Jillian van Turnhout (Independent) | Oireachtas source

I welcome the Minister of State. The Royal College of Surgeons in Ireland produced a report on the mental health of young people in Ireland. It found that by the age of 13 years, one in three young people in Ireland is likely to have experienced some type of mental disorder; by the age of 24 years, that rate will have increased to one in two. Significant numbers of young people are deliberating harming themselves and by the age of 24 years, up to one in five young people will have experienced suicidal ideation. The experience of mental ill health during adolescence is a risk factor for future mental ill health and substance misuse in young adulthood.

This gives an idea of the scope of the issue we are discussing today which is children's mental health and the need for the services to be developed. As the evidence clearly shows, and I can speak from my experience in this area, when there is a deterioration in mental health in those adolescent years, how that is dealt with frames the person's health for life. For me it is even more urgent that we ensure that we have appropriate and timely mental health services for our children and our young people.

I called for this debate on several occasions and the latest occasion was following the results of the national review panel report chaired by Dr. Helen Buckley. Those findings were produced on 26 March 2015. They reviewed the cases of 26 vulnerable children or young people either living with families known to the child protection services, in the State care system or in aftercare. Of those 26 vulnerable children, eight young people died by suicide, compared to four such deaths in 2013. Shockingly, when I read the report, three out of the four teenage girls who died by suicide were known to child protection services and for lengthy periods before their deaths were on waiting lists to be seen by psychological services. According to the individual reports pertaining to the circumstances surrounding 12 of the deaths, one of the young girls - Jennifer - at one point before taking her life, had been on a waiting list for psychological services for two years. Her mother had tried to access mental health services the week before she died. This happened last year.

I refer to another case of a teenage girl named Zoe who had been in and out of State care in childhood. Her case with the social work department had been closed months before she died by suicide. Dr. Helen Buckley, who is the chair of the national review panel, said that mental health difficulty is very prevalent among young people and among their parents. She referred to the long waiting lists for psychological services - the report cited up to two years - and the treatment time is often limited. A person may have access to a service but there is very little scope for ensuring he or she has recovered. Dr. Buckley also called for more integrated mental health services. She said that a strong theme was the difficulty in accessing appropriate psychological and mental health services for suicidal young people. Indeed, this is replicated by the child care law reporting project which is being led by Dr. Carol Coulter and her team and which gives us an insight into child care proceedings in the courts. When I read the reports from the child care law reporting project the characteristics and the demographics and all those interplaying factors identified by Dr. Buckley are strikingly similar to those identified by Dr. Coulter. This is the most recent research but it seems to me to be a ground hog day. I could have been making the same speech four years ago and that is my frustration. In my opinion, which I think is shared by others, there is a systemic and endemic problem within our child and adolescent mental health services.

The Minister of State has identified that it is not an issue of funding. There have been delays in staff recruitment under three successive budgets. The money is ring-fenced but we cannot get the people and yet, children like Jennifer and Zoe are in need. Many child and adolescent services are under-resourced. The waiting list has increased by 8%. More people are seeking help. Community teams are struggling to cope with the increased demands on services. There are too many agencies involved in children's mental health care and inadequate inter-agency communications and collaboration between the services. I have raised this matter with the Minister of State. I strongly believe the child and adolescent mental health services should have been part of the Child and Family Agency and this should be rectified. I do not understand what part of child and adolescent mental health services does not fit into the Child and Family Agency because when I talk to parents or study the reports, the pathway to CAMHS is not there. It should be available through the Child and Family Agency. Families are finding it difficult to access CAMHS due to lack of information, restrictive referral criteria and pathways, lengthy waiting periods and the lack of out-of-hours crisis services. Our mental health does not switch on at 9 a.m. and switch off at 5 p.m. and that one can choose to access services between these times. Many mental health services in Ireland offer support to young people with moderate and severe mental health problems and they rely on formal diagnosis. However, I have been informed many times that there is a lack of services for those experiencing mild and emerging mental health problems. We need to wait until it comes to a crisis point and that is not good enough.We know we have to be dealing with it earlier.

I also have a concern that the doors of some CAMHS are only open to those under 16 years of age whereas others are available to those up to 18 years of age which means there are fewer clear pathways for those between the ages of 16 and 18, depending on where one lives. As a result, these young people do not always receive the developmentally appropriate care in a timely manner.

It is shocking that one third of all children concerned, that is, 89 of them last year, were admitted to adult wards. We have all agreed it is wrong and should not happen, and yet one third of the children went into an adult ward.

I will try to be more constructive about what we can do. We need to increase information. In fairness, the National Office for Suicide Prevention is doing excellent work at empowering and encouraging NGOs and civil society organisations to promote positive mental health. The key on which we need to focus is the delivery of and access to services and that is the role of the CAMHS and the HSE. We need to resource mental health services, particularly in primary care. There needs to be a clear framework for co-operation, which needs to be published and which everyone needs to know in order that we can hold people to account.

We also need to get better data. It is an issue I have raised previously with the Minister of State, Deputy Kathleen Lynch. I want to be able to applaud her but if we are not collecting the data, I cannot know whether services are improving or deteriorating. My problem is the reports tell me it is getting worse.

We need to develop local alternatives to inpatient services such as an assertive outreach early intervention in psychosis and other community-based intensive supports. This is a recommendation from the Children's Mental Health Coalition. We need the HSE to develop community-based alternatives to those inpatient services. We need to ensure there is accessibility to developmentally appropriate and evidence-informed specialist inpatient services for children with complex or acute mental health difficulties, including children or adolescents with a dual diagnosis of mental health and substance misuse, which diagnosis arises increasingly in my experience.

As we are discussing the issue of CAMHS, I applaud in particular the work of Headstrong and the Jigsaw initiative. This innovative initiative for those between the ages of 12 and 25 is in ten communities in Ireland, and I hope it will expand. The preliminary evaluation findings of Jigsaw are what we all want to aim for. One young person stated: "When I came here to Jigsaw first, I was always crying. Now I walk out smiling." That is what we want to achieve. We want to intervene early with young people and equip them for life, but also ensure the services are in place when they need them. We should not wait for it to be a crisis but, equally, the services must be in place when there are crises.