Mary Butler (Waterford, Fianna Fail) | Oireachtas source

I welcome the opportunity today to restate the Government’s commitment, as well as my own personal commitment, to the continued development of mental health services and supports. It is important that we have the opportunity to revisit and debate what happened in south Kerry child and adolescent mental health services, CAMHS, together with the broader reforms which are under way in the area of child and youth mental health. This includes the significant enhancement of specialist eating disorder services.

It is almost a month since the publication of the Maskey report into the care delivered by south Kerry CAMHS. Senators will be aware that the HSE has considered the report locally and nationally, has acknowledged the devastating and systemic failures which occurred over a sustained period, and has accepted all recommendations.

I have previously set out in detail the many contributory factors which led to this catalogue of failures, including an absence of clinical oversight and appropriate governance, organisational and management structures. Work is under way to implement the full suite of recommendations as a matter of priority. There are 35 in total. Of these, 6 have already been implemented with 13 having commenced implementation. I have sought fortnightly updates from the HSE on progress made to ensure momentum is sustained.

I have requested that the HSE commission the independent nationwide audit of compliance with existing CAMHS operational guidelines by all CAMHS teams immediately. I am in ongoing discussions on the independently-led prescribing audit for each of the CAMHS teams, which I sought as an additional action, beyond the recommendations set out in the Maskey report. It is important to me that this audit is comprehensive and robust. It will cover community and inpatient teams and it will be independently led.

The HSE is finalising the details of the further independently-led audit of case files in north Kerry. Alongside these audits, a separate independent review will be carried out by the Mental Health Commission and is expected to commence over the coming weeks. In tandem, the HSE will commission qualitative research to identify the experiences of children, young people and their families using CAMHS nationwide. I have also requested that this research experience study commence immediately. This will be undertaken by an academic group. I continue to work with my colleagues in the Government and the HSE on the reinstatement of a national director for mental health to ensure vital strategic direction to the development and improvement of mental health services.

Importantly, the Government has committed to a non-adversarial scheme for compensation for these children, young people and families affected by the report. The HSE, the Department and the Attorney General are collaborating intensively to confirm the arrangements. A number of meetings have been held to date to discuss and finalise details of the scheme as quickly as possible. It is of critical importance to me and the Government that we minimise the stress and anxiety for families involved, acknowledging the significant distress and upset experienced by many families already. This is the aim behind the non-adversarial scheme. These families have been through enough and I do not want to put them through any more.

I am in regular contact with the HSE locally and nationally regarding supports for the children and young people involved. I will be meeting with a group representing the families next week when they travel from Kerry next Wednesday. The HSE has assured me that it is in ongoing direct communication with the families. This follows the HSE writing to all of the young people to let them know what the review found in their care; meetings between the families and the HSE to discuss the care deficits they received; and a verbal and written apology for any harm caused. Families and young people affected can still meet with the HSE, if they did not wish to previously.

Of note, there was clear evidence of significant harm caused to 46 children, with this number likely to change as new information becomes available from meetings with those affected. On Friday, 18 February, the HSE wrote to these 46 children and their families, to advise them of this and to offer face-to-face meetings to discuss this further. The HSE has provided families with key information and referral to appropriate services and supports. This includes counselling supports and appropriate services from within child and adult mental health services. An information line is open on 1800 742 800 and will be open from 8 a.m. to 8 p.m., seven days a week, for anyone affected by the report. Through this support line, the HSE can provide external counselling.

The HSE will have a clinical support team in Killarney to support families and it is anticipated that this will be up and running in a number of weeks. The HSE will be in direct contact with the families shortly with details of this team. The HSE is also working with two CAMHS consultants from outside the area to provide support and ongoing care. There is no doubt that the report is shocking and frightening and my thoughts are still very much with the children and young people affected. The systems we have in place must be fit for purpose, to support the good work that we know is going on, as much as to bring to light and address where harm is caused.

As we all know, the vast majority of people who work in our health system, including our mental health services, are experienced, skilled and deeply committed to supporting and empowering people who need our services. The work that needs to be done as part of implementing the recommendations of the Maskey report is not a judgment on dedicated staff, but is about providing reassurance to children and families across the country that their confidence and trust in the services is not misplaced.

Broader developments in child and youth mental health will be supported through funding allocated under budget 2022. Specifically, it provides for two new CAMHS telehubs and €6 million is available to expand the capacity of community mental health teams nationally, with a particular emphasis on CAMHS.This includes 45 CAMHS staff, building on 53 clinical CAMHS posts recruited in 2021. This is in addition to more than 400 new posts between 2012 and 2019.

On consultant psychiatrists, 93% - 80 whole-time equivalents - of CAMHS posts are filled, and where there are recruitment gaps, which is currently six posts, community healthcare organisations, CHOs, look at every option to ensure the least impact on service provision. The Cathaoirleach will be interested to hear that the post in Kerry that had been vacant since 2016, was filled by a non-consultant hospital doctor. Unfortunately, we are here six years later and even though that post has been funded for six years, it was still not filled. We are acutely aware of that and are doing everything we can to try to recruit somebody in there.

Eating Disorders Awareness Week is beginning next week on 28 February and will provide an excellent opportunity for us to learn more about the impact of eating disorders and how we can best support those affected, and their families and friends. Sadly, many of those who present with eating disorders - this has especially been the case during the pandemic period - are young. In response to the growing demand for specialist services in this area, a total of €6.85 million has been allocated to the eating disorders national clinical programme, reflecting the Government's ongoing commitment to providing and expanding high-quality treatment and support for all of those affected.

I recognise that while significant progress has been made in the development of eating disorder services to date, further substantial improvements are necessary. In 2021 I secured the balance of €3.94 million for the development of specialist eating disorder services, including further investment in specialist posts. This allows for the completion of the three existing specialist eating disorder teams of which two are CAMHS, and the establishment of three new teams of which one is CAMHS. Among the three existing teams of CHO 7, CHO 4 and CHO 6, 25.2 new staff have been recruited, with additional posts in the recruitment process. All of these posts are funded. With regard to three new teams I announced last year, CHO 4 is adult, CHO 9 is adult, and CHO 2 is CAMHS, and 19 new staff have been recruited to date, with remaining posts being progressed. That is a total of 45 staff.

For the purposes of budget 2022, I ring-fenced €1.15 million in funding for the national clinical programme for eating disorders. This will enable further development of specialist eating disorder teams throughout this year, including another dedicated CAMHS team. More specifically, it will provide for three full-time additional eating disorder teams and two additional partial teams, bringing the total of nine full teams and two partial teams by the end of the year. This will mean that all nine CHOs in the State will each have one eating disorder team.

This year, we will also be investing in the development of online guided self-help resources to support people through early intervention for eating disorders. In addition, the Government continues to provide annual funding for Bodywhys, the national eating disorder association, which allows them to run a helpline and support groups for adults and young people with eating disorders. The HSE has also developed a self-care app, which provides valuable information for those with, or the people who care for somebody with, an eating disorder.

I acknowledge that we have significant challenges in our mental health services. I am fully committed to driving the necessary reforms in line with Sharing the Vision, our national mental health policy, and the current overhaul of our mental health legislation.