Dáil debates

Thursday, 21 November 2019

Mental Health: Statements (Resumed)


3:00 pm

Photo of James BrowneJames Browne (Wexford, Fianna Fail)
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I wish to share time with Deputy Butler.

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
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Is that agreed? Agreed.

Photo of James BrowneJames Browne (Wexford, Fianna Fail)
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There are no staff to care for children who suffer from disabilities such as autism or Down's syndrome and who also suffer from a mental health illness in three health areas, CHO 1, CHO 3 and CHO 6. These children with disabilities are four times more likely to suffer a mental health issue and are least able to cope when they receive the worst mental health care services of any mental health service. Meanwhile, the number of children admitted to adult units was 68 three years ago but was 84 last year. The number is clearly going in the wrong direction.

I wish to refer to consultants not on the specialist register but who practise as psychiatric consultants. The appointment of junior doctors who are not on the specialist register as consultant psychiatrists has rightly been condemned as scandalous by the President of the High Court. It clearly unsafe and may even put lives at risk. The Mental Health Commission confirmed yesterday that it will not allow such consultants to sit on mental health tribunals. Some patients have had their involuntary detention orders overturned because they were signed off by unqualified consultants. That is a scandal.

Only 1% of all mental health services in Ireland are regulated. I am concerned about the potential for serious risk to arise in some such facilities which ought to be regulated. Given the breaches of regulation highlighted in reports by the inspector of the Mental Health Commission into regulated facilities, one must worry about what is happening in the unregulated facilities. Similar facilities for disability care and physical health are regulated by the Health Information and Quality Authority but not those for mental health.

The abolition of the role of director of mental health in the HSE has been decried by all in the mental health community. That was a backward step. The Mental Health Commission stated that as the highest level of our mental health services workforce, it is both noteworthy and disappointing that the HSE removed the post of national director for mental health. The removal of this core leadership position sent out a clear and unambiguous, although perhaps unintended, message that mental health is not a priority. It is also evident to the commission that this has negatively impacted on the delivery of services nationally. That action must be reversed because it is clearly having a very detrimental impact on mental health services.

We are now 13 years into the ten-year national mental health strategy, A Vision for Change, yet the update to it has still not been published. The independent review group published its proposals for updates to the Mental Health Act 2001 in 2013 and we still have not seen the heads of a Bill. In 2013, the independent group charged with monitoring progress and implementation of our national mental health policy was disbanded and has not been re-established. There is much work to be done in areas of mental health policy reform.

I refer to the situation that arose in St. Luke's in Kilkenny. This year, our mental health services had to suffer the ignominy of its first ever prosecution in the courts. St. Luke's in Kilkenny was prosecuted because of the lack of care for some of our most vulnerable people. No mental health facility should ever be allowed to fall so low that it needs to be prosecuted. There is clearly a lot to be done in order that people across the country have fair and equal access to mental health services. The key points I have highlighted reflect only some of the many issues I could have highlighted if I had sufficient time. I hope we will have time to discuss them in the future.

Photo of Mary ButlerMary Butler (Waterford, Fianna Fail)
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As the Minister is well aware, the department of psychiatry at University Hospital Waterford, UHW, has been in the news for all the wrong reasons in the past month. As a result, confidence in the unit by patients, staff and the general public is at a low ebb. The catchment area for UHW covers Waterford and Wexford.

I was appalled when I read the report from the Mental Health Commission which found that the department of psychiatry at UHW had a mere 57% compliance rate this year. The report's findings are extremely worrying and serve to highlight the serious issues within our mental health services. Over the past three years, compliance levels have fallen from 64% in 2017 to a record low of 57% this year. It is obvious that no structures were put in place in 2017 to halt the decline, which is worrying.

The report raised issues with regard to the fact that children were being admitted to adult settings despite the fact that not all staff had received training in the context of the Children First guidelines. Children did not have access to age-appropriate advocacy services and facilities. The conditions at the unit also raised red flags. The report described two toilets as malodorous with overflowing bins, discarded cigarette butts and thick cobwebs. Also of great concern was the fact that residents' general health was not monitored and assessed by their specific needs. This is very worrying. Physical examinations were inadequate and did not consistently include an assessment of residents' body mass index, weight, blood pressure, smoking status or dental health. For anyone who is long-term in the unit, that is particular a concern. Anyone with a loved one in the unit would be rightly concerned. I have no doubt that the staff in the wards are doing all they can to give the best care and attention to the residents. However, severe staff shortages are undoubtedly having an impact. The Psychiatric Nurses Association of Ireland, PNA, has highlighted concerns with senior management, the HSE and the Mental Health Commission and felt compelled to hold a two-hour stoppage recently to raise awareness of the conditions.

In 2010, St. Senan's in Wexford was closed and the department of psychiatry at UHW was deemed suitable for Waterford and Wexford inpatients. No extra capacity was provided and hence the issues arose. The question is why standards are slipping so drastically. The issues highlighted are simply not acceptable and must be addressed as a matter of urgency. Recently, images of overcrowding with patients sleeping on chairs and floors were circulated on social media. These are deeply distressing and completely unacceptable. However, they came as absolutely no surprise to anyone working within this unit. I have met and spoken with three residents who were in the unit this year and they all confirmed that overcrowding with patients sleeping on the floor is an ongoing issue and was not unique to the bank holiday weekend as was stated. One very brave young woman, Shauna is her name, spoke with me today on WLR radio outlining the many challenges she faced, the conditions in the unit and the severe overcrowding. At one stage over the October bank holiday weekend, an additional ten residents were facilitated. This meant that there were 54 people in a 44-bed unit. Health and safety rules and regulations were obviously ignored as capacity was well exceeded. The reports from UHW are absolutely damning. Not only is the treatment of patients there unsafe, it is inhumane.

