Topical Issue Debate

Cycling Facilities Provision

Two weeks ago, on 18 April, a 19 year old man, Mr. Harry Boland, was knocked down and killed while cycling on the Stillorgan dual carriageway. His death was a terrible tragedy for his family. I offer my condolences to his parents, brother, extended family and all of his friends. I bring forward this Topical Issue and mention the death of Mr. Harry Boland because, unfortunately, his tragic death meant that he was the sixth cyclist to be killed on the roads this year. It is regrettable that the number of deaths of cyclists on the roads has increased in the past two years. In 2017, 15 cyclists were killed on the roads, an increase on the ten killed in 2016. So far this year six cyclists have lost their lives.

I raise this Topical Issue to ask the Government and, in particular, the Minister for Transport, Tourism and Sport, Deputy Shane Ross, who I am pleased to see in the Chamber to devote more attention to improving the safety of cyclists on the roads and more resources to ensuring there is sufficient infrastructure in place to protect them. If we are serious about protecting cyclists, we must increase the level of Government investment in cycling infrastructure. I cycle around the city and it is a very efficient and environmentally friendly way of travelling around it, but, regrettably, I cannot say it is very safe. The biggest threat to cyclists is posed by the proximity of very large vehicles. To diminish that threat, we must segregate and protect cyclists from large vehicles. Unfortunately, the level of investment by the Government in cycling infrastructure shows that it is not devoted to improving the safety of cyclists. The Minister may or may not be aware that approximately 95,000 people cycle in Dublin each day. I am sure there are very large numbers of cyclists throughout the rest of the country. We know from an answer given by the Minister to my colleague, Deputy Robert Troy, that the level of investment in cycling infrastructure has decreased significantly in recent years. The Government spent €16.3 million on cycling infrastructure in 2011 and €18.8 million in 2015.

Regrettably, in 2017, the Minister's first full year in charge of the Department of Transport, Tourism and Sport, only €7 million was spent on improving cycling infrastructure. I also know from my colleague, Deputy Troy, that the Minister has announced that this year only €8 million will be devoted to cycling infrastructure. It is a derisory amount. It marks a significant decrease in the amount of money Government is spending on cycling infrastructure.

If the Government is serious about trying to promote cycling and ensure that cycling is encouraged among our population, it must play its part in trying to make cycling safer. There always will be dangers and threats on the road but it is imperative that the Government tries to ensure that cycling is made safer for citizens who use it. The Minister and his Department should be aiming for 10% of his budget to be spent on cycling and walking facilities. In fact, the United Nations recommends that it should be in the region of 20%.

I would like to hear a commitment from the Minister that steps will be made to spend more of the resources of the State on making cycling safer.

I would first like to join Deputy Jim O'Callaghan in expressing my sympathy to the family of Harry Boland, who as he says was the sixth cyclist killed on the roads this year. I thank him for raising this issue, which is a very serious one to which we are paying a great deal of attention, and we acknowledge the need for improvements in this area.

My highest priority in all areas of transport is safety. Tragically, many lives are lost on our roads each year, with 55 people killed to date in road traffic incidents in 2018. That figure includes the six cyclists to whom Deputy O'Callaghan referred.

We have made a great deal of progress in recent years, and 2017 saw the lowest number of road deaths ever in Ireland at 159. However, no one is complacent about this issue. My Department and I, working in conjunction with the Road Safety Authority, RSA, the Minister for Justice and Equality, An Garda Síochána and the local authorities, are continuing to implement measures under the road safety strategy to ensure the number of fatalities and serious injuries on our roads will continue to fall.

Cyclists are particularly vulnerable road users, and we are addressing the issue of cyclist safety through a variety of initiatives. The current road safety strategy, which runs from 2013 to 2020, contains measures to promote the use of personal protection equipment and high visibility clothing and developing a standardised road safety cycling proficiency training programme for schools, the Cycle Right programme. Cycle Right was launched in January 2017 and rolled out during the year to as many primary schools as funding allows. Cycling Ireland administers and manages the Cycle Right scheme and maintains a web-based public register of qualified and approved Cycle Right trainers. This new cycle training initiative, which includes an on-road element, will result over time in an increase in the number of children choosing to cycle to and from school safely.

