Dáil debates

Tuesday, 27 February 2024

Mental Health (Amendment) Bill 2023: Second Stage (Resumed) [Private Members]


The following motion was moved by Deputy Mark Ward on Tuesday, 27 February 2024: "That the Bill be now read a Second Time."

Debate resumed on amendment No. 1:

8:05 pm

Photo of Duncan SmithDuncan Smith (Dublin Fingal, Labour)
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I thank Deputies Cullinane and Ward for bringing forward the Bill and acknowledge the work of Deputy Ward in the field of young persons' mental health over recent years.

The Mental Health Commission's report into CAMHS highlighted a multitude of concerning issues on which we have seen too little action from this Government. To list some of the issues highlighted, we have seen children being lost to follow-up care or unable to access care in the first place, a lack of monitoring of psychiatric medicines and unacceptable waiting times for high-risk referrals among many other issues. To call this scandalous is, quite frankly, an understatement. The reality of this is not news to those directly impacted or to their families. They know the pain, the fear and the concern that this crisis in CAMHS has caused them as they try to navigate a system that is failing and collapsing at an impossibly difficult moment in their lives. The fact that families have to come begging and pleading to local representatives is an absolute disgrace and an indictment of a system that is beyond failure. We are losing people because of this. The Minister of State knows this, as does every Member of this House.

The statistics speak for themselves. Waiting lists for first-time appointments for CAMHS have skyrocketed by 83%, with certain CHOs experiencing an alarming threefold increase since this Government assumed office. Even more distressing is the nearly 300% surge in the number of children waiting longer than a year for a first-time appointment. This statistic is not only unacceptable, but deeply concerning given how important early intervention is in the field of mental health. We cannot afford to ignore the consequences of this inaction, which is why this Bill is so timely and prescient.

Mental health issues among young people are complex and multifaceted. Just about every study conducted says the prevalence of these issues is growing and that their impact is exceeding projections. The figures we have prove this. These issues require prompt intervention and comprehensive support rather than increased waiting lists and increased isolation. Every day that passes without proper assistance exacerbates the suffering for our children. This is not an issue the Government can just kick down the road. Our children cannot wait any longer.

In her opening statement, the Minister of State, Deputy Naughton, mentioned the mental health Bill that is to come in the summer term. We will hear more about it in the Minister of State, Deputy Butler's closing statement. In that statement, the Chief Whip mentioned that the summer term begins in April. However, in recent summers, we have seen it promised that Bills, particularly health Bills, will come before us in April only for them to be introduced in the last week of July. They are then debated well into the autumn and, if any progress is made, it is well into the following year. We know the clock is ticking on the lifetime of this Government and this Dáil. If the Minister of State's Bill is going to stand any chance, it must be presented in the first week of the summer term.

By granting statutory powers to the Mental Health Commission to regulate CAMHS and implementing the recommendations outlined in the commission's report, we can have the opportunity to effect real and meaningful change. If passed, this Bill would give the commission statutory powers to oversee and implement the remainder of the 49 recommendations. The Bill would not only ensure accountability and oversight, but would also facilitate the implementation of central governance and clinical reform, which are long overdue.

An issue within these services that such regulation could address is the treatment of people with autism, an issue highlighted by a previous speaker. Simply put, the system is failing them as well. CAMHS operational guidelines set out that admission to services can be refused to autistic children where there is an absence of a moderate to severe mental disorder. Where there is such a disorder, it is the role of CAMHS "to provide appropriate multidisciplinary mental health assessment and treatment". However, we are frequently not seeing care provided even where such a disorder is present. Many families are facing this barrier and we feel that children with autism are being frozen out of the system and denied treatment. The responsibility is passed on to someone else rather than CAMHS trying to tackle more complex issues.

One of the biggest indicators that the State is failing in its responsibility to provide adequate medical care for its citizens is those citizens having to fly abroad to get it. There have been countless cases of this in different areas over the years and we now see it in our mental health services. Parents of children with autism are travelling to the UK, Spain and other places to get care for their children. This is another example of absolute crisis and failure. Parents should not be expected to fight and to go to such lengths to get basic supports and rights for their children. They should not have to fight at all. Every issue children have within the entire spectrum of mental health needs to be looked at and those children need to be cared for and processed locally in the community.

When children with autism present, everything seems to get linked to their autism. It is a cop-out by the mental health services. If I go to the doctor seeking a prescription for hay fever medication, I do not expect to be told I do not need it because I have a stomach bug. The diagnoses are not related. The care we provide needs to be more responsive and more dynamic. This is something regulation can help with. If we keep putting people into a box and relating their every issue to that one other diagnosis, these young children will never get the care they so desperately need.

A change to the regulation of CAMHS would also provide an opportunity to ensure that people availing of these services are neither overmedicated nor undermedicated. A number of instances of overmedication in Kerry were revealed last year. The Maskey report stated that significant harm was caused to 46 children because of overprescribing by a junior doctor. Overmedication is extremely dangerous and can result in lifelong damage. That does not need to be restated but it is a fact. The overmedication and crisis in Kerry CAMHS sent shockwaves throughout the entire system and further weakened whatever little remaining confidence people had in the system, if they had any at all.

Ultimately, all the Government needs to do is to look at what the chief mental health inspector, Dr. Susan Finnerty, said in her report on CAMHS. If the chief mental health inspector cannot assure parents seeking a service's care for their children that it is safe, effective and evidence-based, that service is not working. It is failing and needs to be regulated. Dr. Finnerty outlined that a lack of clinical governance, ineffective leadership and inadequate resources meant that CAMHS was "creaking at the seams, with increasing risk to children for whom the service is provided." We and the Government know this to be the case and yet it refuses to support progressive legislation such as the Bill before it this evening.

The Government also has to acknowledge that the failure of the service is due to the lack of resourcing. The HSE has confirmed that, of the 72 registered CAMHS inpatient beds in the State, only 51 are operational. As of October last year, 30 were occupied. The main reason for this is staff shortages. There can be no excuse for this. Every time we bring up funding, the Government states that it is providing record funding and that the health budget is the biggest in the history of the State. However, it is not getting to where services are needed and it is not resulting in the staff required to meet basic service requirements such as ensuring that the registered beds we have are operational.

