Covid-19 (Mental Health): Statements

Before we start, it is very difficult when Deputies approach as we are just starting the prayer and starting the session. I remind Members that there is a pandemic and a distance to be kept. That is the first thing. Second, when the Ceann Comhairle or Leas-Cheann Comhairle is approached as we start the session, it is extremely difficult to concentrate on what is in hand. I will start the session and, if Deputies wish to put their names down to speak on Questions on Promised Legislation, I will take their names as best I can.

I thank the House for allowing us time today to discuss the very important issue of mental health during and beyond Covid-19. I welcome the opportunity to restate my own and the Government’s commitment to the continued development and enhancement of mental health services and supports, from mental health promotion, prevention and early intervention to acute and specialist services.

The pandemic has been very challenging, and some people are finding it more difficult than others. Financial and employment worries have caused anxiety and the disease itself has caused significant stress. This has been exacerbated, in many cases, by isolation and bereavement. While the Government’s overall focus is on reducing Covid numbers and ensuring the safe and effective roll-out of the vaccine, our citizens’ mental health needs, particularly for those already vulnerable to or with existing mental health difficulties, remain a priority.

At the outset, both the Department of Health and HSE mental health services put in place, in the safest environment possible for staff and service users, a range of proactive responses to provide for any rise in service need. Our approach to Covid-19 risk mitigation and infection control in mental health services has been systematic and structured.

Residential services were quickly identified as the highest risk areas for staff and service users. The Department tasked the Mental Health Commission with developing a risk control and monitoring framework for residential mental health facilities to identify and address infection risks. The commission collected Covid data and reported weekly to the Department and the HSE on the suitability of premises, preparedness, training and equipment levels. From this process, many facilities were reconfigured to single rooms to reduce the risk of cross-infection and into possible Covid and non-Covid areas. In addition, staff training, personal protective equipment, PPE, provision and testing were implemented to recommended levels. As a result, HSE residential mental health services have continued throughout the pandemic. There has been reduced capacity in some settings to ensure staff and service user safety, and there have been some outbreaks, but the protocols and procedures in place have reduced the impact of these as much as possible.

In this current episode, case numbers in mental health facilities have started to reduce, in line with national figures. Although suspected and confirmed staff and resident cases are still too high, HSE mental health services have worked tirelessly with public health to mitigate the spread of the virus. A tripartite oversight group, comprising representatives from the Department, HSE mental health services and the Mental Health Commission, was established to monitor outbreak control. It continues to monitor and identify issues and risks, find potential solutions and follow up as appropriate.

With respect to vaccine roll-out, the HSE has undertaken to prioritise vaccination of those over 65 years in residential settings, including mental health facilities. The majority of the 46 units with residents over 65 years have now received the first dose of the vaccine.

At this point, I would like to remember the 28 people who have died due to Covid while resident in a mental health centre. I believe that, without the work on outbreak control, the situation could have been much worse in our residential services, and I commend the dedication of staff, the HSE, the commission, the Department and families of residents who all worked to keep infection rates down and our people as safe as possible.

The Department also introduced two pieces of emergency legislation to protect staff and people in hospital for mental health treatment. The first allowed mental health tribunals, which review involuntary detentions, to be held remotely and with one person if staff pressure led to unavailability. Luckily, these measures have not been required so far. The second provided for patients to be transferred temporarily from the Central Mental Hospital in Dundrum to the new Portrane facility to allow for a Covid isolation facility in Dundrum during the second quarter of 2020. Those involved have since moved on to other accommodation in line with their care and treatment plans.

Community mental health teams continue to provide services following rapid reconfiguration and with adaptations in place to protect service users and staff. Significant supports are in place and telehealth services are fully established, with online psychosocial supports now embedded in service provision. Seven-day telehealth services include, the information line 1800 111 888, the crisis textline 50808 and NGO partners’ online supports.

It must be noted that availability of staff has been a significant issue throughout the pandemic. Mirroring national services, most cases of Covid-19 have been among staff and this has added pressure to our mental health services.

While we do not yet fully understand the impact of Covid-19 on mental health and any subsequent demand on services, it is acknowledged that there have been increased presentations in certain areas, especially in first episode psychosis and eating disorders. I am particularly concerned about the rise in eating disorders among girls and young women.

I have met numerous times with the HSE regarding the mental health national clinical programmes and launched models of care on mental health and intellectual disability and ADHD in recent weeks. The programmes and models of care will facilitate significant service improvements and will ensure consistent delivery of high-quality mental health services that can be replicated nationally.

I am pleased to say that the 2021 budget allocation will enable continued development of the programmes, including the national clinical programmes for early intervention in psychosis and eating disorders. Funding to enhance eating disorder services will be allocated this year for the recruitment of staff to enhance and establish specialist teams in addition to capital works. I am fully committed to ensuring that this money is spent in full and translates into real improvements in service provision for people with eating disorders.

The HSE psychosocial framework, published in January this year, acknowledges the pandemic’s impact on mental health in all areas of society. It aims to mitigate longer term effects and sustainably support the mental health and psychosocial well-being of both the public and healthcare workers through targeted actions.

We need to maintain psychosocial supports to protect the mental health and well-being of all our citizens. This year, 2020, saw the Government provide €1.1 million for a mental health promotion and well-being campaign and a further €1.1 million for a psychosocial campaign. This funding sought to address potential demand from the public, front-line health professionals and people with new or existing mild to moderate mental health issues.

Online counselling supports have been developed and include those provided through NGO partners such as MyMind, Turn2Me and Jigsaw. As an example, MyMind delivered nearly 10,000 free online appointments in 2020.

While the numbers of people accessing and NGO partners’ websites seeking information and supports have increased in some instances, there is still some unused capacity in this area. The Department and the HSE continue to plan for any surge in demand as it arises.

Currently, data show no evidence of a significant increase in self-harm presentations to emergency departments. It is too early to speculate on suicide figures, which the Central Statistics Office, CSO, reports each June following coroners' verdicts. However, early international evidence indicates no increase in suicide, with a decrease in self harm-suicide attempts earlier in the pandemic. However, these findings should be interpreted cautiously as we await more up-to-date analysis.

Implementation of Sharing the Vision is proceeding and the national implementation and monitoring committee, which I established late last year, is meeting monthly. The committee will drive reconfiguration of mental health services, monitor progress against outcomes and begin delivering the commitments in Sharing the Vision. The policy is closely aligned with Sláintecare’s vision of the right care in the right place at the right time. It aims to create easier access to multidisciplinary, user-centred supports in primary care, focusing on early intervention.

Of the additional €50 million secured as part of budget 2021, €23 million is allocated to commencing implementation of many of Sharing the Vision’s short-term recommendations. Fifteen million euro will assist with Covid-19 challenges. There will be more step-down beds and extra resources for community mental health teams as well as reconfiguration of facilities, in line with Mental Health Commission recommendations. There will also be a focus on enhancing digital mental health supports and increasing additional capacity in private sector approved centres.

In addition to this significant investment, the national forensic mental health service will be relocated this year from Dundrum to Portrane. This follows the passing of legislation which I brought through the Oireachtas before Christmas. In that regard, I would like to thank all the Deputies for their support.

The review of the 2001 Mental Health Act, which has involved many stakeholders over quite a few years, is concluding and the heads of the new Bill will be ready to publish very soon.

I acknowledge the tremendous efforts and sacrifices our citizens have made to follow public health advice and mitigate the spread of Covid-19. I encourage everyone to link with the Government's well-being campaigns, including Keep Well, which my colleague, the Minister of State, Deputy Feighan, will speak on now, to promote physical and mental well-being in the safest possible ways.

The pandemic has posed particular challenges for all of our citizens in terms of their mental health and well-being. As part of our response to these challenges, we have provided guidance and support for people to manage both their physical and mental well-being through public health information campaigns such as our In This Together campaign and through information networks, including key organisations working with vulnerable people.

Following on from the In This Together campaign, in November of last year we launched the Keep Well campaign, which is aimed at supporting our citizens through this difficult winter. Significant funds are being invested into this initiative, with €7 million to support the delivery of a range of actions and support services. The campaign encourages us all to do something that is good for us each day or week, like going for a walk, connecting safely with friends or family, engaging in a hobby or reaching out for the supports that we may need. By doing so, we will create balance, routine and resilience.