The RSA continues to work with cycling groups to promote cycle safety and to produce advertising campaigns aimed at the public, with a particular focus on the need for drivers to take extra care when sharing the road with cyclists. We are also improving our cycling infrastructure. There has been significant investment in this area in recent years, and that is continuing.

As part of budget 2018, I secured a significant increase in Exchequer capital funding for cycling infrastructure over the period 2018-2021. Capital investment of more than €110 million will develop cycling and walking infrastructure in the greater Dublin area and regional cities over the next four years. Budget 2018 also saw an increase of €30 million in the multi-annual allocation for Greenways, bringing the total for 2018 to 2021 to more than €55 million. In addition, more than €0.75 billion is being invested in reconfiguring the bus network as part of BusConnects, and this will entail construction of new cycling facilities alongside bus routes.

Finally, I announced earlier this year that I will bring in new regulations prescribing a minimum passing distance for vehicles overtaking cyclists. As all overtaking offences under road traffic law reside in secondary legislation, my officials have already submitted draft regulations to the Office of the Parliamentary Counsel for consideration and settling. I understand it has been sent for legal advice. These provisions will assist in improving cycling safety and in changing driver attitudes to cyclists.

Taken together, I believe these measures will provide increased safe infrastructure for cyclists and contribute to a change in behaviour which will enhance cycle safety.

I thank the Minister for his response and I agree that cyclists are particularly vulnerable road users. However, what I have not heard from the Minister is a commitment that he and the Government will take steps to improve road safety for cyclists.

The Minister mentioned some figures in his answer. Unfortunately, he cannot get away from the fact that infrastructure spend in 2017, which was his first full year as Minister for Transport, Tourism and Sport, was only €7 million. It also appears to be the case that in 2018, that spend will be only €8 million. That is not sufficient. The Minister and the Government need to give a commitment that they recognise the importance of cycling and that they recognise that it is a form of transport that needs to be encouraged among young people and older people. However, that cannot happen unless people believe their cycle ways and the manner by which they can cycle will be safe. Currently in this city, in other cities and in rural areas it is not safe. The only way it will be made sufficiently safe for more people to use them is if there is delegated and allocated space on the road for cyclists. We do not have that at present and we need to ensure that occurs. It will lead to a huge increase in the number of people who are using cycling if they believe they and their children will be safe when they are out cycling on the roads.

I welcome the fact that the Minister has indicated that he will shortly bring in a statutory instrument giving effect to the minimum passing distance legislation. That is a proposal my colleague, Deputy Robert Troy, has been very much to the fore in putting forward. However, that will be of very limited effect unless it is combined with a commitment by Government to ensure there will be cycle paths throughout our cities and rural areas. The Minister should visit cities such as Copenhagen and Amsterdam. He will see how those progressive cities have devoted huge amounts of resources to facilitating and encouraging cycling. It would be to the benefit of society as a whole but, regrettably, when we have a Government that will not commit investment in the infrastructure we will find ourselves in a situation where people will not feel confident about cycling around the city.

I acknowledge much of what Deputy O'Callaghan said, although I have done quite a lot of it already. I was in Copenhagen recently and observed exactly what he referred to. The progress of cycling in countries like Holland and Denmark is something to which we aspire and admire, and we are a long way behind the achievements in those particular nations.

I do not believe it is particularly fair to criticise us for our lack of ambition, achievement, aspiration or declaration. I said in the initial part of my reply that I got a significant increase in Exchequer capital funding for cycling infrastructure over the period from 2018 to 2021. Capital investment of more than €110 million, which is a lot of money and is a huge increase, will develop cycling and walking infrastructure in the greater Dublin area and regional cities over the next four years. That is directly targeting safety and improving the infrastructure, which is what Deputy O'Callaghan also referred to as being necessary for safer conditions for cycling. That is exactly what we are doing.