With 22,000 children being referred to CAMHS per year, there should be no surprise within the Government that the service needs proper support with regard to both staffing and funding. Upcoming generations face enough hardship and uncertainty already. They do not need a service that is meant to be there for them when they are at their lowest to have collapsed. I ask the Ministers of State to think about what the young people of today have to protest. They live in a country where the chances of them owning a home before they are 40 are terribly low. In fact, the chances of them accessing a home in any way before they are 40 are terribly low. They know from the generations just above them that moving across the water or emigrating is an option they will have to consider. They are facing a world of increasing insecurity and the impact of climate change is felt more keenly among the younger generations than among the generations above them that caused the climate disaster. Our children deserve better. They deserve a mental health system that is responsive, accessible and effective. Today could be the first step in achieving that if the political will was there. There is no excuse for not regulating CAMHS or for pushing it into the summer. Members of the parties in government have called for just what is being offered today. Along with the entire Government, those Members should put their votes where their words have been. The Government should withdraw its amendment and support this Bill today.

8:15 pm

Photo of Róisín ShortallRóisín Shortall (Dublin North West, Social Democrats)
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I will start by thanking Deputies Ward and Cullinane for their work in producing this legislation. The Social Democrats are very happy to support it. Yesterday marked seven months since the damning report by the inspector of mental health services into CAMHS was published.

That report revealed a level of dysfunction that went very far beyond what was first feared and spelt out in the starkest terms the most serious shortcomings in service provision but these revelations came as no surprise to the many families who have been dealing with CAMHS over many years. They are all too familiar with the State's failure to provide an appropriately staffed and governed service. Last July when the Mental Health Commission's report was published, the Minister of State with responsibility for mental health and older people, Deputy Mary Butler, issued a statement welcoming that report. The Minister of State, however, stopped very far short of committing to implementing the 49 recommendations in that report.

The first and highest priority recommendation called for the immediate and independent regulation of CAMHS by the Mental Health Commission. At the very least, that primary recommendation should have been a priority for this Government but, clearly and unfortunately, that is not the case. Given the condition of children's mental health services in this country, there can be no excuse for continued inaction. There have been problems with children's mental health services for well over 20 years and the story is the same every year. Money is provided in the budget but the money does not get spent and the excuse is, "We cannot get the staff". Why can CAMHS not get the staff? Why has the Minister of State not dealt with this long ago? Why has there not been proper workforce planning in this area so we know the necessary therapists and specialists needed for recruitment in this area are trained and available? This has not been the case and of course it is then a vicious cycle because the more vacancies there are, the more scandal there is in the service, the less likely it is that people want to be part of CAMHS. This is why it needs a complete root-and-branch change and needs to come under the remit of the Mental Health Commission.

We have to bear in mind that when the recommendation was made last summer, that was not the first time it was made. When Dr. Susan Finnerty took on the job of looking at CAMHS and producing this report, she was so concerned about the major shortcomings in the service that she issued an interim report. That interim report reflected her serious concerns and the urgency with which she believed the issue needed to be dealt with. She published the interim report in January 2023 recommending the immediate regulation of CAMHS. This is the only way we are going to get any kind of transparency and any kind of action in bringing CAMHS up to an acceptable level. We have had enough obfuscation in this regard. We have had enough cover up and lack of frank reporting from the HSE about the serious problems that exist there. We cannot continue with the situation where there is, essentially, self-regulation of CAMHS by the HSE. It is absolutely critical that the primary recommendation by the Mental Health Commission for the independent regulation of CAMHS is implemented as a matter of urgency.

At this point, it is very difficult to come to any conclusion other than the HSE and the Department of Health cannot be relied upon to be upfront and transparent in respect of the nature of the problems within CAMHS. I am very slow to make that allegation but I cannot come to any conclusion other than there are cover-ups going on and there have been for some time. There is an incredible lack of transparency around the reality of the problems within CAMHS. We must not forget that the sorry state of this service only came to light because of a whistleblower, Dr. Ankur Sharma, who was brave enough to speak out about the problems in County Kerry. Rather than encouraging an open culture - and this is a huge mark against the culture within the HSE - we again see those who speak being ostracised. This is why, along with the immediate regulation of CAMHS, cultural change is essential.

We are led to believe that the regulatory functions of the Mental Health Commission will be dealt with in the long-awaited Mental Health (Amendment) Bill 2023. There is a strong view that giving responsibility to the commission to regulate CAMHS is possible under existing legislation. The Minister of State seems to be nodding her head. I do not know if she agrees with that. If there was a political will to do it, this could be done under the existing Mental Health Act. Regulating of CAMHS can be done by that route, or under this legislation. It is short and concise legislation to make an amendment to the Mental Health Act. Has the Minister of State received legal advice on the ability to do that without primary legislation? At the very least it can be done by a very small amendment to that Act.

The repercussions of not acting quickly are far too serious. We have seen major problems and we have seen children utterly failed by the existing service. There is a responsibility on the Minister of State to take on board the very clear and concise recommendation from the Mental Health Commission, which is to have independent, outside regulation of CAMHS so that standards can be driven.

There is no doubt that wide-ranging reform of the Mental Health Act is clearly required but the Government has not even published that Bill. It is still only on the priority drafting list of the spring legislative programme, as was also the case this time last year. People cannot be blamed for being very sceptical of what the Government is proposing to do. We are led to believe that this Bill will be published in the summer legislative session but one would be forgiven for not believing that promise yet again. Reform of the 2001 Act is a programme for Government commitment but one and a half years after the mental health sub-committee's pre-legislative scrutiny report, we are still waiting for the Bill to be published. This does not fill anyone with confidence, not least when at most there is one year left in the term of this Government. The failure to progress a new mental health Bill in a timely manner is just further proof that reform of mental health services is simply not a priority for the Government.

Reform of this Act has been on the table for more than a decade. How many more governments will it take? The 2001 Act is not compliant with the European Convention on Human Rights or, indeed, the UN Convention on the Rights of Persons with Disabilities. In February 2023, the Committee on the Rights of the Child highlighted serious concerns with practices in our children's mental health services. It is deeply disappointing that the practice of refusing access to CAMHS for children who have autism has been allowed to continue. The parents who formed the group, Families for Reform of CAMHS representing 800 families, many of whom are in the Visitors' Gallery tonight, highlighted this issue. Children with autism and mental health difficulties are being left with no service whatsoever. Again, the Minister of State does need legislation to deal with this. At the stroke of a pen, the Minister of State could deal with this tomorrow. This is the minimum we expect her to do. I urge the Government to stop this nonsense about waiting nine months. It should deal with it now. It is an urgent matter.

