Violet-Anne Wynne (Clare, Independent)
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I raise the crisis facing child and adolescent mental health services, CAMHS, in County Clare, particularly the poor accommodation in which those services find themselves operating. The issue has historical value in the sense that only in 2019 they were operating out of hotel rooms, which is completely inappropriate. I make the point as it shows a pattern of years of poor decisions and an unwillingness to prioritise mental health services for our youth and our future.

CAMHS in Clare are split between two teams, one for east Clare and one for west Clare. One might assume east Clare appointments would be taken somewhere like Scarriff and west Clare appointments would be taken somewhere like Kilrush. As the Minister of State well knows, that is not the case. The service has not even been planned sufficiently to ensure the safety of staff members or service users. Our youth in those areas face the added challenges of isolation, deprivation and the associated difficulties. The Government said that after Covid we would build back better but these individuals, our most vulnerable, are being left behind.

All CAMHS appointments in County Clare take place in the same unit in the Quin Road business park in Ennis, which is obviously neither east nor west Clare. They have clinic room space equating to 4.5 rooms and one is block-booked for emergencies from 2 p.m. every day. The situation on the ground is that 22 staff simply cannot work out of 4.5 rooms. As for office space, I was told you would be better off working in the car. Some staff are working on the end of tables and some have been without a computer device for several weeks. They have issues with Internet connection and storage for files. It has been said to me the staff are distressed, the building is distressed and, therefore, the service user is distressed.

A recent survey document explained that Limerick CAMHS have more than twice as many rooms available for referrals as Clare, even when the greater demands posed by Limerick’s larger population are taken into consideration. I have spoken to staff members who described the practicalities and impact of this: searching for empty rooms, moving the client mid-session to find a space, and calling primary care centres only to be told that the space needs to be booked two weeks in advance, as is the case in Ennis. They described the uphill battle they face on a daily basis when they are just trying to do their jobs.

Why is there such a constraint on space? Incredibly, they must share their building with environmental health, which is in no way connected. If they had the entire building, there would not be an issue with space. Why has that not been explored and delivered? Surely if management was actively listening since the issues were raised as far back as 2017, which is six years ago, resolution would be in sight. However, that is not the case. Instead, it seems there is a level of arrogance and ignorance within the community healthcare management team. That has to be said. They have created and maintained this unsatisfactory situation. Now intervention at senior Government level, such as from the Minister of State, is needed at an existential level for the continuation of CAMHS in Clare and nothing less.

The Government has a surplus of €11 billion projected for next year. I have constituents who are locked in their bedrooms, unable to eat, unable to sleep and refusing to go to school. In some cases, they are a danger to themselves or others. As a parent, that is the worst nightmare. To know your child is suffering with their mental health leaves a massive element of fear. For the sake of my young constituents and their families, will the Minister of State commit to ensuring the use of the entire building as a starting point or source another building that is large enough and appropriate? Can we use the proposed site in Parteen for the east Clare team and work together to relocate west Clare CAMHS in west Clare and provide a more comprehensive wraparound support for children and young people in the county? In the general election of 2020, I called for 24-7 mental health support in the community. That was a vision whereby all staff and service users would be supported.

Mary Butler (Waterford, Fianna Fail)
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I thank the Deputy for the question. The development of a high-quality mid-west CAMHS has been a key priority and focus for mid-west community healthcare in recent years. I cannot agree when the Deputy says CAMHS are in crisis. There might be issues with location, premises and space but there are 21,000 children in the support of CAMHS as I speak. There were 225,000 appointments last year for young people and adolescents in the care of CAMHS. Language is important here. I will address the location, premises and space, but I will not call into question the service offered by multidisciplinary teams the length and breadth of the country.

This has led to improvements for CAMHS, including increased capacity in the mid-west. The additional investment in CAMHS mid-west over the last three years is around €2.5 million. These developments have had a positive impact on all CAMHS teams, including the two in County Clare, both of which have seen an increase in staffing levels. However, those increased staffing levels, as the Deputy rightly said, have placed additional pressure on already limited accommodation space.

The east Clare and west Clare CAMHS teams work out of a premises on the Quin Road in Ennis. HSE mid-west community healthcare has experienced significant challenges in securing additional office and clinical space in the town. With the introduction of the new primary care centre in Ennis and the relocation of services into this facility, mental health services are exploring the additional opportunities for suitable clinical and office space this might create. Mid-west community healthcare is advancing a capital plan for east Clare CAMHS in Inis Gile, Parteen, to facilitate clinics there which would be suitable for service users from that side of the county. This will help to alleviate pressure on space in Quin Road. It is anticipated that this facility will be available for use in the near future.