The campaign is focused on five main themes, the first of which is keeping active and being outdoors, even during the winter. Physical activity can be very helpful in improving mood and reducing anxiety, in addition to keeping us all fit and healthy. Sport Ireland is leading a series of initiatives that will support us to keep active and to exercise within our own local areas throughout the winter. In addition, sporting organisations and clubs have been invited to develop ways to support local communities within the public health regulations.

Second, staying connected with people, addressing isolation, supporting volunteerism and initiatives that support person-to-person connection is important to our well-being. Isolation of people of all ages is a significant risk during the Covid-19 pandemic, particularly during periods of tight restrictions on movement and social interaction. The Community Call programme was introduced in the spring to provide local helplines through local authorities for practical supports, information sharing and befriending. As part of the Keep Well campaign, this has been expanded to be proactive, with outreach to potentially isolated persons as the main aim. We are also working with partner organisations, including An Garda Síochána, NGOs and Volunteer Ireland. There is a particular emphasis on identifying and supporting those most at risk of isolation.

Third, switching off and being creative or learning something new, getting back to nature and finding ways to relax can also be really beneficial for general well-being. We also look at the local authorities and libraries, with advice from Creative Ireland, and working with partners at national and local level, we are providing a range of initiatives to support individual and community creativity in the arts, crafting, culture and heritage.

The fourth theme is eating well. By nourishing our bodies and minds, we can develop a better connection between the food we eat and how we feel and positively impact our physical and mental well-being. Bord Bia is providing information and resources to support healthy eating this winter.

The fifth is minding your mood. Under this theme, people can access information on where to go if they need support. This is also linked with the local community helpline to ensure that people can access the help they need. That includes a series of Minding Your Wellbeing online videos, produced by the HSE, which provides an opportunity for people to learn more about key elements of mental well-being such as mindfulness, gratitude, self-care and resilience. Additionally, the Children and Young People's Services Committees in every county across the country are developing and delivering youth-specific campaigns to support young people’s physical and mental health and well-being at this time.

I want to touch briefly on what is being done for homeless people, including those with a dual diagnosis. A further €11 million has been provided for Covid-19 measures in the HSE winter plan and Covid-19 pandemic plan introduced for people who are homeless. This funding will ensure the Covid-19 protective and responsive measures for people who are homeless are continued for all of 2021.

I will use approximately four minutes initially, allow three minutes for the Minister of State to reply and an Teachta Donnelly will come in after that.

Under this Government we have gone from a mental health crisis to a mental health emergency. There are 2,500 children and young people waiting for child and adolescent mental health services. More than 8,500 children are waiting for a primary care psychology service. Behind each of those figures is a child with a family who is being left behind.

When will the Government provide the early interventions that are key to a child's development and stop failing our children? Since 2017, under Fine Gael and Fianna Fáil Governments, 242 children have been admitted into adult psychiatric services, with almost 30 of those children admitted in the first ten months of last year. When will this Government stop that draconian practice and stop failing our children yet again?

I ask for clarity from the Government as to when the HSE service plan will be released. Many organisations in the charities sector have got in touch with me. They are waiting to find out if there will be sufficient levels of funding this year to be able to provide essential mental health services in our communities. NGOs and the communities they serve need urgent clarity on that funding.

The Government and the HSE have entered into a surge capacity deal with private hospitals. The deal between the HSE and private hospitals will allow the health services to use up to 30% of private hospital capacity. Why did the Government fail to deliver the same deal for mental health provision during Covid-19? I have written to the Minister of State and asked her to consider this solution to help with the mental health emergency people are experiencing right now. This would take pressure off public hospitals, which are dealing with the Covid-19 emergency, and it would provide essential care for people suffering mental health problems. People suffering with mental health problems are still arriving at accident and emergency departments because they have no alternative service. The accident and emergency department is not the right environment for anybody experiencing a mental health episode.

I acknowledge the Minister of State's response to my correspondence in which she stated that she would investigate the use of surge capacity for mental health purposes. What stage is that investigation at? When will the decision be made? People need help right now and they need access to emergency mental health care on a 24-7 basis in order to get the care they need when and where they need it.

There has been mention of people suffering from eating disorders but such people would benefit from this surge capacity right now. There are currently only three beds in the State reserved for adults with eating disorders. The Government has failed in its promise to deliver specialist eating disorder teams in each of the nine community healthcare organisation areas. I welcome the Minister of State's comments on new funding coming down the line next year but people need help right now. Could surge capacity be enabled for people suffering from eating disorders?

Funding for mental health as a percentage of the overall health budget has fallen from 16% in the 1980s to 6% in 2019. I got a response to a parliamentary question this morning that indicates the spending was 5.2% of the overall budget last year and it will fall again this year. During a national emergency, it is an absolute scandal that the percentage allocated to mental health spending has fallen. Sláintecare recommends 10% of the health budget should go to mental health services and international best practice recommends up to 16%.

The Government announced in its budget last year an additional €4 billion for health spending, which is very welcome, but mental health services received just 1% of this additional spending. People are sick of the platitudes when it comes to mental health. The "we are all in this together" brigade is not washing with people any more. When will the Government put its money where its mouth is and bring mental health spending up to international standards? We are a First World country with a Third World mental health system.

Who in the HSE has budgetary control of the funding for mental health? The programme for Government indicated that the reappointment of a HSE director for mental health would be examined but why has this appointment not happened? I also welcome the news about the monitoring committee for the Sharing the Vision policy. Has an implementation committee been set up to implement the 100 recommendations in Sharing the Vision? The news I have heard is that it has not been set up. Mental health services seem to be the very definition of a Cinderella service and without mental health, there is no physical health.

I thank the Deputy for his questions and he has asked about quite a lot. I will try to cover as many matters as I can and we can get back to him in writing for the questions we miss.

I acknowledged the letter he sent about surge capacity in the private hospitals. The HSE has engaged with private mental health hospitals over the period of the pandemic to provide for additional capacity. The additional capacity includes the purchase of acute beds, as well as longer-term care beds that free up capacity in the statutory sector. The HSE has set up a project to provide for four cohorts of users in acute units. The HSE has met six different providers in the past couple of weeks and the plans are ongoing. We always use capacity in the private sector to supplement the beds we have.

The Deputy had questions on child and adolescent mental health services, CAMHS, and the primary care waiting list. The Deputy knows I secured an extra €23 million for CAMHS in the budget and there will be 29 more whole-time equivalent staff members as a result. I want to tackle the CAMHS waiting list. There has been a significant reduction in the Cork and Kerry area in the past six months, and that should be acknowledged.

On the primary care waiting list initiative, I have had several meetings with representatives of the HSE primary care policy unit and we are giving consideration to options for developing an intervention to reduce the number of children on it. I am very concerned about this list. I met the Minister, Deputy Stephen Donnelly, last Thursday to discuss funding and work is ongoing to progress the waiting list initiative.

The Deputy asked about children and teenagers under 18 in mental health facilities for older people. The Deputy is well aware that figures were well reduced last year but I have said on record many times that one child in such services is one too many. I am working hard on that. We will get back to the Deputy on the rest of his questions if that is okay.

I thank the Minister of State for sticking to the time. I know it is difficult.

In her statement, the Minister of State indicated the vision for care is the right care in the right place and at the right time. I refer her to a case that developed in my constituency last week. I was contacted by a mother who was upset and distraught about her son, who had a mental health breakdown. The emergency services and gardaí were called before an armed response unit was eventually called to try to deal with the case. The person was brought to Connolly Hospital, where he was told he would be admitted. Unfortunately, the unit there was locked down because of Covid-19. He was told he would get a service somewhere else and although he waited all day, that did not materialise. He was in the accident and emergency department for three solid days before staff eventually told him it was not an appropriate place for him, and that was absolutely correct. Unfortunately, there was not a single bed available for him the entire State. The man was told to go home and his mother asked what would happen if another episode took place, as he was still in a distressed state. She was told to call the gardaí, which is completely unacceptable in this day and age. It is also at odds with the Minister of State's speech, which spoke about the right care at the right time and in the right place.