In addition to that, the introduction of the minimum passing distance was greeted with a great deal of surprise. It is quite revolutionary. It is extremely unpopular in certain areas but it has been done exclusively for the benefit of cyclists. It is something which has provoked hostility in other areas but it is a recognition of the fact that we must do this, and it will be implemented at the earliest possible time in order to protect cyclists. As the Deputy said, it will not produce a panacea. The Deputy also spoke about the need for advertising. The RSA has embarked on a campaign encouraging the minimum passing distance, MPD, which has had a huge effect on public care in terms of overtaking cyclists before it is even implemented.

Ferry Services

I thank the Leas-Cheann Comhairle for taking this matter. The Minister is aware of the issue with Inishmurray Island where the Marine Survey Office under his Department has directed that no licensed craft may land on the island.

This is a very serious matter. As the Minister is not personally familiar with Inishmurray island, I will paint a picture for him. Inishmurray island is the Blasket Islands and Skellig Michael rolled into one. It is the site of a monastic settlement founded by Saint Molaise in 520 AD. People have been landing on the island for 1,500 years. In more modern times, 102 residents lived on the island at the turn of the last century. They raised cattle on the island and brought them to the market on the mainland regularly. They also fished there. For the past 30 years, Inishmurray has been a very important aspect of both the Sligo offering and the Irish offering in terms of tourism. Indeed, if Members who live here in the Pale broadened their horizons and thought a little bit more about what we have up there, then maybe "Star Wars" could have been shot on that island. It certainly has scenery that equals Skellig Michael or the Blasket islands.

The Marine Survey Office, MSO, has unilaterally taken action which will put boat people out of business and inhibit former islanders - members of the Brady and Herrity families who are still alive - and many hundreds of descendants who have a tradition of visiting every single year. The Minister must work on a cross-departmental basis to get an immediate derogation for landing on Inishmurray island until such time as a permanent solution can be identified and put in place. Even if the Minister was to make the money available today to design and build a new pier or whatever the MSO deems necessary, it would be four years before anyone could set foot on the island. I appeal to the Minister to work with everyone involved to get a derogation on landing on Inishmurray island immediately and then to knock heads together to ensure that a more permanent solution is put in place.

I thank the Minister for dealing with this Topical Issue matter today, which is very serious. Last week the Minister of State at the Department of Transport, Tourism and Sport, Deputy Griffin, attended a meeting in Sligo on the matter of boats landing on Inishmurray. Representatives of Fáilte Ireland attended, as did boat owners, skippers and families from Inishmurray. Up until 1957 people were living on the island and people have been landing there for hundreds of years. The MSO has done these people a disservice. The monastic site has been mentioned. There is also a graveyard on the island and families go back out to tend the graves of their deceased family members. I understand that it was once more difficult to embark and disembark on Skellig Michael than on Inishmurray. Perhaps if "Star Wars" had visited the latter, we would not be in this situation.

We have an obligation to those skippers who have paid up to €200,000 for their boats. Why would they risk their boats in terms of landing on the island? They have their own insurance for passengers to embark and disembark at Inishmurray. One of the boat owners had 30 groups scheduled to visit Inishmurray during the summer, but unfortunately, due to the inclement weather, only ten of those scheduled visits took place. Would a disclaimer suffice until such time as the island receives funding for proper landing facilities? We need a common-sense approach to resolving this matter. Sligo is part of the Wild Atlantic Way which is being promoted to tourists. Inishmurray is a major hub in north Sligo and it is vitally important that the Minister would ensure that those in the MSO who made this decision reverse it immediately.

I thank the Deputies for raising this issue which has been raised with me many times by Ms Marie Casserly, a local councillor with whom both Deputies will be familiar. It is important that the Deputies realise that they are not necessarily the first people to bring this subject to my attention.

I and Deputy McLoughlin have been raising this for the past 16 years.

The Marine Survey Office, MSO is the safety regulator for maritime transport in Ireland, and one of its key responsibilities is to ensure the safety of all passengers travelling by boat. In 2008, officials from the MSO carried out an assessment of the landing facilities at Inishmurray island and deemed the recognised landing on the island to be wholly unsuitable for landing passengers. As a consequence, no passenger licences have been issued which include Inishmurray on their plying limits. It was recommended that no such licences be issued until such time as the appropriate landing facility has been provided. No passenger boat licences have been revoked due to this issue and those passenger boats which have the appropriate licences may approach the island so that passengers may see the island and take photographs. It was brought to the attention of the MSO that certain boats were advertising trips to the island and as such may have been operating outside the terms of their passenger boat licences. As safety regulator, the MSO has a responsibility to ensure the safety of passengers and officials of the MSO contacted the owners of these vessels to remind them of their obligations.

