Mary Butler (Waterford, Fianna Fail) | Oireachtas source

I thank all the Senators who contributed and all of those who have stayed to the very end, which is much appreciated. It is one of the most serious issues that we are all dealing with. There was a common denominator running through many of the presentations and I will try to deal with that.

I was struck by the point made by Senator Keogan, who said she was not able to read the report. I do not think I will ever forget that Sunday evening when I got the report. I had to drive to my office in Dungarvan, approximately 30 minutes from where I live, to print the report. I came home and I went into a room on my own, and I did not come out of it until 10 p.m. I will never forget the feeling of reading that report and learning that 240 young people had been identified as not receiving the standard of care they should have had from this service, that there were 46 children with significant harm and that a further 13 other children were found to have been unnecessarily exposed to a risk of harm from other doctors.

I want to say one thing that is important to put on the record of the House. The chief officer of CHO 4 in Cork and Kerry acted very swiftly when he became aware of this. He put in place a look-back scenario and Dr. Sean Maskey from Maudsley Hospital in London, who works for the National Health Service, NHS, and is independent, was brought in to do it. They did a random sample audit of 50 files and red flags were raised by that. They then looked at 1,500 files and found 500 children who were not medicated and 500 who were medicated to the correct degree, but they then discovered there were 240 young people who were challenged.

We can go back and look at 2016, when the consultant psychiatrist role could not be filled. It was funded and it was not an issue of funding. What was decided at the time was to put in a non-consultant hospital doctor. He had three years' experience dealing with adult mental health issues and he was put in there with the correct supports, apparently, for governance and oversight, but there was none there and it all fell apart. What pains me the most is that it was flagged in 2018 by a locum doctor who came in to try to reduce the waiting list. However, it was not acted on, and it was 2020 before it was acted on by another locum doctor who came in. It was finally acted on but it pains me the most that two years of overprescribing could have been halted. He came in during 2016 and it was flagged in 2018, but it was not actually stopped until 2020.

Of those 46 children and their families, I have spoken to some of them and others are coming up next week from Kerry. No family or child heard about it on social media, they did not hear about it in the playground and they did not hear about it in the shop or on the street. It was handled correctly from the very start. There were 198 meetings with families. I spoke to one man and asked how long his meeting was, and it was three hours. A consultant psychiatrist was brought in to do the meetings, with social workers there just to support the families. I want to reassure people that, from that perspective, it was all handled correctly.

It is a difficult situation. What I have to do now is build confidence in the 73 CAMHS teams in the country. After reading that report on the Sunday night, and then reading it again and reading all of the ancillary supports that went with it, and having listened to parents, with the support of the team in the Department, we decided very quickly that we needed to do an audit. The audit I looked for initially was an independent random sample of all 73 CAMHS teams in the country, similar to what had been done, to see if there are any red flags in regard to prescribing. The other audit that has been agreed on is academic, which will be done in one of the universities, where we will look specifically at young people and their families who avail of CAMHS services all over the country to see how they got on with CAMHS, how they interacted and whether they got the support they needed, and we will have data from that. The third piece is looking at the composition of the multidisciplinary teams that make up a CAMHS team, in what areas they are challenged and whether they have the full composition of psychiatrists, psychologists, mental health nurses, dieticians, occupational therapists, social workers, mental health nurses and the whole way down.

We spent €125 million on CAMHS last year so it is very important to for me to have this real-time data to know where we are in regard to the composition of the teams, what governance is there, whether they are carrying out their standard operating procedures and so on. We hear about children who are referred to CAMHS who do not meet the criteria, but why is that? We hear about children who are caught between two CHOs and they are not part of this CHO or that CHO because of their address, but why is that? These are the questions. Believe it or not, I welcome that this research will be done. It is not going to be easy but I welcome it because a huge amount of good work is being done on the ground.

A week and a half ago, I met with the Mental Health Commission, which is the independent oversight body for mental health. It is doing a similar review and that is almost under way. In fairness to Dr. Susan Finnerty, who will be leading out on this, she has secured a consultant psychiatrist from Scotland already and another from Ireland who is not currently working in the HSE.