I said I would come here to speak on behalf of that man and his mother, as well as the countless others whose experiences I hear of on a daily basis. Even last night I was out for a walk and spoke to a person who manages a centre who said the same thing about its service users. I am pleading that the Government activates that surge capacity, if it is there, for a mental health service. I got a call last night informing me the St. John of God service was also in lockdown. People who were able to be discharged were discharged but it was taking no new patients. We need surge capacity for the people who are really in desperate positions. Their families may be in desperate positions as well and they do not know where to go. We do not know where to tell them to go either.

I thank the Deputy for his question. As he knows I cannot comment on an individual case but if he wants to forward to me the details, we are quite happy to have the unit take a look at this. The premise of Sláintecare is the right care at the right time in the right place. That is what we all aspire to delivering. There are currently many challenges and some of the units had to close because of significant Covid-19 outbreaks. As I stated earlier, I am thankful we have only lost 28 people in mental health facilities over the past year but, unfortunately, many staff are out on Covid-related breaks. This has an impact on whether units can remain open. If the Deputy wishes to refer that case to me, I absolutely encourage him to do so.

I will raise several matters in the short space of time but I have one specific question for which I will leave time for a reply. Covid-19 has exposed many gaps in our mental health services. We always knew there were significant gaps but they have been exposed even more. I have spoken to many people but never seen such levels of worry and depression across so many different cohorts in our country. It is affecting all of us but particularly certain cohorts and I will speak about some of them.

The levels of social isolation, loneliness, anxiety and work pressure - or pressure from a lack of work - are really coming home to roost. I met a young man yesterday who goes for two 10 km runs each day as it is the main activity keeping him going. I am deeply worried about the time younger people are spending online into the early hours of the morning. If they are of schoolgoing age, they may not be able to deal with schoolwork.

There are some significant issues that will cause us problems for many years. There are some good things that have come out of Covid, in relation video therapies. They should be used more often and should be expanded into the future. However, in respect of our young people and those working from home, I have serious worries and concerns about the legacy of what is happening. Working from home is of huge benefit to all of us and to our country, but there is an always-on culture. By God, in this House we could all do with learning from it. The always-on culture needs to be addressed, because social media is taking over our lives. I know it is not in the Minister of State's area, but we also need the right to switch off. We have produced legislation on this issue. The right to switch off for people who are working from home must be prioritised when we get on top of this pandemic.

On the issue of elderly people, my mother turned 80 during this pandemic. At the beginning of last year she was about to go on her 15th consecutive trip to work in the orphanages in Belarus. There is a marked difference between her life standards at the beginning of last year and the beginning of this year and in what she can do, as somebody who is the most active person in the community that I can think of. There are hundreds of thousands of people like her. The impact that is having on the mental health and well-being of elderly people is incredibly bad and sad. They are the group of people who have paid their taxes and have done everything. I really feel that there must be intervention mechanisms.

I want to raise an issue concerning those who are bereaved. Unfortunately, I lost my mother-in-law very suddenly in the last couple of weeks. This issue was brought to attention by my colleague, Deputy Sherlock. I have now experienced it, along with my wife and her family. It concerns the amount of bureaucracy in respect of having to contact so many different State organisations in the case of bereavement. We should forget about politics. I ask the Minister of State to lead the charge on this issue. It is Deputy Sherlock's idea. There should be a one-stop-shop whereby if somebody passes away, family or next of kin can register the passing as part of a central process and it can be filtered out across all State agencies and potentially utilities also. I would be very happy if the Minister of State would commit to that today. It is an excellent idea and it would help people who are dealing with bereavement. During the pandemic, it is much worse. I have experienced it myself. It is so hard to grieve. It has such a lasting on people's mental health in respect of the loss and the continuous process of grieving, which goes on much longer and in a much more difficult way, because of Covid.

There are two final issues I would like to raise. My colleague, Eoin Barry, from Laois, who works in the area, has raised the issue of eating disorders. He has seen a significant increase in eating disorders during the pandemic. Obviously, the period from a psychiatry diagnosis and the length of service requirement afterwards is quite long. I ask the Minister of State what has been done on this issue.

Finally, I would like to raise a local issue. There was a recent case concerning a middle-aged lady with some psychiatric and addiction issues. The family situation was not good and she kept coming back to the house, being taken away by the police, put in an ambulance and sent to University Hospital Limerick. Over the course of a few days, this happened repeatedly because she was not being sectioned. I know that it is difficult to section people. Where there are serious addiction issues, this cat and mouse game cannot go on, whereby a person is taken away by gardaí, the person cannot or should not put in a cell, he or she is sent off to an acute setting in a Covid situation and then the person is sent home. I will pass the details onto the Minister of State. It is happening all over the country. It is ridiculous.

The issues being raised are all very sensitive, but there is no time for the Minister of State to reply. I must keep within a time limit.

This is an important debate. I welcome the Minister of State and the speech she made. We all have concerns in this House about Covid-19 and the impact is it having on people's mental health, in particular, in respect of the passing of people. I agree with Deputy Kelly on the point he made about family losses. Unfortunately, I lost my brother-in-law, Joseph Quinlan, yesterday to Covid. He was a great man for watching Tipperary play hurling and a very good husband. I know that other people here have also lost family members. I know the tragedy and the loss that is to everyone. If there is one thing that is clear from all of this tragic loss of life, it is the commitment and the supports given by medical staff, namely, doctors, nurses, nursing home staff and healthcare assistants. It is phenomenal and fantastic. It is deeply appreciated by all the people I have spoken to who have lost loved ones. They are aware of the impact that Covid must have on the capacity of staff to deal at 100% with the care and the love that they offer to their patients. We must offer any necessary additional supports to healthcare staff, whether they are ambulance staff or healthcare assistants and so on. It is a huge burden on people, given their work commitment, professionalism and dedication.

The other point I wish to make concerns those who have passed in this tragic Covid pandemic. We must make a significant contribution to recognising the sacrifices they have made through a day of national commemoration or remembrance. It is hugely important to show that these families are not alone and the community does care. We must show how much we care in terms of our State and society respecting them.

I know time is short, but I have one question for the Minister of State. There will be increased anxiety among those aged over 70 now in relation to the AstraZeneca vaccine that they are not going to get. I have had communications already this morning from people over 70 who are worried and concerned. They were concerned any way. I ask the Minister of State what reassurance she can offer them to ensure that they will get the vaccines that have been identified for them, namely, the Pfizer vaccine and so on, and that they will get them as quickly and effectively as possible. They are already deeply stressed and worried about their situation, particularly given that as they get older, their systems do not respond as well in terms of immunity. I ask the Minister of State to address the issue.

First, I offer my condolences to the Deputy and his family on the death of his brother-in-law, at what is a very difficult time. As Deputy Kelly stated earlier, it is very difficult when only ten people can attend a funeral. Considering all the hoops that must be jumped through in normal times, it is most difficult.

On the question the Deputy raised, there is increased anxiety in respect of vaccines. Yesterday we heard that the AstraZeneca vaccine is not being recommended for the cohort of people aged over 70. The high-level task force is meeting as we speak to look at the issue. My understanding is that the commencement of the administration of the vaccine to those aged over 85 in mid-February will go ahead. From speaking to many constituents, I know that GPs and their staff have been very active in putting together lists. However, things will definitely have to be configured. We will have to wait for details from the HSE, the task force and the vaccine roll-out teams. It does make things more difficult, because we all know that the Pfizer vaccine must be stored at -70 degrees. As Dr. Colm Reid said, it is a fussy vaccine and it is not as straightforward as the AstraZeneca vaccine.

I thank the Ministers of State for their presentations. It is an important area, because of the huge challenges posed by Covid. There is a huge problem in respect of the financial strain placed on everyone, especially those running small businesses and those who have lost their jobs.

People who have lost their jobs are worried about support for their immediate family. It is hugely stressful for young people as well. The Covid pandemic has highlighted a number of key areas for attention, one of which is mental health. It is important that we have an overall review of services. The HSE website states that there has been a 490% increase in access requests to the website over a very short period of time. That increase highlights the extent of the issue.

I want to raise three issues with the Minister of State. The first was already raised by a colleague, namely, the need for a dedicated director for mental health reporting directly to the CEO of the HSE. Is that recommendation being looked at and is consideration being given to moving forward with an appointment?

