Ruairí Ó Murchú (Louth, Sinn Fein)
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I thank the Minister of State, Deputy Butler, for being present to respond to this issue. This is World Autism Awareness Day. I want to specifically discuss autistic children who require supports provided by mental health services, including CAMHS. The Minister of State was in the Chamber when I raised with the Taoiseach the case of Senan Maguire, a 13-year-old autistic boy from Grange on the Cooley Peninsula. David, Tina and the wider family have all gone through huge stress due to the lack of support. We must try to bridge the gap in some way and, in the long term, put a proper system in place.

This case was also raised in the Sunday Independent the week before last. Senan is 13 years old now. When he was six, he lost his four-year old sister, Sophia, who had Down's syndrome. She was his best friend. He witnessed the attempts by paramedics to resuscitate her. His situation became a lot worse after that, in the sense of issues arising due to him experiencing increased anger, including within the school setting. He is currently out of school. That is something that must be addressed. We all know there is a wider issue relating to school places. Experts have stated that Senan is suffering from post-traumatic syndrome disorder, PTSD.

Unfortunately, the family have gone through a ping-pong scenario, which many other people have experienced, whereby issues are bounced between the CDNT, CAMHS and CAMHS-ID, which deals with intellectual disability. It is always a case of no room at the inn. I tabled two parliamentary questions on the matter - one on 14 February, the reply to which I will read into the record:

Senan Maguire is not currently on the waiting list for Child and Adolescent Mental Health Services (CAMHS) in Louth as he does not meet the assessment criteria for this team. If his needs have changed since previous referral to CAMHS Louth he can be referred again by his GP.

A CAMHS-ID Consultant has been recruited on a temporary contract. The consultant is not yet in a position to take on a caseload as a multidisciplinary team are not yet in place. Louth Meath Mental Health services are actively working to recruit the additional team members required to complete the multidisciplinary team (MDT) through the Pay & Number Strategy (PNS).

That is a frightening term because we all associate it with the suppression of posts.

Once the CAMHS-ID MDT is in place the GPs and teams in Louth and Meath will be notified and a referral can be made for Senan.

I was informed on 5 March that: "Senan is not currently on the waiting list for Child and Adolescent Mental Health Services (CAMHS) in Louth." I was again told that "he can be referred again by his GP" and that "A CAMHS-ID Consultant has been recruited ... and services are currently being set up." There is again no timeline. We need this to happen as soon as possible.

We are talking about a situation that has been going on for years. It was raised by Gerry Adams when he was a TD, long before my time. I have buckets of correspondence and I am aware the family has an even greater amount of it. In 2021, when they were dealing with the CDNT, they were promised speech and language therapy, which did not happen. I understand they are getting respite, which is necessary in order that they can focus on other family members. There is a general belief and the family's doctor insists that the child is showing signs of ADHD. In some respects, I would need to have four Ministers to respond in full to the issue I raise, but I ask the Minister of State, Deputy Butler, to deal with the issues that relate to her area of responsibility.

David Maxwell (Cavan-Monaghan, Fine Gael)
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There is a difficulty in mentioning children's names. When the Deputy comes back in-----

Ruairí Ó Murchú (Louth, Sinn Fein)
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I understand. This is in the public domain. It was put there by the family itself.

David Maxwell (Cavan-Monaghan, Fine Gael)
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I just have to point that out.

Ruairí Ó Murchú (Louth, Sinn Fein)
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That is fair enough.

Mary Butler (Waterford, Fianna Fail)
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I thank Deputy Ó Murchú very much for raising this important issue to specifically discuss the care of children with autism who also have mental health issues. In addition, I acknowledge the Deputy's constant advocacy in this area. We have had many exchanges and discussions on trying to provide services. I acknowledge the case of the young person he mentions, whom he also mentioned last week in the Dáil.

As the Deputy is aware, our child and adolescent mental health services are for those aged up to 18 years and who have a moderate-to-severe mental health difficulty. Access to CAMHS is on the basis of prioritised clinical assessment. All referrals to CAMHS are assessed by a multidisciplinary team. Approximately 2% of children and young people require support from this specialist service, with more than 90% of the mental health needs of younger people being successfully treated in a primary care setting.