From that perspective, the most important thing I want to do is reassure parents that when a child is referred to a CAMHS team, they can have confidence. There is so much good work being done every day of the week, and I want to acknowledge that. It is only fair to acknowledge that during the Covid pandemic over the past two years, 85% to 90% of all mental health services were available and did not close. They were not like respite in that, initially, disability services were closed. Mental health services stayed there the whole way through. Many of them had to move online or move to a blended approach, but they stayed there, and I want to acknowledge that.

CAMHS currently has a waiting list of approximately 3,300 children. As Minister of State, I find that very difficult. Cases are very complex. It is not just about one visit to a consultant given a child might need six, eight or ten appointments, or more. It is important to know that we are acutely conscious of that. I travelled to many of the CAMHS teams and approved centres around the country, when I was able to do so to meet with the teams and to see what challenges they have on the ground because it is important for me to do that.

The issue of primary care psychology was raised. When I came into post a year and a half ago, there were 10,000 children under 18 waiting for primary care psychology and approximately 5,000 were waiting more than 18 months. I put in place a targeted approach. What I learned by putting in place that targeted approach is that it does work. I secured funding of €4 million from September to December last year. We got in touch with all of the CHOs and asked them to look at their primary care psychology list for those waiting more than 12 months and to try to buy capacity. Some of the consultants had late clinics on a Tuesday and Thursday night, others hired locums and we outsourced some of it privately. I just asked them to take the children off the list and we got 1,600 off it between September and December, many of them complex cases.

Since then, I secured just over €1 million for January and February and there is a memorandum going to Government next week looking for another €5 million. We want to keep the momentum going. However, as we take children off the list, more are coming onto it the whole time. I want to focus in particular on those waiting more than 12 months. I am a parent myself. If a child is waiting more than 12 months, the parents are devastated.Everybody said it here; early intervention is key. The earlier a person can get to those supports, the better. Oversight and accountability across all mental health supports is really important. As Senators will all know, the new legislation is currently being worked on and many changes will be made to the 2001 Act. I put it out to consultation again last year. There are 142 recommendations that have to be factored in but one of the areas, which I believe Senator Warfield mentioned, is with regard to capacity issues for 16-year-olds and 17-year-olds. That will be changed in the Bill, which I know will be very welcome because before they would have had to have parental consent.

One of the issues that was raised quite a lot was with regard to 18-year-olds and aging out. One of the recommendations in Sharing the Vision is that we should look at this area. An 18-year-old could be doing the leaving certificate examination, leaving home for the first time or going to college. It is a very difficult area. If that person has been in the care of CAMHS for three or four years with an eating disorder, the last thing he or she wants to have to do is change and go into an adult team, which Senator Flynn raised.

The national implementation and monitoring team, which has been put in place to look at the implementation of Sharing the Vision, has put in place three subcommittees, one of which is in relation to CAMHS. The team is specifically going to look at this area, however. A person might age out at 21, 23 or 25. I am actually open to all the ages; I am there to be persuaded. It is a much easier solution for outpatient services, however. It is not as easy for inpatient services.

As Senators will know, we have four CAMHS units throughout the country. We have one in Merlin Park University Hospital, one in Cork at Éist Linn and two in Dublin. I have visited them all. We have capacity there but the difference is that it would be very hard to put a 12-year-old with an eating disorder, who might be really challenged and be a slight little slim girl, with an 18-year-old or 19-year-old male or female, perhaps with psychosis. It would be an awful lot easier to deal with from an outpatient perspective than an inpatient one. Maybe we would have to look at having services for those between the ages of ten and 16, and also for those between the ages of 16 and 23 or whatever. We are actively looking at that.

One of the issues raised was that we have 25% fewer beds than we should have or that we have fewer beds than other countries in Europe. That 25% of our capacity is bought from the private sector never gets factored into any of the correspondence that Members get. It is important to know that. We spend a huge amount of money every year buying private capacity.