The second issue concerns the recommendation in A Vision for Change that a national mental health directorate be established. We need some clarification on that.

Finally, a member of my immediate family was involved in a mental health facility where nine out of 27 people died in a very short period of time due to Covid. Part of the reason was that there were six residents per room. It was impossible to control the spread of Covid in that setting. An overall review was conducted into community hospitals and HSE nursing homes and there is now a detailed plan set out for refurbishment and upgrading those facilities. Can there be an overall review of all mental health facilities in the country with a view to setting out a clear plan for how and when they will be refurbished and brought up to the standard that is required? That is extremely important and the review should be started now. During a debate yesterday, we heard that more than €709 million was not spent by the Government. Now is the time to prioritise projects such as what I am proposing. The funding is there. Let us get on with planning and delivering it. Will the Minister of State indicate whether a review is in progress in respect of all mental health facilities and, if so, whether it will be presented to the House, through the health committee, in the not too distant future?

I thank the Deputy for his questions. He is right that the programme for Government includes a commitment to examine the reappointment of a national director for mental health in the HSE. I will be engaging with the HSE on that in the next couple of weeks. I am very supportive of it. We spoke about the new Sharing the Vision policy. The national implementation and monitoring committee is in place and one of the key issues we will be looking at very shortly is a review of bed capacity throughout the whole country to see what the situation is.

As the Deputy knows, the Mental Health Commission has oversight in regard to our mental health facilities. I met with the HSE yesterday to discuss our budget proposals, where we will be spending the money this year and making sure it is spent in parallel and in tandem with ongoing Covid efforts. There was €6 million allocated for the upgrading and refurbishment of a number of mental health facilities that were identified by the Mental Health Commission. I take on board the points the Deputy made in regard to mental health facilities throughout the country. I am delighted that the national implementation and monitoring committee is in place under the chairmanship of Mr. John Saunders. We have much work to do and a lot of issues to look at. The steering committees and sub-committees that will be put in place will hold the Department, the HSE, the Minister for Health and me to account. The issues the Deputy has raised are all issues that are to the forefront of my mind at this time. We will be looking at all of them. I thank the Deputy for his constructive approach.

In the three and a half minutes available to me, I want to raise a number of issues with the Minister of State and give her time to respond. I will put my questions as distinctly as I can and I hope to get a response. Everybody is affected by what is happening at the moment and it is causing real challenges and difficulties for every section of society. Some are more impacted by it than others. Representatives of the Psychological Society of Ireland have told me that loneliness, isolation, anxiety, stress and the economic impacts of the pandemic are causing another hidden epidemic in mental health. We would all accept that.

I want to focus on a couple of cohorts of people who need to be acknowledged when we talk about mental health and Covid. One of those groups is our front-line healthcare workers, who have gone through a hugely difficult and traumatic time. At this point in time, thousands of them are out sick. Some 7,000 healthcare workers contracted Covid-19 in the month of January alone. It is horrific. Sinn Féin has brought forward a Bill to protect those workers and make Covid-19 a notifiable occupational illness. Is that something the Government will support? We need to recognise the impacts of what is now being called long Covid, including its impact on people both physically and mentally. Is that an issue to which the Government is giving consideration?

I have a very specific question regarding the vaccine roll-out and the news yesterday that the AstraZeneca vaccine will not be used for the over-70s. That is causing a lot of confusion and will slow down the roll-out of vaccinations for people in that age group. People want to know if they will be vaccinated and there is particular concern about those most at risk. People aged over 70 are among those most at risk. Is there a revised vaccination timetable? How can the Minister of State address the concerns of those aged over 70 who are listening to the news that the vaccine they were told would be the best for them and would allow them to get vaccinated more quickly will not now be used? What impact will that have on their mental health?

I thank the Deputy for his questions. I agree with him wholeheartedly that loneliness, isolation and anxiety are a problem. People are really concerned at the moment and we have never seen such high levels of issues from the low impact of mental health challenges. The HSE's psychosocial framework is particularly focused on healthcare staff. That does not just include staff in the HSE sector; supports and counselling are available across all the sectors, including for those working in nursing homes. The Deputy referred to the number of healthcare staff who are off work on Covid leave. There are another 2,000 of them in nursing homes and 300 mental health staff.

The Deputy asked whether there will be a revised vaccination timetable. I am sure there will be but I do not know about it yet. The high-level task force is meeting today. All of this news broke yesterday and the only information I have is that the roll-out for over-85s, which was to commence mid-February, is still planned to go ahead. Obviously, it is going to be logistically way more difficult now because the AstraZeneca vaccine can be stored at room temperature whereas the BioNTech vaccine has to be stored at -70 °C. It will be more challenging but I am sure we will have a lot more detail in the next 48 hours.

The pandemic is taking its toll on everyone's mental health. It is especially felt by people living alone, young people and people who have not been able to see their family members since last March. The key to addressing increased anxiety and isolation is an effective Covid elimination strategy for the island of Ireland, such as that proposed by the We Can be Zero campaign. We need immediate measures, a massive investment in public health resources, distribution of the vaccine, mandatory hotel-based quarantining for people landing on the island and significantly greater co-operation with Northern Ireland. This strategy would get us back to normal more quickly, give people hope and, therefore, help to address mental concerns. In addition, quicker decisions on issues like the leaving certificate and junior certificate examinations and better consultation with the people involved would help to ease stress and anxiety around those matters.

The Covid-19 crisis has highlighted the continuing underinvestment in our mental health services. There is an over-reliance on GPs and overstretched NGOs, a lack of multidisciplinary teams in settings where they are required the most and a continued practice of keeping people with psychiatric conditions in congregated settings. The recent report by the Mental Health Commission on mental health services for older people highlighted the inadequacy of services and the need for urgent improvement.

I wish to raise three specific issues. Time is limited for the Minister of State to reply but I would appreciate written answers to questions she does not have time to address. First, staff in primary care mental health services, which were already overstretched before the pandemic, have been redeployed to other services. Resources have been taken away from the preventative and early intervention areas. Before Christmas, the Irish College of General Practitioners informed the Oireachtas Sub-Committee on Mental Health that many of its members had stopped referring patients to primary care mental health services because of extensive waiting lists driven up either further by staff redeployments. As a result, the only option for many GPs is simply to prescribe medication, which is in no one's interest.

Demand for these services will only increase and people's conditions will become more complex and more expensive to treat. How does the Minister of State intend to address this issue?

A major concern I share with many is the inappropriate accommodation of people with disabilities in congregated settings. There are over 1,500 people with disabilities under 65 in nursing homes. Some psychiatric patients reside in institutions and there are many living in intellectual disability services. Therefore, despite the best efforts of all involved, Covid-19 spreads quickly in congregated settings. I understand that the Minister of State inherited this situation but she still has to respond to it now, and urgently. I wonder what steps have been taken to protect the people in question, including through the distribution of the vaccine to those under 70 in the congregated settings.

The Minister of State mentioned eating disorders. We are aware that Covid-19 exacerbates existing mental health issues. It is very worrying, therefore, that no funding was allocated under the national eating disorder treatment plan for 2020 and that none of the €1.6 million allocated in 2019 was spent. Eating disorders, which disproportionately present among young women, are among the psychiatric conditions most associated with mortality. While the decisions made were HSE decisions, I would appreciate it if the Minister of State could look into the matter personally and urgently and get back to me.

I thank the Deputy for raising these really significant issues. I will work backwards. On eating disorders, I have been really concerned that over the past three years, very little of the money designated has been spent. I had a meeting with HSE officials yesterday on this matter and on staffing issues in respect of eating disorders. Speaking off the cuff, I believe €4.7 million will be available to me this year. I guarantee the Deputy that all that money will be spent. I am very concerned about eating disorders. I have met the HSE clinical programme leaders and representatives of Bodywhys and I am very concerned.

On the roll-out of vaccines, I will give an update. The Mental Health Commission has reported that as of 28 January, last Thursday, with regard to 46 mental health facilities with residents aged 65 and over, staff in 31 and residents in 36 had received the vaccine. That was the position last week and the roll-out is continuing this week. I should have more up-to-date figures by the end of next week.

What about people with disabilities in those congregated settings?