I thank the Minister of State for meeting Deputy Browne and me the week before last and for agreeing to visit the unit in the near future. I have been informed by the hospital management that a deep clean has taken place and that the aspects in the report in respect of malodorous smells, overflowing bins and cobwebs have all been dealt with. However, I am appalled that the conditions were allowed get to that state and I know the Minister of State is, too. It is well recognised that additional capacity is required with a figure of 20 beds being the general consensus for the Waterford-Wexford region. The fact that these beds will not be achieved in the short term is further evidence of a hands-up approach to mental health issues in Waterford and Wexford. Kate Killeen-White, chief officer with South East Community Healthcare, said she could not defend the situation in Waterford. John Farrelly, the chief executive of the Mental Health Commission, has admitted that the conditions are unacceptable. Next March, registration is due again for this unit and a meeting will be held in the coming weeks. The Mental Health Commission has warned that significant improvements and changes need to be made for the centre to be permitted to re-register. Unless a clear, agreed, corrective plan is put in place, implemented and adhered to, I would be extremely concerned. We cannot afford to lose this unit from Waterford.

3:10 pm

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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I am sharing time with Deputy Ellis. I welcome the opportunity to have this debate. A number of us tabled a Topical Issue matter on the Waterford psychiatric unit some weeks ago. The Minister of State was not in a position to be here, which was unfortunate because this was not just a scandal in Waterford or the south east. It was seen as a national scandal to have patients being treated the way they were. We all know that child and adolescent mental health is important but it is in disarray and crisis. There is oversubscription, underfunding and understaffing. We hear from the trade unions representing the staff who do their best on a constant basis to provide the services that the system is under fierce pressure. In Clondalkin, there is a campaign to save services. Councillor Mark Ward of Sinn Féin is involved in that. In Wexford, there was also a protest in recent times. Mental health is a big issue.

The issue regarding Waterford is extraordinary, particularly because it was allowed to happen. For what has been reported in Waterford to be allowed to happen in any psychiatric unit in the country is extraordinary. What is terrible about this is that everybody knew about it. It is not the first time the Mental Health Commission has shone a spotlight on the psychiatric unit in Waterford. It does not blame the staff. They are not to blame, they are doing their best. The Mental Health Commission blames capacity. I want to give a flavour of what it found in its report, which makes for very depressing reading. It found that residents' general health needs were not monitored, nor were they assessed in line with their specific needs. It found that eight children had been admitted to an adult unit in the past 18 months. These children did not have access to their appropriate services. The general health needs of adult residents were not monitored and assessed on the basis of their specific needs. They did not have access to a supply of appropriate emergency personal clothing; there was only old clothing, which was stored in a disorganised manner. It was unclear what was available concerning size and gender-specific clothing. No emergency underwear was available to residents. Bins were overflowing in both the male and female communal toilets. Discarded cigarette butts were found in the sink of the ladies communal toilet. Thick cobwebs were observed on the skylight in the Brandon unit. Brown staining was observed in the assisted bathroom. In addition to the report and all it contains, there is photographic evidence of patients lying on floors. When the management of the unit were asked about this, they said it is a regular occurrence because it is over-subscribed. When I spoke to the trade union officials on this, they said the unit needs more capacity. There is a difficulty because a previous Government, I think it may have been a Fianna Fáil Government, took the decision to close St. Senan's in Wexford which had disastrous consequences because all the patients there are referred to Waterford with no additional capacity. However, the real problem here is A Vision for Change. It is in the community. That is what the unions are telling us. It is in the community, in primary care and in proper residential care facilities for people with psychiatric needs. It is across the board.

I do not know if the Minister of State has visited the Waterford centre yet or when that visit is going to take place. This needs to be taken very seriously. This has been allowed to happen time and again, year after year, when we had several reports from the Mental Health Commission. I am sure the Minister of State read the report. I am sure he took the time as I, Deputy Butler and Deputy Browne did when we tabled a motion on this issue. I am sure the Minister of State must have been as horrified as I was considering the state of the unit, the massive overcrowding on an almost daily basis, the lack of capacity, patients being sent home with no proper treatment and no plan in place for some patients. The pressure is coming about because there has not been investment in primary care and people are being sent to the acute psychiatric unit, maybe sometimes unnecessarily. All of that is down to not implementing A Vision for Change in full.

It is easy to dump it all on the Minister of State. He is one individual but he is the Minister of State with responsibility in this area. If he has read that report, he has to be as outraged as we and the people of Waterford and the south east were. There has to be change. We cannot come back here in six months or a year and hear the same stories. What I want to hear from the Minister of State is what it is that the Government is going to do to make sure we do not see this happening again in the future.

Photo of Dessie EllisDessie Ellis (Dublin North West, Sinn Fein)
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While some progress is being made with regard to mental health services, it is a slow process and not something for which the Government should take credit. I thank Mental Health Reform and its CEO, Dr. Shari McDaid, who is moving on, for their tireless work in highlighting and pressurising the Government to act.

4 o’clock

People, young and old, are talking more openly about their mental health. It has taken time to break down many of the old prejudices which in the past stigmatised mental health and those with mental health issues. The credit for such progress is down to individuals who have personal experience of mental health issues themselves or within their families and communities. Their initiative and passion resulted in many local support groups being founded. It was because of such local community initiatives that so many others in our communities found that they were not alone and had somewhere and someone to turn to when they needed help.

Mental health issues do not discriminate. They affect everyone regardless of gender, sexual orientation or demographics. Austerity has also had a major impact on people's mental health. Mental health is linked to socioeconomic circumstance and people have not recovered from the long years of austerity and in fact many people in the communities I represent have not felt any recovery from austerity at all. Mental health issues can affect a family member, a work colleague, a close friend or a neighbour. These issues know no bounds. Statistics show that one in four of us will experience mental health problems. Studies also show that many people live with the symptoms of mental ill-health for long periods without accessing mental health advice or treatment.

Mental health is not a priority for the Government. If the Government was serious about making mental health a priority, it would give the Department the resources and funding to develop a new mental health Act to meet the United Nations Convention on the Rights of Persons with Disabilities treaty requirements.

There is clearly a crisis in mental health. There is an inadequate provision of services and a lack of proper resourcing for existing mental health services. There are insufficient staffing levels and mental health services are haemorrhaging staff at an extraordinary rate. These people are not being replaced. In fact, there are more than 2,600 fewer staff working in mental health services than the Government's recommended staffing level.

