Dáil debates

Thursday, 29 February 2024

Child and Youth Mental Health: Statements


2:50 pm

Photo of Mary ButlerMary Butler (Waterford, Fianna Fail)
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I am pleased to have the opportunity to discuss child and youth mental health services and highlight the work that has been ongoing over the lifetime of this Government to bring improvements to mental health services. I assure the House that the Government is fully committed to the delivery of modern, high-quality, person-centred, recovery-orientated mental health services. As Minister of State with responsibility for mental health, it is very important to me that parents, guardians, children and young adults have confidence in the mental health services they access, including child and adolescent mental health services, CAMHS. I am proud of the work that has been accomplished to date in increasing funding, improving access to services, developing new models of care and developing legislation that is modern and person-centred. There is much more to do. We should always strive to make services better and ensure that all young people feel secure in the knowledge that they can access mental health supports if they need them.

Everyone in this Chamber, be it through constituency work or personal experience, has heard first-hand accounts from families who have struggled to access the care their children need. I am here today to emphasise that each of those individual experiences has been heard and that I, my Department and the HSE continue each and every day to work to improve capacity, increase staffing levels and make sure that every euro of investment in our mental health services is used to better the experience of all those accessing our services. This is why it is so unhelpful to characterise the provision of mental health services in a persistently negative light. It has an impact on whether staff want to work in the area and dissuades young people from training to work in the area. It suggests to parents that services are not available and that there is no benefit in even trying to seek help for their children and it risks causing vulnerable people not to come forward to seek the supports they need.

Around 12 months ago, I travelled to Kerry to attend an older persons' conference. Later in the day, while we were having a cup of tea, I asked a woman sitting beside me who she was representing and she said the HSE. She said she worked for CAMHS but did not tell anyone that. She just tells people she works for the HSE. That struck me. Every day I try to build confidence in what CAMHS does.

We have to recognise, although we are operating in the context of a fast-growing population and pent-up demand since the Covid-19 pandemic, that access should be faster. It is my job as Minister of State with responsibility for mental health to deliver on that. However, as part of today’s statements, it is important for parents, families and those seeking help to know that when they experience a mental health difficulty, there are services available to support them. They are staffed by a dedicated mental health workforce, who deserve to be acknowledged for the valuable work they do each day. These staff work with the most complex and sometimes most vulnerable people and very ill people with acute and enduring mental health illnesses.

Last week, the Children’s Rights Alliance published its report card and allocated an E rating to child and youth mental health, citing inappropriate placement of young people in adult psychiatric facilities. Consultant psychiatrists do not take the decision lightly to admit a young person under 18 to an adult mental health facility or approved centre. That decision is made using extensive clinical judgment and experience to determine what course of action will best serve and meet the young person’s needs at that immediate time. Such admissions only happen in exceptional circumstances, with appropriate safeguards in place. On the limited occasions that young people are admitted to an adult mental health facility, they are cared for on a continuous one-to-one basis and always in line with the Mental Health Commission’s code of practice. All admissions are notified both to the commission in line with the code and to a national CAMHS lead manager in the HSE.

Admissions have decreased significantly in recent years, as cited in the Children’s Rights Alliance 2024 report card. Work to end the admission of children to adult psychiatric units is a commitment in the programme for Government. In 2019, there were 54 admissions. The figure fell to 20 in 2022 and 12 in 2023. In 2023, the majority of young people admitted to an adult mental health facility were aged 17. They were admitted on a voluntary basis - that is important - and for periods of less than a week. In some cases, the young people turned 18 and automatically entered adult services during their stay. Those who remain under 18 stay for short periods and move, as appropriate, back home to a CAMHS facility or community-based CAMHS team.

I accept other criticisms in the latest Children’s Rights Alliance report card, especially in relation to lengthy CAMHS waiting lists which I will address shortly. I disagree, however, that a clinical decision made in real time by a consultant psychiatrist should prompt an E grade. It simply does not reflect the on-the-ground experience of the clinicians delivering care to young people enduring severe mental health difficulties. Young people are admitted to adult mental health facilities only after all efforts to place them in a CAMHS facility have been exhausted.  A range of factors can influence the clinical decision, including crises, suicidal ideation, immediately available capacity or distance. We need to reflect on that because it is too simple to say we will give you a fail or an E score because consultant psychiatrists took decisions, more than likely to save a young person's life. If we continue to hammer consultants for taking a decision to save a child's life, I worry where we will end up.

There are currently 51 fully staffed inpatient beds available for CAMHS. A total of 31 young people are inpatients in these approved centres. We also contract and use private providers as needed. As in much of the rest of the health sector, we are actively recruiting more specialist staff for increased services and beds. There is no young patient on a waiting list today for an inpatient bed, and I am updated weekly on the level of demand for CAMHS-approved centre beds.

Regarding CAMHS community supports, we now have 75 CAMHS teams across the country. Between 2020 and 2021, the rate of referral to CAMHS increased by 33%, while the number of new cases seen increased by 21% in that same period. Provisional figures made available to me this week indicate that nationally in 2023 there was a decrease of 480 children on the waiting list for CAMHS community mental health services, down from 4,239 in December 2022 to 3,759 a year later.

Provisional data provided to me by the HSE shows 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. Thirteen thousand one hundred and fifty-five new and re-referred appointments were offered last year. Of these, 12,338 were seen. Eight hundred and seventeen appointments were not attended. I accept that some young people might have aged out at the time. There are 820 staff working across the country in CAMHS. While we stand here today, they are busy working in their offices and clinics supporting young people.

I acknowledge that there are challenges in meeting the growing demand for CAMHS. I thank the Mental Health Commission for the work it undertook over the last 18 months to review all services provided by CAMHS to ensure there are no failings in the standard of care that our children and young people across the country receive. All of our CAMHS teams have worked closely with the Mental Health Commission over the past year and more to develop and implement improvement plans following the interim and final reports of the commission's review of services provided by CAMHS nationally, and their work continues.

The HSE continues to progress three national audits concerning CAMHS arising from the Maskey report on south Kerry. Included are the national review of CAMHS prescribing practice and the national audit of compliance with the 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, University College Cork is undertaking a qualitative review of service-user experiences.

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. This will also receive my full attention, and its implementation will bring about valuable improvements.

This year, I allocated nearly €150 million to CAMHS in dedicated funding, in addition to €110 million to community-based mental health organisations and NGOs, such as Jigsaw, Pieta, spunout and Belong To. The list is endless. A significant proportion of the funding is dedicated to supporting young people. In addition, I recently announced a further €10 million in funding from the Revised Estimate volume for youth mental health. I am placing a dedicated geographical focus on the allocation of this funding to address what is often postcode-lottery access to services.

Budget 2024 also provided for 68 additional posts. Together they will strengthen CAMHS teams nationwide, enhance CAMHS hub teams and develop key clinical care programmes such as programmes concerning early-intervention psychosis, eating disorders and dual diagnosis. The HSE increased staffing in community CAMHS from 659 in December 2021 to around 820 posts. This staffing figure will increase to nearly 900 by the year's end on the back of 2024 investment and recruitment plans.

