Mary Butler (Waterford, Fianna Fail) | Oireachtas source

I thank everyone for being here for this debate. I appreciate the attendance of everyone who sat through the entire debate. I always look forward to coming into the Seanad to listen to the various contributions.

I will try to answer as many of the questions asked as I can. It is important to note that significant investment has taken place in community organisations that provide vital early-intervention services for children. While €125 million was spent on CAMHS last year, an awful lot more money is provided from my budget. Jigsaw, for example, was funded with approximately €12 million in 2022. It provides essential early-intervention supports for children and young people aged between 12 and 25. It had more than 2,600 appointments last year and 85 mental health workshops. Along with funding Jigsaw, we also fund MyMind. A sum of €1 million was provided last year to continue to deliver free-of-charge counselling sessions to clients in over 14 different languages. It is important to recognise that there are many who do not speak Irish or English and that we ensure they are catered for. I thank Mental Health Reform for its continuing advocacy. I also fund that through my budget so it will be able to hold me to account and inform everyone of the challenges we have. There are many.

There are a couple of points I want to make. Evidence shows that only 2% of children will need the support of CAMHS specialist services, with the majority of mental health supports for children and young people delivered through the communities. That is why I fund the communities through the budget. A further €1 million was provided through Mental Health Ireland for community and voluntary agencies last year.

I had a meeting last week with the consultant psychiatrist to tease out an issue raised quite a lot, which I have asked about myself. I am referring to the level of referral across the various CHOs. The rate is as low as 38% in some areas and as high as 81% in others. I was informed that a decision is not made by just one person. When a child is referred – by a GP, for example – the multidisciplinary team considers all aspects of his or her referral. In many cases, the child will be assessed and the multidisciplinary team will determine whether he or she meets the criteria. Many parents contact me and believe their child should be in CAMHS but I say I am not a medical person and do not have a clinical background and therefore must put my faith in the fact that the consultant psychiatrist and multidisciplinary team, working with the psychologist, dietician, occupational therapist and mental health nurse, make the determination. However, I am concerned that the rate varies widely, from as low as 38% in some CHOs to as high as 81% in others.

Five CHOs were examined: CHOs 3, 4, 5, 6 and 7. It has to be recognised that there were no issues raised in one CHO. If that is the case, it shows it can be done. There was a lot of talk about CHO 3 in respect of 140 lost files to be followed up. CHO 3 informed the Mental Health Commission in March that it had 140 files that had not been followed up for quite a while.I am always open to correction on this but my understanding is that a medical consultant had left the practice and only three and a half posts had been in place. This figure has increased to seven. This is the reason. The team itself was proactive and informed the Mental Health Commission that 140 files had not been followed up. They have been followed up since. I know the staff were not place immediately to do this but it has happened since. It is positive that they have been followed up.

Across the other three CHOs, a further 28 files were still open. At this stage, they have all been followed up on. I have requested, as has the Mental Health Commission, that all open files be examined. Last week I met Dr. Colm Henry, Mr. Damien McCallion and Ms Yvonne O'Neill from the HSE. They will look at all open files. Open files are those where the child or young person has not been seen in the previous six months. Approximately 3,500 files must be looked at. This is the estimate for the entire country. When I speak about doing a review of CAMHS, I want it done across all 73 teams. This is the only means by which I can find out what the picture is on the ground.

I spoke about the acceptance rates. These which tie in with the postcode lottery. Something I have been doing since I became a Minister of State two and a half years ago is funding the clinical programmes. When I came into the post, there was funding for three eating disorder teams. There is now funding for nine. It takes 12 to 18 months to put in place a multidisciplinary team. We almost have six going and another three are funded. By the end of this year, all nine should be in place.

Mention was made of ADHD. It is very important to point out that 40% of referrals to CAMHS are for children with ADHD. The report refers on page 20 to medication management and states that it was pleasing to note that in the majority of the sample of the files reviewed, physical monitoring was completed for children and young people with ADHD on stimulant medication. This has to be acknowledged. I have to look at the report in the round. I was very concerned about many issues and I have escalated them to the highest level to which they can go. At the same time, my main concern when I asked for the reports and audits to be put in place was coming off the back of overprescribing in Kerry. The evidence is that in 40% of ADHD cases physical monitoring has been done. This was not the case when I received the previous report.