HSE estates continues to explore all opportunities to acquire additional office and clinical space in the Ennis area. CAMHS in Clare also access bookable rooms in the Kilrush health centre. Options are being explored for outreach in west Clare. There is regular engagement with the Clare CAMHS accommodation committee to explore reconfiguration of existing space to better support the work of the team.

Since 2020, HSE mid-west has undertaken significant actions to support the Clare CAMHS team. These include an upgrade of social worker posts, an upgrade of a psychology post to a senior post and extra administration support for the team. An assistant director of nursing, a principal psychologist and a business manager, along with health and safety representatives and a service manager, have mapped current and future accommodation needs. Additional medical governance has been provided as a response to a consultant vacancy and efforts are ongoing to recruit a full-time CAMHS consultant. There has been massive investment into the region in relation to the clinical supports necessary.

HSE mid-west community healthcare is committed to listening to and engaging with all staff and to further enhancement of all CAMHS services, including improvement for both staff and service users. Mental health services actively engage with line managers in respect of retention of staff, while acknowledging that various factors lead to vacancies, including retirement, promotional opportunities or family commitments. Mid-west CAMHS are currently engaging with an external facilitator to develop a CAMHS service improvement plan. This process is well advanced. All CAMHS staff are represented in this process and successful workshops are taking place.

Violet-Anne Wynne (Clare, Independent)
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I appreciate the information the Minister of State has supplied. I suggest she should visit them. She mentioned upgrades but when I speak to the staff, they are of a different opinion. I encourage her to visit the building in Quin Road and maybe then she will get a clearer picture of what is on the ground.

Last week, it was reported in bothTheClare Championand on Clare FM that an internal staff survey - another red flag on management and communications - found that 94% of respondents felt the Clare CAMHS clinical environment was not suitable for the support of young people. Incredibly,100% agreed or strongly agreed that a shortage of clinical space was putting children supported by the service at risk; 100% also agreed that poor staff retention was putting not just the children and young people who access the service, but also those languishing on waiting lists, at risk; 94% of staff felt their mental health suffered due to poor working conditions; and the same 94% reported staff morale as poor or very poor. Does it make any sense that those who have chosen to work in mental health are now at risk of mental health issues themselves, due to the lack of solution-focused management? Only 6% were happy with staff morale and not one said they would recommend working in CAMHS to a friend or family member. Their experiences, which I have heard, are deplorable. The picture it paints is incredibly stark, which I am sure the Minister appreciates. It pre-empts an imminent mass exodus of staff, which, unfortunately, has already begun from a service dying on its feet due to the recruitment and retention crisis. The issue with staff will have a direct knock-on effect for the service, as not keeping staff affects how the service can manage its emergency rota, which needs experienced staff members to run it.

I want to speak about CAMHS mid-west as a whole. The Minister of State said "crisis" was the wrong terminology; I beg to differ. I raised the independent review, which found that 140 children and young people fell through the cracks, with the Minister of State in the House a few months ago. I was assured then that they were being followed up on. I cannot help but point out the obvious - the lack of clinic space forced nine children to receive no appointment in Clare CAMHS in March, while it also had to postpone 18 and shorten seven. This is precious time and the clock is firmly ticking. I request that Dr. Finnerty’s final report on the independent review be laid before the House upon completion. We cannot put a price on the lives of our children.

Mary Butler (Waterford, Fianna Fail)
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I thank the Deputy for her passion. Development of a high-quality CAMHS service nationally, in line with Sharing the Vision, the HSE service plan and other related initiatives, is a priority for me and the Government. This year, €137 million will be spent on CAMHS and €80 million will be spent on organisations such as Jigsaw, MyMind, SpunOut, Pieta and others, to support people with mental health challenges in the community. The money being spent applies equally to County Clare. The actions I outlined are based on consistent investment in services and the intention to improve them. We must be fair to the teams working in mid-west community healthcare. It was the consultant psychiatrist who brought those 140 children lost to follow-up to the attention of the Mental Health Commission when it did its review. It had lost several staff - consultant psychiatrists - at that time and it was they who brought it to the attention of the Mental Health Commission. In fairness to them, they were very aware and have dealt with that issue since. I am trying to build confidence in the 75 teams that work in the country. There is no doubt that there are issues in relation to what the Deputy referred to - location, premises and space - but we are dealing with those. Mid-west community healthcare is advancing a capital plan for east Clare in Inisgile in Parteen to facilitate clients where it would be more suitable for service users from that side of the country. I have just finished holding a series of round-table meetings on CAMHS and how we can support the 21,000 children the best we can. As I said, 225,000 appointments were issued last year to children. I compliment all the staff, who work so hard in this area.