Examples of service initiatives for mental health under budget 2024 also include the development of a central referral mechanism or "no wrong door" for services for children. This service will ensure that those children who require services receive the care that 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, as well as external agencies across the education, childcare and youth justice fields, are also important.

The additional €10 million in funding will also provide additional staff for CAMHS hubs, CAMHS crisis cafés, CAMHS out-of-hours services, investment in a new single point of access to children's services, investment in an electronic health record, and additional funding to allow Foróige and Jigsaw to develop upstream mental health services in primary care and community services. Specialist clinical care programmes, such as the national clinical programme for ADHD, will also be enhanced, as will recovery-oriented services.

I must also point out that for the first time in the history of the State, we now have a dedicated national office for child and youth mental health in the HSE. This is a very significant development that I delivered, and it will improve leadership, operational oversight and management of service delivery. A new HSE national clinical lead for child and youth mental health and a new HSE assistant national director for child and youth mental health have taken up post. They have been in post for six months and I meet them regularly.

The HSE must also be commended on fully utilising opportunities offered by telehealth technologies to mitigate recruitment challenges and modernise delivery of mental health care. This includes a new multidisciplinary model of care for CAMHS hubs, which I launched last September in Cork, with pilots across five sites in CHOs 2, 3, 4, 6 and 8. Support from these hubs is designed to be over a short period as they provide targeted and intensive interventions with flexibility to respond to different young people's needs, or parent or carer needs.

Ensuring that mental health legislation is modern and person-centred and that the human rights of anyone, child or adult, receiving care in an approved centre are respected is at the core of the new mental health Bill. I will introduce the Bill to the Oireachtas shortly, and this will completely overhaul and modernise the existing legislation and provide comprehensive regulation of all mental health services, including community CAMHS.

I acknowledge that the development of the Bill has taken longer than expected. Many of the issues addressed in the Bill are legally and ethically complex and require consultation with key stakeholders and extensive legal advice. Furthermore, it is a very lengthy Bill and will have in excess of 130 sections. Despite the length and complexity of the Bill, I am very happy to say it is now in the final months of drafting and will be published in the next Dáil session, which begins in April.

The regulation of community CAMHS under the new Bill will bring a high level of scrutiny to this sector for the first time, with a significant percentage of private service providers in the sector. Children and young people accessing community services, and the service providers delivering these services, deserve a regulatory system backed by a clearly defined, robust legal framework. I would, therefore, like to emphasise how much I support the regulation of community CAMHS. My colleagues in government and I all recognise the importance of ensuring all mental health services, including both inpatient and community and both adult and child and adolescent, are fully registered, regulated and inspected by the Mental Health Commission in its role as the independent regulator of mental health services. It is a matter my officials have been carefully considering in the drafting of the Bill.

The Bill will comprehensively address the expansion of the commission's regulatory remit to include all community mental health residences and services, including all community CAMHS. The provisions in the Bill have been subject to ongoing and lengthy consideration by officials in my Department. A Part of the Bill is devoted to the regulation of all mental health services and will provide very strong legal underpinning to regulate community CAMHS.

In addition to expanded regulation, the Bill will overhaul the involuntary admission and detention process, modernise provisions related to consent to treatment, provide enhanced safeguards for people accessing inpatient treatment, and provide a new, discrete Part that relates exclusively to the care and treatment of children and young people in inpatient settings.

Last week, when listening to a radio interview, I was struck by the choice of language used in relation to suicide.

It is crucial that all of us use sensitive and non-stigmatising language when engaging in a conversation, talking or writing about mental health, in particular suicide, and in the media. Using language and words that are helpful and respectful will encourage open and safe conversations about suicide and its prevention. In particular, using the term "commit suicide" can imply a sin, criminal offence or act, and, can, therefore, be stigmatising, of the person who has died or of people who have been bereaved. We have come so far as a country in opening up about our mental health and working actively to remove the stigma of mental health challenges. The act of suicide was decriminalised in Ireland in 1993 and the terms "commit"or "committed suicide" should always be avoided.

To conclude, parents and their children have the right to have confidence in being able to access mental health supports across the country where they need it and to meet their needs. I am committed to a no wrong door policy and the core concept that there is no health without mental health.

I thank all Deputies for the opportunity to speak to this Government's commitment on child and youth mental health services and I look forward to hearing all the contributions throughout the afternoon.

3:10 pm

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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I call Deputy Ward, who is sharing with his colleagues.

Photo of Mark WardMark Ward (Dublin Mid West, Sinn Fein)
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It is timely that we are having this debate on child and youth mental health after the Minister of State voted to delay the Sinn Féin legislation to regulate CAMHS by nine months last night. The Minister of State's rationale to vote against this important legislation to improve services within children and adolescent mental health services is compromised. The Government spent its opening ten minutes trying to dismantle the legislation. The Minister of State, Deputy Hildegarde Naughton, stated, "I cannot see how the Bill, as currently written, [is] meaningfully ..." If the Minister of State, Deputy Butler, believed that this Bill was not meaningful, why did she kick it down the road for nine months? Why did she not vote it down? It will be the same Bill in nine months. For parents who may be watching today, what happens after nine months is that this Bill will be read a second time without debate, which means that my party's Bill to regulate CAMHS that the Government said is not meaningful will progress to Committee Stage and pre-legislative scrutiny. The Minister of State is talking out of both sides of her mouth.

She mentioned restoring confidence in CAMHS. The first step to restore confidence in CAMHS would have been to regulate the services to make it safer for young people and parents who experience it. She also mentioned that the Children's Rights Alliance gave CAMHS an E grade for the placement of children in adult psychiatric facilities. I welcome the decrease in that regard, which has to be acknowledged, but that was not the only reason the services was given the E grade. It is the second or third year running CAMHS was given an E grade. The reason the services was given it was the overall failure in children's mental health services that was highlighted by the Maskey report and the Mental Health Commission's.

I agree with what the Minister of State said about the CAMHS worker who she met in Kerry who should not be shamed. She definitely should not be shamed. The shame belongs to successive Governments that have presided over abject failure in children and youth mental health.

I opened my speech last night by thanking the workers in CAMHS. Any of those I have met are dedicated. They see it as a vocation and they go in there to help children, but they are let down by systemic failures within the HSE.

The Minister of State also talked about hope. I do not have much time. I can talk about problems here all day but I will give the Minister of State some solutions. The biggest hope that people have out there is a change of government because it is difficult for the Government that has presided over all the problems in youth mental health to be the one that will be the catalyst for the change needed to improve children's mental health, and we need to see that change. In government, Sinn Féin would rebalance care towards early intervention and condition management by multidisciplinary primary care and community-based teams.

We produced a comprehensive document, "Child and Youth Mental Health". I gave the Minister of State a copy. I do not know if she read it. If the Minister of State has not, I suggest that she do that over the weekend because this will give her the solutions to help tackle the crisis that has been caused in youth mental health. It will help the Minister of State engage with workers and their representatives to resolve and recruitment and retention barriers, plan further and higher education places based on future service need to deliver new teams and ensure safe staffing levels, ensure that services can support patients with disabilities, and strengthen linkages with specialist secondary and acute care services, such as for substance misuse and eating disorders.

