Mary Butler (Waterford, Fianna Fail) | Oireachtas source

I am pleased to join Senators here in the Seanad to discuss the very important topic of child and adolescent mental health services. We had a debate in the Dáil for two hours yesterday and a further debate lasting three hours last Thursday to discuss the Mental Health Commission's report. I know the Seanad had invited me here prior to the publication of that report. I was happy to oblige. All of us in Government have listened most closely to the views and contributions expressed over recent days.I have welcomed the opportunity to address a number of issues raised by my Dáil colleagues over the past week.

The Government recognises the challenges facing CAMHS and the value of the findings highlighted in the Mental Health Commission's interim report on CAMHS. It is important to point out that, this time 12 months ago, I stood before the Seanad to discuss the Maskey report. As a result of that report, I asked the Mental Health Commission to expand its report on CAMHS. I funded that work in order that it would be able to report fully on all 73 CAMHS teams. It was important that I be provided with this relevant information to help me make the best changes possible to ensure that our CAMHS teams were working well throughout the country.

The findings of the interim report highlight areas where services can be improved to benefit CAMHS throughout the system. The Government remains fully committed to the delivery of a high-quality, safe and compassionate mental health service for all, which is reflected through the delivery of our programme for Government commitments on mental health. Therefore, I welcome this opportunity to highlight the services and supports available to young people experiencing mental health difficulties and their families. It is important to the Minister, Deputy Stephen Donnelly, the Government as a whole and me that young people are aware of the services available to them, as well as the work that is ongoing to improve CAMHS.

The Mental Health Commission's interim report is one of a number of reports and audits currently ongoing into CAMHS. They, the reports and audits arising from the Maskey report and the final report of the commission will serve to provide important information on how mental health services can be improved. They will also provide an opportunity to highlight good practice throughout the system and to share best practice. Nonetheless, and as the Minister and I indicated last Thursday and again last night in the Dáil, the interim report's findings identify several issues that are not acceptable to anyone. The Minister and I supported the commission in carrying out its annual thematic report into CAMHS. We await the final report on all nine community healthcare organisations, CHOs, and welcome the role the commission plays in ensuring high standards of service provision in our mental health services.

All areas of concern identified by the commission in carrying out its interim report were escalated at once to the HSE for immediate action and resolution, including the review of open patient cases that the HSE is undertaking. This will initially consist of a review of all open cases where the patients have been prescribed medication by their CAMHS consultants or doctors and who have not been seen in the past six months by their CAMHS teams. In addition, the Department of Health will work with the HSE to develop immediately a model of care for prescribing practices in CAMHS. This review of open cases will provide an assurance that these children and young people are receiving appropriate care that reflects their current and future needs. It will include a focus on physical health monitoring of those on medication.

Regarding the interim report's recommendation on regulating CAMHS, the need to regulate CAMHS has been built into the provisions of the upcoming revised mental health Bill. We all empathise with young people and their families who may be worried about receiving the care they deserve. Much good work is being done by our CAMHS professionals across the country, and it is appropriate to recognise their strong commitment to vulnerable young people and their families.

Recognising the challenges and concerns in this regard, it is important to note that the majority of young people who experience mental health difficulties have access to a variety of services and supports. Of those who seek care from CAMHS teams, the vast majority experience positive outcomes in terms of care and recovery. This is important work, as recovery is always possible.

Annually, CAMHS teams receive and triage nearly 21,000 referrals and deliver 225,000 appointments for children and young people requiring assessment and intervention. Between 2020 and 2021, CAMHS experienced a 33% increase in demand and saw 21% more cases with the same staffing levels. Currently, there are 80 consultant psychiatrists in post working across 73 teams. The HSE is continuously working to ensure that all funded positions are filled and staff are available to provide this important service.

Recruitment began this week for a new post of youth mental health lead at assistant national director level in the HSE. As opposed to just one post, four and a half whole-time equivalent posts will be associated with this. A further new post of national clinical lead for child and youth mental health has also been announced. Recruitment for it will start quickly.

We had an intense and passionate debate in the Dáil last Thursday and last night, with positive contributions overall from all sides of the House. We must always bear in mind that, while any deficiency in CAMHS needs to be acknowledged and addressed insofar as possible, we must also be conscious of the sensitivities and needs of those using CAMHS. The Government is accepting of constructive criticism, but we must all offer reassurance to the public and instil confidence in the strong and important health services that are operating every day. As we debate the report of the Mental Health Commission and other issues relating to CAMHS, I am conscious that there are children sitting in waiting rooms the length and breadth of the country and there are 73 fantastic CAMHS teams working. The children's parents are also supporting them. We must be conscious of these factors. It is important for me as Minister of State to be able to build confidence in the CAMHS structure. A balanced and evidence-based approach, including listening to the lived experiences of service users, is always the best way to analyse concerns collectively and find the solutions we all seek.

Real change in mental health services has been under way in recent years and will continue through implementation of the widely agreed Sharing the Vision policy. There is a record €1.2 billion allocation in 2023, representing a significantly increased investment by the Government of €220 million since June 2020. Importantly, dedicated funding for CAMHS is administered as part of the overall HSE mental health allocation every year. In addition, funding has been provided for two new CAMHS telehubs and there is a dedicated €6 million to expand the capacity of community mental health teams nationally, with a particular emphasis on CAMHS.

For those who need access to the specialist supports and services that CAMHS provides, it is acknowledged that children and their families can experience varying waiting times. Some 93% of urgent referrals to CAMHS are responded to within three days. Steps are also being taken to reduce waiting times actively. In collaboration with local CAMHS, a waiting list initiative is under way in six CHO areas, specifically targeting areas where children and young people have waited for longer than nine months. Focusing on the specific issues impacting each area, one-off funding of more than €1 million was allocated in May for CHOs 1, 2 and 7 and €1.23 million was allocated in June for phase 2 in CHOs 6, 8 and 9. Targeted activity is also being used to reduce waiting lists for primary care services. Up to the end of 2022, waiting list initiatives in primary care psychology services have resulted in a reduction of more than 3,500 young people on these waiting lists. These important and welcome initiatives ensure that young people access care supports as early as possible. For every one child leaving the list, though, two more are presenting. The number of presentations we are seeing makes for a difficult situation.

The continued reduction in the number of children admitted to adult units is a priority for the Government. In 2022, 20 young people of 16 and 17 years of age were admitted to adult facilities. The majority of them stayed for less than five days. Such admissions took place for a variety of reasons, including clinical decision-making and geographical considerations. On foot of recommendation No. 36 in Sharing the Vision, a youth mental health transition specialist group has been established by the HSE and is focusing on a more seamless transition for young people and integrated care pathways. Work by the Department of Health and the HSE to respond to the recommendations of the Maskey report is ongoing.

The new mental health Bill has been selected for priority drafting for the spring season and work is continuing on introducing it in the Oireachtas as early as possible this year. I look forward to taking the Bill in the Seanad soon. I hope for Senators' support for this large piece of work.

I wish to take this opportunity to mention the Mental Health Commission's important and independent role in supporting and assisting us in developing and improving mental health services.