Dáil debates

Thursday, 3 June 2021

Mental Health During and Post Covid-19: Statements


1:20 pm

Photo of Mary ButlerMary Butler (Waterford, Fianna Fail)
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I thank Members for the opportunity to update the House further on mental health services during and post-Covid-19. At the outset, it is important to acknowledge that although we are, hopefully, past the worst of the pandemic, we are not out of the woods yet. When we talk about mental health post-Covid-19, therefore, we should acknowledge that the impact of Covid-19 will be felt for some time to come. It is also important for me to acknowledge the significant impact the cyberattack on the HSE has had, including on mental health services. I have remained in close contact with the HSE and I know how hard the staff are working to overcome the existing challenges. I commend all the staff working across the country on their unwavering commitment in continuing to provide vital mental health services.

I have regularly been here to update Members on mental health service provision. Delivery and development of such services are underpinned by our policies in this area, namely, Sharing the Vision, and, for suicide reduction, Connecting for Life. Our approach to the continued enhancement of mental health services is also reflected in the HSE national service plan 2021 and in specific commitments under the programme for Government. Our national policies set out recommendations to improve the mental health outcomes of our population. All these together represent the broad framework through which we are moving forward, addressing challenges, implementing policies and developing an integrated response to mental health.

Covid-19 has undoubtedly caused considerable upset and disruption to people’s lives, and while we do not yet fully understand the extent this will have on people’s mental health, it is acknowledged that a range of post-pandemic mental health and psychosocial challenges are likely to arise. These may persist for months or years, and will likely be compounded by economic impacts. The Government’s overall focus is on keeping Covid-19 case numbers down and reopening our society and economy while ensuring the safe and effective rolling out of the vaccines. However, the mental health needs of our people remain a priority, particularly for those already vulnerable to or experiencing mental health difficulties. Stress, anxiety and low mood have become part of many people’s lives. Many of us, at some stage, have experienced emotional difficulties, including grief, sadness and loneliness.

In response to the pandemic, the broad range of mental health services and supports provided by the HSE, and its partner organisations, were significantly expanded to address the additional demand created by Covid-19. A range of psychosocial responses were introduced, including self-help supports, which promote positive physical and mental health. The Keep Well campaign continues to provide practical advice and empower people to maintain and improve their overall well-being. Digital mental health initiatives were rapidly enhanced to enable services to meet not only current demand, but new and emerging needs. It has enabled us to continue providing much-needed supports where face-to-face service delivery was not possible. This includes video consultations and signposting to online counselling, self-help initiatives and other supports. Face-to-face assessments continue to be provided where remote assessment is not possible or appropriate.

We have also expanded our telephone and texting supports. E-mental health is now embedded and enables us to offer a blended, more up-to-date mental health service offering to meet evolving demands and circumstances. Digital mental health has aided provision of seven-day tele-mental health supports, including yourmentalhealth.ie, the information line 1800 111 888, the crisis textline 50808 and NGO online supports. These include one-to-one counselling and group and peer supports delivered, for example, through MyMind, Turn2Me and Silvercloud. MyMind provides free online counselling, in 15 languages, to people in communities nationwide. It delivers 4,000 counselling and psychotherapy appointments each month, supported by HSE and Sláintecare funding, which has been further extended to September 2021. As online activity has increased, we have increased capacity to allow for an upsurge in demand.

Early in the pandemic, the HSE moved rapidly, under public health guidelines, to continue community mental health services to the greatest extent possible, with enhanced digital mental health models adopted for service user and staff safety. Face-to-face supports continue where necessary and high-support residential placements have continued. Overall, specialist mental health services, in both community and acute settings, have operated at 85% to 90% of pre-pandemic levels.

Vaccination of mental health staff and individuals in long-term residential mental health care, who consented, is complete. In addition, vaccination of people with mental health difficulties in the community who fall under cohort 4, that is those at very high risk, is complete. Individuals with mental health difficulties who fall under cohort 7, that is those at high risk, continues to be rolled out.

While referral rates were initially below normal, the level of appointments offered and waiting times to access all community mental health services have remained consistent with previous years. This is despite adaptations to service delivery due to the considerable challenges posed by Covid. In anticipation of a requirement for increased mental health hospital beds, the HSE has worked with private hospitals on additional acute and longer-term beds to free up public capacity. Dedicated funding of €13.65 million has been allocated for this purpose.

As restrictions are easing and we move into summer, HSE mental health services have planned and are prepared for expected levels of service demands. The HSE psychosocial framework forms part of this, both now and into the future. The framework builds on existing psychosocial supports and provides a co-ordinated, consistent and collaborative approach to mental health service delivery at national, regional and local levels. It recognises the impact of Covid on mental health in all areas of society and aims to mitigate longer term effects while sustainably supporting the psychosocial well-being of both the public and healthcare workers during and beyond the pandemic.

The HSE social prescribing initiative is an additional route to providing psychosocial and practical support. In over 30 locations across the country, partners are offering social prescribing opportunities through many local community activities to support people to improve their overall health and well-being. Just last week, I announced the phased reopening of day care centres for older people which will have a considerable impact on promoting the mental health of this group of people. A total of 101 day centres are expected to reopen by the week of 5 July. More centres will resume later in July and August, with any remaining services that require adaptation works reopening before the end of the year. Funding will be made available for centres that require adaptation works.

Youth mental health is a critical issue and I assure the House that this continues to be a priority area for me and the Government. The pandemic has been hard on our children and young people. Schooling has been affected and physical, social and mental health difficulties are becoming more apparent. There are currently 13 Jigsaw sites nationally, with the fourteenth due to open to referrals in Thurles this July. As a national organisation, with increased capacity across its online supports, the services of Jigsaw can now be accessed from anywhere in the country. It offers much needed advice and early intervention to our young people and their families.

Underlining the Government’s commitment to mental health, budget 2021 saw an increase of €50 million bringing the total budget to over €1.1 billion. This does not take account of additional funding allocated to mental health in other areas of the health system or through other Departments such as Justice, Education and Social Protection. The new funding allocated this year will allow for implementation of many of the short-term recommendations of Sharing the Vision. It will fund 153 new staff in community mental health services, including 29 posts for CAMHS teams and tele-health hubs, bereavement counselling, employment supports and crisis resolution teams. Work is progressing in each of these areas. Similarly, service improvements are being achieved through investment in the national clinical mental health programmes and models of care, such as perinatal, talking therapies and specialist mental health of intellectual disability services. I am happy to report that recruitment is progressing successfully for many of the specialist posts. These programmes and models of care facilitate significant milestones in improving access to and enhancing the quality of mental health supports, ultimately seeking better outcomes for people using our services.

I am very aware of the increase in numbers and acuity of people presenting with eating disorders, particularly since the start of the pandemic. I am fully committed to ensuring that the €3.94 million I secured for the national clinical programme on eating disorders is fully invested in 2021. This will allow for the completion of the three existing specialist teams and the establishment of three new teams. Significant work on the recruitment of these specialist posts is progressing.

We have achieved much in recent years, through new developments and improvements to existing services. Our national policy, Sharing the Vision,will guide and enable us to enhance provision of mental health services and supports across a broad continuum, from mental health promotion, prevention and early intervention to acute and specialist service delivery. To drive implementation of Sharing the Vision, I established the national implementation monitoring committee. In addition, the HSE implementation group held its first meeting in May. A review of mental health inpatient bed capacity will be completed this year through the work of the committee.

It is acknowledged that there are aspects of mental health services that require improvement. However, I remind the House of the enormous amount of work being undertaken to improve our mental health services. The National Forensic Mental Health Service will relocate to a new purpose-built facility in Portrane and is scheduled to open in the next month or so, subject to ongoing challenges associated with the recent cyberattack on the HSE. This is a major step forward in providing a world class service to the highest international standards of quality and excellence and to greater numbers of people who need this care.

The Mental Health Act 2001 is undergoing a major overhaul and heads of Bill will be brought to Government for approval before the summer recess. The draft legislation will​ give effect to the recommendations of the expert group on allowing 16 and 17 year olds to consent to mental health treatment; the regulation of mental health community residences and services; the involvement of family members and advocates in a person's care, with the individual’s consent; the introduction of a set of guiding principles for the care and treatment of people in mental health services; and enhancements to the right to care plans and information for all people receiving inpatient care.

Our services continue to work closely with the Mental Health Commission to improve further inpatient residential settings. Covid-19 has further impressed upon us the need for single en-suite bedrooms and the importance of infection prevention and control. The HSE has been upgrading facilities, where feasible, to improve residential environments, creating more private, personalised and dignified settings.