8:35 pm

Photo of Gino KennyGino Kenny (Dublin Mid West, People Before Profit Alliance)
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I congratulate Deputies Ward and Cullinane on the Bill. It is a timely and topical Bill. A few months ago, a number of organisations came before the health committee, one of which was the Mental Health Commission. Recently, Families for Reform of CAMHS also came before the committee. The picture they painted, which was very stark and concerning to say the least, was of a service that was dysfunctional and did not provide timely intervention for children. There is something very dispiriting when we see a family coming before a committee to say that children are not getting the intervention they need. That stuck in my mind. When children get the timely intervention, they need there are better outcomes for everybody. We all agree on this.

The report of the Mental Health Commission was extremely stark. One of the statements the commission made, and I had to ask its representatives before the committee to repeat it, was that CAMHS is not safe for children. They said that in certain areas CAMHS was not safe. The report, which makes 49 recommendations, states there are serious deficits in CAMHS and a lack of clinical oversight. Alarm bells are ringing. It also states there is an arbitrary nature to access due to location. It calls for reform and restructuring of CAMHS.

The most important thing about all of its recommendations is whether they will be implemented. Will the Minister of State give a commitment that these recommendations will be implemented? Otherwise, like all the reports we see here, it will just gather dust. The families in the Gallery want these recommendations to be implemented and their children to get timely access.

The Children's Rights Alliance has also been very critical of mental health services for children and adolescents. Recently in a parliamentary question, I asked the HSE how many CAMHS beds in the State were functional. To my surprise, I was told that fewer than 60% of CAMHS beds are operational. A total of 40% of CAMHS beds in the State are not functional because of a lack of staff. This is pretty damning.

I would like to hear what the Minister of State will do about this. This is a very good service when it is functional and when children can get timely intervention. When will families be given reassurance that the service is safe and functional and that their children will get timely intervention? That is all the families want. That is all we want. We want children to get the timely intervention they deserve and should get but that they are not getting. There is something wrong and it is in all of our interests to get that right.

Photo of Mick BarryMick Barry (Cork North Central, Solidarity)
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Recently the Children's Rights Alliance gave the Government an E for its performance on youth mental health. I wonder what it would have given the Government for youth mental health services in the Cork and Kerry region? At the end of September, there were 728 young people on the waiting list in our region. This is 16% of the total on the waiting list nationally with just 11% of the population. Because of a recruitment and retention crisis only, one in three of the recommended nursing posts is filled. The wait time for appointments after being referred for depression is four months, more than double the time for any other region. The average wait time for all appointments is 131 days, which is the highest in the country. The numbers who present to an emergency department while still on a waiting list is 13%, more than double the national average.

I support the Bill. The Mental Health Commission should have the power to regulate the CAMHS service under the Mental Health Act. It should have statutory powers to oversee the implementation of its recommendations. This, of course, is only one change that needs to happen. The major change, by far and away not the only one but the major change, is that there must be increased investment to hire more staff and cut waiting times. This is a scandal that has gone on for too long.

Photo of Peter FitzpatrickPeter Fitzpatrick (Louth, Independent)
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In the programme for government document Our Shared Future, published in 2021, 16 commitments were made to children and young people. While the Government made progress in areas such as online safety, affordable access to childcare and the school books scheme expansion during 2023, when it comes to mental health care and supports we continue to fall far short of what is required.

Children with a dual diagnosis of mental ill-health and an intellectual disability are falling through the cracks, as are neurodiverse children. A lack of emergency CAMHS out-of-hours services is resulting in 16-year-old children presenting in emergency departments. If they are lucky enough to speak with a CAMHS psychologist, they are commonly recommended residential care. However, residential care is not available on an emergency basis. Children have to wait until a bed becomes available. They are being passed from pillar to post.

On top of this, when a child attends an emergency department, if they are under 16, they are referred directly to CAMHS but if they are aged 16, they are considered an adult and admitted to an adult ward. However, the issue in my constituency is that despite being eligible for an adult ward, they are not eligible to access the psychological doctor in Our Lady of Lourdes Hospital as that service is for adults only.

The annual report of the Children's Right's Alliance, the umbrella body for approximately 150 organisations working with children, highlights this practice which needs to be addressed, as well as the unacceptable rise in waiting lists for CAMHS. Access needs to be increased and we can only do this through recruitment and funding, yet both have been stalled for health. The diminished funding for health in this year's budget means it is spread thinly across all Departments, with children losing out. Last week, a leading provider of intellectual disability and community mental health services in Louth, St. John of God Community Services, which works with approximately 8,000 children and adults, announced a decision to transfer its operations to the HSE because of unsustainable budgetary issues.

We discussed only last week the deplorable wait times for children with spina bifida and orthopaedic services due to funding and recruitment barriers. The HSE recruitment freeze no doubt has had a significant effect on wait times in children’s mental health services. For example, over the Christmas period, which is undeniably a hard period for many, GPs in County Louth received a letter informing them that there would be no consultant psychiatrist cover in the Elms CAMHS for the next four weeks, and so no action was taken on referrals received within this period. Elms is one of three teams that provides the main HSE child and adolescent psychiatric services for all of the county. Doctors were further advised to send any emergency psychiatric presentations of patients experiencing mental health crises to emergency departments.

Figures show there has been a significant increase in the number of young people waiting to be seen at CAMHS for first-time appointments in the HSE CHO 8 area covering County Louth, with the numbers almost tripling over the past three years. Figures increased past 4,400 in 2023. This cannot be allowed to continue. Re-referral rates for CAMHS are high, with some children and young people being referred two or three times for the same difficulties. It was also highlighted in the report that there were varying wait times for follow-up appointments, monitoring and prescriptions, with some children taking medication without appropriate blood tests and physical monitoring, which is essential when on medication.