Sinn Féin would expand CAMHS to cover young adults up to the age of 25. It has been demonstrated that approximately 50% of mental health problems are established by the age of 14 and 75% by the age of 24. At present, young people who develop a mental illness fall through the cracks. If they are in the CAMH services, they are more likely to age out of the services and not get the care that they need in adult mental health services.

I am happy to give the Minister of State a copy of these solutions. I will give up my time here because I want to let my comrades in. I am happy to leave a copy of these solutions with the Minister of State because children cannot wait any longer and our children deserve better. She should take the weekend to read it

Photo of Matt CarthyMatt Carthy (Cavan-Monaghan, Sinn Fein)
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Sometimes I feel that there are parallel realities - one that reflects the Minister of State's remarks where one would think that Government has a handle on mental health services and the other that is reflected to me and other Deputies by our constituents who are at the coalface of Government's failures in this regard. Those people are part of the growing numbers who are on waiting lists that have almost doubled since this Government came to office.

There is the Minister of State's reality that talks about the prioritisation of early intervention and emergency care and then the reality of people in my constituency, Cavan-Monaghan, where there is not a single out-of-hours mental health service. I have dealt with families who have come to me whose children are in dire distress who are concerned and worried for their children's well-being and the only advice that is given to them is to attend an emergency department in a hospital.

There is the reality of the Minister of State where she talks about the increased resources and then there is the reality in my constituency where only 65% of the recommended staff are in place and where there are no CAMHS consultants available to teams for longer periods. There is the reality of the Minister of State who says that she is prioritising this issue and then there is the reality whereby Government frustrates a Sinn Féin proposal bringing forward an amendment to the Mental Health Act that would give statutory powers to the Mental Health Commission to oversee and assist the HSE in implementation of the recommendations of governance and clinical returns. What does Government do? The Government parties did not have the guts to vote against it. They simply delayed it by nine months.

There have been too many delays. There have been too many broken promises. Our children deserve better. They deserve the mental health services that will allow them to live full and meaningful lives.

Photo of Kathleen FunchionKathleen Funchion (Carlow-Kilkenny, Sinn Fein)
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At this stage, many of us feel like we could write a book, and, unfortunately, not a positive one, on CAMHS. I refer to the battle that parents face trying to find the appropriate service, the paperwork involved in filling in the forms when people are already experiencing a difficult and stressful time in their lives, and then being told this is not the appropriate service but not necessarily being told what is the appropriate service and where to go to access that.

I also want to raise the issue of dual diagnosis and how people get constantly sent around the houses in that regard. I do not see what is so difficult to understand. Just because somebody might have a diagnosis of autism or an additional need, it does not mean that he or she does not also have an issue or a difficulty in respect of his or her mental health. It seems to be a pass-the-buck exercise. I know of various situations where children have been left waiting in emergency rooms where they wait for CAMHS to come and visit to see what the appropriate method will be or what is the appropriate path for this child. It is totally and utterly unsuitable.

I want to raise an issue that came to my attention only today about a lady who has a child with an additional need that they suspect is ADHD. Briefly, I was told that only a child psychiatrist can formally assess a child with ADHD. Only a child psychiatrist can prescribe a child with medication. The only way to access a child psychiatrist is through CAMHS. This lady's GP, in County Kilkenny, has referred them to CAMHS and received a letter back advising that CAMHS is not accepting referrals at present. I do not know how that is the situation. This person is based in Thomastown. I will take the opportunity afterwards to follow this up directly with the Minister of State-----

Photo of Mary ButlerMary Butler (Waterford, Fianna Fail)
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The Deputy might send me on that letter.

Photo of Kathleen FunchionKathleen Funchion (Carlow-Kilkenny, Sinn Fein)
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-----because I do not see how that is acceptable.

This person is fearful that the fact of her child's intellectual disability will be used as an excuse to reject a referral. That is already this mother's expectation. I do not see how it is acceptable for CAMHS to say it is not taking new referrals.

3:20 pm

Photo of Dessie EllisDessie Ellis (Dublin North West, Sinn Fein)
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Statistics provided to the Oireachtas Joint Committee on Children and Youth Affairs in 2019 showed that one third of young people were struggling with mental health issues on an ongoing basis. My constituency of Dublin North-West is an area that reflects the dysfunction in the provision of mental health services, with a lack of proper resourcing and severe underfunding. Since 2019, when it was clear there was a crisis in youth mental health, there has been very little improvement in the provision of such services for young people. In fact, the situation has become worse for them.

Measures taken during the Covid pandemic, including lockdowns, have impacted greatly on young people. The extended periods of social isolation have taken a toll on their mental health. Such measures have caused a significant rise in anxiety, depression, social ideation and self-harming. The psychological change in adolescence means adolescents are more susceptible to mental disorder than at other times in their lives. Mental health disorders peak during adolescence and young adulthood and are a leading cause of disability in that age group.

This is why early intervention is so important. For that to happen, a number of issues must be resolved. Accessing CAMHS is a big problem. The time taken to do so can vary greatly and often depends on where people live. The kinds of treatments available to children can also vary depending on location. Vulnerable children such as Traveller children or those in care have even greater difficulties accessing CAMHS. These problems are also compounded by staffing issues. Many CAMHS teams cannot hire the staff they need. The problem is particularly acute in hiring for specialist roles, particularly psychologists, occupational therapists and social workers. CAMHS also needs to co-ordinate better with other services. The failure to do so is causing difficulties for children who need to access additional services.

If young people access mental health supports early, they are less likely to continue to experience mental health issues into adulthood. However, mental health services as they stand are failing children and those failures have ongoing consequences. They mean these children may never reach their full potential in life. They might negatively impact on their future employment. We cannot allow these children to become a lost generation. They deserve to be able to lead full and productive lives. The problems with CAMHS must be urgently addressed. Young people in need of mental health services must be able to access all the services they need and do so without delay. If the Government is serious about resolving these problems, why did it vote down my party's Bill on mental health?

Photo of Patricia RyanPatricia Ryan (Kildare South, Sinn Fein)
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I thank Deputy Ward and his team for all the work they have done on this issue. Children's mental health services are in crisis. Instead of addressing the problem head on, the Government has allowed a crisis to become an emergency. In my constituency of Kildare South, 417 people are waiting to access CAMHS, with 27 of them waiting more than a year. This is totally unacceptable.

In the past week alone, I have had parents in my office desperately trying to get help for their child. They have gone everywhere and to everyone but there is no resolution. I mentioned this child to the Minister of State yesterday and I hope she will come back to me on the issue. The child cannot get a suitable school place and has received no respite or safeguarding. His mother has been told it is her job to supervise her child in the home and that if she did so properly, the child's situation would not be happening. That is deplorable. These parents are at their wits' end. CAMHS has failed them and their child in their hour of need. It is the job of CAMHS to be there for this family at their time of need but it has failed miserably to do so.