People with disabilities do not come under my remit. The roll-out is currently for people of 65 and over only. The people with disabilities to whom the Deputy referred will be part of the next cohort.

We are in the middle of a virus pandemic and I am afraid there is a mental health pandemic waiting at the other side of it. Day after day, I am contacted by people in genuine trouble. This week, from 1 February to 7 February, is Children's Mental Health Week. Mental health issues have come to the fore for children and adults alike over the past year. The pandemic has taken a great toll on everyone's emotional well-being. Among children, including young children at home, and leaving certificate students, it has led to a lot of anxiety and fear. Doctors who have not seen children presenting before with mental health issues are seeing them more and more. They are worried about what comes next for these children. I have heard of cases of doctors from the children's hospital having referred patients to a local service only for it not to have followed up. In these times of increased anxiety and mental health issues among young people, what are we doing to resource services of the kind required in counties such as Carlow, where there are no child and adult mental health services to speak of?

While I am aware that the Minister of State is committed, we are behind on resources. Recently, a damning report by the Mental Health Commission found significant shortcomings in the HSE-led mental health rehabilitation services in Carlow. People with severe and enduring mental illness are some of the most vulnerable in our community. Rehabilitation provides them with an opportunity to recover and retain quality of life. The report made it clear that an opportunity was lost. We must not lose these opportunities. People dealing with mental health issues are the most vulnerable. They matter and we need to make sure they feel that.

I recently proposed that Carlow become a talking town, a place where anyone can access the help he or she needs at any time without stigma, judgment or obstacles. Can we consider rolling this out nationwide? It is so important. We need to treat mental health like physical health such that going to someone to talk is regarded as the same as going to the gym for a training session. There is no stigma attached to one so there should be no stigma attached to the other. There are supports available but we need to tie everything together and accord to mental health the priority it deserves. I know the Minister of State will do this so I ask her today whether we can establish a system whereby somebody in need of mental health support can just walk into his or her local shop displaying a logo and find the resources needed. This is so important. Information is the key in this regard.

I was going to ask about the vaccine and I am glad the Minister of State is giving the information. There is fear over access to the vaccine, particularly among the over-70s regarding the AstraZeneca vaccine. I am aware that the Minister of State will have a plan in place so people can get the relevant information. It is crucial that they get it. Once they do, it will help. I thank the Minister of State.

I stand here before the Minister of State following a very useful and informative meeting she had in my constituency with representatives from the GAA, the HSE, Pieta House and SOSAD, and, of course, people affected by the loss of a loved one through suicide. I stand here before the Minister of State to reiterate the points I made at that meeting on the critical needs that arise. There has been a disproportionate increase in the number of young people taking their own lives or attempting to do so in my constituency. I firmly believe the resources that are required do not exist in my constituency. At the meeting, I had three specific asks. One was that the likes of Jigsaw should come to the constituency of Cavan–Monaghan. I am aware that the Minister of State is very much to the fore in supporting that idea but we need to see the HSE coming on board and making a commitment to the area because the service would provide early intervention. I am absolutely convinced the service is needed for young people in the area.

Could the Minister of State commit today to the provision of suicide crisis assessment nurses, SCANs, for Cavan–Monaghan. I am aware from speaking to those working at the coalface, including HSE staff, general practitioners, nurses and others who are presented with the problems of people coming in to them, that SCANs would be instrumental in providing early intervention for young people when they find themselves in dark places.

I ask that primary care psychologist supports be put in place for young people across Cavan–Monaghan. I cannot reiterate enough the needs that arise. I have noted the dark places in which I have seen young people and the number of lives that have been lost. People as young as 16 have taken their own lives in my constituency. I do not need to tell the Minister of State the trauma and trail of destruction this leaves behind for family members and communities. People rally together but in these times it has been particularly difficult to support families in the way required. That is why Jigsaw is needed for Cavan–Monaghan. SCANs and primary care psychologist support are needed. The extra hours would be much appreciated.

I thank the Minister of State for facilitating today's important debate on mental health. I recently received a copy of the HSE Psychosocial Response to the Covid-19 Pandemic. It is certainly a well-thought-out document. It identifies the needs of various segments of society and the proposed action points. It also highlights specific relationships that we can all develop to keep us well and to stay well. It provides an overview of the seriousness of the mental health impact that the pandemic has had on Irish society. The document highlights children and adolescents as comprising a priority group that requires particular consideration.

In my constituency, two organisations — Mindspace Mayo and Mayo Mental Health Association — provide significant support to people in a relatively wide range of age groups. Mindspace Mayo provides support to those between 15 and 25 and it has hubs in Castlebar and outreach services in Ballina and Erris. However, I am particularly concerned about the supports for people under 15 because there seems to be no organisation in Mayo catering for them specifically. They are experiencing extreme disruption in their daily lives. Normal supports, such as school and friends, are not available during the current restrictions. Jigsaw provides services to youths from 12 years of age but it is based in Galway and Roscommon. I would be grateful, therefore, if a dedicated service for youths between 12 and 15 could be established in Mayo.

We have funded this year the additional staff required to develop the HSE psychosocial framework. The primary care list, which we all know is extremely long, is, as one Deputy said earlier, something I inherited but have been working on intensively. Currently, there are 12,000 under-18s on that list and 6,000 of them have been waiting over 12 months, which is not acceptable to me. I met with the HSE recently and with the primary care team. We are putting in place a 12-month approach to reduce the waiting list. I spoke to the Minister, Deputy Stephen Donnelly, last week on the funding. I am hopeful that in the next three or four weeks, I will be able to bring forward a proposal that will significantly reduce that waiting list. People are quite right that GPs are putting children onto waiting lists. Some are going onto the CAMHS waiting list and some are going onto the primary care waiting list. When there is a child who needs these supports, people and parents cannot wait. As a parent, I understand that so I am working hard to devise a targeted approach to the waiting list, especially for those waiting over 12 months.

I call Deputy Buckley. Does he have questions or a statement?

Just a statement. I thank the Minister of State for her opening speech. I will tip on two issues. I am glad the Minister of State noted in her speech that the availability of staff is and has been an ongoing issue. She stated in her opening statement:

While we do not yet fully understand the impact of Covid-19 on mental health and any subsequent demand on services, it is acknowledged that there have been increased presentations in certain areas, especially in first episode psychosis and eating disorders.

I will quote from a column in The Irish Times in January as a means of pointing out how serious an issue this is. It relates to the challenge the Minister of State and her Department will face after Covid:

There's a 'tsunami of mental health need' coming when Covid-19 recedes. Ireland's mental health system is not prepared for a crisis - [Why?] Because it was in one before we ever heard of coronavirus.

It continues by quoting Dr. Karen O'Connor, who is a psychiatrist and the national clinical lead for early intervention in psychosis:

I don’t want to overstate it, but it’s based on the numbers that we’re getting out of our early intervention and psychosocial services.

What she means by that is illustrated by a quote from a patient who took part in a survey mentioned in the article in The Irish Times. I want to highlight this quote because it shows how service users are feeling at present. I think we will be in an even bigger crisis after we have come out of the Covid situation. According to this patient, as quoted in The Irish Times:

I was convinced I was starting to have a psychotic episode and I did everything they tell you ...  [I contacted the HSE funded text service] 50808 who told me to contact the Caredoc or 999 ... I called 999 who told me to come into the hospital where my usual psychiatrist was on call. She proceeded to tell me I need to learn coping mechanisms ... and that they couldn’t do anything because I’m not suicidal and sent me home. Since then I’ve had nurses calling and doing the checklist shit with me every day or so, but they don't seem to have any plan to stop me feeling this way.

I could go through the figures of 10,000 and 20,000, but instead I will explain what I am really worried about. When I was brought up, my parents used to tell me not to worry about what would happen tomorrow but to plan how I would deal with it. Over recent months, I have been speaking to laypeople and people in various services who are genuinely terrified that when Covid is over, there will be knock-on effects on mortgage relief, marriage break-ups, family break-ups, damaged children and other effects across the board. We need to have a plan. We can work on all side of the House on this. I appeal to the Minister of State and her Department to start getting ready now for what will happen in 12 or 18 months' time, when this will be a serious tsunami. I noted a recent survey in the US which found that there has been a 42% increase in mental health issues and anxiety among those surveyed. We are no different from anybody else. We are a small country. We have been hit harder. It is time to prepare for the tsunami that is coming. Let us hope we will not be here in 12 months' time saying, "We hate to say we told you so, but we told you so." We do not want that. We want to work together to get a better mental health service.