More people die by suicide each year in Ireland than on the roads and yet only a fraction of the Government's budget is spent on suicide prevention. In 2008, for example, €45 million was spent on road safety and accident prevention measures while only €4.5 million was spent on suicide prevention in the same period. The introduction of 24-7 crisis intervention services is slow and behind schedule. No extra funding for the development of such services was included in the budget. The absence of 24-7 intervention services will actually cost lives. Mental health crises do not occur during set hours or on a nine-to-five basis, they are, by their very nature, unpredictable and unexpected. If someone is experiencing a serious mental health crisis, he or she has few options available. A person can go to the Garda or to the accident and emergency department. Neither of these would offer the appropriate care that is required for someone experiencing a mental health crisis. Statistics show that more than one in five individuals are repeat attenders for self-harm. Most are sent home after a few hours and will have received little care.

In general, mental health services are available Monday to Friday on a 24-7 basis, but a major anomaly is that they are not available around the clock on Saturdays and Sundays. We also have had many situations where people with suicidal ideation are being turned away from accident and emergency departments. The Government made a commitment that there would be psychiatrists available in accident and emergency departments 24-7. Those with mental health issues who present at accident and emergency departments generally have to wait a number of hours before being seen by a psychiatrist. At that stage, it can be the case that the individual's psychotic condition has changed or that he or she may show improvement while waiting. This can lead to an inaccurate view of the individual's true mental state being formed. That also can happen when an individual presents at a Garda station.

If it is really serious about tackling the crisis in mental health, the Government must put in place fit-for-purpose mental health services as a matter of urgency.

3:20 pm

Photo of Mick BarryMick Barry (Cork North Central, Solidarity)
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I have had hundreds of discussions about mental health and the mental health crisis in the past two weeks because Solidarity decided to make the mental health issue one of the top issues in its campaign in the Cork North-Central by-election. We adopted this approach after an internal discussion in which many of our younger members said that we should do so. We consulted widely with supporters and listened, in particular, to the views of younger supporters and decided to do that.

I regard myself as being fairly well in touch with the concerns of my constituents but even I have been slightly surprised by the extent to which, on going to people's doorsteps and provoking a discussion on mental health, this has prompted a response and a willingness from people to talk about how this has affected their own households, friends and the communities in which they live.

Broadly speaking, the points that have been raised with us on the doorstep fall under two headings. The first one is the issue of mental health services and how people across the board see them as falling well short of what is needed, despite the valiant efforts of workers in the mental health sector and volunteers within the communities.

A common report back when we have our debriefing in the office at the end of the canvas is where someone says that they met someone tonight who went down to the accident and emergency department with their son or daughter. The then waited patiently to be seen, got the best possible treatment available from the people who work there, but in reality were brought into a room where they had a brief conversation, a glass of water and a pill, and were sent home. They are waiting for services now and went on a list to queue for that service. The waiting times have been long. I am not the first Deputy who has raised the point on the numbers on the child and adolescent mental health services, CAMHS, waiting lists in the Cork and Kerry area. The figure is more than 400, more than 100 of whom have been waiting in excess of 12 months.

One idea that we have raised on the doorsteps is the idea that there should be 24-7 crisis centres and these should also be in the communities. If one has a mental health crisis, irrespective of the day or time, one can go and be seen and at least have an initial contact with mental health professionals, with perhaps a team being available from that centre to go out and make a quick visit in one's own home or to a place where one would like to meet them.

We have pointed out to people that in the UK, for every £100 spent on the National Health Service, £13 are spent on mental health services. The comparable figure for the HSE in Ireland is that for every €100 spent, €6 are spent on mental health services. We have openly said to people that they have been betrayed by successive Governments which have failed to put the resources and the services in place that their children, friends and neighbours need.

We have a young generation that suffers from greater levels of anxiety, depression and even suicide than perhaps has been the case in the past. There are clearly not sufficient services to cope with that situation. We need a national health service. That would involve a massive increase in spending on mental health services. It should be immediately doubled, with subsequent significant increases each year.

The second point that has come up frequently is the pressure that people feel from society bearing down on them, challenging and damaging their mental health. The current economic system of capitalism is negatively impacting on people's mental health in a wide variety of ways, including precarity of employment. There has been an end to the idea of a job for life and the opposite has happened, with people surviving on 12 or six-month contracts and dealing with the associated uncertainty. Precarity of accommodation is an issue, especially for renters who know that they are just one note under the door away from a notice to quit, telling them to leave by a certain date, leaving the threat of homelessness hanging over them. There is a struggle to make ends meet with low pay for the working poor and the pressure they feel they are under. Mental health is a complex issue with genetic, biological and a wide variety of other factors. Without a doubt, the pressures of 21st-century capitalism with its precarity and its drive to maximise profit at the expense of working people, the stresses on their lives etc. are a significant factor in the mental illness epidemic in this country.

I read in the newspapers today about a report from the Economic and Social Research Institute, ESRI, and Trinity College, stating that most 20 year olds still live with their parents and that they are preoccupied with the housing crisis. They ask if they will ever own a house or be able to afford to rent. One in four of those young people already shows signs of depression. Other issues mentioned by young people surveyed about things that concern them include a new phrase that I learned recently, eco-anxiety, the question of climate change and thinking about what the world will be like 20 or 25 years from now. Poverty has not gone away, which is a key point raised in the survey.

As a socialist, I am in favour of pushing back against capitalism and its agenda which is, as I say, an agenda of precarity, inequality and discrimination. In pushing back against capitalism, people who are a part of that pushback are also part of the pushback to defend and to improve mental health in this dog-eat-dog society.

3:30 pm

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
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Is Deputy Connolly sharing time with Deputy Nolan?

Photo of Catherine ConnollyCatherine Connolly (Galway West, Independent)
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Yes, with five minutes each. I have checked back on speeches and I am looking at one I could read out again to the Minister of State. It is my own, from April 2017, over two and a half years ago. We do not need to reinvent the wheel and give personal anecdotes of all of our experience with mental illness and mental health services. I come from Galway where, unfortunately, there is a group of people who feel that they have to conduct suicide patrols of our waterways. I come from a city where a brand-new psychiatric department has at least four delayed discharges, that is, patients who are ready to be discharged but there is no money. I understand that there is a broken door. I have brought all of these matters to the attention of the Minister of State and want to move on to general matters. It is a symptom of what is happening in our mental health services, yet at the same time we seem to be returning €12 million. The Minister of State might tell me that I am totally wrong about that. I have a background in this area, so forgive me if I am a little impatient.