Enhanced 24-hour crisis services have been called for. Sharing the Vision makes recommendations for the enhancement of crisis resolution supports, including the provision of out of hours and urgent mental health assistance, building on services already in place. This is a critical area of service development to which I am fully committed. The continued development of tele-psychiatry and tele-health solutions, which are already provided through the 24-hour crisis text line and tele-hubs such as CAMHS Connect in the west of the country, are also recommended. Further funding is secured for CAMHS Connect this year, along with other identified sites.

A sum of €1.4 million has been allocated for the continued development of the Castlerea hub in 2021. The hub includes CAMHS Connect and a CAMHS day hospital. The release of funding is imminent and local services have approval to proceed with developments this year. In 2020 approximately €400,000 was spent on refurbishment and €400,000 on staffing. Continued investment and implementation of the national clinical programme for the assessment and management of patients presenting to emergency departments following self-harm will also be provided for.

As we face continued challenges from the pandemic and its impacts on mental health and well-being, it is important for us to recognise that the majority of people will be able to manage many of the difficulties that they may experience in the short-to-medium term through low-level supports. However, some will experience distress over a longer period after the immediate crisis has passed and a minority will require more specialist input. To address this, we will continue to provide sustained psychosocial responses to effectively manage the overall well-being, resilience and mental health of our population.

I wish to repeat my thanks to the House for keeping us focused on our citizens' mental health and well-being during and post Covid, and for reminding us of the first class service everyone deserves, and for which we continue to strive to deliver. I also want to thank again the many front-line workers, healthcare workers and voluntary partners, whose tireless dedication and commitment have helped us reach where we are today, on the cusp of reopening our society and economy.

While a range of post-pandemic mental health and psychosocial challenges are likely to arise, a negative mental health outcome for our population from the pandemic is preventable if we respond to the challenge in a cohesive manner.

1:35 pm

Photo of Mark WardMark Ward (Dublin Mid West, Sinn Fein)
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Last night the Government rushed through legislation that will impinge on people's civil liberties. I was waiting to speak on amendments I put down that would repeal Part 5 of the Mental Health Act 2001, which allows mental health tribunals to be reduced to one-member, paper-based tribunals. This legislation was introduced to reduce the amount of personal interaction between relevant persons in order to prevent the spread of Covid-19. Since this legislation was introduced there have been 755 mental health tribunals and not one of these tribunals has had to use the emergency powers. There was no need to extend these emergency powers and all the evidence suggests that they are not being used at all.

At the recent Joint Committee on Health meeting, Mental Health Reform stated that the legislation is an infringement of service users' rights. The Government should be focusing on substantially increasing investment in our mental health services and supports to address the challenges of the pandemic and its aftermath. Last night's debate was one of the most undemocratic processes I have ever been involved in. The debate was guillotined, which took away the opportunity for me to ask the questions I had. For example, what input did the Minister of State's Department have in this decision and why does she think that extending these extraordinary powers was warranted?

We also had an informative meeting of the Sub-Committee on Mental Health this week where we met representatives of the LGBTI+ community. This is Pride month and I want to send a message of support and solidarity to all members of the LGBTI+ community. We received a comprehensive report that stated that 93% of LGBTI+ young people were struggling with anxiety, stress or depression during Covid-19. This was in comparison with 53% of the general population. These findings are really stark and we need to put in place measures that will positively impact on their mental health and physical well-being. I ask that the Minister of State read the report and implement the appropriate measures outlined.

The Minister of State mentioned in her statement that current legislation around the age of consent in accessing or refusing mental health treatment represent barriers to all our young people. However, there is a specific barrier in which only those aged 18 and over can consent or refuse treatment. This poses a significant barrier to LGBTI community again. I acknowledge the Minister of State's commitment to amending the Mental Health Act 2001. On mental health, this creates circumstances for LGBTI young people wherein their access to mental health services is dependent on their willingness to share their needs with their parents or guardians. As research has demonstrated, many LGBTI+ young people are not supported in their home environments because of their sexual orientation or gender identity. This can become a barrier to them obtaining the proper supports.

What really concerned me is that young people in the LGBTI community are still being subjected to conversion therapy as they do not have the legislative right to refuse this draconian practice. Deputy Mythen and I have introduced legislation to the Bills Office. The Mental Health (Amendment) Act 2018 might supersede this but our Bill will enable 16 and 17-year-olds to both consent to and access mental health treatment on parity with physical healthcare. This so called conversion therapy has no place in our society. It is harmful and destructive and has been condemned and discredited worldwide by institutions such as the UN Committee Against Torture, the European Parliament and the Irish Council for Psychotherapy. It is plain and simply wrong. My colleague, Senator Warfield, introduced the Prohibition of Conversion Therapies Bill in 2018. I call on the Government to act on this legislation to ensure it becomes a reality and to protect LGBTI people of all ages from this harmful practice. There can be no more delays.

The Sinn Féin motion that was unanimously passed in this House recently called for an increase in investment in talk therapies. We called for the removal of the medical card barrier and for additional resources to be supplied to our community-based services to provide this treatment. I have read the Minister of State's 76-page Model of Care Adults Accessing Talk Therapies report and I have to say it is not worth the paper it is written on. It is more a staff induction handout pack than a comprehensive report into appropriate access to talk therapies. The latest figures I have state that there are still over 10,000 people waiting on a primary care psychology appointment. The vast majority of these are children. We all know that early intervention is key to people progressing and to stop them from regressing in their mental health. Of the 10,000 people waiting on primary care psychology appointments, 5,500 are waiting over a year for an appointment. This is just not good enough. Can the Minister of State imagine the regression in people’s mental health that can happen in a year? Can the Minister of State imagine the impact this can have on a family over a year? At the launch of the document in April the Minister of State said the therapies would be accessible and would ensure that everyone gets the right supports in a timely manner. Over a year is not a timely manner. We do not need another box ticking exercise. We need to have the appropriate service in the right place.

Covid-19 has shone a light on the frailties of the mental health services and we have heard that the shortfalls in access to appropriate services have impacted all members of society. We were in a mental health emergency before Covid and we are now in a mental health crisis. I acknowledge that the Minister of State inherited problems but she is coming up to a year in office and people are not seeing any significant progress in how mental health supports are provided. I urge the Minister of State to introduce the three Rs: resource; rebuild; and reform our mental health services. The Minister of State has a unique opportunity to be able to do this. She can do the following: allocate substantial investment in our mental health services and supports; create a dedicated lead for mental health within the HSE who reports directly to the CEO; and increase staffing in the HSE adult community mental health teams and in CAMHS to address the unacceptable waiting lists.

There is another thing I would like the Minister of State to do. She can also mental health-proof decisions made at the Cabinet table. Every decision that is made has an impact on people's mental health. If the Government can address the challenges of inadequate income, employment and housing then this would have the biggest impact on positive mental health and quality of life.

Photo of Patricia RyanPatricia Ryan (Kildare South, Sinn Fein)
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The pandemic has had a huge effect on the mental health of our older people. Over the last year I have spoken to many of the groups that represent and advocate for our older people. The stories they have told me are shocking. Our older people have been left behind by this Government. One older person described their time during Covid as looking out the window waiting to die.

Too much is being left to charities and non-Government groups with little funding offered to them. The little that is made available can only be accessed by jumping through hoops and wading through red tape. Many of the groups only exist because of the failure of the Government to provide the vital and lifesaving services that these groups are providing. I commend the work of groups like Hope(D) in Newbridge which is doing great work with little funding. The HSE refers people to this group but does not provide funding. We have spoken about this on many occasions. Only an hour ago I spoke to Terry in Hope(D) and she tells me that funding is urgently needed for core support. I ask the Minister of State to even meet these people to talk to them.

I am a member of the Committee on Budgetary Oversight and we heard last week that the Irish Fiscal Advisory Council has concerns over the roll out of Sláintecare. This needs to be addressed immediately to make up for lost time. We need to prioritise in-home care and I appreciate that the Minister of State has mentioned that, which is important. Increased funding for the home help scheme must be delivered for all older people and we need to simplify the process for our older people to apply for assistance. I mention forms like the carers allowance application form. It is 40 pages long. It needs to be simplified. It is an onerous task to fill in and it must change. People cannot fill it out, particularly our elderly people.

I would like to speak about a sensitive matter. I will not discuss the details here but the Minister of State will know of the case I refer to and I commend Andrew McGinley for his bravery in discussing the matter. He is calling for a particular change which is a long overdue reform recommendation of a mental health working group from five or six years ago. Action is needed to allow for patient advocacy. A family member or a friend who is aware of a person’s mental ill health, their full treatment plan and medication can assist the person in coping with the difficulties that this presents.