Deputy Gino Kenny is sharing with Deputy Barry. Is it questions or statements?

It is questions and answers. I have two specific questions. One relates to correspondence I have received in the last couple of weeks about the frustration of psychiatric nurses concerning the roll-out of the vaccine, particularly for those in acute mental health services. There is no timeline and there is complete frustration for psychiatric nurses in that setting. Will the Minister of State give reassurance or a timeline for psychiatric nurses in the mental health services getting the vaccine?

The second question, which other Deputies have touched on, relates to the effects of the pandemic on children. We all have mechanisms or coping exercises to deal with this pandemic and we are all different. Regardless of one's identity, we all have a sense of anxiety in relation to what has happened and what will come. This has a particularly detrimental effect on children because of the lack of school, everyday routines and so forth. What new resources will the Minister of State put into CAMHS in the short and medium term?

I thank the Deputy for his two questions. On the vaccine, I met with the executive mental health clinical directors on Tuesday afternoon and we discussed at length the situation relating to the vaccine. Public health nurses and those working for mental health services will come under cohort 2. Some 70,000 of those staff have been vaccinated and the roll-out will continue in the next couple of weeks.

On CAMHS, which is close to my heart, I met yesterday with the HSE in relation to the €23 million I secured in the budget. There will be 29 extra child and adolescent mental health staff put in place. The waiting list is currently at around 2,500 and I am anxious that it be reduced.

I want to put on the record my serious concern about the impact of the leaving certificate crisis on the mental health of the nation's 17- and 18-year-olds. The leaving cert is stressful in normal times, which is one of the reasons I am in favour of the abolition of the exam. We are told that 50% of teens normally feel nervous when they think about exams and 25% feel physically unwell. However, with Covid, things move into a higher gear altogether. Some students have experienced Covid directly. Students have had family members with the disease. Students have relatives who have died. Students live with family members who have underlying conditions and can be terrified of bringing the disease home. Students have lost 15 weeks of classroom teaching time already. There are some students out there who cannot sleep. There are others who are not eating properly, as well as some who are crying, who cannot get out of bed and who have gone on medication to get them through the exams. Not all students show these symptoms, perhaps not a majority, but all are feeling the strain.

No doubt the Minister of State will tell me the Government will make a decision next Tuesday and that this should relieve much of the stress. However, I say the Government's decision must relieve the stress and not add to it. I am fearful that the Government is close to making a decision which does add to the stress. A late summer leaving cert means that exam stress goes on for an extra four to six weeks and that the students who need to work for the summer to make money to go to college cannot do so. A hybrid leaving cert risks being the worst of both worlds. Students can end up with the stress of a written exam and the stress of handing in papers that go towards calculated grades. That creates two hurdles and potentially twice as much pressure. The best solution by far is to cancel the exams, give every student a cert and invest in third level to the point where open access can be provided next year.

Will the Government support the commissioning of a National Educational Psychological Service survey to assess the mental health of the nation's 61,000 leaving certificate students?

The Department of Education, through the National Educational Psychological Service, NEPS, is providing school-level emotional and psychological support. I have no doubt the Minister, Deputy Foley, will bring the decision to the House when it is made.

The report of the expert group set up to review the Mental Health Act 2001 was published in 2015. It contains 165 recommendations, including provisions intended to strengthen protections for people who are detained without consent at approved centres. In June 2016, the then Minister of State with responsibility for mental health, Deputy McEntee, stated that the draft legislation would be completed by the end of that year. In July 2019, a draft heads of Bill was sent to the Mental Health Commission for its consideration, with a six-month turnaround. In the past few months, responses to parliamentary questions from some of my Dáil colleagues indicated that the Department was preparing a final draft of the heads of the Bill on a part-by-part basis, with a view to finalising the draft Bill by the end of 2020.

By any metric, that is a very unsatisfactory timeline for the development of legislation that is so badly needed. Given that the delays date back more than five years, we cannot lay this at the door of Covid-19. The Minister of State said we will receive the Bill soon. Numerous dates have been given for publication of the draft legislation and none of them has been met. These delays are highly problematic given the lengthy duration to date of the review of the Act and the seriousness of the gaps in human rights protections for adults and children receiving inpatient mental health treatment.

In 2018, the Mental Health (Amendment) Bill was successfully put before the House, but the Act has never been commenced. As the mental health community waits for the fully revised mental health legislation to be produced, and we have waited for more than five years, will the Department and the Minister of State consider commencing at least some limited aspects of the 2018 Act? For example, there is currently no definition in our mental health services of what constitutes a voluntary patient. This has created a grey area whereby a person's right to reviews and tribunals is not clearly set out in law, leaving vulnerable people even more so in a system that is still underfunded and lacking in supports.

Could we have a timeline for the development of the fully revised Mental Health Act? Can we get a certain date for the completion of the revision of the 2001 Act, even if that date is slightly further away than we would like? Will the Department and the Minister of State consider commencing some limited sections of the 2018 Act in the meantime?

There is no doubt that the pandemic has been difficult for everyone's mental resilience and mental fitness, but two groups find it even more difficult than most. When one's toolbox is full, one will find it easier to respond to a global pandemic, whereas when one has challenges and when there are complexities in one's life, it is inevitable that one will suffer more. The two groups I have in mind are dealt with in my area by the Finglas Counselling Service and the Finglas addiction support team. I imagine that the Finglas Counselling Service is the same as many community-based counselling services throughout the country. It provides an excellent service and responds to the service failure by the HSE to provide much-needed counselling, often at an entry level to issues that can be resolved easily within counselling before more profound mental health difficulties can develop. What can we do to support such community-based counselling services?

The other group I wish to raise is supported by the Finglas addiction support team. The Minister of State will be aware that I have spoken many times about the issue of dual diagnosis. Dr. Amir Niazi, the clinical lead in this area, stated to the Special Committee on Covid-19 Response last year that he looked forward to bringing forward a report that would deal with the four recommendations in the Finglas addiction support team's report, namely, re-establishing a clinical governance programme, amending the Mental Health Act to provide that there is no such thing as a wrong door for people with either an addiction or a mental health problem, and providing education for professionals in both services in order that the two issues could be linked.

Covid has visited significant pressures on mental health services. For all of us, isolation and restrictions have been a considerable challenge, but for those battling their way through life, it has been nothing short of a nightmare. In August, I first spoke in the House about the following young constituent. His family desperately wanted to get him out of seclusion, but at the time, St. Loman's Hospital in Mullingar was not in a position to manage that process. Months passed and this man spent 110 days in isolation, more than half the time he has spent in the care of mental health services since he was admitted in July. His family have fought desperately for help, and at a family conference with his medical team in November, it was agreed that two care centres would be approached in the hope they could provide the intensive rehabilitative care that this young man realises is necessary if he is to return to the community. He himself craved the move and wrote to the Minister of State to ask that the process be sped up. On behalf of the family, I acknowledge her support and that of her staff for the family and for their fears and concerns.

Christmas for this young man and his family was a nightmare. On one side of a window in St. Loman's Hospital, his mother desperately hoped she would never see another Christmas like it. As the days turned into weeks and months, the young man grew ever more frustrated and, unfortunately, last Friday he lashed out at a fellow patient and was returned to isolation. Needless to say, his family are crestfallen, fearing that the prospect of a possible recovery has been all but quashed. The promise of that intensive rehab lies in the balance, as is the promise of a life and of a future. Thankfully, he was released from isolation last night but he is heavily sedated and medicated.

This is just one young man caught on the mental health treadmill, a seemingly never-ending cycle of uncertainty and bleakness that, unfortunately, has been fuelled by Covid. For this young man and his family, I plead with the HSE to get him the care he so desperately needs. I ask it not to leave him to languish within the walls of the system and not to turn out the lights on this young life, and to deliver him the intensive rehabilitative care he so desperately needs.