These figures, which are not unique to my constituency, show a complete failure by the Government to prioritise young people's mental health care. The report of the Children's Rights Alliance found there were 72 beds in four public child inpatient units but just 51 of these beds were operational or available for admission and only 30 of those 51 operational beds were occupied. Fewer than 60% of the beds available for children with serious psychiatric illnesses are being used as a result of chronic staff shortages. This is of serious concern. It is essential that the Government does everything feasible to attract medical personnel to our mental health services. It needs to address the barriers to qualified people taking up employment in the system.

Children’s mental health services must be funded and regulated. The development of standards and rules for the provision of CAMHS community services across the State, as proposed in section 33 of the health (amendment) Bill is the first step in tackling the crisis in children's mental health and will lay the foundation to reduce waiting lists.

The Government is now faced with the question of what it wants to see happen for children and young people in the final year of this programme. It is troubling that children with mental health issues are being failed by the Government. Every day, children are suffering because of inadequate access to the care they need. There is an inconsistent continuity of care and many young people fall out of services or never access them at all. These failures mean that early intervention is passing young people by. Vulnerable children deserve better. They deserve timely access to the care and support they need to thrive. We need to listen to the voices of children, families and experts who have been advocating for change. Together, we can ensure that no child is left behind and that every child has the opportunity to grow up in a healthy and happy environment. The time for action is now.

8:45 pm

Photo of Seán CanneySeán Canney (Galway East, Independent)
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I welcome the opportunity to contribute on this important issue. In my constituency of Galway East, parents are coming to my office with serious concerns about their children and the lack of CAMHS.

I am baffled by something. When a Bill is published, we can all say that it is not perfect and we can pick holes in it, but addressing that is what Committee Stage is for. It is a bit rich and cynical that this Bill would be deferred for nine months in what will probably be the last year of this Dáil. Time is of the essence. If there are things wrong with the Bill, let us put them right. Let us put the services right and have them regulated for our children.

I listened to some of the Deputies who spoke tonight. They all referenced issues in their constituencies. The most important point to remember is that this is about young people. As long as we are able, we should try to give every young person the best chance we can. We did not do that in bygone days. All of this stuff was brushed under the table and not even spoken about.

We put services in place but we have not supported them. The HSE has no badge of honour over what is happening. Something needs to be done urgently. I ask that the Government reconsider deferring this Bill for nine months. If there are amendments that the Government wants to make to it or if the Government wants to take it on, the Government will get the House’s support, but I am baffled to think that it would postpone the Bill for nine months.

I do not know what parents think when they hear this kind of talk. This situation has been going on for far too long. I meet parents who are beside themselves trying to get help for their children. They go to CAMHS but are told that their children are not bad enough, so they go home again. Beds are supposed to be available but there are no beds when it comes down to it. There is paper pushing, excuses and so on.

If we do not do something for our children’s mental health, then we will be going nowhere. I am very annoyed that this Bill would be deferred. It was an opportunity for the House to make some change for good. Based on the Mental Health Commission’s recommendations and what the Children’s Rights Alliance has been saying, everyone is crying out for regulation. The only body that seems to be pushing back on that is the Government. Shame on the Government for taking that attitude to such a sensitive subject in our country. I plead with it to reconsider what it is doing with the Bill.

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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Next is Deputy Michael Collins, who is sharing time with his colleagues.

Photo of Michael CollinsMichael Collins (Cork South West, Independent)
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The country is grappling with a deepening mental health crisis and it is children who are bearing the brunt. The Government, despite its many promises, is failing on all fronts to provide the necessary mental health support to young people. The coalition has been a saga of unfulfilled promises when it comes to child mental health services. The Children’s Rights Alliance’s latest annual report card underscores that failure, pointing out that the Government has been unable to fulfil even its modest mental health commitments for three consecutive years.

It is disgraceful that the Government is abandoning children with mental health issues and disabilities. Every day, children are suffering due to a lack of access to the care they need. This grave injustice cannot be ignored. The country is severely lacking in essential mental health services, with a mere 6% of the annual health budget allocated to such facilities. This spending is significantly lower than the average spend in countries, for example, the UK’s 10%, Norway’s 13.5% and France’s 15%. The current situation, which is characterised by unacceptably long waiting lists for appointments and children being denied essential care, is nothing short of scandalous. The Government is failing to fulfil its own programme for Government and it is the children who are paying the price. Our vulnerable children deserve better. They deserve timely access to care and support. They need to thrive. It is high time that the Government prioritise the mental health and well-being of our children and take immediate action to address this crisis. The call is for the Government to heed the voices of the children, families and experts who have been advocating for change together. We can ensure that no child is left behind and that every child can grow up healthy and happy. The time for action is now.

In the past week, I have seen the disastrous fallout of mental health issues with the death of my nephew through suicide. I would like to add to anyone who is feeling down or depressed or not feeling themselves to reach out to your family, to your friends, to your neighbours. The alternative is leaving a wave of devastation behind you when all it could take to change everything is a phone call or a conversation.

Photo of Danny Healy-RaeDanny Healy-Rae (Kerry, Independent)
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I am glad to have the opportunity to contribute and I thank Sinn Féin for introducing this Bill. The report shows that waiting times for an appointment were between 80 and 200 days in some CHO areas. A 60-day wait for suicidal intent services is damning. Children went without proper monitoring while on anti-psychotic medicine and children were lost when transitioning from CAMHS to adult services. Budget after budget has failed to fund CAMHS. Multi-annual budgets are needed. The morale of staff is low and they need support. All of the staff in CAMHS are doing their best but they are not being supported by Government policy.

We all now know what happened in south Kerry and north Kerry and the way young people were let down badly by the HSE’s services. A junior doctor was blamed for mistreating many youngsters, some of whose lives have been changed forever, but then we found out that the same thing had happened in north Kerry. Where was the oversight of services? What has changed since then? Clearly, these children were mistreated. They were maltreated and let down. Their parents and families watched them deteriorate in front of their eyes, pumping stuff into them with no real knowledge of what, if anything, it would do for them.

Photo of Michael Healy-RaeMichael Healy-Rae (Kerry, Independent)
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I thank Sinn Féin most sincerely. It is ironic. I will say this directly to the Sinn Féin Members. Last night, I was at a meeting with a young adult who had been adversely affected by what happened to her because of the situation in south Kerry. I told her that this debate would be coming up tonight thanks to the Deputies and their party and that we would have an opportunity to speak. I told that young adult that I would not name her, but she said that she wanted to hear her case being spoken about because she wanted an acknowledgement. This young adult was adversely affected and, to this day, is suffering greatly. I saw that even in my discussion with her last night.