One of the other things I want to mention, which was brought up a bit as well, is with regard to NGOs and whether we should be outsourcing to private hospitals or whatever. I look at organisations such as Jigsaw, which is absolutely fantastic and provides coverage to 66% of the country. It is moving very quickly now to provide online coverage everywhere. A person aged between 12 and 25 can self-refer to Jigsaw. It does absolutely phenomenal work. I am a really big fan of it.

As part of the €10 million I secured during the year, secondary schools and third level colleges will be doing a new initiative this year to provide support. I know an awful lot of people raised that issue. I will also discuss that with the Minister, Deputy Foley, and the Minister of State, Deputy Feighan, who has responsibility for well-being. Much of this comes into well-being and emotional distress as against mental health. This is the first step and then it might develop into mental health challenges.

I produced a mental health leaflet last year and this year that points out exactly the supports people need. It was sent to all 4,000 schools in the country. I decided it was better to send it in paper form. It is online as well. It is really important that a young person might bring this leaflet home and see what supports are available, whether it is support from Bodywhys in respect of body image or an eating disorder, LGBT+ support, support related to self-harm or suicidal tendencies, or some other form of support. I felt that perhaps if they put the leaflet into their schoolbag, they might look at it that evening.

We are doing other work with regard to the national implementation and monitoring committee. We are looking an awful lot at lived experience, which is hugely important, and minority groups. When I was allocating the €10 million before Christmas, I allocated €1 million to MyMind, which is an organisation that provides counselling. It provided counselling for us all during the Covid-19 pandemic. I funded it for another 12 months. It provides free counselling in 15 different languages. A person can be referred through his or her GP to that organisation. It is really important that it is still there.

We have heard much about community groups. I have allocated another €1 million to this area. It is being dispersed now through the Mental Health Ireland website, and the closing date is next Monday, 28 February. There will be amounts of between €5,000 and €30,000. Applicants can go online to mentalhealthireland.ieto see whether their organisation is suitable and meets the criteria to get funding. This is for groups that would not normally get Government funding. It is really important for this to be done by anybody who wants to do so.

I am conscious of how hard Senator Flynn works with regard to raising issues for minority groups. As I have said, we have three subcommittees that are looking at women's health, minority groups and CAMHS. I am acutely aware of the issues. When we were putting the national implementation and monitoring committee in place, it was important for me that we had every single category represented. We have a service user on it and Senator Flynn's organisations in respect of the Traveller group were included. It is not only that all minorities are included across the board, which I felt was really important; it is also that we have to move to lived experience and peer support, crisis cafes and day hospitals. If a person has a mental health difficulty, the most important place to try to avail of the supports is in his or her community first.

One of the issues I am worried about and which many people have spoken about is suicide. I have attended three funerals in the last two months; those of a 13-year-old, a 32-year-old and a 57-year-old. They were all male and all died by suicide. We see the devastation and effect it has on families and friends but the whole community is devastated. Thankfully, during Covid-19 over the last two years, and these are only preliminary figures, we did not see any rise in suicide levels, believe it or not. I am concerned about the last three to four months, however. Every single elected Member here, whether they are in the Dáil or Seanad, tells me they were at a funeral this week or last week. We have to be acutely aware and conscious of that. When I attended these funerals, on the way home I wondered if these people knew that help was out there but did not know where to get it. That is one of the areas about which I am really concerned.

Other than that, we are putting a huge emphasis on the clinical programmes, which I want to continue to fund. Money has been secured for those with eating disorders, mental health difficulties and intellectual disabilities and in respect of self-harm and suicide. All these areas are being fully funded. One of the areas into which I put much emphasis this year from a funding point of view, again, was community mental health teams. I really believe it all starts in the community. If a person can get the supports in the community, that can make the real difference.

I thank everyone for their time. My door is always open. It is so important. Every day is a learning day; when I hear about different things, I take them on board.