I urge the Minister of State to meet with Mr. McGinley, Ms Una Butler and other families to ensure we see a change in this area as soon as possible.

1:45 pm

Photo of Alan KellyAlan Kelly (Tipperary, Labour)
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I thank the Minister of State. Our mental health service capacity was in crisis before Covid-19 first arrived on our shores. The pandemic has only further exposed the gaps that exist in our mental health system. As it stands, more than 2,500 children are waiting for access to child and adolescent mental health services and over 10,000 people are waiting for a psychology appointment through our primary care service. Can we set an ambition to dramatically impact those waiting lists by the end of the year? It would be helpful if the Minister of State would outline the Government's plans to change those figures, if nothing else, to ensure that we are not back in the same situation at Christmas.

We are often bombarded with statistics when it comes to waiting lists in our health service. The numbers are stark but behind them are children and young people who are struggling with anxiety, depression, suicidal thoughts, eating disorders and many other health challenges. There are many stigmas attached to mental health. I have spoken to a number of young people in recent months. In some cases I have done so off my own bat and, in other cases, I have been asked to do so. It is a difficult situation. Mental health issues often become quite pronounced before a person reaches out to a doctor or someone else for help. It is good when they reach out and it is the beginning of a process.

In this House, we all know the sheer number of hoops young people need to jump through in order to access services. We should not be putting bureaucratic or cost barriers in the way of people's mental distress. It should not matter what door a person walks through, as I have said previously. They should not have to worry about the convoluted way in which they have to access services, they should simply be able to access them. The mental health service should be seamlessly integrated and allow different providers to refer patients to the most appropriate service in a timely manner.

In a report into the impact of Covid-19 on the mental health services in Ireland, leading Irish psychiatrists, including the HSE national clinical lead on psychosis, Dr. Karen O'Connor, warned that a "tsunami of mental health need" will arise some time after the peak of the initial pandemic. The report stated the tsunami will persist for months, if not years, and will be compounded by the economic impact of the pandemic. That is awful. It is terrifying to think about but Dr. O'Connor is summarising what we all knew at the back of our heads. We collectively need to plan for this tsunami. The service is already under strain so one can imagine what lies ahead.

Covid-19 has had a profound impact on the collective mental health of the nation. I have spoken about that in the past, particularly of its impact on the elderly. I have two elderly parents and know all about the issue. It is a very difficult period. As a nation, we have been experiencing grief since March 2020. We have lost loved ones. Friends have been unable to meet one another. Loved ones have been unable to meet. We have been unable to mourn properly, something I have experienced. We have been unable to visit the people we love and I have experienced that. Our very way of life has changed.

According to research published by the Irish Youth Foundation on Tuesday, 73% of young workers believe that the pandemic will cause serious damage to the long-term mental health of young people in their communities. The economic impact of the pandemic on those who are already in precarious economic situations has been recognised as something that will impact significantly on mental health. The Institute for Fiscal Studies has stated that the economic downturn will have significant consequences for people's mental health outcomes in the short term and the longer term.

The HSE clinical lead in psychiatry is warning that a tsunami is coming. Youth workers are concerned and Mental Health Reform has also outlined its concerns about the impact future strains of the virus could have on our services. The Minister of State has been warned. We have had at least four debates on mental health since January in this House. We cannot keep going around and around here. We must match our words with action. It is not good enough that our spending on mental health is only 5.1% of the entire health budget. I hope the Minister of State will fight in that regard. She has the capacity to fight to improve that allocation. Our neighbours in France, Germany, Sweden and the UK allocate between 10% and 13% of health spending to mental health. Increasing spending will allow for more staff on mental health teams and help to reduce unacceptable waiting lists. We also need to fund new services that go beyond talk therapies and truly focus on a person-led approach which works far better.

We know what needs to be done to tackle the pressures that exist within the system. We know that the will is there from the health professionals. Many of us on this side of House are agreed on what needs to be done. It is time for the Minister of State and the Government to step up to the mark.

I would appreciate it if the Minister of State, in her reply, will give an update on Jigsaw services in my own county.

Photo of Mary ButlerMary Butler (Waterford, Fianna Fail)
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Those services will be available in July.

Photo of Alan KellyAlan Kelly (Tipperary, Labour)
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I thank the Minister of State for confirming that. A pathway towards some mental health beds in my own county would also be welcome.

Photo of Jennifer Murnane O'ConnorJennifer Murnane O'Connor (Carlow-Kilkenny, Fianna Fail)
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Supporting positive mental health and well-being must be a priority because these services are very limited. We have a lack of consultants in the area and limited appointments, assessments and treatments. It is a worry. I understand that the pandemic has had a big part to play in those limitations but it has also highlighted that these services are urgent and essential. The Minister of State spoke about funding, which is a big issue.

We must look after our older people. I am aware that is one of the priorities of the Minister of State and it is important. We also need funding for our younger people. Is there a plan to put a programme in place for children and young adults in order to teach them the life skills they will need? That is important.

If anything, the pandemic has changed the way I see things. It has affected people. Surveys have been done that reflect an increase in the numbers of people reporting symptoms of stress, anxiety and depression caused by the pandemic. What extra supports can we provide for people? Anxiety, depression and stress are understandably affecting people.

A campaign, Hello Carlow, launched last week. It is all about connecting with each other and asking others the simple question, "How are you?" I have spoken to the Minister of State and know how dedicated she is to working on different programmes. It is important to ask others, "How are you?" and get that communication out there. People should talk and they should know they can go somewhere to talk. Talking is a part of healing. I ask that we promote more campaigns like the one in Carlow. It was great, and I compliment all the volunteers who were involved. I understand they might look at rolling out the campaign nationally next year. Will the Minister of State put a programme together to fund national campaigns to encourage people to say, "Hello, how are you?" to each other? Perhaps the Minister of State will come back to me on that. I know we need to look at funding.

I am concerned that we are going to see a fall-out from the pandemic for years to come. What can the Minister of State do? What can Deputies do, working in our areas and working with young people, perhaps through schools? It is important that talks are delivered in schools. However, we need something stronger. Every county needs to put more resources into examining what more we can do to help. I have no problem volunteering. We have to be able to talk. We have to know that we can go into schools or other areas where we can talk. We can see what we can do. Perhaps we should work with professionals on that.

I know how hard the Minister of State is working. I encourage her to ensure that funding is not going to be an issue for services, going forward, and that we will not be getting phone calls from people telling us they cannot access services. We must make sure of funding. Mental health must be a priority in general but especially after a pandemic. We must put more funding into the mental health sector.

Photo of James O'ConnorJames O'Connor (Cork East, Fianna Fail)
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I thank the Minister of State for being here to have a conversation with us on the issue of mental health.

I have said it many times before but, as the youngest member of the Oireachtas, I will say this is obviously a very important issue to many younger people across society.

First, I commend the Minister of State on the work she is doing on her own portfolio. It has not been easy to deal with that in the midst of a global pandemic and to handle also issues with older people. Perhaps that is where I will begin; it is an interesting combination.

I hear an awful lot about the issue of rural isolation from people living across rural Ireland, and it particularly affects many older people in our communities. Many people also tell me they have a desire to move into urban areas and have access to accommodation, whether rental accommodation or by selling their family homes or, perhaps, if they are living on their own, by selling where they are living and moving into urban areas to be around village communities. I am talking about places like Cill An Oir in County Cork or Portlaw in County Waterford, in the Minister of State's constituency. People want to move into those settings to be with other people and tackle the issue of isolation, which is obviously very important across rural Ireland.

I want to come into the House with suggestions. I heard much negativity today from the Opposition about the performance of this Government but the reality is that we are dealing with the biggest challenge that has faced this State since its foundation. We have done a relatively decent job of protecting people's health, livelihoods and their families' incomes. I am glad the Minister of State, Deputy Butler, is the person in this particular role of dealing with the enormous challenges in front of us. I know she will do her very best in this area.

I would love to see a focus being put on people who are hoping to move location from rural Ireland into more urban settings where they will be around the support services in our villages and towns. The Minister of State could champion this. It is specific to both areas within her Department as somebody who works on issues facing older people and also on mental health. Of course, rural isolation comes very much into that.

Another very important issue is the effect of social media, which can take an awful toll on the mental health of young people. I grew up in a generation where every young person in the country had access to a mobile telephone or smartphone and social media. I am probably part of the first generation that was really raised with it from a young age. It is doing enormous damage to young people's confidence in themselves. Online bullying is a major contributor to people developing serious mental health issues and, unfortunately, also to suicide.