Children deserve better mental health services. How many reports and recommendations does the Minister of State need to do what is required? She and the Government have had years to implement the 49 recommendations from the Mental Health Commission. Instead, they have sat on their hands. We all know CAMHS does not come under the legislation to which reference was made. Why has the Government not moved on that? Sinn Féin will move on it for the sake of our children. Our Bill will give the Mental Health Commission the vital statutory powers to oversee and assist the HSE in implementing the recommendations and vital clinical reforms that are urgently needed.

How long will the Government stand idly by as our children and their families are left to suffer through a doubling of the waiting lists for first-time appointments? Children who are on the list are waiting a year or more to see someone. These children need to access services now, not in a year's time. It is past time that the Mental Health Commission is given the powers to ensure its recommendations are implemented. Children's mental health services cannot wait and our children cannot wait. I am beyond frustrated at the lack of support for our Bill this week. The Minister of State said that saving a young person's life is highly important. I absolutely agree with her but we must save the parents too.

Photo of Duncan SmithDuncan Smith (Dublin Fingal, Labour)
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It is seven months since the Mental Health Commission published its final report on child and adolescent mental health services. Earlier this week, we heard that the Government does not want to regulate CAMHS now, choosing instead to wait until the summer session of the Dáil to introduce its own Bill for that purpose. We do not yet have sight of that Bill. Those of us involved in health matters have gone through a number of years in which complex health-related legislation has been published late in the summer session and has not really been looked at until well into the autumn. My fear is that the same will happen with the Government's Bill.

The Mental Health Commission's report into CAMHS made 49 recommendations. We know that without their implementation, we will continue to see the multitude of crises that have been on display in CAMHS across the country. We have children being lost to follow-up, a lack of monitoring of psychiatric medicines and unacceptable waiting times for all referrals, including high-risk referrals. The word "crisis" is often overused in this House but it is not an overstatement to say that we are at a crisis point when it comes to youth mental health. In fact, we have passed that crisis and are now into an emergency. The issues in CAMHS countrywide have not only jeopardised the well-being of many of our youth but also have undermined the effectiveness of our mental health service as a whole.

As the Minister of State knows, the statistics are stark. Waiting lists for first-time appointments at CAMHS have skyrocketed by 83%, with certain community healthcare organisations, CHOs, experiencing an alarming threefold increase since the Government assumed office. Even more distressing is the nearly 300% surge in the number of children waiting more than a year for a first-time appointment. This statistic is not only unacceptable but also is deeply concerning. Parents and families have been screaming about all of this. Now they have a sense of hopelessness and despair about the prospect of their child getting a service.

The consequences of inaction from the Government will be severe. Mental health issues among our youth are complex. In the age of social media and in the aftermath of the Covid period, we know those issues are growing faster than we can keep up with. We require prompt intervention and comprehensive support for children, not waiting lists that are trebling while families are left feeling isolated. Every day that passes without an intervention exacerbates and compounds the suffering of our young people who are dealing with mental health issues.

A particular issue in our youth mental health services is the treatment people with autism receive or, more accurately, the lack of treatment they receive. People with autism are finding it especially difficult to access mental health services as the mere fact they have been diagnosed with autism is used as a barrier to access. Many of their mental health issues are diagnosed as outcomes of their autism rather than something separate. This is an absolute scandal and an example of children with autism in this country being treated despicably. I have spent all afternoon discussing with principals from all over the country the lack of consistency in the provision of autism units in schools. This is another example of how children with autism are left behind in this country.

The Mental Health Act 2001 is not compliant with the European Convention on Human Rights or the UN Convention on the Rights of Persons with Disabilities. We are again lagging behind our counterparts worldwide and especially our European neighbours. Currently, 22,000 children per year are being referred under the Mental Health Act to a service, in CAMHS, that is no longer fit for purpose to deal with that number of referrals. The Government knows this, which is why the reform of the Act is part of the programme for Government. While the sand trickles down the hourglass, it is only now that the Government is stating it will bring forward a Bill in the summer. We know that Bill will not go through in the lifetime of the Government. The families know it. They know their children will not be helped and that CAMHS will not be reformed within the timeframe that is needed.

The purpose of Opposition parties is to hold the Government to account on issues such as this.

We have done so over the past four years, most recently this week with Sinn Féin's Private Members' Bill on the regulation of CAMHS. Unfortunately, the Government voted against that.

Our children deserve better. They deserve a mental health system that is responsive, open, accessible and effective. There is no excuse for delaying the fixing of a service that has been described by the chief mental health inspector, Dr. Susan Finnerty, as "creaking at the seams, with increasing risk to children for whom the service is provided".

I will close by referring to the Minister of State’s comments on the use of language, which struck a chord with me. The first lesson I learned relating to this House when I was preparing speeches for my former boss had to do with wording in respect of suicide. As a first-time speech writer, I wrote a speech that used the phrase “to commit”. I was enlightened and educated in what was the first of many lessons I have had while in Leinster House. It was 13 years ago when I was a staffer. It is always worth repeating that there is always someone out there who is ready to hear the lesson and improve his or her own language. As regards this debate, something that we all need to learn is to use sensitive language and the language of understanding and inclusion.

3:30 pm

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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Wise words, Deputy.

Photo of Ruairi Ó MurchúRuairi Ó Murchú (Louth, Sinn Fein)
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It goes without saying that we are disappointed by what happened to Deputy Ward's legislation on the regulation of CAMHS. The Minister of State has heard many Deputies, and will hear many more, refer to the necessity of such regulation. We were not shocked, but I am not sure we are willing to accept the Bill being kicked down the road. That is done to many Bills, but we all accept that CAMHS deals with young people and families that are in the worst of circumstances and, sometimes, in the darkest part of their lives. I do not know how many times the House has discussed early intervention and how we will tackle issues. Sometimes, we end up repeating the exact same speeches. That is a pity.

Something else we do is talk in statistics. Unfortunately, I am going to do a bit of that myself. The most recent figure we have for the number on the CAMHS waiting list in CHO 8, which includes County Louth, is 695, of whom 115 have been waiting more than 52 weeks. Obviously, those are at the more serious end. The figure of 695 is an incredible increase on the 270 that were on the list in July 2020. I wish to put on the record the large amount of work that is done by those in mental health services, particularly child and youth mental health services, while accepting that people experience considerable issues in accessing those services.

A number of Deputies have referred to the silo problem that we constantly discuss, that of disability services and mental health services not crossing over. At a recent committee meeting, Mr. Bernard Gloster and some of his team spoke about the autism protocol that is currently in play. While we all welcome that, Mr. Adam Harris met the autism committee earlier and spoke about the significant issues that still exist in the real world, in that CAMHS will at times refuse those with a diagnosis of autism. Having the protocol is all well and good, but we need to get down to brass tacks and deliver for people. There are pilot schemes under the no wrong door policy and so on, but even if the autism protocol were mentioned in rules and regulations, it is not much good to people if it is not implemented.

I had a case that I had dealt with previously but I had never met the child. The mother brought the child to me to humanise their circumstances and, in fairness, she got across her frustration with the situation. The kid has a diagnosis of autism but is also dealing with severe anxiety. There has been interaction and CAMHS has agreed to a consultation, so I hope I will not need to revert to the Minister of State on the case. We are seeing the autism protocol in operation, but I am still hearing of cases where it is not in effect. I will chase them up.