I should make it clear that this issue relates to the issuing of passenger boat licences. A passenger boat is defined in the Merchant Shipping Act 1992 and includes a boat carrying up to 12 passengers for reward or while carrying up to 12 persons to or from their place of work. It would not include persons using a boat by themselves or while carrying friends or family as non-fare paying passengers. Such vessels may be considered to be recreational craft which do not require passenger boat licences but may still be subject to other regulation. The Department recently updated its code of practice on the safe operation of recreational craft.

The solution here is simple, namely, the provision of an appropriately safe landing facility. This is a matter for the owner of the property on which the facility would be built and the appropriate local authority, which in this instance is Sligo County Council. I am mindful of the importance of tourism to the local economy in Sligo and elsewhere. That said, passenger safety is a top priority. Once an appropriate landing facility is provided, officials of the MSO will assess it and any passenger vessel proposing to use it with a view to granting the appropriate licence.

On the basis of the concerns raised about Inishmurray island, the Minister of State at my Department, Deputy Griffin, travelled to Sligo last Tuesday, 24 April, to meet locals and listen to their concerns. As a follow-on from this, the Minister of State agreed to facilitate a meeting as a matter of urgency involving agencies that may be able to deliver a solution which would ultimately enable the MSO to reassess the matter. Obviously, as the MSO is the regulator, it would not be appropriate for that office formally to advise on the matter. I hope that such a meeting will chart a course of action to remedy this issue, address the safety concerns and enable tourism to the island to develop. Deputies will be aware of the fact that this proposed meeting will take place very shortly.

I am glad the Minister mentioned local councillor, Ms Marie Casserly, but it seems that even she is not capable of getting the Minister, his departmental officials or the MSO to see common sense. The Minister would not be happy if the MSO had any input into Powerscourt, near his home, or the Bog Meadow, which is even closer to his home, and closed amenities, ensuring that owners, not to mention tourists, could not use the facilities. The Department is kicking this out on the never-never. The MSO has been intimidating boat owners, telling them that they will be reported to An Garda Síochána and prosecuted. Are there any brains in the Department at all? People have been going to Inishmurray island for 1,500 years. They raised and sold cattle, fished and supplied food to people on the mainland. Is the Minister so bland that he cannot use leadership and common sense to instruct that office to implement a derogation until such time as a solution is found?

The Minister exemplifies the fact that Ministers are increasingly like presidents of a golf club. They get to stand in for the photograph but they have no say, nor do they want a say, in terms of directing that to which the people are entitled. This is a disgrace. The Minister should not shirk his responsibilities to the people. I hope that his good colleague, Councillor Casserly, has registered the fact that the Minister is choosing to ignore what Deputies McLoughlin, Scanlon, Kenny and I have been demanding, namely, that he stick his head out of the Pale now and again and give people that to which they are entitled.

The response is typical of the Civil Service. There has never been an accident on Inishmurray. I met the boat owners and skippers who confirmed that there has never been an accident involving passengers embarking or disembarking at Inishmurray. The Minister should check the records or the files to see if there is any report of an accident.

These skippers are acting responsibly. They have invested significant moneys in the boats. People sitting in an office in Dublin have insulted some of these skippers, for example, by saying they will report them. I ask the Minister to check the facts. I suggest the Marine Survey Office check the embarking and disembarking places on Skellig Michael.

People have been killed there.

I do not want to see any place closed, but the fact is that it is easier to get onto Inishmurray than it is to get onto some of the other islands. I think the people in question should be brought to book. The Minister is responsible for ensuring people in the Marine Survey Office will not start to use a heavy hand in that regard.