It is completely unacceptable that in the year 2021, decades after social media came into play in people's lives, we still have not grappled globally, never mind in Ireland, with how to take on the issue of online bullying with tech giants. We should work very closely with many of the companies located here to find ways to make social media a safer space for younger people, and deal with the confidence issues many younger people experience because of the pressures of social media. They are extraordinarily large issues, which cannot be underestimated. At a European level, the European Commission also needs to show leadership. The more states that work together on this particular issue, the more progress we will achieve together.

One interesting point raised by many Deputies, of which my colleague, Deputy Pádraig O'Sullivan, is very much supportive, is the ability to bring people who are working in areas such as sports - many of our famous sports stars, for instance - into schools to give motivational talks to students to help boost their self-confidence in those very early years of their secondary education and throughout. That is often when people become much more self-aware in terms of their growth and development. It is also quite a vulnerable age for many students going on to third level.

Finally, it is important for Government to take up the following message. I am going to be 24 years old this month; I am 23 now. Many people I know are wrapping up their higher education at the moment. The effect of the pandemic on many people's ability to communicate with others or meet up with friends and on their social lives by not being in their traditional educational setting, whether they are in university or in further education, has been hugely damaging. A major priority of this Government should be to make sure that we can get our students back into lecture theatres and into their tutorials, in person, so they can get the interpersonal experience that third level education is supposed to be in people's lives. I would be absolutely delighted if we could just get that goal sorted out.

1:55 pm

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
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I thank Deputy O'Connor. I call Deputy Cairns.

Photo of Holly CairnsHolly Cairns (Cork South West, Social Democrats)
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Speaking at the Joint Committee on Health, Ms Fiona Coyle, CEO of Mental Health Reform, outlined the stark reality of mental services in Ireland. She stated:

Our mental health system was and is not capable of coping with a surge. Our system was struggling and close to breaking point long before the pandemic hit.


Covid-19 [now] underlines the need to reconfigure mental health services. We ... [need to finally] put service users at the centre of design and delivery.

The World Health Organization recommends that each state spends 12% of its health budget on mental healthcare. In Ireland, however, it is less than 7%. Not only has the pandemic caused a whole range of mental health issues, it has revealed the inadequacies of our system. To be clear, I know that is a system inherited by the Minister of State and not one she created. In response, though, we need to not only put in place the necessary staffing and infrastructure over the long term, but we also need a temporary investment to deal with the current surge in mental health concerns.

The psychological impact of Covid-19 is intersectional. People with pre-existing mental health difficulties, healthcare workers, women, young people, people in precarious work or those who are experiencing homelessness are all more likely to have negative effects.

The Irish Youth Foundation’s report, Generation Pandemic: Futures Are on the Line, highlights that the pandemic will have a profound long-term impact on the mental health of the young people in disadvantaged communities. It also points out the knock-on effect that mental health takes on all other aspects of life, including education and employment.

Almost 9,000 children are currently waiting to get access to psychological services in the HSE and more than 2,700 young people are waiting to get access to child and adolescent mental health services, CAMHS, of whom 98% have been waiting for more than a year. The impacts of these delays are significant for young people and their families and they require immediate intervention.

Women, especially those in low-paid jobs, have been disproportionately affected. They have had increased home and childcare responsibilities throughout the pandemic, incidents of domestic violence have risen significantly and the distress of ongoing restrictions in maternity hospitals has taken its toll. Specific and targeted interventions are needed for the groups most affected. We need considerably more funding that goes into front-line services to offer targeted and preventative measures.

I really want to raise with the Minister of State the mental health of people with disabilities, which has been under-discussed during the pandemic and in general. The cessation of many services last year, and ongoing restrictions, have significant negative effects on people with disabilities. Research carried out by Inclusion Ireland last summer shows increases in loneliness and anxiety for people with intellectual disabilities, as well as an erosion of independence and developmental progress. In particular, young people with disabilities need structured and dedicated interventions, and studies to assess and respond to their mental health needs as a result of the pandemic.

People with intellectual disabilities often feel invisible and poorly treated by mental health services. A Vision for Change, which was launched in 2006, set out targets for mental health services. Almost 15 years later, however, services for people with intellectual disabilities remain at 33% for adults and 12% for children.

I am highlighting disability because the reality is that disabled people and their families are too often neglected by the State. Ireland was the last country in all of Europe to ratify the UN Convention on the Rights of Persons with Disabilities. Appallingly, we have yet to ratify the optional protocol, which would enable people to hold the State to account for its failure to realise these rights.

I sit on the Joint Committee on Disability Matters and the reports we have received from Departments have been beyond appalling. They were so disappointing and unsatisfactory that I barely have the words. They lacked basic sufficient detail to understand the issues on different scales and to provide accountability. One Department actually considered a single page response to the committee to be sufficient. This is indicative of the way the State views its obligations to people with disabilities. This requires a fundamental change in the way people with disabilities are treated, not only in terms of mental healthcare services but in all services across all Departments.

Our mental health services need sustained strategic development. We need to bring spending up to the levels required and to tackle the surge in issues raised by the pandemic. Simultaneously, the Government needs to address many of the underlying causes of mental distress.

Mr. Martin Rogan CEO Mental Health Ireland highlighted that the pandemic has revealed:

... underlying tensions and ... fragility that ... [many Irish people] live with ... strained social bonds, overstretched families ... insecure housing ... long commutes, inadequate childcare provision, drug and alcohol misuse and financial uncertainty.

To tackle the mental health crisis, we require proper State interventions that provide fully funded mental healthcare as well as sufficient housing, funded childcare and workers' rights. Only then can families and communities be assured the Government is taking mental health seriously.

Finally, I would appreciate if the Minister of State could give an update on the disgracefully low number of inpatient beds for people with eating disorders. There are currently only three HSE beds for such patients.

2:05 pm

Photo of Pádraig O'SullivanPádraig O'Sullivan (Cork North Central, Fianna Fail)
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I am sharing time with Deputy O'Donnell. I echo the sentiments of Deputy O'Connor that there is nobody better placed than the Minister of State, Deputy Butler, to take up the challenge in regard to mental health. She has a great track record on these issues and I hope, in the years to come, she can put her stamp on the Department. As she said in her opening statement, we are not yet fully aware of the true extent of the impacts of the Covid crisis on our mental health as a society. Different people have been affected in different ways and people have different resilience thresholds. The true impacts might not be felt for years to come. Nevertheless, we all recognise the glaring difficulties Covid has put before us. There is a whole host of challenges that need to be met.

In a recent Amárach Research poll, 80% of the youth workers polled confirmed that the pandemic is having profound long-term effects on the mental health of young people. For second level students who are doing the leaving certificate and other examinations, for example, the added stress of the pandemic is clearly demonstrable and a cause for concern. The same is true for third level students, who have also faced many challenges. They have not had a conventional third level experience and that needs to be considered when we are devising appropriate responses for that sector.

As a member of the Oireachtas education committee, I am aware of the issue of bullying, including cyberbullying, to which a number of speakers referred. The Ombudsman for Children and other representative bodies called recently for the presence of psychotherapists in schools. It is not necessarily the case that a psychotherapist would need to be assigned full-time to every school. We could have a system where, in the different regions, a number of professionals would be identified to go into a number of schools and meet the most vulnerable and at-risk students and seek to address their needs. This is something on which the Government really needs to focus.

Deputy O'Connor mentioned the technology giants, including social media companies, and the role they can play in addressing cyberbullying. Many multinational companies in this country are very good at this type of engagement in the various industries in which they operate. They play a large role in terms of corporate responsibility and giving back to the communities in which they are located. The Government should look to engage with Facebook, Twitter and other companies in regard to their corporate responsibilities. Cyberbullying is increasing at a dramatic rate and everybody in this Chamber has suffered abuse on social media at one time or another. That type of bullying is very prevalent among younger people. Speaking on a personal level and in a local context, I have seen the ill effects of cyberbullying on younger people in a school setting. Unfortunately, in some cases, it can have the gravest of consequences by contributing to people self-harming and taking their own lives. We need to put a challenge down to the social media companies and other technology giants that they have a corporate responsibility role to play in this regard.

My final point concerns the mental health of older people, which is part of the Minister of State's brief. I want to raise a specific issue on which she may be able to work with the Minister for Housing, Local Government and Heritage. Throughout the country, there are elderly people living in large houses who may not want to go into any type of service, but want to downsize and live in a community with other older people. A number of people in my constituency are currently involved in a couple of planning applications to provide that type of accommodation. However, they are facing difficulty because of An Bord Pleanála's density thresholds. An Bord Pleanála is suggesting they need to comply with the same density requirements that apply for regular housing units. That baffles me. We are talking about purpose-built retirement settings and the people involved should not be held to the same standard as house builders and developers. I would appreciate if the Minister of State would take that issue into consideration.