In 1984, we had the Planning for the Future report, which was a recognition that we needed to do something about our mental health services and we did. Such was the slow pace of change, however, that we brought in the A Vision for Change strategy in 2006. Everybody, including the Mental Health Commission, has said that it is a brilliant document that comprehensively set out exactly what was needed. It addressed every area, including the importance of carers of families and getting rid of the stigma associated with mental health and the high rates of suicide in 2006. Not only was the document excellent but those who were behind it stated that as they did not trust the Government of the day or any Government, an implementation body would be needed and an independent implementation body was set up. It did its job so well in two three-year periods that it was abolished. After it was abolished, we have played linguistic games with regard to A Vision for Change. It is appalling to use the word "refresh". The review should be about the appalling failure to implement A Vision for Change. Some progress was made and the Mental Health Commission acknowledges that but there has been an utter failure to implement it in total.

After 2016, when the allotted years ran out, we decided to set up an evidence-based, desktop review of the literature. That was done speedily when it sat and it reported in July 2017. The implementation of A Vision for Change was due for January 2016 but it took until July 2017 to get an evidence review that looked at literature. That literature told us that prioritisation of mental health is a major societal issue. Can the Minister of State imagine that we needed a review to tell us about primary prevention, positive mental health, social inclusion and recovery, mental health services and their importance, as well as governing and financing? If that was not insulting enough, we now need another refresh of A Vision for Change, when all we needed was for the independent monitoring mechanism to be set up again to implement A Vision for Change.

At the time, A Vision for Change talked about money and there is no parity of esteem. We cannot have health without mental health, yet we have absolutely no parity of esteem. I know the Minister of State agrees with this on a personal level but he is not here today on a personal level. He is here as a Minister of State. He has to tell us why A Vision for Change was not implemented. Will he put back in the independent monitoring system that was there? It worked very well. The proof in the pudding is that the Government abolished it because no Government, not just that of the Minister of State, wants to hear the truth. When the A Vision for Change strategy came in, it talked about a certain percentage of GDP going to mental health. It made that comment in the context of the mental health spending that had declined considerably in the 20-year period leading up to A Vision for Change.

There is no parity of esteem between mental health and general health, even though both are inextricably linked. There is no independent monitoring and money is returned when we have delayed discharges, among many other things. Most importantly, because this might get through to the Government, the economic costs are set out in the review. The economic costs of mental health issues are enormous, with figures suggesting that it may amount to as much as 4% of GDP in some countries. In Ireland, the most modest estimate of the GDP lost is 2%. This does not include the health costs. I will stop because my five minutes are up. I appeal to the Minister of State to answer as to whether the Government is putting back the independent monitoring system.

Photo of Carol NolanCarol Nolan (Offaly, Independent)
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Ba mhaith liom buíochas a ghabháil do Teachta Connolly a thug an t-am dom chun labhairt inniu. It is alarming to see that demand for acute CAMHS is increasing. More than 2,500 young people are waiting for an initial appointment. Hundreds have been waiting for assessments for more than a year. This situation is unacceptable. It concerns all of us. We hear from families in our offices who are desperately seeking solutions and support and all that we can do is write letters to the Minister, Ministers of State or to the services directly. We need more action in this regard as it is getting worse by the day, unfortunately.

The worsening crisis is leaving more vulnerable children at risk. I have seen cases involving children whose anxiety is so bad that they have had to leave the school they are in and to apply for home tuition. That should not be the case. If the preventative measures were in place, it would not reach that point. We need to take stock of what is happening and put actions in place. It is shameful that preventative mechanisms and supports or services to deal with mental health problems before they become serious in children, teenagers and adults are not in place. Very often, the wait for children and teenagers is too long and they can be in distress for over 12 months. It is not much different for adults, who are also being put on long waiting lists for appointments.

It is unacceptable to have these waiting lists when we now know so much more about mental health. We have never had as many reviews and as much emphasis and people are coming out and speaking about it. However, in the absence of action, we are going nowhere with regard to getting to grips with this issue. It is worrying that doctors who have not specialised in the area of mental health are also trying to fill the gap. This needs to be investigated and dealt with.

The escalating crisis is a national scandal. It is a failure of our system that children, the most vulnerable in our society, are being admitted to adult wards, which has been happening for years because there are not sufficient beds. This has to change. I have met many distressed families who are worn out trying to fight for vital basic services for their children. They feel frustrated and feel they are doing this against the odds, with little or no support and in desperation at times.

If we did not have organisations such as Jigsaw and other voluntary mental health services, as well as the many GAA clubs throughout the State, which have also done their bit in regard to mental health, this crisis would be far worse. Thank God, we have all those people in place to help and play their part. I take this opportunity to commend all of those in these organisations, in many communities. These organisations are filling a gap left by the absence of other adequate services and supports in our system, which is failing children. Many organisations find it difficult to continuously fill that gap and many have told me they are stretched to the limit, so we need more HSE intervention.

Adults living in remote rural areas who experience social isolation have also been failed to a degree by the lack of support. It would be worse only for people in their communities who are active on this issue, such as key community activists, as well as organisations such as the Men's Shed, a fantastic initiative which came from Australia. I attended the briefing on it here a few months ago and was amazed at what it has achieved in such a short time. If it were not for those organisations stepping up to the mark, we would be in a far worse situation today.

We need Government-led initiatives in dealing with all of the problems across society for both young and old, men and women. We have to deal with the problem through preventative measures. We need to respond to the crisis we face in a timely manner. By doing so, we will prevent the heartache and distress that has already been experienced by too many families and individuals throughout this State. We need urgent and meaningful action. The recent reports are a wake-up call. They show we have an increasing number of teenagers and young adults experiencing anxiety and taking antidepressants. Surely that is the wake-up call we need to take this urgent action once and for all to make sure we are serving and protecting them as best we can.

3:40 pm

Photo of Mattie McGrathMattie McGrath (Tipperary, Independent)
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I welcome the opportunity to speak on this important matter. I acknowledge the genuine attempts that have been made by the Minister of State, Deputy Daly. We now have a newly designated Jigsaw service in Thurles, which I warmly welcome. However, I am worried about the timelines. We need to see it set up and it is already five years late. That said, I have expressed my concerns and the Minister of State will know they are shared by Fr. Michael Toomey, who he has met and for whom he has great respect. Fr. Toomey has done tremendous work. The morning after the Minister of State's visit on Tuesday morning, he was on radio with Joe Leahy and another speaker, and those three people are at the coalface. While they welcomed Jigsaw, they want to see it rolled out in other towns like Clonmel and Carrick-on-Suir, and in villages like Kilsheelan and Ballyporeen, and right up to Tipperary town and west Tipperary, which is in a bad state regarding mental health services, and on to north Tipperary. It is a big county and those areas need it.