I said it to her last night, so I can say it in public – I am worried about how her recovery will work because, quite simply, she was poisoned at the hands of the services she went to and her parents took her to for help and care. She was severely harmed.

That is an awful thing to happen, done by an agency of the State. It is an awful burden. This was not the Minister of State's, fault. It did not happen on her watch. Nobody is pointing any finger at her about this, but she is there now to answer the questions. We appreciate her work and the good work that has been done by some people in the HSE who are now trying to put the wrong right, but we have to make sure it is not happening all the time.

8:55 pm

Photo of Richard O'DonoghueRichard O'Donoghue (Limerick County, Independent)
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First and foremost, I would like to sympathise with Deputy Michael Collins and his family on the death of his nephew and friend - a young man who left this life due to suicide.

Friends of mine have died from suicide. Friends' children have died from suicide. Mental health is a big problem in this country. It is a bigger problem if the most vulnerable people, when they go out and ask for help, cannot get help in areas when they need it. A good friend of mine passed away from suicide. I met him two days before he died and I did not know.

All men can say they are big and show bravado. I would say to the males of this country that they should turn around and talk to somebody. Females are way better at spreading their problems and looking for help but males think it is not macho to do that. It is absolutely the opposite. Anyone can ask for help. A problem shared is a problem halved. Whether you are male or female, it does not make you any less of a person. It makes you a better person when you can do something like that.

I know the Minister of State is doing her best in the place she is in but much more can be done within the services to help people who share. When they share their problem with us and they do not get help, that is where I have a big concern.

Photo of Mattie McGrathMattie McGrath (Tipperary, Independent)
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Gabhaim buíochas le Sinn Féin for bringing forward this motion tonight. I sympathise with Deputy Michael Collins, his partner, Val, his own children, Eileen, Marie and young Michael, and his sister, the mother of that young man. I know how the Deputy was so fond of him. I was present when he had many phone calls with him over the past number of months. I know how hard Deputy Collins tried to assist. Many of us do not get that opportunity but Deputy Collins did. I thank every side in this House who was so sympathetic last week in the Chamber. The Deputy would not have been aware of it because he was tied up in his grief at the funeral, but sympathy and empathy came from all sides of the House. That is what is important.

It is so sad when young people reach out. Deputy O'Donoghue mentioned that men are not great, and we are not. Women are better. Mothers reach out and beg for and implore that their young children be seen. We had the horrible experience in Kerry north and Kerry south. Our CAMHS situation in south Tipperary is just non-existent. I do not have the number but countless young adults have been incarcerated in psychiatric institutions because they cannot get treatment from CAMHS. I am not blaming the Minister of State either but someone needs to take hold of this. Plenty of money has been pumped in but they are just not getting the services. The poor mothers, fathers, siblings and families see people self-harm. We have had many suicide attempts and suicides as well. It is shocking in a system that is supposed to be so caring. We lost St. Luke's and then St. Michael's in Clonmel. We do not have them. The system is failing these young people and the máthair, athair and the clann go leir are begging and imploring that something be done. We are raising it here day in, day out.

I am sure there is a Government countermotion to this. We need to deal with it, not just talk about it. These people need help and our support.

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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The whole House joins with us in extending our deepest sympathies to Deputy Michael Collins on his bereavement. There is not a Member in this House or a person in this country who has not been touched in their hearts and lives by the cold hand of suicide.

Photo of Thomas PringleThomas Pringle (Donegal, Independent)
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I would like to echo the words of the Ceann Comhairle in respect of Deputy Collins. It is very true and important.

I thank the Minister of State for the opportunity to speak to her on the Bill and I thank Deputy Ward for tabling it. I fully support this legislation for the regulation and reform of CAMHS under the Mental Health Act 2001. I am extremely disappointed with the Government's amendment, which, as other speakers have outlined, is to delay the second reading of this Bill by nine months, which effectively delays it until after the election. Basically, rather than vote it down, the Government has delayed it for nine months in this way.

The Government has said it is currently drafting its own legislation to regulate community mental health services, including CAMHS, but given the urgency of this issue, we cannot afford to wait. Action is needed now. The immediate reform of CAMHS structures and the independent regulation of CAMHS by the Mental Health Commission should be given the Government's top priority. I wonder where the Government's Bill is. Maybe the Minister of State could outline when we can expect to see it in the House, so we can see whether there is a chance of it actually being passed before the Government falls.

As we know, the Children's Rights Alliance published its annual report card last week, which examined the Government on promises and commitments made to children in Ireland. It is absolutely unacceptable to see an E grade for the third year in a row in respect of children's mental health. It gave such a low grade due to the unacceptable rise in waiting lists for CAMHS and the continued practice of admitting children to adult psychiatric units. Despite the Government's prior commitment to ending the admission of children to adult psychiatric units, 12 children were admitted to adult units last year. While that is a reduction, it is still unacceptable that it is continuing. It is a completely unacceptable practice and means that children are not getting the necessary care they require.

Figures for first-time appointments for CAMHS are rising exponentially, increasing past 4,400 in 2023. This cannot be allowed to continue. It is clear that urgent action is needed before the crisis gets even more out of control. The State is failing children and will continue to fail them even more if it does not get a handle on the crisis soon.

The unacceptable postcode lottery of care also continues, with certain counties receiving far lower quality of care than others. This is particularly the case in rural counties. Last year, it was found that CHO 1, which includes my constituency, Donegal, had the fifth highest waiting list for CAMHS in the country, with a total of 367 young people on waiting lists. I have been contacted by a parent in Donegal who has been seeking urgent services for her young child for a year and has been waiting for a first appointment with CAMHS for months. It should never be the case that a child is forced to wait this long for a vital service. It should never be the case that parents are left without the option of getting the child the help they need. This can be particularly frustrating for families in rural Ireland, for whom many services are inaccessible. Concerned parents and guardians in Donegal and throughout the country are doing all they can to secure vital services for the children who need them.