Photo of Kieran O'DonnellKieran O'Donnell (Limerick City, Fine Gael)
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I spoke on this subject a number of weeks ago and I asked to speak on it again today because it will be a hugely important issue into the future. We probably will be living with Covid indefinitely. It is like no other pandemic that has gone before. Covid is going to be on the horizon in some shape or form, possibly for the rest of our lifetimes. Lockdowns will potentially be required at different times. Life is not going to be as we once knew it.

When it comes to mental health services, there must be a basic trust that an adequate level of service will provided, but the service also has to be Covid-proofed. I have a number of questions for the Minister of State in this regard. Is the national mental health policy document, Sharing the Vision, Covid-proofed? I understand a national implementation monitoring committee has been established to oversee the putting in place of measures set out in the document. However, people need to sit down and think about what else is needed in a world where we have ongoing lockdowns, with people unable to attend day care centres, for instance, or schools and colleges. I prefer to talk about mental well-being as distinct from mental health. Sharing the Vision is the blueprint for mental health services delivery and it must be Covid-proofed. The implementation monitoring committee should be involved in that effort, just as it is key in ensuring national policy is implemented. The HSE's Covid-19 psychosocial response framework will also form part of this work.

As a Deputy for Limerick city, I have seen the impact of Covid across all age groups and sectors. I have seen it at first hand in my own family, as we all have. It has affected people in college and school, in particular, as well as elderly people living on their own. We need to have different dimensions to our response. Sharing the Vision is the founding document in terms of how we are going to shape the future of mental health services delivery in this country. I ask the Minister of State to set up a policy group to ensure it is Covid-proofed. Everything we do from now on must recognise that we are living in a world with Covid. It is now generally acknowledged that stamping the virus out completely may not be on the horizon for a long time, if ever. We need to adapt to the Covid world in which we live and that brings different dimensions with it. For people working from home, for example, a lack of social interaction may be an issue. As I said, I would not even regard this as an issue of mental health but, rather, one of mental well-being. Many employers are now telling their staff they are not to work in their bedrooms and must dedicate another room in the house for working.

In conclusion, I have a very straightforward request for the Minister of State. Sharing the Vision, the national mental health policy document, and everything else to do with mental health services provision within the HSE and the Department of Health must be Covid-proofed. I would like a commitment from her that this work will get under way and we will see a revised policy document published.

Photo of Martin BrowneMartin Browne (Tipperary, Sinn Fein)
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I am sharing time with Deputy Martin Kenny. When Covid struck, the country went into firefighting mode because we were battling a threat about which very little was known. Decisions were made and restrictions imposed that have affected every man, woman and child, with impacts on emotional, mental and physical health. While it is understandable that very difficult choices had to be made, it is regrettable that so few measures to address the impacts of the restrictions were put in place. With a reduction in services, existing gaps in the system were made even wider and many people found themselves falling through them. Now that society is in a position to reopen gradually, the job ahead of us is to look at the impacts the restrictions have had on people and how to address them.

Throughout the crisis, Sinn Féin has warned that measures needed to be put in place to deal with the impacts of the restrictions on people's physical and emotional well-being. In many instances, the Government failed to do this.

In the months since the restrictions began, I have regularly brought to the attention of the Dáil, the HSE and Government Departments issues of particular concern that members of the public have contacted me about. Children and adults with special and complex needs were particularly affected. Many of their routines were broken and social outlets were cut off for many. This caused regression in some people and distress for their families but the response was slow and inadequate. We had to fight for the introduction of the summer provision last year, yet when it was finally introduced it did not get to everybody. For many, the challenges they were already facing have become even more challenging and much work is going to have to be done to address the regression that has taken place.

Only recently I raised one particular situation in which a young man with special needs from County Tipperary found himself suffering because he could not access the day centres that were so important to him. He was also affected by the cancellation of local sporting activities which were a very important outlet for him. His mental and emotional welfare suffered considerably but the reduction in services, coupled with already long waiting lists, have meant that over four months after his family started seeking a psychology assessment he is still waiting. Despite attempts from the Opposition, contingency plans to deal with the fallout of the restrictions and the anxieties that were increased due to Covid were not thought out properly.

All people, no matter their background, who have found themselves in situations where their mental health needs were put on hold are now going to need greater attention and more accessible supports. Similarly, this applies to people who have lost loved ones in the course of the pandemic and were unable to grieve properly. Many people whose businesses were affected or who were in a grim financial situation are going to need help. Domestic violence increased. Many people are likely to have found their ability to escape abuse has been limited because Covid has limited their options so much. This week, the Irish Youth Foundation shed light on how investment in youth services is important in providing counselling and enhanced intervention supports. Extended absences from school and long periods of isolation and a lack of structure are a particular concern for the long-term mental health of young people and must be addressed.

Earlier this week, I welcomed the planned reopening of day centres for older people. It is an important milestone for those who suffered considerable isolation. We now need certainty that the physical and emotional needs that have built up since the onset of the pandemic will be recognised and provided for. It is therefore crucial that funding for the adaptation of centres is accompanied by increased availability of mental health staff, occupational therapists, physiotherapists and other support workers our older people will need in order to address their mental and physical health needs.

The WHO has said that 14% of a country's health budget should be set aside for mental health. At 5.2%, we fall way short of this and the 10% minimum pledged under Sláintecare does not live up to that standard. The Government must meet this standard because Covid will be with us for some time and so will the impacts of the measures needed to deal with it.

2:15 pm

Photo of Martin KennyMartin Kenny (Sligo-Leitrim, Sinn Fein)
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We are all very conscious of the mental health services and the poor provision in place before Covid even came along. Very many people were struggling to get assessments and services and to have a sense of continuance and a sense that services was going to be there for them in the future. That is a legacy the Minister of State has inherited. I know she is doing her best to try to cope with it under difficult circumstances. I have spoken to her about CAMHS in counties Sligo and Leitrim and some improvements have happened there. There has been recruitment and I acknowledge there has been progress made, which is very welcome. However, there are a whole lot of other services where there is a similar absence of ensuring people are looked after.

I recently spoke to the mother of a young man who has very serious difficulties with drug addiction and addiction problems in general. He has been diagnosed with mental health issues which are probably a consequence of his past drug abuse. When he goes into the service, he gets looked after for a short period of time and then he is put back into the community in a rural house in the middle of nowhere. He has no backup there. There is a little piece missing here in the service. That piece is to provide for people like that, who probably do not need to be in a long-term psychiatric institution but, at the same time, are not well enough to go out and live on their own in the community. I am referring to a type of sheltered accommodation that was available in the past, up to 15 or 20 years ago. However, with the drive to put everyone out into the community, that was taken away. That has been a real problem and needs to be re-examined. Not just where I am in the north west, in Sligo and north Leitrim, but across the country I am sure one will hear similar reports of people who unfortunately find themselves in this gap where there is no service for them, other than perhaps a mental health nurse calling once or twice a week. That is just not enough, given the state of mind people in this situation may be in. They have families who are very concerned and worried about them. I ask the Minister of State to look at that issue in particular.

On the question of what needs to be done around positive mental health, I am thinking of the responsibility of the social media platforms from which many young people get their lead in life and where they do much of their communication. What we would normally have done in the past by getting together and talking to people, they now do online on their phones. While that may be a negative in some senses, perhaps we can try to find a way of turning it into a positive. There could be messages going out through those platforms which would reinforce people's positive mental health and do something to reaffirm their value in the world and in life in general. We must examine how the Government can work with these platforms which have got very bad press, and deservedly so in many cases. There is an opportunity here for them to do something to redress that. The Government should try to engage with them and try to make progress in respect of that.

Photo of Gino KennyGino Kenny (Dublin Mid West, People Before Profit Alliance)
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I want to focus on children and young people in the context of the public health emergency we have gone through. It has had a terrible effect on that cohort. This week's report from the Irish Youth Foundation, Generation Pandemic, paints quite a stark picture of disadvantaged children and the pandemic. One aspect of the report relates to children and young people who have fallen out of the school system and probably fallen out of groups they would have had. Usually when that happens - not always but sometimes - they fall in with darker forces in society. Those darker forces will educate them, but in a different way. They will use them, abuse them and normally use them for criminal enterprises. That is obviously compounded by the fact that the things young people gravitate towards were generally suspended over the pandemic.

Social inequality is one of the greatest detriments, if not the greatest detriment, to anybody's mental health. If a person who lives in poor housing is in a situation where inequality is compounded, it can be extremely difficult for their well-being and health. That is one thing we must address.

