Colette Kelleher (Independent) | Oireachtas source

I will not move or discuss the amendment relating to the review period because that has been superseded by Senator Freeman's amendment. I will discuss the amendment relating to training and I also wish to speak in general terms in support of the Bill.

In Ireland today, a significant number of children and young people are living in pain and distress, reflected in poor mental health, sometimes ending tragically in suicide. We all know a child and young person that meets that description. We have all been at one of those awful funerals. Those that love them - their parents, brothers and sisters and their families - share in that pain and distress. They are desperate for help for their son or daughter, brother or sister and for themselves.

The Seanad Public Consultation Committee, ably chaired by Senator Freeman, reported in October 2017 on children's mental health services. The report states that of the approximate 1.15 million people under the age of 18, estimates show that 115,000 have mental health illnesses, and that 23,000 children have very serious and disabling mental health problems. That is a sizeable grouping of people that we are talking about here tonight.

The causes of the pain and distress among children and young people are many and varied. Each person has his or her own unique story. Some reasons date back to infancy and poor attachments to loved ones. Others stem from growing up in insecure and anxious circumstances. Poverty is not good for children and young people's mental health and well-being, it never is, nor is growing up around parental addictions. We can imagine that the mental health and well-being of our children is not well served by living in emergency hostels, hotels or hubs, living in consistent poverty and all that goes with the transience borne of a broken housing system. A June 2017 study, Homelessness and Mental Health, found that those suffering from housing-related burdens are far more susceptible to mental ill health than the wider society, and that has its own effects on children and young people.

We know some groups of children are particularly vulnerable to mental ill health, for example, children and young people with disabilities, who often fall through the cracks of a system that does not work for them. Another such group is children and young people with autism. We heard today of people being afraid of an autism diagnosis because they are directed to the CAMHS system which is not able to provide the necessary level of support. In addition, children and young people who are LGBTI are vulnerable because issues of deep-rooted discrimination can undermine their mental health. Another such group is children and young people from the Traveller community, in which suicide and the impact caused by bereavement over suicide is startling. The suicide rate within the Traveller community is six times higher than that of wider society. That heart-breaking trend sadly affects all ages, and the impact of those losses on children's mental health is shocking. As one woman from the community recently put it, "We've a pain on our shoulders from carrying coffins."

In Ireland today we fail, time and again, some of the most vulnerable and precious children and young people. They are children whom we should be wrapping in cotton wool. They are children and young people who need our love and care the most and who with the right early supports for themselves and their families could be spared a life of medication, and intermittent and often inappropriate incarceration in settings not suitable for them. It is a case of lives being interrupted and wasted.

Since 2006, Ireland has witnessed a shrinking in care, in State-led support, and an ever-increasing trend of neglect towards children and young people with mental health issues. Statistics on the state of mental health of young people in Ireland are disturbing. In 2017, UNICEF's report entitled, Building the Future: Children and the Sustainable Development Goals in Rich Countries,showed that Ireland is lagging behind its European counterparts. The report outlines a decades-old decline in mental health care, riddled with reductions in Government spending allocated for mental health services. Numbers do not lie. The percentage of the total health budget allocated for mental health stood at 13% in 1984, dropping to 7.3% in 2004. Today, in 2018, this percentage stands at 6.1% of the overall health budget. In 2006, the HSE's A Vision for Change recommended that 100 inpatient beds would be made available for a child population that was 21% lower than it is now. Despite the recommendation, and a clear increasing demand, inpatient beds in July 2017 stood at 48 beds. Year after year, figures continue to show a complete lack of respect or even denial of the gravity of the problems in child mental health in Ireland.

In October 2017, the Seanad Public Consultation Committee, of which I am a member, released a report on the state of children's mental health services in Ireland. While the report and the voices it drew upon highlighted the courage and bravery of hundreds, perhaps thousands of parents of mentally-ill children, and the sheer commitment of doctors, hospital personnel, and all those within our broken mental health services system, it remains just that, a broken system. It is a system that is quite frankly unfit to care for children and young people in Ireland.