I acknowledge that there are children and adolescents with complex care issues who may present, for example, with a moderate-to-severe mental health difficulty in addition to presentations such as an intellectual disability or autism. While the needs of children with autism are often best met by HSE primary care and children's disability network teams - the CDNTs - where a child or adolescent presents with a moderate-to-severe mental health difficulty, regardless of whether the child also has autism, it is the role of CAMHS to provide appropriate multidisciplinary assessment and treatment for the mental health difficulty.

In plain language, a young person who receives support from CAMHS normally has a primary mental health diagnosis. Then, there can be a secondary diagnosis for autism or other condition. I agree with the Deputy that there is no doubt it is a challenging area for many families of children who have more than one diagnosis. Sometimes, they might be refused entry to one service while they are on a waiting list for another.

On Monday of this week, I visited three different CAMHS teams in the south of the country as part of a process whereby I am currently visiting CAMHS teams. It is interesting to hear that the presentations have changed. Almost 55% of all presentations are linked to ADHD, but a big percentage of presentations are also linked to autism. Prior to this, there was a lot of depression, anxiety, self-harm and suicidal ideation, but there has been a definite swing towards ADHD and autism. It is important that we prioritise the area more.

When information indicates that there is more than one HSE service that could best meet the needs of the child or adolescent, consultation should take place to determine which is the most appropriate service or whether a joint approach to assessment and intervention is indicated. In order to ensure a person-centred pathway to meet the needs of children with a complex disability and their families, the HSE and Tusla have a joint working protocol to promote best outcomes for children known to either one or both agencies. There is strong collaboration to ensure the needs of these young people are met.

Lots of parents come to me as well with the same situation. They feel their child probably does not sit in either service but they need the support of both. That is where it is becoming problematic. It is an area we are focusing on because we need to. When CAMHS teams were set up originally, autism was not as significant an issue as it is now. A Minister of State, I will put a strong focus on that to support those families because all they want is a pathway. I acknowledge that today is World Autism Awareness Day.

Ruairí Ó Murchú (Louth, Sinn Fein)
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We need an absolute focus on this issue. We have all seen the silo operations. On the particular issue around Senan, we need the multidisciplinary team to be set up as soon as possible. Will the Minister of State respond with a timeline for that? I hope the pay and numbers strategy will not negatively affect the delivery of it as this would be unacceptable. We are talking about a family who has been failed over many years.

The other idea we need to work that people always talk about is that of there being no wrong door and having a one-stop shop. In the Scottish equivalent of CAMHS, all the families go through one place and the services are provided as they are best suited. We need an assessment of the entire need. Something has been done on the CDNTs. In October, I think, there was a workforce review and according to that, 530 positions are vacant in the CDNTs. With how the CDNTs are set up, to deliver assessments and therapies will require many more than 530 additional staff. I have raised school-based therapies with the Minister of State previously.

We have heard about the autism protocol as a means by which there would be no ping pong between the CDNT or primary care and CAMHS. We need to ensure that happens. It also need to be ensured that all the teams are in place because a family cannot be failed because it fits in a certain box but the team is not in place. That is not forgivable in any way, shape or form.

I will revisit this issue. Will the Minister of State outline a delivery time for the multidisciplinary team so we can at least get that under way? Will she also talk to the Minister for Education about the current issues in schools?

Mary Butler (Waterford, Fianna Fail)
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I am determined to make further progress through the national office for child and youth mental health in the HSE, which as developed a new youth mental health action plan, published in February. This three-year plan for comprehensive reform across all youth mental health services sets out a roadmap to ensure all children and families have the pathway we have discussed. The new action plan aims to enhance integrated care across youth services, including supporting children and young people who have co-existing neurodevelopmental and mental health needs, which is the area we have been talking about.

I checked out the mental health with intellectual disability, ID, team last week after the Deputy raised it in the Dáil. Mental health ID teams are a little different from CAMHS. They are multidisciplinary and might have nine to 12 positions. Across the board, mental health and ID teams are led by consultant psychiatrists who can deal with psychiatry and intellectual disability and it only takes four members of staff across the team. My understanding is that the consultant is in place and the auxiliary staff are being recruited at the moment. However, I understand the urgency of this area. What I have tried to do in the past five years with the 44% increase in all the various budgets is to build incrementally. There are two new mental health ID teams this year, along with two eating disorder teams and four ADHD teams for adults. They are being built incrementally. The pay and numbers strategy will not be an issue because these posts are ring-fenced.