I thank the Leas-Cheann Comhairle for giving me time to respond, certainly to one of the representations. While I acknowledge the difficulties in which people have found themselves, they should be debated in a calmer atmosphere. This is a safety issue, for which there is a remedy. I have spelled it out. Like any responsible politician, I am not prepared to allow people to take risks by bringing fare-paying passengers to places that are deemed to be unsafe, regardless of whether they are islands or tourist spots. The moment it is safe to do so, the relevant authorities will give those involved the go-ahead to resume bringing passengers to the island in order that it can retake its position as a very worthy tourist destination. That is what we are aiming to do. I hope Deputy Marc MacSharry is not annoyed that I mentioned Ms Marie Casserly. She has been presenting the case for Inishmurray in a far more calm and reasoned way than the Deputy has today. I suggest the Deputy would be more effective if he were a little less excitable and a little more reasonable and logical.

Of course, the Minister has been a sage of reason during the years.

That would make it easier for me to listen to any-----

It is all right for those from Enniskerry because the Minister will look after Powerscourt, while the rest of us can sing for it.

The Deputy knows the rules.

The Minister can use Government time all he wants to promote his own candidates-----

I am going to move to the next Topical Issue.

-----but it is an abuse for him to do so when he should be answering the questions that have been rightfully put to him by Deputy Tony McLoughlin.

I thank the Deputy.

The Minister is a disgrace.

It is a pity that the Deputy cannot stick to the subject.

The Minister is a disgrace.

I will consider this matter favourably, despite the Deputy's representations.

That is not the Minister's choice as an individual. It is for the people, not me.

We will move on. The Minister and the Deputy can go to the back of the Chamber if they want to meet for a discussion. While they are here, we must have some order.

Mental Health Services

RTÉ programmes broadcast on three nights last week showed how children were being failed in this State. The programmes in question covered the issues of gambling and foster care and troubled young people, the latter of which is being raised by five Deputies by way of a Topical Issue. Although I can only talk about my own area, CHO area 2, I can empathise clearly with what the young people on the programme said about child and adolescent mental health services and facilities in general. It is shocking to think that at the end of January, some 6,181 children were waiting for a primary care psychological appointment. Most of the 1,200 high priority cases within that cohort have been waiting for approximately 12 months. I cannot understand why we have to wait for children to become acute before there can be an intervention. Why do we have to wait until they are in sixth class before there is an intervention? Why do we always have to wait until they are nearly on the brink of self-harm before there is an intervention? As we know, child and adolescent mental health services, CAMHS, teams are not completely filled. While we have the teams, we do not have the full complement of staff. I wonder what the Minister of State and the Department of Health are doing to recruit to fill the teams. To be honest, we do not have a functioning child and adolescent mental health service or functioning child and adolescent mental health teams. When one of the 11 components needed is missing, it can be a key driver that spreads throughout many other services. I wonder how the Minister of State intends to address the issues raised last Thursday night.

I thank the Leas-Cheann Comhairle for giving me an opportunity to speak about serious mental health cases among young people. On RTÉ's "The Big Picture - Young and Troubled" broadcast last Thursday we witnessed some heart-rending examples of the distress being experienced by young people with mental health issues and their families as they tried to access child and adolescent mental health services. Unfortunately, the stories we heard from these brave families on RTÉ last Thursday night are reflected across the country. The Government consistently states it is doing all it can, but the facts speak for themselves and I will provide some recent examples. A significant number of children are still being placed in adult units, some for up to six weeks. Some of them have to sleep on chairs or in hallways. At the end of January, over 6,000 children were waiting for a primary care psychology appointment. Over 1,500 of them had been waiting for more than one year. There is a similar situation in child and adolescent mental health services, with over 2,500 children on the waiting list, of whom 351 are on the list for over one year. Barely over half of the number of staff needed to provide a basic child and adolescent mental health service are in place throughout the country. When we engage in early identification and integrated intervention, we can help to reduce significantly the burden of mental ill-health on young people. We do this by identifying symptoms and warning signs at an early stage and, having done so, providing expedient and suitable care. Mental illness is particularly receptive and responsive to early intervention. The mental health system for young people seems to be geared towards triage and crisis intervention. When will the Government provide access to the timely and appropriate early intervention that is desperately needed by young people with mental illnesses?