Fr. Michael Toomey officiated at a mass last week for my closest neighbour, Paul Ryan, who ended his own life after suffering for 40 years with mental health issues. He was a tutor in Cluain, a voluntary organisation for people with certain disabilities. He was a wonderfully skilled craftsman, a potter, and we can see his last pottery and all the work he had done in the midst of his mental illness. We could see the profound sense of shock and sadness in the church that afternoon, with all the service users of Cluain and his colleagues there. The man thought he was only going to have a few at its funeral and he made a request that the few who were there would be asked back to the pub. The pub could not hold them. The biggest church in Clonmel could not hold the crowds, such was the impact. He was a wonderful man, gone too early from his wonderful wife and two daughters. It is so sad. It is an epidemic. I can only think of what he went through. As I said, we never had a nicer neighbour in our lives. He was a lovely, wonderful, helpful man. He helped so many people and it came back to him in spades, but he thought he was in such a dark place that nobody wanted to have any interest in him, although thousands had. It is so sad.

We now have interventions and organisations in Clonmel like Jigsaw and C-Saw, another wonderful group which has a quiz tonight in the Hillview Sports Club. Former councillor, Joe Leahy, and May Walsh, who works in my office, and many volunteers are out fundraising every night to support these services, such as drop-in services and confidential lines. The people out there want to do this. The Minister of State heard about a service in Nenagh, which I am ashamed to say I have not seen yet but I must visit, as should the Minister of State. Again, this is run by volunteers from the bottom up.

As Deputy Connolly asked, what happened to A Vision for Change? We had the vision, we got the change and we closed all of the beds, but we got none of the state-of-the-art services we were promised. As I said to the Minister of State at the meeting, we were not badly burned in Tipperary, we were scalded. We lost St. Michael's unit and the Minister of State has admitted it was wrong to take it away from us. We do not have a single long-stay bed. The crisis houses are struggling to get two extra beds and the HSE and the Minister of State have accepted there is a difference of at least 20 beds. We need ten of those in south Tipperary and ten in north Tipperary. North Tipperary patients have to go to Ennis. I will not even mention what happened in Kilkenny. Above all, I cannot understand for the life of me, with a new 40-bed modular unit about to open in St. Joseph's unit at South Tipperary General Hospital, Clonmel, why we cannot have a room there so people do not have to sit through the trauma and disturbance of a mad accident and emergency unit, which is over-packed and crazy, with all of the staff under pressure. Fr. Michael Toomey told us eloquently last week about visiting there and waiting with a patient. I salute him and the other clergy of all denominations. He waited and waited but there was no bed for a patient who was on a trolley. It is not acceptable that these people have to be put through such suffering. I want to highlight these concerns.

There are many people who have worked tirelessly and collaboratively over the last seven years to ensure we have a service like Jigsaw. The Minister of State was at pains to point that out, although some politicians could not wait to have it announced. It is not about announcements. It is about the duty of care to our fellow human beings. This is a positive outcome. I acknowledge the concerns that are emerging in terms of the accessibility of the Jigsaw service because the county is so big and, while there is good access from Dublin, there are poor transport networks throughout the county. That is why it is vital that outreach hubs are developed in parallel with the development of the main unit.

We know Jigsaw caters specifically for young people between the ages of 12 and 25 who are experiencing difficulties with mental health. These are the groups who are being particularly affected by the scourge of rampant drug use and misuse in our county, and it is vital they have accessible services. I know the Minister of State will agree with me about social drug taking, in particular the taking of cocaine by people of all types as recreation at weekends - our own equals as well as those we would not associate with. It is now very common, which is shocking and frightening. It has to be tackled. We know the violence and the abuse that goes on with drug cartels and gangs. It is not all right to take cocaine as it is supporting mobsters and gangsters, who should be taken off our streets.

They are raining terror on the country, including Clonmel and the other villages in my county. This is why I hope the Jigsaw service can be expanded throughout all the towns and villages. We need them from north to south, whether they take the form of a mobile service or whatever else. I do not know how we might do it but we just cannot have that long distance because people will not and cannot travel it.

Last February, the report on St. Luke's psychiatric facility in Kilkenny was published. It revealed a litany of appalling hygiene and service provision failures. I do not even want to repeat them here. The HSE was fined and brought to court. It admitted liability. That is like rubbing butter on a fat cow's you-know-what. Who is paying the fine? The taxpayers. It means nothing. Can anyone in the HSE be held accountable? I said this to the Minister of State the other day in the building in which we had the meeting. My wife was a nurse in the former St. Luke's Hospital. I used to visit it with the chairman of the council. I was there for Christmas parties. It is all closed now. There were a couple of hundred patients there at the time. St. Michael's, on the other side of the main hospital, contained the short-term and long-stay places where people had to go. People with these issues, sadly, will need places from time to time in their lives and ongoing treatment. Now all of St. Luke's is offices, offices and more offices. We had to run the health service when we did not have those offices. They were hospitals. Up the road, in Cashel, €22 million was spent on Our Lady's hospital before it was closed down. What is in it now? Not one bed. It is a patient-free zone. It is just offices, offices, offices. That, again, was a functioning hospital. I had my appendix taken out there. I was there a few times when I was young. They took even the lift out of it to ensure that no patient could go upstairs. It is desecration and vandalism, and this is carried on by the HSE. We had that big hospital, the 300 patients in St. Luke's, the 40 or so beds in St. Michael's, and Our Lady's. That adds up to probably 700 patients. We did not have all these offices and management to run those hospitals but we had the matrons, and my God should we bring them back. The hospitals were clean. When the matrons were in charge, there would not have been a report such as came out on St. Luke's. We can do nothing in here only attack the clergy and the Vatican and whoever else day in, day out. These people gave us our education and our health service. They were visionaries who went all over the world and looked after people, set up field hospitals and did wonderful work, and all we want every day in the midst of our housing crisis and our mental health epidemic is to attack the people and institutions that served us all so well. I hope to God people might realise sooner rather than later the folly of their ways.