I and others received an open letter some weeks ago from broken hearted and broken spirited parents. I spoke to the father on Monday and I understand they wish to meet the Minister of State. The letter outlined how the broken mental health system is failing a beloved 17-year old young woman and her family. The letter outlines their daughter's first experience of the system when their happy, healthy then 14 year old daughter suddenly, without warning became severely mentally ill. She had to go through the gamut of accident and emergency, which not an easy place for a distressed child. She was then admitted to a public ward, albeit a children's ward. The letter sets out the impact of the young woman's illness on her young brother and sister who have also been "traumatised" by the situation. The letter underlines how having access to a dedicated child mental health setting, as Senator Freeman has proposed, and providing a range of supports including family therapy enabled their daughter to recover.

We know that mental health can be fragile and so the young woman became ill again in early 2017 but she was no longer a patient of the dedicated setting. Only after pressure from her parents did she get access to the dedicated unit and recovered again. Some of the doctors were insisting that she be admitted to the children's public ward which did not work for the child during her first breakdown. In the letter her family wrote that before Christmas the young woman became ill again.The young woman is now under the care of the HSE child and adolescent mental health services. Senators will soon see how little this means. Her parents contacted CAMHS and went to the CAMHS clinic. They said that to enter the CAMHS clinic they had first to walk through a chemist and a series of waiting rooms for the dentist and general practitioner services. They said this exposed their distressed daughter to the eyes of the public. They were told by a secretary that the staff did not see distressed children in CAMHS. I had thought that was what CAMHS was all about. Then they were told to wait in a public area with their daughter who was agitated, delusional and frightened. The family were then told there were no more private rooms in which to wait. They were told that no consultant was available to see their daughter. Then their daughter was suddenly seen by a consultant after all. They requested access to the dedicated unit but were told that the setting was full and that it was best to apply for beds hundreds of miles away. There were no beds there either. Eventually, they were informed that no bed was available for their daughter in any children's mental health unit in the entire country. Eventually, the distressed young woman was offered an adult bed with a promise that a bed in a dedicated unit might become available if funding was secured. The suggestion was to transfer the young woman from the CAMHS clinic to the hospital by ambulance. The family objected, taking the view that it would only add to her trauma. They preferred to drive her there themselves. The only way they could leave CAMHS privately was through a fire exit down a dark stairway. At the exit, the alarm was triggered as they walked into the darkness of the car park of an Aldi supermarket.

In the letter, the parents remarked that the most compassion they and their daughter received was from a cleaning lady in CAMHS and a security guard in the hospital. There is something altogether wrong with this situation. It is astonishing that this happened to such a vulnerable young woman and her family in Ireland only some weeks ago. This situation is not isolated. Senator Freeman referred to a case involving a young woman and the decision by Mr. Justice Peter Kelly.

These cases should not arise for our children, our young people and their desperate families in 2018. It does not have to be like this. We need an adequate budget for mental health and child mental health. We must move back to the 13% allocation we had in 1984. We need a CAMHS service that, instead of gatekeeping, is loving. We need a service that cares for our children. The service should welcome them in rather than running away from them and their families.

In these CAMHS services and in primary care we need easily accessible family therapy to be a standard feature of the range of supports in every community in Ireland. It should be as available as dentistry. Family therapy has been researched and shown to have proven benefits on the state of mental health, especially for young people. Family therapy has benefits for a wide range of reasons. It exposes young people to a more open comfortable environment while respecting their dignity and treating mental illnesses without overbearing reliance on mediation. It has a proven track record in reducing the necessity for psychiatric hospitalisation.

In the case of the deeply troubling experiences of the first young woman I talked about, alternative treatment proved highly beneficial and helped her family as well. We need a range of services and supports, including inpatient beds and child-appropriate settings. We need an end to children and young people being cared for and treated in adult settings. They are inappropriate and the staff there may not have the training they need. It is important that children and young people are reviewed regularly, since a person's condition can change positively or negatively and the care and support may need to change accordingly.

I congratulate Senator Freeman and I support the Bill, as amended, including the amendment I have proposed on training. The best proven means of treatment of young people involves treating them as young people in environments where they are most comfortable. They should be treated by people they know and trust and those who have specific expertise and understanding in supporting them. The deteriorating state of our children's mental health service urgently requires some forward, progressive thinking. We are doing our best in the Joint Committee on the Future of Mental Health Care. Family therapy needs to be made commonly available and, as I said, it should be as common as dentistry. We need new thinking on this serious issue.

I appeal to the Minister of State to support the Bill, to accept the amendments and to consider the benefits of family therapy. I call on the Minister of State to outline his plans for family therapy in future.