A friend and constituent of mine, Ms Daniella Russell from my home village of Ardfert, was featured on RTÉ's "The Big Picture - Young and Troubled" broadcast last week after her mother, Joyce, had been forced by the State to bring her daughter to England to be treated on foot of the HSE's refusal to give her treatment in a specialist facility in Dublin. The Minister of State, Deputy Jim Daly, emailed my office the day before last week's programme was aired to tell me that Daniella's mother had requested referrals to Lois Bridges, a private unit in Dublin that offers alternative forms of treatment to those with eating disorders. The girl is skin and bone and very lucky to be still alive. The HSE has advised that there are beds available in the Sliabh Mis unit and wishes to ensure all options within our own services have been explored sufficiently. Unfortunately, our own services have been explored but not successfully because they are not sufficient. My office was contacted yesterday by the mother of a 17 year old girl from County Kerry who had just been released from University Hospital Kerry after trying for a second time to take her own life. Last June, or almost 12 months ago, a request was made for funding to start dialectical behaviour therapy, but it has not yet been approved. The families of these two young girls are on a knife edge. Daniella will not survive unless she receives the proper treatment and I fear for the life of the other girl unless she also receives the proper treatment.

I have loads of notes, as Deputies can see, but much of what is in them has been covered. I do not think enough time has been provided to debate this utter travesty and absolute emergency. I compliment RTÉ and, more importantly, those who took part in the documentary. How many more documentaries will we have to watch before the country wakes up? I got angry last week when I was told by one of two witnesses who had to appear without prejudice at the Joint Committee on the Future of Mental Health Care that they had been threatened by management for coming here to tell us the truth. We are trying to get to the truth and the root of this issue to stop people from dying. It was reported at the joint committee that 70 schoolgoing kids had died by suicide last year.

If it was a school bus full of kids, it would be on the front page of every newspaper in the country. It excludes 16 to 18 year olds not turning up for school who are more vulnerable.

There is a crisis in CAMHS and I know that the Minister of State will mention staffing and recruitment, but he will have to come to reality. No matter what must be done, I ask him to sit down with nurses, staff, unions and whoever else to get this right. I am dealing with children aged six, eight, 11 and 13 years and can read what is written on their legs. They are going to doctors who cannot refer them to CAMHS. They are told that they are not sick. A number of weeks ago we had the awful case of young Elisha Gault, of which Members are well aware. I would upset the public if I was to relate what had happened to that young girl before she went for help. The system is failing and we should be absolutely ashamed of ourselves. I am very interested in the Minister of State's reply, but we must do something.

This has often been described as a crisis and it is no longer in any way a controversial statement. The state of mental health services is very clearly a crisis and an emergency. Last week we saw the RTÉ programme "The Big Picture - Young and Troubled"; it was an excellent piece of public service broadcasting. The matter enters the heart of the public debate every so often, but for the young people affected, in particular, it is an ongoing and daily issue. Day in and day out, they wait for appointments. The Minister of State is aware of the particular interest in this issue in Cork as there has been much concern expressed in the past 12 to 18 months as the suicide rates in the city and county are above the national average in recent years. The Cork and Kerry area accounts for a substantial part of the mental health waiting list, making up 29% of the total. Last year there were approximately 120 people waiting for more than 18 months and that pattern is replicated nationally. There are approximately 250 young people waiting for longer than 12 months for an appointment with CAMHS at this time, which is scandalous. These young people find themselves portrayed as statistics, but the reality is that day after day they go about trying to live fulfilling lives by attending school or work and trying to find satisfaction or hope in life and all the while they wait months for appointments. Some of them could be in crisis. As there are not enough mental health professionals available, they are in the difficult position where they have to try to triage in what is a most severe crisis. As many of the young people who are waiting are in a very severe crisis, mental health professionals must try to establish whose cases are the most urgent. It is a fish and loaves job, as there are not enough professionals to go around. Young people are suffering as a consequence.

