Lynn Ruane (Independent) | Oireachtas source

I welcome the Minister of State to the House. This is an important conversation but it feels like it is just a conversation. I do not feel urgency in the room. It all feels a bit nice. We are talking about the lives of people and children. I do not know if the Minister of State has experience of communities with a high concentration of young people with severe mental health issues who are trying to access CAMHS. In west Tallaght, in particular, it is extremely difficult. We spoke earlier about numbers and triage. In that triage space, people are being told that the service is not for them. Women in my community wince if they are referred to CAMHS. They think they cannot go near CAMHS because there is no point and no one will see them. That is the culture that exists now. CAMHS is not understood as a place where people feel they are going to get support and help. They do not even feel they will get through the door. When one gets past the triage space and into the service, it is great. However, the barrier that exists makes it too difficult for people who are trying to get through the door. There are girls in Tallaght, especially teenagers, who are self-harming to bits. Their bodies are in bits when they arrive at CAMHS. They are told they are not suicidal enough. If they are not experiencing suicidal ideation, they are told the service is not for them. There is something seriously wrong if that is the measurement of mental health. You should not have to be almost about to take your life before being allowed access to the service. That needs to be rapidly reconsidered. That lack of service will lead to suicidal ideation and these people will not be in a service that can deal with it when that happens.

There is a also massive problem in respect of the transition to adult mental health services. Getting an assessment at an adult mental health service is extremely difficult unless a patient is presenting with psychosis or suicidal ideation. I agree what has been said by others about 18- to 25-year-olds. It would match with youth work strategies. We all acknowledge that young people are defined arbitrarily as being under 18. The transition piece is important. The target at the moment is six months but referrals cannot be given while a child is under 18. That means patients must wait until they turn 18 before a referral is made. They are dropping off the system as they try to access services.

Many other Senators have spoken about medication. Children are being lost and it feels as if nobody is taking responsibility. It feels like it is considered a nice phrase that these children have been somehow lost in the system. They just got lost. It is the result of complete negligence. It is neglect on the part of a State service not to know who is on medication and who needs follow-up. Some children were given a prescription for two years without any review by anybody. Other places recommend that patients go into the likes of Linn Dara to be observed while they move onto some of these medications because they can be serious. Those medicines may have psychoactive properties and relate to psychosis, even if they are used for many other things. Some psychologists will only prescribe some medications if a patient enters Linn Dara for a period of time to monitor the effects. That is how serious a matter this is. The fact that many children were not monitored at home and did not have their prescriptions reviewed is neglect.

There is also a postcode lottery. Only two out of five CAMHS are capable of dealing with eating disorders. Four of five can cater for intellectual disabilities. Only one can cater for ADHD. Considerable numbers of young people in the prison system with ADHD also have comorbid mental health issues because they did not receive care. The shortcomings in care spring over to the justice system, antisocial behaviour and everything else. People with ADHD need support at a younger age to allow for interventions. The numbers of people with ADHD who do not receive support and who then engage with the justice system is concerning.

Integrated care and needs-based wraparound services do not exist. According to the interim CAMHS report, there is a blame game among service providers about which organisation should accept referrals to services for treatment. Families are bounced back and forth from CAMHS to other primary care and disability services. However, a child or young person cannot be on multiple waiting lists. They must cautiously seek help, knowing that an upcoming appointment with a primary care service could remove them from the CAMHS waiting list. That a child cannot be on two waiting lists at once makes me wonder at the logic of decisions being made around people's access to support.

This report is savage. I have been working in the area of health equity in the community for years. In my lifetime, I cannot remember a time when we had a functioning CAMHS. I do not know when that existed. When we say CAMHS is in crisis, do we need to acknowledge that a functional and accessible service has never existed under our current model? The interim report reflected the concerns of the Mental Health Commission around the risk posed to children, risks which the HSE claims to have heard nothing about and has no record of, possibly due to a lack of infrastructure or IT services. The blame lies with the health services and the Departments. We need to stand over the report and aggressively address these issues because at the end of the day, children are dying. We may not have statistics for that now because deaths may not be associated with the fact that a young person did not receive an appointment. It is hard to do that. However, there are people who presented with self-harm or eating disorders for many years, did not get the support they needed and are now dead. We need to accept that is neglect on the behalf of the State.