Since 2010, the cuts to youth services have been enormous although they have been addressed over the last couple of years. That has had a hugely detrimental effect on communities that engage with young people. It is important not to malign or alienate young people. We must be very proactive with them. We must be positive with them because sometimes society is very negative about young people. It makes it seem like young people are the cause of everything. We were all young people at one time and we all did certain stupid things we probably regretted in later years but that is the whole idea of growing up. It is important we give the positive aspects of well-being. There is an issue around young people who fall through the cracks. All the systems they have are gone. It is really important for the Government to address that.

Photo of Mick BarryMick Barry (Cork North Central, Solidarity)
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The leaving certificate exams begin next Wednesday. This is the most stressful set of exams done by second level students, by young adults, anywhere in Europe. I challenge any Deputy in the House to dispute that assertion. It is all the more difficult when young people have been forced to prepare for those exams, and now sit them, during a global pandemic. I am certain there are hundreds of students who are only going to be able to get through the stress of these exams thanks to medication and I would not be at all surprised if the real figure was in the thousands. That is not the way young people should be prepared for leaving school and going out into society. The Studyclix survey of 2019 polled nearly 3,000 students and found 75% of them reporting severe stress over the course of the leaving certificate cycle, with 35% suffering insomnia and 28% suffering depression.

The Government decision not to release exam results this year until 3 September does not help and it is not conducive to students making calm choices about college courses. It makes the sourcing of college accommodation very difficult and it adds to stress levels in the run-up to the exams. I am not convinced by the Government's arguments as to why results cannot be released earlier and the Government should reconsider its position on the matter.

The leaving certificate is not compatible with the protection of the mental health of our young people. It should go and be replaced with a policy of open access to third level education.

2:25 pm

Photo of Jackie CahillJackie Cahill (Tipperary, Fianna Fail)
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I have a number of mental health matters to bring to the Minister of State's attention today, some of them unique to my constituency in Tipperary, whereas others can be seen on a national level.

I recognise the work put in by the Minister of State to the Jigsaw project in Tipperary, which will be based in my home town of Thurles. Since being first elected to the Dáil in 2016, this is something I have fought hard for. At that time, Deputy Helen McEntee was the Minister of State with responsibility for mental health and we were told we would have the facility in a couple of months. As with the changes to the fair deal scheme that the Minister of State, Deputy Butler, introduced to the Dáil a couple of weeks ago, she has delivered again with this project. I know she has put much work into it and I appreciate that this service will open in July for referrals.

Early intervention is absolutely essential when dealing with mental health and the Jigsaw project in Tipperary is a cornerstone in building mental health services in my county. I appreciate the work of the Minister of State and the officials in getting this delivered. We had many hiccups along the way and Covid-19 did not help in trying to meet targets. However, we are there now and we look forward to Jigsaw playing a key part in a mental health strategy for Tipperary.

We have a centre for Thurles but we will now look for hubs to open in both Nenagh and Clonmel. It is an essential part of the Jigsaw service that should be around Tipperary, which is a very large inland county. We need hubs in both Clonmel and Nenagh so services can be readily available to all our young people. I know the Minister of State will deliver on this and I very much look forward to that.

The size of my county leads me to my next point, which is the lack of psychiatric hospital beds in Tipperary. There are no such beds in a county of our size. I have spoken about this many times in the Dáil but, unfortunately, we are being blanked by the HSE. We are told there are sufficient beds in the south east or mid west, depending on whether a person is in the north or south of the county. We are told by the HSE that the ratio of mental health hospital beds for the areas is sufficient but there are no beds in Tipperary. When treating people with mental health issues, it is essential they are close to their families. People in the north of the county would have to travel to Ennis while people in the south would have to travel to Kilkenny and it is not possible to have the interaction they need with families to help bring about a good outcome for mental health problems.

I earnestly ask the Minister of State to get the HSE to re-examine this matter. We are not asking for a huge number of beds. We want a small number of psychiatric beds to cover north and south Tipperary. If we are to have a proper mental health service in Tipperary, psychiatric beds must be a cornerstone. The Minister of State has delivered Jigsaw for us in Tipperary and I earnestly ask for her to deliver those psychiatric beds for us as well.

I will speak about third level students, and I am thankful they will return to campuses in September. The leaving certificate results will come out in the first week of September and pupils will probably be two or three weeks later going to university. They have had a very hard time with Covid-19 and the availability of services to them on campuses this year will be extremely important.

We must have major investment in mental health supports in third level institutions right across the country. There are students in third level institutions in my county who have spent the past year studying from home. From dealing with student unions, the message is clear that they need far more counselling services on university and third level campuses, especially in-person counselling services. Face-to-face counselling is absolutely essential to these young people. They have sacrificed much during the pandemic and the past year and a half has had a major impact on them. I hope there will be extra resources for this area as they will pay dividends in the long run. Getting in with early intervention for these students could prevent major mental health problems for people in future.

I will also speak about people who have experienced mental health difficulties through the pandemic. Unfortunately, many people, through no fault of their own, have suffered financial difficulties and they are suffering mental health issues because they are under extreme pressure. We must get the message to them to seek counselling or seek help. Many people have been very successful in hospitality or tourism areas, or the many other sectors that have been badly affected, such as taxi drivers or track bookmakers - the list goes on - and they had their livelihood taken from them because of Covid-19. It was nobody's fault but as a result, people's mental health is under much pressure.

These are people who never knew what it was not to have resources to pay bills coming in through the door. For the past year and a half they have not had any income to meet outgoings, and this has put them under major pressure. We must get a message to these people that there is help and counselling available. They should go their local GP to get access to those services. It is a very important message to get out.

We have spoken about loneliness in older people who have had to self-isolate. Unfortunately, this is not just confined to rural areas and we saw the same in urban areas as well. The pandemic has compounded loneliness for many people. Older people need access to services and help. Loneliness is a major issue and after cocooning, there must be an effort to get people into the habit of going to day care services or meeting people. Older people can go into themselves so it is very important to get them to avail of the services for them. Work must be done to ensure there are day care and other services for older people so we can get them participating in society again. They have had a year and a half of sitting at home and insecurity may have set in with many of these older people, meaning that going out again takes effort. We must help them do that and these services are so beneficial to them.

There has been no way to have a traditional Irish funeral or an ability to mourn. Unfortunately, many older people have lost partners in the past year and a half and a lack of social interaction, including meeting family and friends, has had a great impact on people. That will bring its own mental health challenges as well.

The Minister of State has delivered for Tipperary and my home town of Thurles. I recognise that and welcome it most heartily. Nevertheless, there is still much to do in Tipperary. We lack mental health services in the county and as I have said many times previously in the House, we need psychiatric treatment beds. We do not want the HSE telling us we meet ratio requirements for the mid west or the south east. We want those beds in our own county. For people to get the best benefit from mental health services, it is essential that they stay close to their family. That cannot happen in Ennis or Kilkenny for the psychiatric patients from Tipperary. I know the Minister of State will do her best for us in Tipperary and I appreciate that but these psychiatric treatment beds are very important to us.

Photo of Claire KerraneClaire Kerrane (Roscommon-Galway, Sinn Fein)
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I thank the Minister of State for her statement and I will focus my contribution on the e-mental health hub in Castlerea in my constituency, which replaced the former Rosalie dementia care unit for older people. I raised the funding issue in this Chamber three weeks ago after replies from the HSE to me confirmed funding for the e-mental health hub in Castlerea was not provided this year. I have confirmed this with the head of mental health services, who indicated that funding was provided last year to recruit four staff members but this year funding was not given either to keep those four posts or fill the remaining posts. Funding at no stage was given for the psychiatry of later life element of the service.

I welcome that the Minister of State has acknowledged that €1.4 million will be allocated for the continued development of the Castlerea hub. The Minister of State, Deputy Butler, has said that the release of funding for this is imminent and I would really like to know when this funding will be made available and what exactly will the funding cover. I hope the Minister of State will acknowledge that it is shame it has come to this. This funding should have been put in place last June. I appreciate that works had to be carried out but I wonder why funding was provided for four posts last year and not be continued to pay for those posts this year. They have not been funded at all. We are now into the month of June.

The Minister of State referred to a child and adolescent mental health services, CAMHS, Connect service and a CAMHS day hospital, but made no reference to the psychiatry of later life, which is a key element given what was lost with the closure of the Rosalie unit. Older people who called it their home were moved from here to there and to different nursing homes across Roscommon and Galway, even though a Government commitment was made that those residents would be allowed to see out the rest of their days in that home. This was a really devastating and cruel blow to the people of Castlerea, to the people who called the Rosalie unit their home, and to their families. Added to that blow was the fact that it has been replaced by a service that has not been funded. One year later we are now talking about €1.4 million half way into the year. There is no excuse. This was hailed as really transformative for mental health for young people and for older people, which is a really key demographic in counties such as Roscommon where we have an older population. It is especially key given that, sadly, dementia is a growing issue.

