Paul Gavan (Sinn Fein) | Oireachtas source

The Minister of State is very welcome, as always. It is important that we are having this debate today. The report of the Mental Health Commission is another indictment of the state of medical services. It outlines familiar failings such as a lack of staffing and capacity. The author outlined five areas of particular concern, namely, shortage and high turnover of staff, a lack of capacity to provide needs-based therapeutic programmes, poor monitoring of medication, a lack of clinical governance and, finally, long waiting lists that are impacting the safety and well-being of children. The Minister of State will agree that mental health is as important as physical health and to see such concerns raised about the treatment of children and adolescents must be treated as a major concern by her and the Minister for Health, Deputy Donnelly.

The fact that there are 140 lost children in one CAMHS team alone is abhorrent. As the Minister of State is aware, the area in question is the mid-west, the area from which I come, covering counties Limerick, Tipperary and Clare. Children on medication not having a follow-up for two years is entirely unacceptable. It is inexcusable that some children on antipsychotic medications were not monitored. Whichever way the Minister of State frames it, this report is damning in terms of service failures. Its author, Dr. Susan Finnerty, put it aptly when she stated that she "decided to issue an interim report because of the serious concerns and consequent risks for some patients that we have found across areas of 4 out of 5 Community Healthcare CAMHS". Four out of five areas. This is not just one problematic team; it is a problem that spreads across nearly every area. Later in the report, referring to a particular CAMHS area, she stated "it was unclear at what stage these children would be re-assessed".

Maybe we should not be shocked. We already knew the Government had not provided enough resources to mental health and that, of that scant funding, only 10.8% of the mental health budget is assigned to CAMHS. It is clear this funding needs to be dramatically increased, as does spending on mental health more generally. CHO 3, which covers parts of the mid-west, including Limerick, has been under pressure for quite some time. That is evident from the percentage of referrals the team accepts. In 2019, of the 1,856 referrals it received, 75% were accepted. In the first half of 2022, only 65% of 849 referrals were accepted. The referrals that were accepted are then taking too long to be seen.

I have been dealing with a family with a child born in 2016 who was referred to CAMHS.One year after their referral, they have no appointment and have been advised they will be waiting another year. A child who was referred at six years of age will be nine by the time he gets seen. There is too much lost time and too many lost children.

There is a real lack of out-of-hours services and this is contributing to the overcrowding of our emergency departments. In November last year, 741 young people presented at emergency departments. In my county of Limerick I look forward to the long-awaited launch of the 24-7 mental health de-escalation unit. This will handle out-of-hours calls and triage and ensure that those with out-of-hours mental health concerns are directed to where they can receive the appropriate care. It is imperative that this team is staffed and resourced appropriately. If successful, this model must be rolled out throughout the State.

I urge the Minister of State to act on the interim report and take immediate actions to address the litany of failings in our child and adolescent mental health services. As a priority she must review all open cases and ensure that the so-called lost cases are offered support and a necessary, albeit belated, follow up. The Minister of State should ring-fence the budget for CAMHS and work towards the recruitment and retention of professionals in the field.

I will finish by making a few suggestions on what we believe should be done. Early intervention is key. All children and young people deserve the opportunity to reach their potential. Children and young people must have access to mental health services when and where they need them. Services should be extended to 25 years of age to prevent the cliff edge at 18. The majority of acute long-term mental health difficulties develop between the ages of 16 and 25. We are calling for multi-annual funding for CAMHS to be able to operate and forward plan to be able to staff teams properly. We are calling for integrated IT systems to improve quality of care. We want accountability in mental health services and so we are calling for a national clinical director for mental health, a role that was removed by the Minister, Deputy Harris, in 2016. I cannot stress enough the importance of accountability. It is at the heart of all the issues we are discussing today.

Sinn Féin wants to empower CAMHS to be able to respond to issues raised in the Mental Health Commission's interim report. That report did not come as a shock to any family with experience of accessing CAMHS. They know only too well that the Government has been failing young people as waiting lists have dramatically increased under its watch. We must introduce national standards for monitoring antipsychotic medication. We must develop a joined-up and comprehensive health and social care workforce strategy to increase education places and training opportunities between the Department of Health, the Department of Further and Higher Education, Research, Innovation and Science, the HSE, regional health areas, hospital groups and higher education institutions. We must increase undergraduate and postgraduate courses and training places for mental health professions based on evidence of required staffing levels and projected population needs to reduce reliance on overtime and international recruitment.

Our mental health services are in crisis and we can do much better. We owe it to our children and young people who deserve hope, solutions and mental health services that are fit for purpose.