Where do we stop and start in this regard? I do not know how many interactions we have had to deal with food disorders, just to pick one issue, and to ensure that sufficient resources are in play, services do not depend on where someone lives, places are free and we can deliver for children and their parents at an early stage. We all realise that many cases, if addressed at a very early stage, can probably be dealt with more simply and the interventions are much less costly. It is just a matter of us getting to that point. I accept that there is a great deal to do in terms of workforce planning, having all of the necessary people in position in our mental health services and dealing with the impact of people not wanting to work in what is a difficult sector. If we cannot deliver the perfect system straight away, though, then we must see what we can deliver in the short term while working towards something that is far more beneficial.

Five minutes, ten minutes or 15 minutes, we could speak on this for hours. What we need to see is this issue being tackled and a solution being provided that delivers for these children, young adults and families. In light of what Deputy Ward said about people ageing out and what we all say about adult services, we cannot have people falling off the edge of a cliff.

Photo of Róisín ShortallRóisín Shortall (Dublin North West, Social Democrats)
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I welcome these statements on youth mental health and the renewed focus on the need to improve services in that area, but after Tuesday's debate, I am still unclear about the Government’s position on CAMHS regulation. The Minister still has not committed to acting on the Inspector of Mental Health Services' primary recommendation out of 49 recommendations in total that CAMHS should be regulated by the Mental Health Commission. This is a measure the Government could take that would be transformative. How long will the Government go on listening to excuses and reasons for things not being done by the HSE? How long will the Government continue with a situation where the HSE is effectively regulating itself in an area that has been massively problematic for years? There is a strong view, one that I put to the Government on Tuesday, that it could bring CAMHS under the remit of the Mental Health Commission by using a statutory instrument under the existing legislation. I appeal to the Minister of State to check this view out legally. At the very least, it could be done through a minor amendment to the Mental Health Act, as was proposed on Tuesday. This would be a major contribution for her to make to child and youth mental health services. It would put the responsibility on the experts to oversee CAMHS, call out problems when they see them and start the implementation of important recommendations to bring the model to the point where it is fit for purpose. That is certainly not the case at the moment.

The Government's vague commitment to regulate via the long-promised mental health Bill just does not cut it. The Minister of State knows as well as I do that an election is coming, casting major doubts over the Government’s supposed commitment to reforming the 2001 Act within its lifetime. After all, neither the Department nor the HSE is known for its ability to stick to timelines. For example, completion of the first phase of the north Kerry CAMHS look-back is well overdue. That was supposed to be completed by the end of 2023. This ongoing delay is extremely distressing for families engaged in the process, especially as many of the cases in the so-called look-back are actually current cases.

Can the Minister please provide an update on this?

The discrimination of certain patients, outlined in a recent survey by Families for Reform of CAMHS, is also deeply concerning. According to the survey, 59% of their members have an autistic child. Of those, 85% said that an autism diagnosis negatively impacted the service and support they received from CAMHS. Some members said that services were withdrawn once an autism diagnosis was disclosed, and that anxiety and depression was explained away as just being part of autism spectrum disorder, ASD. The survey also found cases of autistic children presenting with suicidal ideation being turned away from CAMHS. One parent was told that their child’s suicidal thoughts and plans were "not really mental health issues and just their autism".

Children with intellectual disabilities are also being severely mistreated. I pick those words carefully. The survey found that 81% of their members who have children with intellectual disabilities have absolutely no access to mental health services. Under the CAMHS-ID model of service, children with intellectual disabilities are no longer accepted into CAMHS. Instead, they are to be seen by specialist CAMHS-ID teams. However, there are only four or five partial teams in the country, when there should be 16 full teams. This means that in some parts of the country, children with intellectual disabilities are being discharged from CAMHS without any team to care for them. That is completely indefensible.

If this inequality in service provision is to be addressed, children’s health services must be integrated, and the needs of each child must be put at the centre of any package of care. That is a fairly modest expectation of a modern health service, yet the sad reality is that we are nowhere near providing that.

Another major deficiency in youth mental health services is the lack of early intervention and prevention services. CAMHS may be the headline grabber, and there is no doubt that it is in need of major reform, but fixing it is not a panacea for youth mental health services. According to the Mental Health Commission, only 2% of young people experiencing mental health difficulties require the specialist support of CAMHS. However, due to the deficit in multidisciplinary teams and community-based services, such as talk therapy, more and more children are being pushed into CAMHS. This, in turn, is pushing more and more extremely vulnerable children into adult services which are entirely inappropriate. That is why, alongside reform of CAMHS, there needs to be a major scaling up of early intervention services. Research has shown that 75% of mental health conditions are established before a person reaches the age of 25. This is why early and targeted intervention is essential.

However, the reality is that community therapies are at breaking point. Last year, there was almost 16,000 children on a waiting list for community psychology. Almost 6,000 of those were waiting more than a year. It is very hard to contemplate the impact of those kinds of waiting times. I am putting it to the Minister of State to do one thing and to do it now, that is, bring CAMHS under the remit of the Mental Health Commission. That would make a huge difference and would be transformative. She can do it now. I ask her to please act.

3:40 pm

Photo of Emer HigginsEmer Higgins (Dublin Mid West, Fine Gael)
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Some 4,400 young individuals are waiting for support from CAMHS. We are faced with a really stark reminder of the urgency and the immense responsibility we have as a Government in addressing youth mental health issues across Ireland because this number is not just a statistic. It represents real lives in need of immediate attention and the urgent need for reform and for better resourcing across our youth mental health services. We all know someone directly or indirectly affected by this in our local town or village. I see it all the time in my constituency in places like Clondalkin, Lucan, Rathcoole, Newcastle, Saggart, Brittas and Citywest, where parents are struggling to gain access to timely assessments and treatments for their children and teenagers experiencing mental health issues. This, in turn, is causing significant undue stress and worry on the children themselves, their parents and on their wider family. CAMHS, a service whose purpose is to serve as a place of comfort and support for our young people in need, unfortunately now finds itself at a crossroads. While the dedication of the staff working tirelessly within CAMHS is undeniable, the reality we face is one of overstretched resources and ever-growing needs in society. The narrative has become one of frustration among parents and families who, despite calling for action, cannot access timely care for their child or teenage. The knock-on effect is spiralling. The recent independent report by the Mental Heath Commission on CAMHS identified key areas of concern, including inadequate clinical governance; insufficient risk management and a lack of proper oversight and staffing. All of this contributes to a compromised level of care that CAMHS can offer. Echoing these concerns the advocacy group Families for Reform of CAMHS, which represents more than 960 families, has provided extensive testimonials and given voice to the systemic failures that they have experienced within CAMHS. Families for Reform of CAMHS has captured the barriers, anxiety and the fear faced by parents. They tell us parents are afraid to say their child has autism in case of repercussions. Some 85% of respondents said they experienced negative repercussions upon disclosing their child’s condition. Some families have been informally advised against disclosing an autism diagnosis to avoid being excluded from receiving care. That is in 2024 and it is a serious disconnect in our heath service where the very act of seeking help can lead to the exclusion from essential services. That is wrong. I know the Minister of State is doing so much to change that.