I will try to answer as many of the questions as possible. The national clinical programme for dual diagnosis is proceeding and the new clinical lead is in place. I have funded new posts for dual diagnosis in 2021, which I know everybody will welcome.

On the issues relating to the Mental Health Act 2001, this is extremely complex legislation and a great deal of work is being undertaken. I have discussed it with the Attorney General and we will move on it soon. It is not feasible to bring forward certain sections before others. In any event, we are almost at the point of being able to publish the heads of the Bill and I hope it will get the support of the House in due course.

The programme for Government commits to examining the appointment of a HSE national director for mental health. Why has this appointment not happened? Will it happen or has the Government given up on the idea?

I addressed that question earlier, although the Deputy might not have been in the Chamber. I will meet representatives of the HSE in the coming weeks. My primary focus when I came into the job was to get the national implementation and monitoring committee in place for Sharing the Vision. Given that we were dealing with the Covid pandemic, I wanted to ensure that services could be retained insofar as was possible. Between 85% and 90% of all services are ongoing and it is important to put that on record. I will meet representatives of the HSE soon. As I said earlier, I am supportive of that role being created in the HSE.

On a separate front, yet another crisis is descending into a state of emergency. A complete lack of concern has been shown by the Government since the start of the pandemic towards those held at direct provision sites. Does the mental health of these men, women and children even register in the thought process of the Government? What provision and supports has the Government put in place for those at direct provision sites who are struggling with their mental health?

I thank the Deputy for that very important question. The HSE has worked closely with different NGOs to provide counselling supports. MyMind, for example, has provided 10,000 instances of counselling supports in 15 different languages for people living in Ireland and this supports people who live in direct provision.

I am sure we will all acknowledge the unbelievably important role sport plays in mental health for thousands of people, young and old, throughout this country. With the suspension of sport under different levels of Covid-19 restrictions, the support sport gives to the mental health of so many has vanished overnight. What was a mental health crisis pre-Covid is now a mental health emergency. What provisions are being put in place for the many across the sporting community who have watched as the most basic of mental health supports have vanished? What supports have the Minister of State and his Department sought to put in place for participants through organisations such as Sport Ireland?

We have put €7 million in support of the delivery of a range of actions and we have worked with all the stakeholders. Effectively, we are asking people to keep active and go outdoors. Even during the winter, physical activity can be very helpful. Indeed, as I was listening to the radio in Limerick when coming to Dublin today, it was great to hear that local GAA clubs have opened up their grounds so people can walk around. We are working with all the various stakeholders and organisations because isolation is a significant risk for people of all ages during the Covid-19 pandemic. I pay tribute to all the sporting organisations, and this Government is committed to working with them to try to address these issues.

To follow up on that briefly, what engagement has the Department had with Sport Ireland around mental health initiatives to address the concerns and issues of participants?

All mental health supports and initiatives are for everyone. A person does not have to play sport to avail of them. They are there for everyone from the very young to the very old. As the Minister of State, Deputy Feighan, pointed out, a huge amount of support has been put in place for sporting organisations, whether it is the GAA, IRFU or whichever sports are involved. Mental health supports are for everyone, however. A person does not have to play a sport to avail of them.

Deputy Verona Murphy is sharing time with Deputy Lowry. Is it questions and statements?

I will ask questions but the answers may be given in writing.

Today, I want to start by wishing a very special young boy named Gavin from County Wexford a happy 18th birthday. I hope that he, his dad, two brothers and sister have a lovely celebration, not just because it is his 18 birthday but because he almost did not make it as he has mental health problems. I congratulate his dad and family, who have assisted Gavin in every way possible for the last number of years. I must mention the staff in the child and adolescent mental health service, CAMHS, in Arden House in Wexford, who have been Gavin's saving grace.

I want to inform the Minister of State, however, that as Gavin turns 18 today, he moves from the CAMHS to the adult mental health service. It is daunting and it is unclear for him and his family what that involves. I will be there to help, however. I hope the Minister of State will also assist in that transition to ensure he gets the help he requires to see his 80th birthday, because it was not there for him as a minor in the way it should have been.

The staff in CAMHS in Arden House, Wexford have been fantastic but they are under pressure. They are understaffed with no child psychologist and no dietitian. According to a Mental Health Reform document received yesterday by every Deputy in this House, the country has 2,000 children on mental health waiting lists. Many of them are in County Wexford. I have asked continually, every time I stand on the floor of this House, for this to be resolved. We need to provide a full staffing team for CAMHS in County Wexford with added availability for an out-of-hours service. It is a matter of life or death.

Worryingly, as I said, yesterday I received an update from Mental Health Reform and what it contains is frightening. The report says the HSE has seen an increase of 490%; that is more than 800,000 people contacting the mental health website. That is one in six people in this country, and yet only 6% of our health budget goes towards mental health services. There is no vaccine for mental health. There are, however, many voluntary organisations, which are critical to the care and management of mental health sufferers, that are now devoid of funding because of Covid-19.

Will the Minister of State update us on the staffing of CAMHS at Arden House? What is the Government's proposal to assist the many voluntary organisations with funding? Will the Minister of State be able to tell me when public health nurses in the mental health sector will be vaccinated? That can be provided in writing. I thank the Minister of State.

I do not have a question but I have some comments. One year ago, we had no idea that our world was about to be turned upside down. If we had seen Covid-19 coming, I like to think we would have been prepared. Sadly, a crisis seldom gives fair warning. Another crisis is looming and making its presence felt more and more each day, however.

The people of this country, young and old, have moved towards a mental health crisis. That crisis has arrived and it is obvious that we are not prepared for it. This lockdown has hit people much harder. Every age group is finding it harder to cope. There has been an immense slump in the mood throughout the country. We see alarming numbers of daily deaths, new cases, new mutations of the Covid-19 virus, confusion and dismay surrounding the vaccine roll-out, and long, dark and dismal winter evenings. These issues, in addition to the upheaval that restrictions bring to their lives plus the idea that there is no certain end in sight, have proven too much for many people.

It is not just that people have lost their fight, that optimism has deserted them or that they are simply worn down by the life we are now forced to live. It is more than that. People are suffering from what is referred to by psychologists as reactive or situational depression. It is very real. Its most common triggers are bereavement, isolation, health worries, financial concerns, loss of independence or control, and restrictions or limitations that impact normal routines.

We hear the mental health statistics regularly. There has been a 30% increase in prescribed medications and helplines are overwhelmed with desperate callers. We seldom hear the human stories behind these cries for help during this pandemic, such as the woman who has lain in a hospital bed for two months without any visitors, the man who has been inside his home alone since Christmas with only a knock on the door to tell him his shopping has arrived, the family who cannot afford a computer for their child to access schoolwork, the teenager who spends all day, every day, online with no human contact, the family that has lost three members to Covid-19, the woman who is afraid to go shopping in case she touches someone who could infect her, and the elderly lady who cries every day as she is so afraid of becoming ill.

There are endless stories and endless suffering. People will continue to suffer long after the pandemic is over. Many will not bounce back to normal life just because this virus is suppressed. Taking off our masks will not be enough to make people smile again. It will take time and it will take help. We know this now; we can see it coming. We must prepare for what is yet to come. There is no excuse for us to be taken by surprise this time. We must invest in our mental health services, particularly our community services. Now is the time to build the human resource capacity to deliver quality mental health and social care in the community. We owe this to people everywhere. We need to address their suffering. They need intervention help and support. We urgently require a focused approach and a co-ordinated plan that is properly resource and funded so those who reach out for help can be assisted to overcome the burden of mental health pressure.

Deputy MacSharry is sharing time with Deputy O'Connor.

I thank the Ministers of State for the opportunity to speak. As always, my worry is not the commitment of the Ministers of State to their job. I know personally that they are focused on the issue of mental health. The difficulty is that consecutive governments, certainly in my political career, have paid lip service to the issue of mental health when it came to resourcing. We had A Vision for Change that we all rallied around and in its entire lifetime we managed to implement approximately 40% of it.

It is one of those popular subjects that all Deputies, county councillors, Senators and whoever else like to be associated with and say a few words on but once the debate is over that is the end of it. Within the HSE and the Department of Health, the first budget to be raided to facilitate some other aspect is always the mental health budget. I feel for the Minister of State in that respect because she has to fight hard to get whatever she manages to get.