I thank the Deputies who spoke and took the time to ensure we could raise this matter on the floor of the Dáil following last Thursday's programme which highlighted many of the issues debated in this House in recent times in protecting youth mental health and particular issues surrounding the specialist child and adolescent mental health service, CAMHS. Overall, the programme adopted a balanced approach, showing both the positive and negative aspects of the system. It referenced the increasing demands, good practice and the service improvements required.

I stressed on the programme that youth mental health had to be viewed in its widest sense and seen as more than just the specialist CAMHS. A priority for the Government is improving all aspects of prevention and early intervention, including progressing implementation of the 2017 report of the national youth mental health task force. Our aim is to improve access to services by examining options such as seven-day cover, 24-hour cover, developing a national telephone and text helpline and other digital information and supports, as access to early intervention and the signposting to services clearly need improvement for service users.

Mental health remains a priority for the Government. This is reflected by the additional €35 million we gave in the last budget, bringing total HSE funding in the area to over €910 million. The HSE service plan for 2018 is developing CAMHS against a background where the population of children is growing and the demand for CAMHS saw a 26% increase between 2012 and 2017. Approximately 18,800 referrals are expected to CAMHS this year, with approximately 14,300 being seen by this specialist service. A particular issue that came through strongly on the RTÉ programme was that of service variation around the country, particularly in accessing services, addressing urgent cases and tackling waiting lists. The HSE launched a standard operating procedure in 2015 for both inpatient and community CAMHS. The executive is reviewing its operational procedure and this review is expected to be completed by mid-year. We expect it to reinforce the message that services must be delivered equitably across the country.

Other CAMHS-specific measures included in the HSE service plan for 2018 include increasing the number of CAMHS referrals to be seen this year by 27% compared to the number in 2017. The measures will also seek to provide a seven-day per week service for CAMHS to ensure supports for young people in line with Connecting for Life. They will also improve day hospital services within CAMHS and develop eating disorder specialist community teams for young people, with a range of "talking therapies" such as dialectical behaviour therapy. The executive is also enhancing access by older adolescents to specialist mental health services, with continued appropriate placement and care in CAMHS-specific settings.

There have been widely acknowledged difficulties in recruiting and retaining specialist CAMHS staff, while recruitment efforts have been ongoing, notwithstanding a serious shortage of suitably qualified CAMHS consultants at both national and European level. A key approach to reducing pressures on CAMHS is the decision by the Government to increase access to counselling services in HSE primary care services. The recent appointment of 114 assistant psychologists and 20 psychologists will go some way towards developing such a service for teenagers and young people. The genuine and serious issues raised on the recent RTÉ programme will receive full and proper consideration by the Department of Health and the HSE in the context of our collective efforts to improve all aspects of mental health services for young people.

Each Member will have one minute in which to reply. I ask all of them to observe this time limite as we have a long night ahead.

I thank the Minister of State for his response and take on board everything he has said, but I must return to the programme, "The Big Picture - Young and Troubled", in which young people identified solutions and where they and their families needed help. Only a number of weeks ago in Galway the Youth Work Ireland counselling service applied for funding from the HSE to provide a service for 220 children, ranging in age from 16 to 21 years, but its request was turned down. It was only awarded €15,000. The service was to provide support for an entire county - the second biggest in Ireland - but seemingly it did not meet the needs threshold. The needs had been identified by teachers, schools and Tusla as being met by this very good and working early intervention group. I cannot understand how, with an extra allocation of funding, we are not reaching out to groups such as this which have a proven record and good statistics.

I was struck by the comments made by one young person on the RTÉ programme who said people felt abandoned and lost in the system. That probably sums up the experience of many young people and their families in trying to access mental health services.

The second interim report of the Joint Committee on the Future of Mental Health Care was published last week and one of the most notable aspects was that €400 million was being spent on psychotropic drugs but only €10 million was being spent on counselling in primary care settings. That goes to part of the problem to which I alluded in that we seem to triage and deal with crisis interventions instead of dealing with people when they first show early signs of having a mental illness or difficulty. The HSE launched a standard operating procedure in 2015, but it is ineffective when there are not enough staff in place to operate or implement it. Everything is being funnelled into CAMHS and GPs are in a desperate position because they either send people to emergency departments or must prescribe drugs for them. We must provide for earlier intervention and more primary care supports for young people.