On the €400,000 given for staffing expenditure last year, to which the Minister of State referred, why was that funding not retained this year? I cannot understand that. It is disappointing. The service was hailed and opened with great fanfare - I was at the opening - and was a fantastic project. It was really well done, but when it is not funded it is no good at all. It has not served people the way it should have.

Mental health services for young people and for older people are absolutely critical and they are as much needed in counties such as Roscommon and Galway as they are anywhere else. Will the Minister of State please confirm, in writing or otherwise, when this €1.4 million will be allocated and what it will actually cover? Will she also tell the House about the psychiatry of later life element? This is very important, given the loss of the Rosalie home to the people of Castlerea and to the County of Roscommon.

2:35 pm

Photo of Matt ShanahanMatt Shanahan (Waterford, Independent)
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Covid-19 has wreaked havoc on the psychological well-being of many in our society. In many cases it has been indiscriminate to age, gender or financial standing. We have all had to accept the necessity of business restrictions and lockdowns at the early stages of the pandemic but the effects of constant isolation, financial pressures, sickness, and loss has taken a significant toll on many of our population. As we try to navigate our way out of this pandemic the resulting full psychological impacts are only starting to become apparent now.

Pre-Covid Ireland had an acknowledged deficit in many areas of psychological assessment. One of the most topical remains the psychological assessment of children with early learning disabilities. Sadly, that deficit is also extending to adult evaluations. We do not have, nor did we ever have, adequate psychological and counselling supports in the public system to cater for or meet that need. Where the services exist they do not have the capacity to cater for the more serious psychological problems that now exhibit far more frequently.

Parents are trying to access onward learning and disability services and they are waiting months and years for psychological assessments and for approvals to enter learning disability care pathways. The Department of Children, Equality, Disability, Integration and Youth continues to not recognise private psychological evaluations for learning spectrum disorders, which can be provided within weeks. Instead, we force patients to wait to access the public list even though waiting times can extend up to two years. This fundamental deficit must be challenged and changed radically in the State, given the extraordinary moneys we are currently spending in Covid support in other areas.

Psychiatric services are also at breaking point. In my city of Waterford, the Minister of State will be aware that there is no seven day psychiatric access and no on-call service at weekends in University Hospital Waterford, UHW, and the only possible admittance at weekends to the psychiatric department is via the emergency department with a referral. Even with this we have no child psychiatry services or beds available at UHW. This requires child patients to transfer to Cork, which adds to the trauma for many parents and children arriving into their local hospital after some psychological event.

Staff recruitment and retention in the psychiatric services has long been a problem, both in UHW and nationally. It is exacerbated by the increased clinical waiting lists, the extended workloads, the lack of available follow-on beds, and the recurring nature of psychiatric illness. We are also seeing significant amounts of anxiety and depression in our older age cohorts who have been forced to isolate away from family and friends for months on end. Those currently in hospital still suffer restrictions on family visiting times. This is despite the fact that nearly all hospital staff are now vaccinated. Despite the opportunities of identifying possible infection risks by using antigen testing in hospitals to screen visitor infection, the HSE continues to avoid any implementation of antigen testing that could resolve this issue. This remains a dark stain on the reputations of many of those charged with leading our national medical response to Covid.

We are also seeing a dramatic rise in the number of people who are becoming overwhelmed by the financial pressures due to Covid, which is leading to increased anxiety, depression and suicide. There is a significant body of people, most privately or self-employed in the State, who have fallen through the cracks in terms of receiving adequate or any State support to preserve their businesses and occupations, as restrictions have forced them to cease operations. If ever there was an example of disparity between the public and private sector pay divide, it is now most clearly evident in the treatment of the situation that many in the private sector find themselves, when their livelihood and financial reserves have been wiped out. Meanwhile, they look at those of us publicly employed who have suffered no disruption to our income because of Covid. Such inequity does much to harbour rage and anxiety, and it challenges self-esteem, which leads to chronic depression and mental trauma.

The rise in social media activity is also creating esteem and addiction issues. Consider the recent evidence of post-traumatic stress being suffered by social media moderators. The rise in online gambling is destroying family incomes. Image and body shaming narratives are polluting young and vulnerable minds, leading to a lack of self worth, eating disorders, suicidal ideation and sometimes suicidal acts.

If Covid has taught us anything it is the need for people to be with other people. It demonstrates the brittleness of the consumer society we have been building for many years, which has left so many people isolated and alone in its wake. We are not out of Covid yet, but we must begin a new national conversation that seeks to enhance life in all its stages, that seeks to include all differentiation, that seeks to value that which we had forgotten and have only recently rediscovered, namely, the understanding that we are all vulnerable yet invaluable, and that we are all in this together. For our society and people to prosper, all must be included and all must be supported. Community must be at the heart of the future political decisions we take as we try to heal and rebuild from Covid-19.

On the new public strategies and reopening from Covid, we have not mentioned resilience anywhere in the back-to-work schemes in the context of new business improvements. We need to look at this and build a resilience component across all Department policies over the coming months as we try to frame a narrative to leave this pandemic behind us.

Photo of Colm BurkeColm Burke (Cork North Central, Fine Gael)
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I thank the Minister of State for the work she and her Department are doing in dealing with the whole challenge around mental health services. It is important to pay tribute to all the staff in all our facilities in the State for their dedication and commitment during this particularly difficult time due to Covid-19, and their ongoing work in dealing with the new demands.

We are coming from a situation where over the period from 2012 to 2020, the budget for mental health increased by 46%. It shows that we were coming from a very low base.

A lot of work is still to be done in this area. The number of people working in this area has increased, with more than 10,400 whole-time equivalents now. It needs supports and the increase in staff needs to continue. The CAMHS programme is extremely important in dealing with young people. It is also about having a team effort. If one part of the team is missing, it is very difficult to operate. In Cork, one element of a CAMHS team was missing and young people were not able to gain access to the care they needed.

In 2018 and 2019, a number of facilities were identified by the Mental Health Commission as having major challenges. These were St. Loman's in Mullingar, a facility in Drogheda and Carraig Mór in Cork. What I find disappointing with regard to Carraig Mór in Cork is that on 1 May there was a District Court hearing. The HSE is challenging the Mental Health Commission's requirements. It is wrong that we are spending money in a court process challenging the Mental Health Commission on the clear set of advice it set out on what needs to be done. It is wrong that taxpayers' money is being used in this way. There are 18 patients in the facility. It is outdated and it should be about trying to find a solution rather than going through a court process. I ask the Minister of State for the issue to be taken on board mutually to make sure all facilities are brought up to the standards required.

I know of a facility, which is not in Cork, where during the pandemic there were 27 patients. There were six residents per room and nine of the 27 people died in a two-week period. This caused a huge challenge for staff, management and everyone involved because the facility is out of date. It is important that we prioritise updating the facilities and making sure we have an adequate number of staff and that they have adequate facilities to work in.

With regard to people working generally in the HSE, we need to put in place additional supports. Many staff working in the hospital sector have had a very difficult time over the past 18 months. We need additional supports for them to make sure we do not have people having to opt out of the healthcare system because they do not have the adequate supports they need to deal with the many difficulties they had during Covid-19. I ask that this is taken on board. I thank the Minister of State and her staff and everyone working in healthcare for their work over the past year.

2:45 pm

Photo of Steven MatthewsSteven Matthews (Wicklow, Green Party)
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A number of months ago, I was contacted by a GP in Wicklow who wanted to let me know about the difficulties she was experiencing in trying to refer patients for mental health services. Following this contact, I organised a meeting with a representative group of GPs in Wicklow. Across the board, all of the GPs expressed the same concerns to me on the availability of psychiatry and psychology services in Wicklow across the cohort of services for adults, children and people with intellectual disabilities. Each one of them spoke about referring child and adult patients that had come to them. People who were referred were not seen or there were massive delays. Patients returned to GP surgeries having not been seen with a condition that had worsened. This was very worrying for the doctors and we can understand this. They are limited in what they can do in referring people to these services.