When a place has been secured, many families in Donegal are then faced with the issue of getting to these services. Consideration has to be given to those who are unable to travel. Rural service users suffer because of this. This has become even more concerning recently with the announcement last month that Donegal's only child and adolescent counselling service has been forced to close. This news has sent shockwaves through many Donegal communities and has caused significant stress and worry among young service users and their families. The child and adolescent counselling service had grown significantly in our county, with more than 15,000 counselling sessions delivered by 26 counsellors across seven outreach centres in the past six years alone.

The fact that so many children across the county are now being stripped of this vital service because of a lack of funding, with basically one position to manage it, is an absolute disgrace. Some 120 children who were receiving counselling in Donegal are now left in the dark with nowhere to turn, with more than 350 people on waiting lists for this service also affected. The demand for the service was already far more than could be provided for, yet the service was still forced to close, putting further strain on other service providers. The reality is that many of these children will not be able to access the service that they need now, which is an absolute shame. This will negatively affected so many families in Donegal while the Government continues to turn a blind eye to these families and the essential need for mental health services for young people.

We are already failing young people in this country in so many ways and to not provide an adequate mental health service will have a devastating effect on many young lives. That is the difference we are making. Intervention when people are young is a timely intervention. It is an intervention that will save money in the long run. Not only this Government but all Governments talk about how much it costs.

When you look at the cost of not doing it, the cost is insignificant. That is the reality. I know there is difficulty getting adequately qualified professionals, but that needs to be stepped up. They need to be targeted in other countries and brought here to work. That is an idea of immigration that works for the benefit of Irish society, and is vitally important. That will make a difference to people's lives and will save money in the long run. That is what we need to be looking at. That is the way things need to be looked at. It sticks in people's craw to see so much money put aside by the Government, which it has not budgeted for. However, you see services crumbling and the only service for young people in Donegal has had to close for lack of funding of between €40,000 and €50,000 to employ one person to co-ordinate the whole thing. That is the kind of stuff that should not be happening and it should not happen in this day and age. There is no justification for it to happen. Cost is not an issue at the moment.

I know the Minister of State knows this, but some of her Government partners and maybe the Minister for Finance do not seem to know it. Spending money now will save money in the future. That makes a difference and that should be enough. I know the Government and the Department of Finance decides everything on how the spending of money looks. Investment now will save in the future. That is bound to be good and is bound to make sense.

9:05 pm

Photo of Violet-Anne WynneViolet-Anne Wynne (Clare, Independent)
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I begin by commending this excellent Bill, which proposes some things I have mentioned in this House and in committees on many occasions. I also acknowledge the mobilisation of Families for Reform of CAMHS. It has done Trojan work, but its action is a direct result of inaction. We say this quite often in the House, but this inaction has caused major hurt. I was shocked, appalled and, to be honest, sick to my stomach last year when it was revealed that 140 cases had just slipped through the cracks in CAMHS mid west. That is exactly what can happen when you have no external oversight - teams that are stretched beyond the point of breaking and accommodation that is not fit for purpose. What we saw unfold was an exodus of staff from CAMHS. We lost some passionate and hardworking staff, as an internal survey pointed to their own mental health being affected. I have already spoken in the House on many occasions with the Minister of State about the issues of accommodation of CAMHS in east and west County Clare. I will not rehash that tonight. There are many issues of concern with the governance of individual CAMHS teams. These issues need to be addressed at policy level and strategic level. That needs to be done through the central governance of every single CAMHS team in Ireland. I recently met with the team from Jigsaw, which does amazing work across Ireland. However, due to the set-up of CAMHS, it is completely prohibited by CAMHS teams in certain counties from referring to them. I am also deeply concerned that CAMHS does not take referrals for children where the primary diagnosis is autism. That was finally clarified for me in writing by way of a Parliamentary Question. That is shocking, as we also know from the Joint Committee on Autism that children with autism are 28 times more likely to consider suicide.

Approximately 23% of our population is under 18, so when this Government fails one child it fails them all. By refusing to regulate and reform CAMHS this Government is failing approximately 1.2 million young people, their families and future generations. I urge the Minister of State to withdraw the Government amendment and for all Members to support this Bill.

Photo of Mary ButlerMary Butler (Waterford, Fianna Fail)
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I thank Deputy Ward, once again, for initiating the Bill. I also thank my colleague, the Minister of State, Deputy Naughton, for opening the debate.

We are talking about youth mental health tonight and regulation of CAMHS. However, the contribution from Deputy O'Donoghue was so telling, and it especially appealed to males to reach out and ask for support. In 2022, we lost 411 people in this country to suicide, and 331 of them were male. It is a huge issue that men especially do not reach out for help. We know that of those who receive support from CIPC, the counselling services through the HSE, and who access supports from Pieta House, two-thirds are female and one-third are male. We have to do more on this issue. I want to put that on the record. Deputy O'Donoghue's intervention was so powerful at a time of huge distress for Deputy Collins and his family. We all stand with him.

I start by reiterating the Government’s commitment to further improvements in our CAMHS service and our recognition of the importance of ensuring all mental health services, both inpatient and community, and both adult and children and adolescent, are fully registered, regulated, and inspected by the Mental Health Commission in its role as the independent regulator of mental health services. All CAMHS teams have worked closely with the Mental Health Commission over the past year or so to develop and implement improvement plans, as needed, following the interim and final reports of the Commission on CAMHS nationally. The HSE continues to progress three national audits relating to CAMHS arising from the Maskey report on south Kerry. These were the national review of CAMHS prescribing practice and the national audit of compliance with CAMHS operational guidelines, both of which were recently published. Both published reports are being given full and proper consideration by me, the Department of Health and the HSE. In addition, a review of service user experiences is currently being undertaken by UCC.

It is important that everyone recognises there continues to be a substantial and growing demand for CAMHS services. Between 2020 and 2021, referral rates into CAMHS increased by 33%, while the number of new cases seen increased by 21% over the same time. The 75 community teams nationally are currently delivering approximately 225,000 appointments for children and young people every year. There are 820 staff working across the country in CAMHS services. I understand, based on provisional data received today from the HSE, that in 2023 there were 12% more appointments offered to children through CAMHS than in 2022. This highlights how the HSE is working hard to deliver more activity in the face of growing demand for CAMHS services. Some 13,155 new and re-referred appointments were offered last year. Of these, 12,338 were seen, while 817 or 6.2% of appointments were not attended.

