David Cullinane (Waterford, Sinn Fein)
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The number of children on CAMHS waiting lists has doubled from 2,000 to 4,000 under this Government. More than 16,000 children are on waiting lists for psychology and more than 6,000 young people have presented to emergency departments due to a mental health illness since 2019 because they do not have alternative care pathways. CAMHS does not seem to be the solution for them. The service is dramatically underfunded and it has major problems in many areas. Despite lots of good work being done by people who work in CAMHS, there are problems. How much additional core expenditure was allocated to CAMHS in budget 2024 to improve services?

Mary Butler (Waterford, Fianna Fail)
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I thank the Deputy for the question. Year-on-year funding for mental health services increased by €74 million from €1.221 billion announced in budget 2023 to almost €1.3 billion in 2024, with a strong focus on investing in youth mental health. Improving access to mental health services remains a commitment for me and my Department. To this end, funding for mental health has increased by 25% during the lifetime of the Government.

As the Deputy will be aware, we have a new HSE office for youth mental health which will improve planning for and the delivery of CAMHS and wider services in 2024 in line with recent audits and reports, such as those by Dr. Maskey and the Mental Health Commission. I sought these reports because I thought it was important to have real-time data that were not available to us previously because they were not collated.

Examples of service initiatives for mental health that will be funded under budget 2024 include additional staffing of CAMHS teams to improve access to services and reduce waiting lists. I am on the record as stating that I was disappointed about the allocation for new developments next year. Working with the HSE and the Department, I decided to prioritise youth mental health so there will be 76 posts. We will also expand the multidisciplinary CAMHS hub teams to complement traditional service models and further develop specialist mental health teams providing early intervention in psychosis and eating disorders. A lot of recruitment is under way for 2023 and some of the posts funded in 2023 will only come on stream in 2024. In many instances, it takes up to 12 months to recruit someone. Those posts are safe and they will come in early next year. Initiatives also include a new youth mental health app to provide interactive supports and dynamic signposting and the development of a central referral mechanism, the no wrong door approach, which I know Sinn Féin welcomes. As the Deputy will be aware, the HSE service plan is currently being worked out so to give specific figures is difficult at the moment.

David Cullinane (Waterford, Sinn Fein)
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I appreciate that but it is certainly nowhere near enough for what is required. I have on many occasions, both in this Chamber and outside it, welcomed an awful lot of very good work done by both the Minister and the Minister of State, Deputy Butler, and I will always acknowledge where good work is done, good initiatives put in place and additional funding made available. Nevertheless, it is my job to call out, as is right to do, what I feel was a dreadful decision made by the Government and the Cabinet not to fund the health services properly and to starve them of any additional funding for new measures and new programmes.

We had a discussion earlier on the national stroke strategy and we are now talking about CAMHS. We all know CAMHS is not working. Far too many young people cannot get access to it. We have difficulty recruiting psychiatric consultants and allied healthcare professionals, and young people are going into emergency departments in the wrong places looking for care because they cannot get it in the service where they should get it, namely, CAMHS, and that is down to resources and capacity. Starving CAMHS of new funding to the extent we have done in this budget is wrong and will have consequences for people's mental health.

Mary Butler (Waterford, Fianna Fail)
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We have bucked the trend in recruitment when it comes to mental health services. In 2021, a total of 659 people were working in CAMHS, whereas at the moment, there are 820. It is an area in which we have done well to recruit where posts have been available. By the end of next year, 900 whole-time equivalents will be working across the 75 CAMHS teams. Notwithstanding that, there are difficulties, but I am delighted to say the waiting list fell to 3,900 during the course of the summer. The latest figures are for the end of August and it will be interesting to see how they continue to come down.

Turning to year-on-year funding for mental health services, the budget for CAMHS is €137 million, but we also support NGOs to the tune of €108 million. A lot of that relates to youth mental health organisations such as Jigsaw, SpunOut, Turn2me, Pieta, Barnardos and Shine.

David Cullinane (Waterford, Sinn Fein)
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Again, I am duty-bound to point out that a scathing Mental Health Commission report on CAMHS made a lot of recommendations, some of which, I understand, will be implemented, whereas in the case of others, the Government is pushing back against them. The Government might have its reasons to push back against them, but we cannot push back against the dire need to invest in CAMHS services to give young people better opportunities. I accept some of what the Minister of State said about additional posts that have come on stream, but it is still far from where we need to be and key specialist posts throughout the State are not in place, which is having an impact. We all saw what happened in CAMHS in the south west, and in other areas over recent years there has been scandal after scandal and crisis after crisis. A lot of that is down to poor workforce planning. The Government and the Minister for Health waited until very late in the day to put an emphasis on workforce planning, and that, in my view, is part of the problem.

I reiterate that not properly funding CAMHS and other mental health services next year will have consequences for young people and their mental health.

Mary Butler (Waterford, Fianna Fail)
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It is important to put some balance on the discussion. In 2020 and 2021, there were 33% more referrals to CAMHS. I have to build confidence in CAMHS and, as the Deputy conceded, a great deal of really good work is going on. Approximately 21% more children were seen during that period and that was at a very distressing time during Covid. Last year alone, CAMHS teams allocated 225,000 appointments to people under 18 throughout the country. A huge amount of very good work is going on. A new mental health office is being led by Dr. Donan Kelly, who took up the post on 1 September, and for the first time ever, there is a clinical lead doctor, Dr. Amanda Burke, who has 30 years' experience of working in CAMHS. With that dedicated focus in the HSE, we can now try to address the waiting list once and for all.