Getting back to the services, I will make a contrast with the Minister of State. The Minister, Deputy Harris, came down and saw the situation in Cashel. We saw offices - plush offices, I might add, with colour-coded carpet and the finest of paintings on the walls - yet we do not have a bed for a patient suffering a psychotic attack tonight. Such a patient must be left sitting on a chair. The Minister of State told us we cannot have trolleys, and then there is what happened in Waterford recently. We have all these offices and officials and so on and no services. There is something rotten in the system. When these were functioning hospitals, we had nurses, doctors, attendants and so on - very good people. Now we have legions of staff - I will not call them battalions because they do not go to battle - and what are they doing? They are pushing paper from here to there to wherever else and pushing it back again. That is what is wrong. There is nothing else wrong. The Minister of State talked about the funding increasing from €700 million to €1 billion but it is being gobbled up by administration. It is sad. The HSE has many good people, but many of the chiefs are self-serving and cannot see what is going on on the ground. There are none so blind as those who do not want to see at all. It is so sad.

In Clonmel, we have the likes of Fr. Michael Toomey and the other priests in the area, C-SAW and the volunteers. I should also mention the River Suir Suicide Patrol and TaxiWatch. I was out late in Clonmel last Friday night, at 3.20 a.m., and met three women going off to walk the quays to ensure people were kept out of the river. It is so sad. They have to do it. We have all this administration using all this money yet no services. I know that the Minister of State is doing his best and will soon retire from politics, but the system is badly broken. A Vision for Change was to be the Bible, according to John Moloney, who was Minister of State at the time, and the former Minister of State, Kathleen Lynch, but it all collapsed. The book was closed and left there. All the services were taken away with all the hospitals closed. The Government told us the doors of these Dickensian places would be opened up and all the patients let out - to hell or to Connacht. Then no services - absolutely zilch - were put in in Tipperary. I salute the front line, the Psychiatric Nurses Association of Ireland, the nurses and the other groups, including the community care services. There is something very badly wrong, though, and someone needs to fix it.

3:50 pm

Photo of Tom NevilleTom Neville (Limerick County, Fine Gael)
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In 2019, €55 million was allocated to mental health services, bringing spending on those services to in excess of €1 billion. However, a reply to a parliamentary question I tabled on 22 October stated that €33 million had been drawn down, with €10 million to be sanctioned and €12 million not to be spent in 2019. I am seeking clarification as to why that €12 million will not be spent in 2019, given the report by the Joint Committee on the Future of Mental Health Care, the scale of deficiencies in the system, which we highlighted at the time, and the requirement for funding. It seems we are repeating now something that happened a number of years ago. Given what was highlighted through that report, I am looking for accountability and clarification from the HSE as to why this money is being left unspent. Is it a matter of systems or recruitment? If so, what changes have been made to the recruitment process or recruitment flow since the joint committee report was published? What changes have been made to the IT, business and reporting systems since then? There was a recommendation in the report that over three years the IT, business and reporting systems be changed in order that the HSE might highlight or be able to manage this and get out in front of any issues that would arise with funding or the lack of spending of funding. I am seeking clarification as to what the HSE has done on this. Like every other Member, I want that €12 million ring-fenced for mental health services. I want the necessary improvements to be made to allow us to keep spending that because the Government is supplying the money but it is not being spent. Where is the blockage, and what is happening? Are the reporting functions up to scratch to allow the HSE to report back to the Government as to what exactly is going on? My fear is that they are not. When I highlighted this in a meeting of the committee 18 months ago, I was unable to get straight answers on funding and specific subspecialties, hence my point about the reporting systems. A total of 60% of funding was drawn down by October 2019. There are two months left in the year for another 40% that is in swing. I do not understand the mechanisms of accounting for this, but, again, I seek clarification on that as well. Why is the 60% not drawn down in June or July to front-load the funding and give the Department four or five months to draw down the remaining 40%? What is going on behind the scenes?

I have tabled a number of parliamentary questions on the pathfinder programme. On 25 May 2018, I was told that the Departments of Education and Skills and Health were "working with DPER to resolve some technical issues with the above proposals" and that "a timeline to full implementation can not yet be agreed as the participating departments have not received final approval from DPER". On 19 July 2019, I was told that at the end of May the Minister of State had a constructive meeting with the Minister for Public Expenditure and Reform, Deputy Donohoe, and his officials on the proposal. The Minister of State said they were very supportive of the proposal. Subject to resolving the outstanding matters, the Minister of State said, his officials were in regular contact with their counterparts in the Department of Public Expenditure and Reform. He said he hoped to make substantial progress on the matter in the coming months. I would like an up-to-date statement on the position regarding the pathfinder programme, of which I am a major supporter. I know that many groups are also pushing for that integration within the various Departments to bring all these ideas into the education sphere and into the schools and to use them to help the teachers themselves to try to work to bring these ideas forward. I refer in particular to the way technology and communications are moving. Yesterday the Joint Committee on Children and Youth Affairs, of which I am a member, discussed social media, communication, interaction and so on.

During the week I attended the launch of the My World Survey carried out by the UCD School of Psychology. One of the conclusions concerned social media use. The researchers' findings indicated a significant relationship between time spent online - specifically, more than three hours - and higher levels of depression and anxiety and lower levels of body esteem. These findings concern adolescents. The researchers found several explanations for the potential link between time spent on social media and mental health issues among adolescents and young adults. For example, they stated there is some evidence that time spent engaging on social media might displace other more important activities that protective of mental health such as sleep or face-to-face time with friends. Another explanation was that a major motivating factor for using social media in general involves escapism and diversion from everyday life. Indeed, they stated, the current research shows that young people who reported spending more than three hours online showed significantly higher levels of avoidance-based coping than their peers who reported spending less time online.

It is also important to note that the research does not suggest a causal relationship between time spent online and poor mental health. For instance, a young person who is feeling depressed may turn to social media to try to alleviate his or her negative mood or depressed symptoms, to connect virtually with others or to escape from his or her problems. Findings from current research suggest that many adolescents and young adults are using social media to build and extend their social connections in real life and that there may be some benefits to spending time online. Adolescents and young adults who reported spending less than two hours online per day had lower levels of support-focused coping and lower levels of perceived social support from friends than those who spent two to three hours online. Further research is needed to examine the context and content of social media use. The data provides evidence for both the potential risks and protective possibilities of social media engagement. We need to get ahead of this in terms of research on social media because the landscape is fast moving. As a society we need to get on top of this. This report suggest that we need more data and research on both the negative and positive aspects of social media.

