to the people we are supposed to represent in this House.

Catherine Byrne (Dublin South Central, Fine Gael)
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I hear Deputy Buckley's frustration and concerns.

Pat Buckley (Cork East, Sinn Fein)
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I am frustrated. It is not a personal attack.

Catherine Byrne (Dublin South Central, Fine Gael)
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I know and I am not taking it as a personal attack. I have read the reply I have been given and, unfortunately, I cannot answer some of the specific questions asked by Deputies Buckley and Browne but I have taken note of them and, as always when I am asked to come into the Chamber, I will go directly to the Minister whose place I have taken. I will raise the concerns raised. In reading the reply, it is clear to me that there is a significant shortage, particularly in recruitment in CAMHS. Perhaps some of the reasons involve finance but some of them, which I have experienced as a local Deputy, involve the fact that child psychology is a very difficult place to be. People burn out very quickly and, unfortunately, some decide to move on for whatever reason. I can understand those reasons. The reply I was given is not an adequate reply to some of the questions that have been asked but I will revert to the Minister with both questions I was asked and will ask him to reply directly to the Deputies who raised the issues.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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By way of information for Members, there was a proposal at this morning's meeting of the business committee that time be found in the near future for a plenary session on adolescent mental health. Having heard the Deputies, it would appear that they should ask their party Whips-----

Pat Buckley (Cork East, Sinn Fein)
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Solutions would be better.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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The Deputies should ask their party Whips to seek the prioritisation of such a debate where solutions could be identified.