Articles published by the Journal of Social Psychiatry and Psychiatric Epidemiology highlight the importance of early mental health interventions. Furthermore, research in the Irish Journal of Medical Science sheds light on another pressing issue, namely the well-being of our psychiatrists and our mental health professionals themselves. They want to help. They want to do a good job for these children. That is what they have trained to do. That is what they have chosen their career to do but they are unable to do so. Their resources are overstretched and this is causing issues around retention and motivation in the system. If our mental health system was a patient, we would have diagnosed it with burnout by now. I welcome the strides being made under the leadership of the Minister of State, including the establishment of the national office for child and youth mental health and the commitment by her and her team to putting in place the no wrong door policy. Those are monumental steps towards ensuring that every young person receives the care he or she needs without unnecessary obstacles or delay.

This year, the Government allocated substantial funding towards enhancing our mental health services. An additional €10 million was secured in January specifically aimed at new developments in youth mental health. CAMHS receives €137 million in dedicated funding annually with an additional €108 million in funding provided to community-based mental health organisations and NGOs. This investment is the cornerstone of the Government’s broader commitment illustrated by the €1.3 billion allocated to the mental health budget since the inception of the Government. That marks a significant increase and reflects the high priority the Government places on mental health. The commitment is underpinned by the collaborative efforts of healthcare professionals and NGOs such as Jigsaw and Pieta and the invaluable insights of families who navigate these challenges daily. As we move forward, this needs to remain top of the Government’s agenda. I acknowledge the Minister of State is doing all she can to make sure it stays there because timely access to mental health service is not a luxury; it is a lifeline and one that could change the trajectory of a young person’s life and that is what we need to always remember.

Photo of Réada CroninRéada Cronin (Kildare North, Sinn Fein)
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Every time I am contacted by a constituent on a mental health issue, especially if it is their child, who is a minor, or young adult son or daughter, I feel their helplessness, their disbelief and pain, and, all too often, their panic because I know that by the time they come to me, they have been firing handballs against the haystack that is CAMHS as it operated by the Department of Health and the HSE.

It is my turn to start firing balls at the same haystack - the endless waiting lists, the lack of services and the overworked practitioners. When, in desperation, they reach an accident and emergency department, too often too little time is spent with them. When they can be treated, it is by a doctor who all too often knows little about how to deal with someone in a mental health crisis. That doctor just happened to be rostered for better or worse. It is my understanding that this is what happened in Kerry. Too often, somebody is filling a mental health role on a shift, although their sole experience of psychiatry might be a few weeks' on rotation. They are left to fill an administrative gap rather than fulfil a medical role, often without proper supervision. That is completely unacceptable, but we accept it. This is no way to treat people who are in crisis in body, mind and soul. It is no way to treat young doctors either, giving them responsibility for dealing with people in crisis without adequate training, expertise, support and supervision.

Despite all of this, there are wonderful people working in CAMHS who we need to support. They are people who are making all the difference to young lives, day in and day out, week in and week out. I met a family last weekend who feel they owe their child's life to the workers in CAMHS. Their outstanding work is one of the reasons we need reform and regulation of mental health services. We need these urgently, as outlined in the Private Members' Bill we brought forward on Tuesday. That Bill is down to the great work of my comrade, an Teachta Ward. The Government put a pause on it, and has done itself the luxury of pushing it down the road to a time when the Government that succeeds it will have to deal with the matter. I hope Deputy Ward will be the Minister dealing with it. Our Bill would have been of great use to children who have been left to fall through the cracks, especially those with a dual diagnosis. A mother emailed all TDs yesterday to tell us about her child of 14 who has not been to school for seven years. CAMHS will not see him because he has ASD with a pathological demand avoidance, PDA, profile. How is this acceptable in a supposed, albeit unfinished, republic? Where is that child's right to education and to mental health services? The Bill we brought forward would help children like that. It was designed for children like that.

Our Bill comes - and is needed - after damning reviews of CAMHS by the Mental Health Commission and in the Maskey report. As the Minister of State knows, the Mental Health Commission made 49 recommendations for the reform of CAMHS and to improve care services for children. The first of these recommendations was to regulate CAMHS under the Mental Health Act, which would give statutory powers to the Commission to oversee the implementation of their recommendations. This is what we proposed in our Bill, which the Government has pushed down the road. In north Kildare, the waiting list in this area rose from 131 in 2020 to 417 in August of last year. That is an increase of 286. It is the same Government neglect of children's needs that we see in respect of the lack of school places for children who are left struggling at home with inadequate home tuition.

The Government parties have had 100 years in office between them, and look where we are. It is really time for change - a change for the better for our children.

3:50 pm

Photo of Richard Boyd BarrettRichard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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All I can say is that the parents who come to me who are having issues accessing CAMHS for their children are, in many cases, are going through a nightmare. Even now, after all of the stories I have been told, I cannot get my head around the shambles and the mess the system seems to be in. I do not claim to be an expert, because I think the people who truly are experts are the parents who are struggling to access diagnoses and services for their children and who are getting pushed from pillar to post in a system that seems to be failing chronically.

I will relay some of the latest stuff in this regard. It was probably referred to earlier in the debate. I am sure the Minister of State is familiar with the Families for Reform of CAMHS. What that group is arguing, as the Minister of State knows, is that we need reform of CAMHS and we need the Mental Health Commission to have reviews of CAMHS every year. I certainly support this in order that there will be some sort of review and monitoring of the ability of CAMHS to deliver. In my limited understanding of this, I am of the view that goes further. What I think is lacking are a holistic view and a holistic service. From the tales of woe I am being told by parents, I understand that there is a situation whereby if you have autism, that becomes an excuse for you to be turned away from CAMHS and sent towards the child and disability network teams. However, the child and disability network teams do not have the resources or the capacity to deal with many of the people sent to them. The idea that there is a strict demarcation line between mental health, the CAMHS remit and autism, which is the child and disability network team, is just not the case. In reality, those with autism are substantially more likely to develop mental issues precisely because the services are not available or, in general, because having autism makes them more susceptible to mental health issues. The child and disability network teams do not have the staffing required, and they do not have psychiatrists. Psychiatrists only deal with mental health when the people sent to the child and disability network teams have a dual diagnosis of autism and mental health issues. There is another subdivision for children with intellectual disabilities who are sent to the CAMHS-ID teams. According to A Vision for Change, there were supposed to be 16 of these teams. Families for Reform of CAMHS states that there are only a handful. In many areas, they do not exist. A person cannot be referred to the teams that do exist if he or she lives in a particular area. This is a mess. It seems to be a mess created using different bits of services that are unable to cope because they do not have the staff. We are pushing the problem around. The net result is that people are just not getting the services they need. That is what seems to be happening. There is a real struggle and, in some cases, dangerous situations for parents. These children really need the services. Parents are not able to cope, and we can end up with quite dangerous situations. It is very bad for the children and for the families.