I am aware this situation predates Covid and it predates the Minister of State taking up her role and I do not blame her for it. However, it is a very serious situation. I have no doubt that during the past 18 months more pressure has been put on these services and on GPs. Huge pressure has been placed on every aspect of the HSE. I have listened to Deputies relay stories from their constituencies and I can see it is an issue throughout the country. One of the questions I asked the GPs at the meeting was whether they thought it was a systemic failure or a failure in Wicklow. They did not know the answer. I wondered whether it was an issue in CHO 6 and CHO 7. I contacted the Department on this issue. I acknowledge that the Minister of State and I have had a number of conversations about this. I also acknowledge her office put together a comprehensive report on the queries I had raised with regard to Wicklow. I accept the difficulties experienced because of the cyberattack. I thank the Minister of State for the time she has given me on this. I look forward to receiving the report.

I look forward to being able to go back to the GPs in Wicklow and say that the Minister of State, Deputy Butler, is on top of it and knows what needs to be done. I understand she has had a number of meetings. I look forward to being able to return and say there is a solution to this, whether it is recruitment in psychiatric and psychology services to clear the backlog, and then have a system that functions properly whereby people will be seen in a timely manner. As we know, with every medical condition, whether mental or physical health, timely and early interventions give a better outcome. The longer we leave something run, as people are experiencing on these very long waiting lists, the less likely there will be a good outcome. I thank the Minister of State and I wish her luck with her work. I ask her to pass on my thanks and gratitude to all of her staff and the HSE for the work they have done over the past 18 months.

Photo of Richard O'DonoghueRichard O'Donoghue (Limerick County, Independent)
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In 2006, the HSE published A Vision for Change for immediate implementation. Unfortunately, most of it was never implemented. The more recent Sharing the Vision policy reads very well. The key priorities that emerged were to prioritise mental health in Ireland as a major issue in society, the importance of primary prevention and positive mental health, a requirement to focus on social inclusion and recovery, the expansion of mental health services to address the spectrum of conditions and needs and the development of governance and financing to include research, evaluation and quality assurance. Will the Minister of State tell me here and now, after two major reports, exactly what has changed?

I have spoken to many people who have said there is no contact point for people in crisis but when I investigated further I found a crisis nurse works from 4 p.m. to 4 a.m. and the service is manned by one person. There are fewer than 50 acute beds in a city the size of Limerick. It is generally full. There is one unit in the area, which means there is a huge mix of groups within the cohort of patients. The unit should be broken down into 20-bed units, with 24-hour health community teams that work weekends as a backup to the crisis team. This would mean a fully operational 24-hour crisis unit.

I pay particular tribute to our volunteers who work on Limerick Suicide Watch and the Limerick rescue group. The number of interventions and incidents in which they were involved increased by 30% in two years. They do so much work in Limerick.

Human rights treaties recognise the right of everyone to the highest attainable standard of physical and mental health. At the core of Ireland’s human rights treaty commitments is a range of principles that underpin the fulfilment of all civil and political, social and economic rights for all people.

This is an extract from Sharing The Vision. Can the Minister of State say this is what is happening in Ireland today? I do not think so. Two reports have been done on this and it has never been implemented.

I have great faith in the Minister of State and I hope this will be implemented in its entirety soon.

2:55 pm

Photo of Carol NolanCarol Nolan (Laois-Offaly, Independent)
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I acknowledge the good work the Minister of State, Deputy Butler, has done to date - it certainly needs to be said here and put on the record - but it is worrying that we have such a deep crisis in mental health that affects people of all ages in the State. Mental Health Reform has expressed concerns at the low priority given to mental health in the Sláintecare implementation and action plan which was launched on 12 May of this year.

There is also concern, as I have said previously, about the budget being allocated to mental health. This year's budgeting being only 5.2%, we face a major crisis - a deeper crisis than we realise. I acknowledge the fantastic work done by so many organisations which are trying to plug the gap left by the HSE.

We have to get the HSE services up to standard. They are really lacking and of a very poor standard. There are not enough mental health services run through the HSE and we need to make sure that we see more Government initiatives in that regard.

Jigsaw is fantastic. Also, accessible counselling, a new counselling service in Tullamore in my constituency in Offaly, run and developed by Mr. James O'Connor, who was one of only five community heroes chosen by Axa which is an outstanding achievement, is doing fantastic work. Were it not for these great community leaders we would be in an even worse state than we are at present.

I am very concerned about people self-harming. I put parliamentary questions in to the Minister for Justice and I was shocked to learn that more than 14,000 people have been engaging in self-harm or harming others due to mental illness since 2018. That is a shocking figure. In 2020, I believe the figure was 5,750. It shows the scale of the problem we face. Rather than let it get into a worse state, we need to put measures in place. Certainly, funding has to be increased. We have to see the HSE rolling out better services and more psychologists and psychiatrists available to people. It is serious.

I will end on a positive note. There are great community people and there is great community spirit and our GAA clubs also are playing a role in that throughout the country.

Photo of Thomas PringleThomas Pringle (Donegal, Independent)
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I am sharing time with Deputy Connolly. I thank the Ceann Comhairle for the opportunity to contribute today on these important statements.

Many Members may be familiar with the Charlie Mackesy image and quote:

What's the bravest thing you've ever said? asked the boy. "Help" said the horse.

The line is from the oft-shared, quoted and Covid-times best-seller, The Boy, The Mole, The Fox and The Horse. Some Ministers, unfortunately, are partial to sharing these types of quotes blissfully unaware, apparently, of the actual power the Government has to expand access to mental health services.

One must have a medical card to access free counselling but since the cyberattack, people have been unable to apply for medical cards. My office has been on to the primary care reimbursement service, PCRS, regularly since the attack for updates. This week, we were informed that the emails are still down so there are limited services available. PCRS staff cannot see the status of cards and they do not have any indication of when this will be accessible again.

This morning, I mentioned this on Questions on Promised Legislation. I raised this issue with the Tánaiste and welcomed his confirmation that GPs can apply for medical cards to be renewed through their offices. The Tánaiste said though that it "is not something we particularly encourage", but admitted that these are exceptional times. The Tánaiste said he would raise the matter with the Minister, Deputy Stephen Donnelly, and that a circular would be sent around to GPs to remind them. Many GPs do not even know that they can do this. It would be interesting to know whether there needs to be a communications campaign around that. GPs are overworked but we must ensure blockages in the process are cleared. My office was advised in relation to emergency medical cards that GPs can do them through their system. Medical card numbers are not issued as systems are down but one will get a confirmation phone call.

Those lucky enough to have access to counselling sessions have, in some cases, had them cancelled or moved to Zoom. Online counselling might be great if you are privileged enough to have access to the Internet and a private space to talk at home, but what about the people who do not have somewhere to go? They do not have a laptop or a room in which to speak freely. There is a free and confidential text number which is a welcome addition to mental health services, but are we looking at the data for that number and what is happening in relation to it? How many texts are coming in? Is there follow-up then for the people contacting the text line? What if that person needs to be referred on to further services?

The country went from, "We are all in this together" to finger-wagging and curtain-twitching, pushing blame on each other instead of looking back at the failures of the State to implement affordable, timely and non-judgmental supports accessible to all who need them, both in times of crisis and in times of building resilience.

Photo of Catherine ConnollyCatherine Connolly (Galway West, Independent)
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I think I just have a minute or two. I stole time from my colleague.

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
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You have two and a half minutes.

Photo of Catherine ConnollyCatherine Connolly (Galway West, Independent)
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I did not mean to; I only wanted a minute. I thank Deputy Pringle.

I am only raising one specific issue and it is to do with psychologists and a new panel. It has arisen because of the changes in the panel system and because of the cyberattack. We have no other way of raising this. We have tried bringing it to the Minister's attention but the emails are being rejected. That is the reason I am using this time but it is directly related to mental health.

According to the Health Service Executive website, all existing panels for psychologist staff will expire on the go-live date of the panel created on foot of the new recruitment campaign. This is a considerable change to the panel system that was there. Panels existed in theory for a year but often they were extended for three years.

The issue is that the people on the existing panel have not been notified of this change. Of course, the HSE is saying that the cyberattack is the reason for not notifying people. As a result, many psychologists on existing panels do not know that they need to apply for the new panel. This is the point. It is time sensitive, as the deadline for applications for the new panel is Tuesday next, 8 June.

Furthermore, due to the cyberattack, only hard copies of applications will be accepted. People are doubly disadvantaged in that they need to get a hard copy application into the post. It is extremely challenging.

It has been an extremely challenging year for all healthcare workers. Of course, we need more psychologists. I need not tell the Minister of State, Deputy Butler, that we need to be supporting them rather than causing extra difficulty. I am asking the Minister of State to ensure the psychologists on that panel are aware of what is happening and that they need to reply, and-or consider delaying the deadline to allow them sufficient time to make application, and, of course, at some stage to clarify why the panel system changed.