At the end of last year, provisional figures show that there were 3,759 children on the CAMHS waiting list. In 2023 there was a decrease nationally of 480 children on the waiting list for CAMHS services, down from 4,239 in December 2022 to 3,759 a year later. I welcome this reduction, but my focus is to keep reducing this waiting list week on week, month on month. Improving access to modern mental health services requires that the waiting lists for CAMHS services be addressed. Targeted waiting list activity in 2024 will focus on those children who have been waiting the longest to ensure they get the care they need. There are currently waiting list initiatives underway across six Community Health Organisations.

The severity of presenting symptoms as well as a clinical assessment of risk is always taken into account in terms of waiting times. Every effort is made to prioritise urgent cases so that the referrals of young people with high-risk presentations are addressed as soon as possible. Some 92.8% of urgent referrals to CAMHS nationally were responded to within three working days, while 91% of new or re-referred cases were seen within 12 months in community CAMHS services in 2023. I also acknowledge there is a variation of referral acceptance across CAMHS teams, and this is an area being prioritised by the HSE to help improve access to CAMHS and to address CAMHS waiting lists. CAMHS canaccept children or adolescents only where there is evidence of a moderate to severe mental health difficulty present. The HSE is taking account of the recent Maskey and Mental Health Commission reports on CAMHS, and is currently finalising a youth mental health service improvement plan, which will set out agreed actions for focused service improvement through identified, timely, and measurable actions. I will announce the details of this improvement plan shortly.

CAMHS is receiving more than €150 million in dedicated funding this year. In addition, approximately €110 million in funding is provided by the Government to community-based mental health organisations and NGOs. Much of this is focused on supports for children and young people from an overall mental health budget of €1.3 billion. The new child and youth mental health office in the HSE is now in full operation, and I work closely with it. The Minister, Deputy Donnelly, and I have had several recent meetings with the office.

At my request, the HSE developed proposals for 2024 funding. The latter will provide much-needed CAMHS investment to meet demand. This includes the 68 posts to strengthen CAMHS teams nationwide that I announced on budget day. In January, I also announced a further €10 million that will allow for further targeted funding in the area of youth mental health. As already stated, I will be announcing details in this regard shortly.

Evidence shows that approximately 2% of young people may need the support of dedicated CAMHS teams. It is important that we also focus on positive youth mental health supports and early intervention in communities for young people who will not need intensive supports. I am particularly focused on the further development and delivery of the no wrong door approach to ensure that those children who may require various services receive the care they need in the most appropriate setting regardless of the complexity of need or source of referral. Improved links to primary care and disability services, particularly such as autism, as well as external agencies across the education, childcare and youth justice fields, is also important.

I welcome the focus on youth mental health. In the context of the provisions of the Bill before us, my reason for seeking this timed amendment is twofold. First, I believe that the Bill as drafted will not provide for the regulation of community CAMHS. Second, I will introduce a mental health Bill in the summer session that will comprehensively update and overhaul our current mental health legislation. I appreciate that the Deputies’ intention with this Bill is to grant additional regulatory functions to the commission. It is my opinion, however, that the intent behind the Bill is not what the text of the Bill reflects. I have been working closely with my officials in the Department of Health in relation to the Government's new mental health Bill over several years. It is important that this complex and lengthy legislation accurately reflects and supports the delivery of person-centred, modern mental healthcare which supports the rights of each individual and puts the service user front and centre. It is important that all voices will be reflected in the forthcoming Government legislation, including those who use the service and those who deliver it.

We continue to invest heavily in and to develop our youth and child mental health services. That is why it is unhelpful to characterise the provision of mental health services in a persistently negative light. This impacts on staff who want to work in the area and take pride in the valuable work they do. It suggests to parents that services are not available and risks vulnerable people not coming forward to access services that they need. I would like to take this opportunity to thank all those who work in mental health services, whether public, private or voluntary. The Government's mental health Bill is in the final stages of drafting and will move to publication in the summer term that begins in April. I look forward to bringing this Bill before the House and to engaging with colleagues on it.

9:15 pm

Photo of Maurice QuinlivanMaurice Quinlivan (Limerick City, Sinn Fein)
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Nobody in this House believes that we will be sitting here in nine months. This Dáil will be gone by then. The Minister of State, therefore, is not just stopping or delaying this Bill, she is torpedoing it. That is unfortunate because the Bill seeks to give statutory powers to the Mental Health Commission to regulate CAMHS. It would allow for the implementation of the commission's recommendations and for it to monitor that implementation. This is an important Bill. We felt obliged to submit it because if we were to wait for the Government to take action, the necessary changes would not come about. The reform of the Mental Health Act 2001 is mentioned in the programme for Government but four years after the latter was published, little or no action has been taken.

Children deserve better. They deserve better than being obliged to wait for treatment. They deserve better than a postcode lottery as to when they will be seen. A child facing a mental health challenge is heartbreaking. It impacts their formative younger years. Not only is it a frightening challenge for that young person, but it also places immense pressure on their parents, their siblings, their schoolmates, their teachers and their communities. Early intervention is so important and often makes a major difference. Childhood is a fleeting time. Where help is needed, it should be offered as soon as possible.

There is a fantastic group in Limerick that offers incredible support to children facing difficult challenges. I refer to the Bedford Row Family Project. I met some representatives of the group yesterday. They are currently battling to secure funding to maintain the group into the future. After a quarter of a century, and its 25th anniversary, the Bedford Row Family Project is facing closure. It has provided coping skills to children and their parents. These people are some of the unsung heroes of our children's mental health service.

CAMHS waiting lists have increased under this Government. There are 3,891 children and young people on waiting lists, with 196 of those being in my CHO area. This is an emergency but it is not being treated as such. We have seen from recent reports, and the Maskey report in particular, that there are significant problems with CAMHS. For far too long in this State, mental health issues have been treated as the poor relation of the health service. Proposed changes and supports never seem to arise. We have been waiting in Limerick for the roll-out of a trial 24-7 mental health de-escalation unit. Every time I seek updates in this regard, I am told it is on the cusp of being launched, but we have not seen it delivered. If the Government were serious about mental health protection, the unit would have been up and running already. These children on the mental health waiting lists have been waiting long enough for the Minister of State. Her type of approach to mental health needs to change.