Another aspect I have come across in our area is that it seems the child and disability network teams are unable to recruit because the employment conditions and pay of the people who work in those teams are not uniform across all of them. In our area, CHO 6, they are section 39 workers. It is much harder to attract people to work for these services, as against people who are treated as public sector workers with the HSE, for example. This is bonkers. The ability to recruit to absolutely critical services is fragmented and it is easier to recruit them in some areas than others because pay and conditions are different. That does not make any sense. We need a holistic view of services, and not services siloed in this way with imaginary demarcation lines. We need decent and uniform pay and conditions for the people who work in these services if we are going to recruit the professionals we need to provide the services to all who need them.

4:00 pm

Photo of Paul McAuliffePaul McAuliffe (Dublin North West, Fianna Fail)
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I acknowledge the motivation of Deputy Ward in bringing forward the Bill earlier in the week. I commend the Minister of State, Deputy Butler, on making this time available to discuss this issue. At the core of both of those things is a recognition that we know the people coming to our clinics need a better service. That is where we have to start. If we get into the game of second-guessing people's motivation, we will not solve anything for those people. When Deputy Cronin said the Government has had 100 years to solve this problem, it is a great line those in Opposition always have at the end of their statements. Let us remember, however, that people with mental health issues 100 years ago were treated in an appalling and abysmal way. To suggest that in 100 years nothing has changed is a glaring example of the hypocrisy of that statement, which I hear over and over again in this House.

That is not to say that mental health services are appropriate. I refer in particular to CAMHS. Equally, I do not judge the motivation of Deputy Ward in bringing forward a Bill to regulate CAMHS. However, the idea that simply regulating CAMHS with one or two amendments to the Mental Health (Amendment) Bill 2023 would somehow solve our recruitment crisis and all the waiting list issues is preposterous. Nobody in the House would say that would happen. The idea that the Government deferring it for a number of months would somehow solve the waiting list crisis is preposterous too. We cannot and should not pretend to people who really need these services. What we are not pretending about is the reform of the Mental Health Act. The work the Minister of State, Deputy Butler, is doing on that is fundamental. It is being done with advocates within mental health. I hope that when the new mental health Bill comes before this House, those in Opposition support the new legislation and the work the Minister of State has done. It will not be long before that decision has to be made.

With regard to CAMHS, I attended this morning's meeting of the Committee of Public Accounts at which we discussed Tusla, where staffing is a real challenge. It is a real challenge in the Garda and in education, mental health services and our health service. All of that results from the benefits of a prosperous economy. We have a prosperous economy, and that provides the resources we can invest in these services. We have made a significant increase in investments. In the last three years, the Minister of State has secured additional resources on an unprecedented level for mental health. That all comes from the economy that supports it. However, it also brings with it the challenge that we do not have enough qualified staff available to be able take up all these positions. We have to find ways to better use the resources we have.

I do not disagree with much of what Deputy Boyd Barrett said. We have a lot of siloed thinking in the system. I often cannot explain to somebody sitting across the table from me why a CDNT will not allow an intervention because it is waiting on an appointment with CAMHS. There need to be much more cross-silo interventions. I hope the new mental health Bill will result in that. In the same way we talk about mental health and addiction, we need to have more of a wraparound service for individuals.

In particular, there is much support in communities that could be available too. The Minister of State visited the Finglas Counselling Service, which is a fantastic service that has been operating in the community for over 30 years. It now has in place a service level agreement, SLA, with the HSE, with more than €100,000 of funding for counselling services. Importantly, it is a counselling service for adults. It has already seen the establishment of the service in a new building, which the council provided. It has the confidence that it has funding now to look after adults, and what has it started to do? It has already started to talk to representatives from the youth centre next door to see whether there is a signposting service they can do. I have no doubt that when it has its governance and it medical model right, its representatives will come back to the HSE and say that perhaps they can help in the space of children too.

Children's mental health services are an entirely different operation from adult mental health services. They bring with them a huge amount of additional responsibility. We will not be able to rely on the community response for child and adult mental health services in the way the HSE relies on community services for adult mental health services. That is because child mental health is so complex for all the reasons pointed out by Deputy Boyd Barrett. Therefore, I do not second-guess anyone's motivation for coming into this House to talk about the issue of mental health among children. Everybody here has the same people attending their clinics and every single one of us wants to make it better.

We also have to think about what is changing in Irish society. There has been a 33% increase in referrals. There is something happening there. Why was there a 33% increase between 2000 and 2021? I spoke about this at the Committee of Public Accounts this morning. Yesterday, I spoke with representatives from St John's Education Centre, which assists people who are struggling in schools or who are early school leavers or school refusals. There is something going on in our schools at the moment. There is something happening as a result of lockdown and many other issues, including the emergence of social media. The 33% increase is in some ways not surprising because of the additional challenges that are there.

We need to keep going with what the Government is doing. I acknowledge that the additional funding in the previous two budgets in particular has been substantial. I reject those within Departments who suggested that the Minister of State, Deputy Butler, was looking for money she could not spend. I can tell them that she will be able to spend the money if she can get it. We have to continue to do that, however. We cannot rest on our laurels. Far more needs to be done. We have not seen the full extent of what will come at us. We need to look at organisations, such as youth services, which are perhaps engaging with young people in a different way and in a different space. It is not a clinical space, but perhaps the space a youth centre provides gives us an opportunity to start a conversation around mental health. I would make a differentiation between mental fitness and mental resilience and mental health and mental illness, because they are very different things. Often, when we talk about the issues in schools and the challenges for young people and so on, it is all at that end of the spectrum around mental fitness and mental resilience. Mental health and mental illness is an entirely different thing. It involves a medical intervention. Like any other service such as those dealing with cancer or stroke, we need to have the interventions in place.

I heard during the week the announcement regarding the improvements to women's mental health we have seen over the last number of years. I hope that over the coming years, TDs in this House are able to stand up and talk about the same improvements in mental health services that come out of the Mental Health Act and from additional funding. We are not there yet, but we are going in the right direction.

Photo of Pat BuckleyPat Buckley (Cork East, Sinn Fein)
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I thank the Minister of State for being here. In fairness, it is not easy. I listened to most speakers today and to the Minister of State's opening statement, and it is true. People still hear it said that it is impossible to commit suicide in Ireland. It is actually impossible; a person cannot commit suicide in Ireland, since it was decriminalised in 1993.

I want to put on the record that I always said I would work with the Minister of State. We have worked on other various projects. I attended the launch of the Minister of State's pilot project in Cork. It is my opinion that we missed a massive opportunity last night because by regulating any service, we make somebody accountable and responsible for their mistakes.

I will go back to when we had the Sub-Committee on Mental Health in the previous Dáil. I will tell the Minister of State how bad it is. It is not the people or the front-line workers. It is the issue with top management. I remember speaking to a child psychologist who was appearing as a witness before the committee. The first question I asked him was about whether he was threatened by senior management for coming to the committee meeting on that day. His response was "Yes". That is a shocking indictment of how something is going to be run. This man was a child psychologist. The Minister of State can go back and check the record on that. A very interesting article on thejournal.ie by Órla Ryan, entitled "Falling Through the Cracks", actually shows how dysfunctional the system we have is at the moment. However, it also points out how we can improve it.