I have tabled numerous parliamentary questions on CAMHS and I welcome the decrease in the waiting lists for the service, particularly in CHO 3. In July 2018, there were 294 people on the waiting list but by October 2018 the number had dropped to 245. Recent figures show that the waiting list stood at 124 in August 2019, which is welcome. In an ideal world there would be 124 fewer people on that waiting list. I acknowledge the initiatives being undertaken to provide a 24-7 access line and on referral pathways. I have spoken to the Minister of State at length on this issue and welcome her work in this area. I want early intervention to continue because, as outlined in the My World Survey report launched earlier this week, adolescents reported higher levels of depression while the number reporting severe anxiety has more than doubled. We do not know why that is the case and we need to do much more research on it. It may be related to social media. In adolescence, there is a decrease in the ability to cope well with problems and to talk about them, which is very worrying. Another finding of the survey was that young adults were increasingly self-harming without necessarily wanting to take their own lives. I have not read the report in full but had a quick look at it prior to this debate.

Deputies Mattie McGrath and Connolly mentioned suicide watch groups, of which there are two in Limerick, namely the Limerick Treaty Suicide Watch and Limerick Suicide Watch. I went out with members of the latter group one night for four hours and saw the great work being done. There is a need to develop a closer relationship between such groups and the Department of Health, the HSE, local authorities and gardaí. The knowledge and experience of people in such groups is invaluable. I volunteered with Limerick Suicide Watch and it was a very humbling experience. During the four hours, we came into contact with people who were down, rather than distressed. There was one intervention on the night that I was out but I was not involved in it. As a volunteer walking around, I was nervous. While I was talking to others in the group, I was on edge and had butterflies. I was watching and waiting and felt like I was on the front line. It put me, as a public representative, on the front line and gave me an insight into what emergency service staff, including gardaí and nurses, as well as volunteers have to deal with every day. I commend them on the work they do. It is special, vocation-like work and we need to attract more people into it. This brings me back to the argument around recruitment. We need to identify the bottlenecks and address them. I worked as a recruiter for eight years all around the world. We headhunted people for high-level positions globally and always found them. We proactively went out and found them. We need to get to the bottom of the problems with recruitment.

4:00 pm

Photo of Niamh SmythNiamh Smyth (Cavan-Monaghan, Fianna Fail)
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The waiting list for CAMHS in CHO 1, which includes Cavan and Monaghan, has increased. This demonstrates that the system is failing children with mental health issues. It is shocking to learn that in one month alone, the waiting list grew by 17, which may not sound like a lot. However, in CHO 1, a total of 282 young people were on a waiting list at the end of September 2019. This represents 15% of the overall national list, which is clearly not good enough. Unfortunately, regional imbalance and inadequate mental health services are a hallmark of the system, as evidenced by the CAMHS waiting lists. The neighbouring CHO, which covers Galway, Mayo and Roscommon, has only 17 people on its waiting list. When one area has a waiting list of 282 and another has a waiting list of 17, it is clear that something is fundamentally wrong with the system.

Over the past decade children and young people have faced new pressures from social media and online engagement. We should broaden access to mental health services rather than limit it. We are letting our young people down because CAMHS is not up to scratch. In fact, we are failing them abysmally. The system is failing children with mental health issues. What is needed is the implementation of a strategy that will bring CAMHS up to scratch but that has not been happening.

We all receive emails on a daily basis from our constituents on various issues but I received one on 17 June last, which left me stuck to my chair. It provided a striking and profound insight into mental health services in Cavan and Monaghan. The writer began, "Dear Niamh, I read with interest your parliamentary question regarding CAMHS data for Cavan/Monaghan" and then drew to my attention the worrying revelation that she, as an adult mental health service user, was potentially taking up a therapy spot for a child. One might ask oneself how that might happen. The e-mailer found this practice "highly unethical" and expressed her concerns to the relevant HSE personnel only to be informed that the ethics of the decision to continue seeing an adult service user once a psychologist has changed posts from adult services to child and adolescent services were not the concern of the service user, in spite of one child fewer being seen as a result. The writer said that she felt she was being stonewalled on the issue. She was awaiting a response to letters sent to the HSE on 3 and 4 May, detailing her concerns. To date, she has not received a response.

I ask the Minister of State to convey my concerns to the HSE regarding this unjust and unethical scenario. I was so struck by the email that I phoned the young woman and met her over a cup of tea. She is a very articulate and concerned young woman who has been using mental health services in Cavan/Monaghan for a number of years. She is very much aware of international models of best practice but has had to battle with the HSE for a service suited to her needs. She is very articulate and has a clear understanding of what will meet her needs. She has articulated in a very clear, understandable and educated way to the HSE that the methodology it is using will not serve her best. What she finds most worrying is that her clinical psychologist, her one-to-one therapist, has taken up a new job with CAMHS. That psychologist moved to CAMHS but took her workload and cases from the adult mental health service with her. She had to carry that work over to CAMHS, which means that she cannot see the children she is meant to see. This adult service user finds that completely unethical and she is correct. She has brought this issue to the attention of the HSE but has not received any concrete answers. I have submitted parliamentary questions on this but have not received a satisfactory answer either. This issue must be examined.

We are told that there are recruitment and staffing problems. Why should this woman who has taken up a job with CAHMS, as she is entitled to do, be expected to take her workload from the adult mental health services with her? The Minister of State met representatives of the mental health services in Bailieborough and so he knows the wonderful work Seán McKiernan and his volunteers are doing there. They are part of a voluntary group which is doing fantastic work. I have heard much about Jigsaw and Fiona Gilmore and Seán McKiernan are championing the idea of bringing Jigsaw to County Cavan. That is a specific service which is not available everywhere in the country. I encourage the Minister of State to engage with us on that because we want it provided in Cavan.

4:10 pm

Photo of Michael MoynihanMichael Moynihan (Cork North West, Fianna Fail)
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I am delighted to have the opportunity to speak in this debate. I welcome to the Public Gallery Daniel Philpott, a transition year student from Presentation Brothers College in Cork who is here on work experience for the week. His people hail from Kanturk. I wish him the best of luck.