Photo of Mary ButlerMary Butler (Waterford, Fianna Fail)
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What is the name of the organisation to which the Deputy referred?

Photo of Maurice QuinlivanMaurice Quinlivan (Limerick City, Sinn Fein)
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The Bedford Row Family Project.

Photo of Seán CroweSeán Crowe (Dublin South West, Sinn Fein)
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The Mental Health Commission's report into CAMHS highlighted several issues, including children lost to follow-up, lack of monitoring of psychiatric medicines, unacceptable waiting times for high-risk referrals and many more operational issues. When I chaired a meeting of the Joint Committee on Health in January, we heard that there were 4,400 children on the waiting list for their first CAMHS appointment. This number has almost doubled in the past five years. This lays bare any attempt by the Government to pretend it is making a difference.

Many multidisciplinary teams across the State are missing key personnel, have long waiting lists and are unable to deliver supports and services for children and young adults. Children with a dual diagnosis of a mental health issue and an intellectual disability, and children with autism in particular, are being neglected in their refusal of CAMHS. This is clearly a broken system that forces many parents, who understandably want to get their children the help they need, into seeking expensive private diagnoses. When there is then no way of accessing public care, it forces them into private treatment and even greater expense. This is no way to treat vulnerable children and their families who need help from our mental health services. Services for adults are barely adequate, but it seems those for children are barely functional. Children cannot wait any longer for CAMHS to be reformed. No child, and certainly no sick or vulnerable child or young adult, should have to wait months or years for quality care within our mental health services.

Photo of Thomas GouldThomas Gould (Cork North Central, Sinn Fein)
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Figures released to Sinn Féin show a shocking increase of 158% in CAMHS waiting lists in CHO 4 from July 2020 to August 2023. Some 348 of these children have waited over 12 months for an appointment. This is completely unacceptable. Last year, I was contacted by a lady whose daughter was in severe distress. She had to bring her to the accident and emergency department for help. CAMHS arranged an appointment but needed a report from the accident and emergency department. Otherwise, the appointment would be cancelled. This woman was out of her mind with stress and worry. I had to contact the hospital and we did get the report. This just shows us, though, how the system has completely collapsed. People do not seek mental health supports for their children unless it is really serious. Equally, the consequences of the impact of Covid-19 on everyone were serious, but especially so for children and even more so for vulnerable children who need supports from CAMHS. This Government has abandoned our children. These 348 children in Cork and Kerry have been waiting for over a year.

Photo of Mary ButlerMary Butler (Waterford, Fianna Fail)
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That is-----

Photo of Thomas GouldThomas Gould (Cork North Central, Sinn Fein)
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The previous Minister for Health, Deputy Harris, said we need to see continued reductions in the number of children waiting to access CAMHS and the length of time spent waiting being reduced. Enough of Fianna Fáil and Fine Gael. All we have seen are children waiting longer. These children are begging for help from the Minister of State and from all of us and they need to get it.

Photo of Mark WardMark Ward (Dublin Mid West, Sinn Fein)
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The Government's response to the text of this Bill is just smoke and mirrors. I know this, the Minister of State knows this and the people listening know this as well. If the Government is not happy with any aspects of this Bill, then it should send it to the joint committee for pre-legislative scrutiny. This is what the committee is there for.

Photo of Maurice QuinlivanMaurice Quinlivan (Limerick City, Sinn Fein)
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Photo of Mark WardMark Ward (Dublin Mid West, Sinn Fein)
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If the Government is not happy with the Bill, why not just vote it down? It will be the same Bill nine months from now. What the Minister of State is doing is contradicting herself. That does not surprise me. The entire Opposition is in favour of progressing the Bill rather than it being kicked down the road to be dealt with in nine months' time. We need to stop this nonsense.

I acknowledge the families who are here again tonight and who have stayed for the two hours of this debate.

They are pulling their hair out with frustration. It just shows how much this really means to them and their families and most of all what it means to their children. Their children simply deserve better than what has been going on in the Houses of Parliament tonight. I do not think there is a bigger crime in this world than denying a child every opportunity to reach their full potential but that is exactly what the Government is doing tonight by delaying this Bill.

I want to address some of the Minister of State's responses to the Bill. She mentioned the reduction in waiting times and any reduction in waiting times is welcome. However, I want to bring to her attention the latest figures I have. When the Government was formed in 2020, we had 2,115 children waiting for a first assessment with CAMHS. This now stands at 3,891, an increase of 1,800 on Minister of State's watch. A total of 656 of these children have been waiting for over a year. How can she stand over this? Based on her response about the budget, if we did not know better, we might think everything is rosy in the garden but it is quite the contrary. The overall percentage for the mental health budget has fallen under this Government. The Minister of State mentioned an increase of 68 CAMHS workers since this time last year. While any increase is welcome, will this increase open the 20 CAMHS beds closed under this Government's watch? Will this increase fully staff CAMHS-ID teams? Will this increase stop children falling through the cracks when they reach the age of 18?

The Minister of State also mentioned the new roles for youth mental health, but that is not what she asked for originally. She asked for - I supported her call - a national clinical director for mental health but she failed to deliver on this. She mentioned that there has been an increase in referrals to CAMHS but she failed to mention the reasons. If our young people are getting early intervention at the earliest possible time, they are less likely to need the more acute services of CAMHS as they get older. I am referring to the 16,000 young people currently waiting for primary care psychology. In some areas Jigsaw is doing really well but a post code lottery exists in other areas where children are not getting the Jigsaw appointment they need.

In bringing forward this legislation, I spoke to parents outside. I do not want to raise people's hopes just to have them dashed. That is not what I am here for. My job is to bring forward good proper legislation as an Opposition Deputy. The Minister of State might have an army of staff there; I just have Joseph O'Callaghan working with me and I want to thank him. Two of us in my office have been working on this with stakeholders and families. We bring it forward here in good faith. The Minister of State had an opportunity tonight not to kick this down the road and let it go through prelegislative scrutiny but she has denied children and their parents that opportunity. I have said it before and I say it again: our children deserve better. We never pretended this legislation was the panacea to fix everything that is wrong in mental health but, my God, it was a step in the right direction.

Amendment put.

9:25 pm

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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In accordance with Standing Order 80(2), the division is postponed until the weekly division time tomorrow evening.