4:10 pm

Photo of Michael LowryMichael Lowry (Tipperary, Independent)
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It came as no surprise to hear on Tuesday night that new laws to overhaul the country's existing mental health legislation would be brought forward before the summer recess. Considering the legislation has been in draft form since 2016 and has taken eight long years to reach this stage, it certainly cannot be deemed to have been rushed. As I mention that legislation, I thank the Minister of State who I know has a personal, as well as a ministerial, interest in this area. I compliment her on her commitment and, above all, on reaching out to and consulting all the various groups, particularly the stakeholders in this sector. That is very important work because the legislation will reflect everyone's views and, I hope, achieve consensus on the way forward.

With 35 sections, the Bill is comprehensive. Last Tuesday night's debate echoed the home truths spoken by the Regional Group in January 2023 when we requested a suspension of Dáil business and called on the Minister for Health to address the House to outline plans to protect children and ensure proper access to child and adolescent mental health services. The 35 sections in the Bill will focus on the regulation of mental health services and provide a different and more effective way of responding to needs. I have no doubt it will be one of the most scrutinised Bills to come before the House in the term of this Government. There will be no room for error or shortcomings. Nothing less than a gold standard service will be accepted because people have witnessed the damage and scars that a less than effective can cause. We are all too well aware that trying to fight against the current system is sometimes next to impossible.

The new mental health legislation will have to tick all the boxes. It will have to identify and make provision for all eventualities. We will have to reassure people that the needs of children and young people will be met by qualified medical professionals who specialise in child and adolescent mental health. In addition, it will have to provide a cast-iron guarantee that the needs of these children will be met in a timely and efficient manner. Years of failure to deliver and meet critical need have made people very wise. They know what is required as they have identified what is missing and not working. They know this will be their only opportunity to ensure a proper and accessible service is put in place. Members of the public, particularly those who suffer with mental health problems and their families, are fully aware that the mental health of their children, grandchildren and young people the length and breadth of the country need this service to work. It will be their mission, and I presume the mission of all Members of this House, to make absolutely sure that this will be the end result.

Having listened to the distressing reports from parents and mentors of depressed and anxious children forced to wait for a mental health appointment, in some cases for more than a year, the content of this Bill must address and provide for a service that works in a timely manner. Delays in accessing proper professional help will not be acceptable. We have learned that delays are dangerous. They have the potential to impact on the lives of children into their teenage years and eventually into adulthood. Failure to access timely health can have catastrophic consequences. The World Health Organization determines that childhood and adolescence are critical stages of life for mental health and well-being. This is the stage when young people develop a wide-variety of life skills that will form the foundation for the rest of their lives. It is difficult for us as adults to see today's world through the eyes of a child or young teenager. Given that we ourselves struggle at times to comprehend what is going on, how must it appear to young and innocent minds? It can often be hard for adults to recognise that a child needs support with mental health issues, just as it can be difficult for the child to verbalise the challenges they are facing. In cases like this, it can be because the child does not understand what is happening around them. Unintentionally, this lack of comprehension can result in what starts as a manageable issue spiralling out of control. By the time this is identified by parents or teachers, it has magnified and become a deep-rooted problem that only a trained professional can help.

Children today are overly exposed to the harsh realities of the world. Every day, television news blasts images of war and suffering from around the globe. News bulletins contain violence and hatred and this fills our homes every day. Films and TV programmes add another layer. In their quest to be the best, they touch on every imaginable subject, often in the most graphic way. These programmes are screened in the early evening, ironically not long after the news programmes. They tackle issues that children do not understand and do not need to be exposed to, yet they cannot be avoided in the majority of homes. Young children do not have an adult understanding of what is happening. They cannot differentiate between reality and fiction. Many of them do not understand that these things are not happening nearby in their local communities. They see children like themselves scrambling for food, standing beside dead bodies or running from explosions. The world as it is portrayed to them on TV or online is a terrifying place. These horrors prey on young people's minds and often they cannot understand how it makes them feel. In most cases, they do not verbalise how they feel.

4:20 pm

Photo of Mary ButlerMary Butler (Waterford, Fianna Fail)
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I made most of my comments in the opening piece. I would like to begin by thanking everyone who has been here today. I know for a fact that were Deputy Verona Murphy not in the Chair, she would have been sitting over there and would have stood up and spoken as well. It is no surprise to me who spoke here today because everybody who did so constantly raises issues about mental health with me. It is probably in sharp contrast to what we saw last Tuesday week, when there was a big affray on the Order of Business when everybody sought time to speak about mental health. I think, however, that Thursday evenings softens it a lot as many Members return to their constituencies. I am not one bit surprised by those who spoke here today because they constantly raise mental health issues week in and week out. I will always welcome the opportunity to come to the Chamber and discuss mental health. We cannot talk enough about it. There is no health without mental health.

The other thing I want to put on the record, because I was struck by how Deputy Boyd Barrett spoke about a more holistic approach and the different things we can do, is that while only 2% of children may need the support of CAMHS, there are another 98% of children out there. I am working really hard with the Minister, Deputy Stephen Donnelly, on what Deputy Lowry raised with regard to the challenges of media, bullying, online bullying and all of that. It has a huge impact.

This morning, in between being here for Oral Questions and then coming back to the House, I spoke at the family resource centres' national conference. I want to commend family resource centres the length and breadth of the country, which do phenomenal work with families and children who have difficulties.

As it is Eating Disorders Awareness Week, I wish to acknowledge that more than €8 million has been allocated to eating disorders in recent years and we now have more than 100 whole-time equivalents, that is, 100 people working in eating disorder teams and they have been recruited. Funding has enabled the set-up of 11 teams to date. Sometimes, people ask me what I have achieved as a Minister of State. When I took office almost four years ago we had one eating disorder team and we now have 11. We have six adult and five CAMHS eating disorder teams at various stages of development. Unfortunately, recruitment of a multidisciplinary team can take up to between 12 and 18 months but we are making a lot of progress. I was going through this yesterday with the team and I thank them for all the support they give me, the team in the Department as well as those in the HSE. We were looking at the additional €10 million I secured recently and how it could be spent. I want to give every Deputy here an insight into what I am looking at. All the spend will be from a geographical point of view. It is really important that we look at each area, see exactly where the gaps are and put staff into the areas and not always just go into the larger areas of population. I think that is really important.

I thank everyone for being here. I have listened and taken note of everything people have said. With regard to the Bill that came before the House on Tuesday night, I set out clearly the reasons, including the legal advice I had received, for why it could not work. If it was only a matter of two amendments to the 2001 Bill it would have been changed a long time ago but the forthcoming mental health Bill not only has 35 sections related to compliance for CAMHS, it has another 130 sections as well, so it is a huge piece of work. I have been briefed on it week by week for a long time. It will take a while to roll through the Dáil, the Seanad and the Oireachtas committee.

I agree with Deputy Buckley with regard to the mental health committee. I wrote to the Ceann Comhairle before it was disbanded asking for it to be retained as I thought it was really important as well.

I thank everyone for their time.

Cuireadh an Dáil ar fionraí ar 5.06 p.m. agus cuireadh tús leis arís ar 5.08 p.m.

Sitting suspended at 5.06 p.m. and resumed at 5.08 p.m.