I thank the Minister of State, Deputy Jim Daly, for the response, even though I do not hold out much hope. Last year, in an independent survey of parents who accessed CAMHS, only 18% of the respondents were satisfied with it overall. Of 177 respondents, only 23 were willing to recommend the services. Only 32% of respondents felt that the service was beneficial to their child. This is not a reflection on the dedicated and committed staff. The problem is a lack of resources. The Minister of State said he intends to employ more people in that service. It is not just a sticking plaster approach that is needed. A fundamental root-and-branch approach is needed to ensure we have the services needed and that they deal with the mental health budget. The services are inadequate. Unless that is addressed in a fundamental and progressive way, we will have the same problems again.

I know recruitment is a massive problem. We know that the Minister of State, Deputy Jim Daly, sees this and he is trying to do his best. I ask him to use his and the Government's power to try to solve this. No amount of money is too much to ensure that services can finally be put in place. It is more than 12 years since A Vision for Change. As I mentioned, 70 schoolchildren died last year. How many have attempted to take their lives? How many have self-harmed or abused drugs or alcohol? We do not know. We surely cannot allow this to continue. It is a national emergency. These are children. They are people's sisters, brothers, mothers and fathers. We said all this before. On the future of mental health care, I ask the Minister of State to listen to the recommendations of the Oireachtas Joint Committee on the Future of Mental Health Care. Listen to our proposals, talk to the unions and please make the changes that we need so that we can get this right. I do not care what it takes. Prevention is better than cure. I appeal to the Minister of State to take everything on board.

I know the Minister of State is sincere and that problems predate his appointment by some distance. There is a lot of discussion about prevention, and rightly so. It is vitally important to resolve this crisis and prevention has to be at the fore. It is going to take many years to build this system properly. There will be prevention in schools and in the wider community. That is going to take some time to work through the system. Meanwhile, we have people in crisis and people who require urgent healthcare. Sometimes a distinction is drawn between physical health and mental health that is not helpful. These are people who are often in bad health and require urgent attention. Often, they are not able to get it, not because the staff are not up to it but because they are overstretched. They need much more support. A Vision for Change is 12 years old. We have only two thirds of the staffing level or a little more than that. That badly needs to be addressed to ensure people get the service they deserve.

I thank each of the Deputies. I know the sincerity every Deputy raising this issue brings to the table. It is not just today that I have seen that.

I have a few responses. On the Youth Work Ireland counselling service in Galway, I have undertaken to look at that for Deputy Rabbitte. There are issues with governance etc. in respect of some organisations that have received money. While I am not suggesting for a second that Youth Work Ireland is involved, the Deputy will appreciate that I can not give her detail now, but I will talk to her again.

We continue to try to fill staff vacancies and to build training. There have been a number of people coming in. The 114 assistant psychologists that have been taken on in primary care will make a big impact. They are supported by 20 full-time psychologists. That will be another level underneath CAMHS. That has been badly needed for years. That is the biggest help we can give to deal with the lists and the numbers that are piling in at the top of the CAMHS list.

On intervention, I appreciate what Deputy Ó Laoghaire is saying about not neglecting the upper level of the pyramid. We will continue to keep resources there. Deputy Ferris mentioned individual cases. He will appreciate I cannot go over those. Deputy Buckley spoke of 70 children. As I understand it, the CSO would dispute that number.

I do not think it is correct, but it does not matter whether it was one child or more. It is neither here nor there. If one child died by suicide, that is one child too many. I am not going to argue the toss over the numbers. People have a responsibility when they supply information to ensure that it is accurate. I am not suggesting the Deputy in this regard but the people who came before the committee.

People know my views on the CAMHS system and what we need to do. I refer to early intervention and rolling out things like the STEPS programme in schools and ensuring we have a more proactive system rather than one that is reactive. For too long too much of it was management. That was highlighted by that show. Different CAMHS teams operated very differently and had much longer waiting lists despite having a similar number of referrals to other CAMHS teams that had no waiting lists. We have challenges within the management of these systems that we have to look at. I reiterate that we take it very seriously.