Much has been said about mental health in the last while. The issue is now very much to the fore and we need to have more engagement on it. As a public representative, I have had much engagement, particularly in the past two or three years, with people seeking help with addiction, trying to get into addiction centres or seeking referrals to such centres. There is a high level of addiction among younger people as well. While there are many strands of mental health, we should focus on young people and the pathways and lifestyles that lead to addiction in early adulthood. Betting is now a phenomenon as well, and many people are being referred to addiction centres for betting. In Ireland we tend to think of addiction in terms of alcohol, but many more issues need to be addressed. When discussing mental health we must also look at those centres.

Various initiatives have been taken in this area over the years, for example, the former Minister of State, John Moloney, who was from County Laois, introduced decongregated settings. Much more work needs to be done to ensure the best possible mental health services are available in the public system. The vast majority of people we deal with as public representatives, who seem to be in the most trouble, are those dealing with the public mental health services. They do not get what they need from them. They might get a referral to the accident and emergency department, from where they are sent home. That is not enough.

There are also many suicide prevention initiatives and organisations in Ireland, such as Pieta House. Deputy Neville spoke of being on the suicide watch in Limerick as well. Large numbers of people are falling victim to suicide and leaving families behind them. Some of those families are doing amazing work in trying to keep the memories of their loved ones alive by preventing more suicides, encouraging people to talk or working with initiatives such as Tree of Hope. That is to be welcomed and encouraged.

If we are to be taken seriously, we must accept that numbers have increased. The Government will answer that the recent mental health budget is the largest we have ever had. While that is true, there are many lacunas in services and many areas are not getting enough funding. We are not opening up enough to the various scourges out there. I had a lengthy discussion only last Monday about the lack of contentment in society and the challenges people face, such as social media and the way society has developed around it. We can bemoan social media and cite its negatives, but it is part of society just as television or radio were two or three generations ago. The question is how we will adapt to it. We must put initiatives in place through the HSE, the health services and the various Departments to empower our young people as we go forward. In my time as a public representative, I have never encountered as many addiction issues as I have in the past two or three years. The problem seems to be growing and that trend is a cause of major concern as we move into the third decade of the century.

Photo of Jim DalyJim Daly (Cork South West, Fine Gael)
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I thank all the Members who contributed to this debate. It is much appreciated. I have always appreciated their collective and non-partisan approach to mental health, insofar as that is possible. I am happy to be accountable to any Members of this House on this issue but I also appreciate the constructive approach people bring to it.

I am obligated to point out some of the positive developments in this area. It is important that we instil confidence in service users to reach out for help and make sure they know that help is available. If we continue the narrative that there is no help available, which I am not suggesting Members are doing, it will disincentivise people from reaching out. We have to get the balance right and be responsible.

The building of the National Forensic Mental Health Service hospital in Portrane is a major development in the delivery of mental health services. It is a brand new central mental hospital, for which we will receive the keys in the next number of weeks. That is a €170 million project which is on budget and on time. It will significantly transform treatment for some of the sickest forensic patients in the system and the environment in which they receive it. They will be moving there from the outdated Dundrum facility. The hospital will also include a 30-bed rehabilitation unit which is very important, as we need to put more emphasis on rehabilitation for people who are mentally unwell. The complex will have 170 beds overall.

The refresh of A Vision for Change, which will come before the Government in the next number of weeks, has been referenced a number of times. I disagree with Deputy Connolly's assertion that it is not important. It is vitally important that, as we learn more, understand more and more academic research is conducted, we revise what we do and how we do it. That will happen in the next number of weeks.

We are also updating the Mental Health Act and the heads of a Bill have gone to the Mental Health Commission for comment. The Taoiseach will launch a new mental health phone line next Thursday. For the first time, more than 1,000 different mental health services throughout the country will be covered under one phone number. A crisis text line will also be established before the end of this year. Digital online telepsychiatry, which I have talked about a number of times, will make it easier for people to access mental health services online. We are using technology to bring those services closer to the people.

As Deputies have noted, the budget will not be the solution to these problems in and of itself. However, it has increased by 45% - almost doubled - since 2012. For a number of those years, there was not much money available for anything. We have significantly increased the budget but I would be the first to say that more money is not the solution. It is about how we do things and implementing structural reforms. Last year, we hired 130 psychologists for primary care for young people. Previously, €2 million or €3 million would be thrown at the system to reduce the waiting lists and as soon as the money was spent, the waiting lists would shoot back up. Last year, we introduced a level of psychology infrastructure for young people in primary care in the community. That is now paying real dividends, and the number of people on CAMHS waiting lists has reduced by 20% so far this year. If we did that in any other area of healthcare, we would be very proud. It is important to recognise where we are making sustainable progress. We have more to do but real improvements are happening. We have also increased the number of training posts for psychology nurses. Deputy Mattie McGrath and others mentioned staffing. Some 130 additional psychiatric nurses will be available from next year onwards. This increase will help.

The number of children in adult mental health wards continues to disappoint. However, the number of children being admitted to adult wards in the latter half of this year has reduced significantly. I commend the Linn Dara child and adolescent inpatient unit on making exceptional progress in the treatment of extremely sick young people under 18 who must be admitted to an inpatient unit. There is now much less reliance on using adult units for young people. Furthermore, fewer younger people are going abroad for treatment as a result of the significant improvement in services at Linn Dara. The number of admissions to the centre has almost doubled this year, increasing from 57 last year to 120 so far in 2019, and successful treatments are taking place.

5 o’clock

I commend it for that.

Next Thursday, we will launch the phoneline which will transform the delivery of mental healthcare services. It will advise people of the most appropriate service in their area. It is confusing to decide whether one should contact Alone, Aware, Jigsaw, Pieta House, CAMHS, the Samaritans or some other organisation. The phone line will be a referral pathway, which is a positive development.

I hope to launch a €3 million community health fund on the following Monday. Many Deputies referred to the very good services being provided in the community. Deputy Smyth referred to Jigsaw. There are other similar groups. The fund will support work being done on the ground by such groups. They will not have to go through the HSE to access the funding as it will be a separate fund to support bottom-up community-led initiatives that try to be more proactive than reactive in the delivery of mental healthcare. I look forward to continuing to engage with Members on this issue.