The report also states that CAMHS staff work extremely hard to try to provide a good service. We are aware that many young people and their families have received excellent care and treatment. Many teams are innovative in trying to mitigate the risks posed by the lack of staff. I recognise this. Another discussion I had with the HSE last week was on looking at the teams that are under-resourced as against some of the teams that are well resourced. It is a bit of a postcode lottery and we are putting a focus on it. I was very concerned about mention in the report that in some cases there was no documental review for two years. This is simply not acceptable. I have zero tolerance of this.

I want to touch briefly on admission to adult wards. I spoke about this earlier. Last year, there were 19 cases where young people had to be admitted to adult wards. There are some instances where it happens with the best will in the world. I will speak about a case where a 17-and-a-half-year-old male was admitted to a psychiatric ward in Donegal on one particular night. A bed was found for him in Merlin Park in Galway. The person was extremely upset. A decision was made that for his own safety the best thing to do would be to move him in the morning after he had slept. Sometimes decisions are taken in the best interests of the health and well-being of the person by a medical practitioner who is way more qualified than me to support that young person.

I know we have been accused breaking various laws on this. My worry is whether I could stand here as Minister of State if a 17-year-old or a 17-and-a-half-year-old person was denied access to a department of psychiatry in an adult unit if nowhere else was available and that young person left the facility and the outcome was death. This is why I have to try to weigh it up. I do not ever want to see a young child in an adult psychiatric facility but there are occasions when we must balance the risk and I have to be conscious of this. There is a risk there. Thankfully, the people involved in the 19 cases last year were all aged 16 and 17.

I have spent a long time discussing this matter with consultant psychiatrists. No consultant psychiatrist wants to put a young child in an adult facility. I have to say that when they are in an adult facility they are monitored 24-7. Somebody sits outside the door looking through the glass window. This happens. This is the one thing I want to say about it. There is balance of risk. There is a little bit of a grey area and it is done on a case-by-case basis. There will never be a situation when we will have acute inpatient services for children in every county in Ireland. This just will not happen. It would be remiss of me not to say this.

A key recommendation of the Maskey report was that we would look at online supports to see what we could to. At present we are using it in Kerry with a doctor who worked previously in Ireland. I will make several points to allay the fears of Senator Conway. Every young child the doctor has diagnosed he has seen in person. He flies in and sees them in person. After the diagnosis has been made he sees the child online. That child is not in his or her bedroom or sitting at home. That child is in the CAMHS unit in Kerry. A member of the multidisciplinary team is sitting beside them. We have been told to be innovative and to look outside the box. We have a fantastic e-mental health hub in Roscommon. It used to be the old Rosalie facility. I visited there with the then Minister of State Deputy Feighan. It gets support from the CAMHS team and the inpatient team in Galway. It does work. There is funding in the budget to roll out two more of these. This year €6 million has been provided. We have to think outside the box in respect of issues such as this.

I know I have gone over time, but I have one more point to make. We are looking at age limits. Reaching 18 is a very difficult time in the lives of young people. They might be doing the leaving certificate or going to college. They might have been receiving the support of an eating disorder team for four years and then they reach a cliff edge. A sub-committee of the national implementation and monitoring committee has been formed to look at best practice, and whether services should continue to the age of 21, 23 or 25 years. I am open to persuasion on all of this. I certainly believe that at a minimum it should be extended to the age of 21. Jigsaw works for those aged between 12 and 25 years and it works very well. I am open to persuasion regarding age. I want to urge a note of caution. This will work very well in the community services but it will not work in the same way in inpatient services. We cannot have a situation where we have a 12-year-old girl who weighs five or six stone and who has an eating disorder positioned beside a young man of 21 who is psychotic. For community services, it could work very well . However, there would have to be a lot of work and research done on inpatient services.

I thank Senator Black for all the work she does with her committee. I fully support her call for a stand-alone mental health committee. I am happy to come before the Seanad, the committee and the Dáil. The more we speak about mental health and the resources we need, the better. I have been very taken today with the number of constructive recommendations that have been made. Everybody wants to see a better service, and I thank the Senators for this. I thank the Acting Chair for her indulgence.