Mark Ward (Dublin Mid West, Sinn Fein)
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Over the weekend I received the devastating news from the Psychiatric Nurses Association, PNA, that 11 of the 23 CAMHS beds in Linn Dara have closed. I thank the association for informing me because it seems no effort was made by the Minister of State’s office to do so. When was she going to inform the public? Was she hoping that the closure of children’s mental health beds would simply go unnoticed? When did she find out there was a problem? What exactly has she done since finding out?

This is not the first time beds have been closed in Linn Dara. A similar incident happened in 2017. It seems the Government has learned nothing. Linn Dara inpatient units provide services for children and adolescents with severe or complex mental illnesses requiring a combination of intense interventions and supervision that cannot be provided by community and outpatient services. The closure of these beds will have a devastating impact on our community and on children. How will the Minister of State address the recruitment and the problem around retention of psychiatric nurses?

Bríd Smith (Dublin South Central, People Before Profit Alliance)
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I heard the Minister of State speak about this in the media and earlier in the House. Frankly, she sounds more like an observer than somebody who has responsibility for it. We are facing a huge crisis in child and adolescent mental health. It is in the news every day. People are constantly ringing radio programmes, such as Joe Duffy's radio programme, about the crisis being faced.

Linn Dara serves people from outside the direct community. As has been said, this is like Groundhog Day. Exactly this time five years ago, there were exactly the same number of beds and exactly the same period of closure. It is not acceptable. It is as if the Government is shutting its eyes to the crisis we have generally in our health service but in particular in maintaining and retaining staff. We bleed staff but we ask ourselves why we bleed them. When is the Minister of State going to sit down with those at the coalface, the nurses themselves and their representatives in the Psychiatric Nurses Association, to get some resolutions to this issue?

Joan Collins (Dublin South Central, Independents 4 Change)
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As the Minister of State is aware, I raised this question on Leaders' Questions this morning. I made the point that Linn Dara is a key facility for child and adolescents mental health services, CAMHS, nationally and for the greater Dublin area, Wicklow, Kildare and, in particular, Louth. The HSE stated that these bed closures, a reduction of 11 beds down from 24 to 13, is a consequence of a shortage of qualified staff.

In acknowledging Sharing the Vision, the Minister of State said that she was hopeful that this implementation plan would advance improvement across CAMHS, mental health team governance, organisation and clinical oversight as well as ensure best practice and patient safety and that in this context, it was critical standardisation and consistency in mental health service delivery were achieved. Does she think she has met that?

Patrick Costello (Dublin South Central, Green Party)
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It is important to remember that Linn Dara deals with the most distressed and the most complex cases of children and young people seeking help. The Deputies speaking tonight are from Dublin South-Central and Dublin South-West but the reality is that Linn Dara serves Kildare, Westmeath, Laois, Offaly, Longford and Louth. As Deputy Collins said, this is a national service and we should really have Deputies from each of those constituencies trying to raise this, although I am not sure how we would divide the four minutes.

The reality is this essential service is closing to very little noise apart from what we are saying in here. That is disturbing because our mental health services are under great threat. Our CAMHS services are quite simply not up to scratch and are not fit for purpose.

Mary Butler (Waterford, Fianna Fail)
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I thank the four Deputies for raising this issue today. Deputy Collins raised it earlier as well. It was raised on Leaders' Questions because it is a very serious situation. I was informed on 11 May 2022 that due to recruitment challenges, the number of operational beds in the Linn Dara CAMHS unit was going to be reduced from 24 to 13 on a temporary basis. Deputy Costello is quite right that the most distressed cases are dealt with in Linn Dara. It is the most fantastic facility with a school attached to it with five teachers. It really is state-of-the-art. I cannot say why this happened five years ago as well but I can tell the Deputies what the situation is now.

No patient has been or will be discharged early from the unit. While the reduction in capacity will have an impact on waiting lists, the demand for inpatient beds in CAMHS units over the summer months is usually around half the normal level of capacity. I have the figures for the past four years and it runs at between 55% and 60% capacity but that still does not make it right. This regrettable situation has arisen because a number of nursing posts became vacant simultaneously at Linn Dara for various reasons. The situation is that there are 51 funded posts in Linn Dara and currently 24 of them are in place. To have a safe staffing perspective for those young people using the service, some of the beds had to be closed. As I said, it is not due to lack of financial resources but solely because the nursing complement available through the use of permanent and agency staff is no longer sufficient to continue to provide a full 24-bed inpatient service to a safe standard.

In reply to Deputy Ward's question, I have spoken to the HSE. I am not an observer. Far from it, I have never been an observer in this role.

I spoke to the HSE, the Department and the clinical consultant psychiatrist - the professor who runs the service. I spoke to him at length again yesterday. The situation is they have explored all possible options, which included redeploying staff from other child and adolescent mental health service, CAMHS, units or teams to Linn Dara, but if they are taken from the community, that impacts the community teams. They had agency staff in place and that worked for quite a time.

I asked the professor why he felt that they were finding it hard to retain staff, and not so much to recruit them, and there were several issues. The young people and children who are in this service are very complex cases and they need a lot of care. He said that many of the nurses who were working there were very young. Some of them have chosen to travel. Following Covid, the world has opened up again so that people can travel. Second, some of the nurses there had promotional opportunities within the HSE and they were promoted. Third, as the Deputies will be aware, it is quite difficult for people to find accommodation in Dublin. Those were some of the reasons cited by staff that they find it difficult.

At the same time, we must get over those issues. What I want to do is to make sure that this service is up and running fully as soon as possible. New staff will be recruited. A new group of graduate staff will be available in July and August. They will be recruited immediately. Hopefully, they will take up the posts. We are hopeful that we would have all the beds back open again at the start of September.

All four CAMHS units nationally - Éist Linn in Cork, Merlin Park in Galway and St. Vincent's, also in Dublin, with ten beds operational at present - hold a team meeting every week and they look at the list. They look at the amount of children who are triaged who are waiting and that already happened this week.

Mark Ward (Dublin Mid West, Sinn Fein)
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I will give the Minister of State some figures. More than 8,000 children are waiting on appointments of primary care psychology, 3,000 of whom are waiting for more than a year. In excess of 4,000 children are waiting for CAMHS appointment, of whom more than 400 are waiting more than a year. If these children get the service they need at an early age, they are less likely to need the more acute services that are provided by such services as Linn Dara when they get older. Does the Minister of State agree that early intervention is key? How will the Government address these failings in the children's mental health service?

These are children; they are not statistics. Behind each one of these children, there are hopes, dreams and ambitions and they are being stalled at present.

Bríd Smith (Dublin South Central, People Before Profit Alliance)
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The Minister of State says she was informed on 11 May that there was a problem with staffing. She was probably informed on 11 May but the Department and the HSE had known that there was a problem with staffing. As I said earlier, it is like Groundhog Day. We can go right back to 2017 to a replica with the same number of beds and the same period of time. The question is: what will the health services do to retain nurses? To get an answer to that, the Minister of State must sit down with the PNA and other nursing unions. She will not know how it is on the ground and the answers to this unless she talks to those at the coalface and I ask her to do that.

Joan Collins (Dublin South Central, Independents 4 Change)
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The waiting list for CAMHS nationally was 3,500 in December of last year. We do not yet have the figures but it is up to, more likely, 4,000. Cutting these beds in Linn Dara must have an impact on children accessing those needs that they can access there. I am asking the Minister of State, as others have asked, to sit down and discuss recruitment and retention with the PNA. It has to be done.

Patrick Costello (Dublin South Central, Green Party)
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On top of the waiting list figures that have been mentioned, a significant cohort of young people seek referral to CAMHS who, through inconsistent application of standing operating procedures, do not get their referral accepted, and who are told that it is either only behavioural or only emotional and it is not appropriate. Behind these figures of waiting lists there is another significant cohort who are not even getting the help they need.

I am also concerned at throwing fresh graduates into a pressured complex environment, which seems to be a recipe for burnout and increasing the retention problem. I would like to know what is being done on that.

I echo the call of the other Deputies to meet with the PNA, particularly around that last issue.

Mary Butler (Waterford, Fianna Fail)
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I do not disagree with anything the Deputies have said. Everybody has the best interests of every child who is on a waiting list and every child who needs to get into one of the approved centres at heart. Everybody feels the same. I am a mother and I feel the exact same. There is not a family in Ireland that, whether directly or indirectly, has not been affected by mental ill-health.

Regarding the figures, last year the referrals into CAMHS increased by 5,177 to 22,600, which was unprecedented. In the same period, the new referrals seen also increased by just under 2,000. On the waiting list for CAMHS, the figure up to March is 3,443. We managed to take 500 off the list from the previous month.

Regarding primary care psychology, Deputy Ward stood opposite me previously and quoted figures of 10,000. They are now down to 8,000. I was able to get 1,600 children off the list by a targeted approach before Christmas, and secured another €5.5 million this year to keep that going. I am meeting with the primary care psychology team next week to see where we are at. My focus is on those waiting more than 12 months because, as the Deputy rightly said, early intervention is key. Nobody can disagree with that.

Overall, 91% of children who present to CAMHS and who are complex and really in need of support - they may be suicidal, it may be self-harm or whatever - are seen with 48 hours but the problem we have is that there are long waiters who are pushed down the list. There is a targeted approach ongoing at present to reduce waiting lists for CAMHS and the target is focused specifically on those waiting more than 12 months. Currently, 9% of children are waiting longer than 12 months. I hope the next time I stand before the Deputies that figure will be much less than 9%. I will keep them informed. I will be working on this on a daily basis.

Deputy Bríd Smith stated that I said at the start I was informed on 11 May. I was made aware unofficially in the few weeks preceding that that there were challenges relating to staff.