I have lived experience of mental health complaints, as many of us will have but in recent months since Covid-19 has been around, the word "tsunami" has been mentioned and I have used it myself. Whether we are suppressing the figures - I am not accusing the Minister of State of doing that - or whether the news cycle is just so focused on Covid-19, we are not even touching the iceberg. I will tell one story that is accurate and that can be got from the archives of Ocean FM. The person in charge of Sligo town cemetery was giving an analogy on 8 September in which he was discussing, at that stage, deaths from Covid-19 that he had to cater for in the cemetery compared with other matters. I know we are in a much different place today but up to that point he had buried one person due to Covid-19 and ten people due to suicide since the previous March. I am sure Sligo is not unique in those sorts of figures.

I am not trying in any way to reduce or dilute the gravity of the Covid-19 situation or of all of the fatalities and the people who we have lost but people's mental health has come second. In the National Rehabilitation Hospital, admissions through incidences of attempted suicide were 17% compared with 1% during the same period in the previous year. In speaking to young people, including 16 year olds through to students in college, the words I am hearing are "despair", "frustration", "depression" and "anger". They have a sense of having lost their rights of passage on so many things, whether it was a summer job, a J1 visa to the United States, the driving test or so many others. I mention elderly people and Age Action is reporting that up to 40% of those presenting to the mental health services for the first time are elderly people. We feel it ourselves and we are the lucky ones who are able to go to the Dáil every week and to our offices and we are busy on our phones trying to help constituents. What about the 16 year old who has not been out since many months ago or the 82 year old who cannot go and visit friends or family?

The Minister of State will know I have been critical of our approach to the entire Covid-19 process in terms of the lack of a strategy. We need a strategy on mental health from now on as we emerge from this process. Hopefully we will get vaccines right because there is a tsunami. It is already out there but nobody is talking about it. I know the Minister of State is aware of it but I suspect, like all of her predecessors in my political career, she is getting the runaround and the lip service to say that it is an important issue and it will be dealt with. The Minister of State should fight harder and make sure there is an appropriate strategy in place for the tsunami and emergency we are already in.

I thank the Minister of State for taking the time to hear statements on the important issue of mental health. Covid-19 has posed fundamental challenges for people's mental health, as many individuals have experienced heightened stress, anxiety, fear or panic. We have come through a dark and dreary winter and we must be proactive to help people through these difficult times. The Covid-19 pandemic and its restrictions have been challenging for people in our society. People are social by nature and restrictions that reduced human contact have been particularly difficult. People miss their communities, friends and extended families dearly. Talking about our mental health and monitoring the mood of the public is essential. It is OK not to feel OK during this period. This time is difficult, but we will get through this.

As part of the response to these challenges, the Government has provided guidance and support for people to manage both their physical and mental well-being and to stay connected. Significant funds have been allocated to the Keep Well campaign, with €7 million being provided to support the delivery of a range of actions and support services, which will be rolled out over the coming months.

Isolation of people of all ages is a significant risk during the Covid-19 pandemic, particularly during periods of tight restrictions on movement and social interactions. The Community Call programme was introduced in mid-2020 to provide local helplines through local authorities for practical supports, information sharing and befriending. This has been exceptionally successful in my view from speaking to people who have interacted with these platforms. Working with partner organisations, including An Garda Síochána, NGOs and Volunteer Ireland, there is a particular emphasis on identifying and supporting those most at risk of isolation. I want to make the message clear; those feeling isolated are not alone in this and people are here to help them.

I would also like to highlight again the use of social bubbles. People in certain categories can form a support bubble with one other household. Those who can form a support bubble include those alone with children under the age of 18, those living alone, those sharing parenting or custody arrangements, those living with an adult to whom they provide care and those who live alone and have a carer or carers who support them. These times are difficult for everyone; there is no doubt about that. We need to try to do our best and get through this. I encourage people to look out for those who are isolated in our communities, to stay connected with those in their community and not to be too hard on themselves, which is important.

We have to accept the fact that the last number of months have been extraordinarily difficult for everybody. Nobody has had an easy ride during this pandemic. It has been quite a challenge and as the youngest Member of Dáil Éireann, I have to say that a lot of young people are suffering out there. We are quite conscious of that and unfortunately, it will be some time yet before we will be back to some degree of normality. I insist that the Government would continue to monitor the national mood for people who have never experienced any mental health difficulties and who are now feeling isolated and lonely. From interaction with people in my age group who were supposed to be going out into the world and starting their lives as young professionals after finishing up college education, many of those are reporting to me that they are feeling lonely and isolated. We have to show considerable focus in that particular area.

I wish the Minister of State well in her Department. I know she is doing a lot of significant and good work and I thank her.

I thank the Minister of State for being here to reply to the debate. The area of mental health services has traditionally been neglected. That has been acknowledged over the last 20 years, particularly since the decongregation of the mental institutions. That was a good thing in itself but alternatives had to be put in place and were not put in place. They need to be put in place now as a matter of serious urgency. In particular, there is a need for access for children, adolescents and adults to emergency treatment and they must be able to access it easily and readily. It is not there at present and countless situations have developed whereby their families have had to try to provide facilities themselves.

The question of eating disorders among young girls has been mentioned already. It is a pressing situation which needs a response that will reach out to them now.

I refer to those who have addictions. There is no place for them to go and they will not be taken into a residential facility if they have an addiction and vice versa. There is an issue that needs to be dealt with as a matter of urgency and I hope that the Minister of State will be able to deal with that. I thank the Acting Chairman for facilitating me.

I commend the Minister of State for all of her work so far. She is doing great work and it is greatly appreciated.

Mental health is an issue that I and my rural colleagues raised in our Private Members' motion in December, when we noted that Covid-19 was having a huge impact on people. We know that mental health is a serious issue in this State, without ever looking at any pandemic and the effects that is having. We have always grappled with getting to grips with mental health. We also know that a significant amount of work needs to be done to address the mental health fallout for students at primary and second level. I know there is a lot of uncertainty among leaving certificate students and I worry for them. I have mentioned this to the Minister for Education, Deputy Foley, in a briefing we had and I hope that some certainty will be given to those students as soon as possible.

Last week, I submitted a parliamentary question asking the Minister for Education if the National Educational Psychological Service, NEPS, is sufficiently resourced and what plans were in place to recruit staff to NEPS to deal with the increase in psychological distress being caused to students as a result of Covid-19-related restrictions.

I welcome the fact that in her reply, the Minister of State confirmed that NEPS is providing student services aimed at managing stress, anxiety and panic attacks and that the number of sanctioned NEPS psychologists currently stands at 221, which includes an additional 17 psychological posts to support the well-being of school communities, but there is much more needed here. We have a tsunami coming at us and it affects people of all ages. We need to be prepared.

While progress in this area is welcome, it is alarming that the share of health funding being allocated to mental health in recent years has ranged from 5.7% to 6.3%. While, in 2019, it was 6.3%, it will fall dramatically to 5.2% in 2021. I ask for that to be looked at because there is an expected significant rise in demand for supports and services in the wake of this pandemic.

Like Deputy Nolan, I wish the Minister of State well in her work in this vital and important area. I will ask the Minister of State a number of questions. Deputy Butler will not have time to reply but she might write to me.

The first is about the current stage of the Crisis House in Clonmel, a commencement date for that house and where it is at, and also about the Jigsaw roll-out in Tipperary. Is the headquarters of the latter in Thurles procured and is it being fitted out and ready to start? When will we have a start date? How many outreach hubs will we have in towns such as Clonmel, Carrick-on-Suir, Tipperary town in the south of the county and, indeed, Killenaule and Ballingarry and up into Nenagh and the rural area up in Roscrea as well? It was never more badly needed.

Members are talking about a tsunami coming down the line. We are in the tsunami. It is here. We are immersed in it, from the cradle to the grave but really among young people of school age, particularly secondary school, those doing the leaving certificate this year who were in fifth year last year and students going back to college or trying to go back or trying to start next year. There are huge issues. There is huge angst. They cannot do what they normally do. Young people need to live their lives and they cannot.

The older people are locked away cocooning and the relentless news and figures from RTÉ is frightening. Deputy MacSharry's figures were telling. That is happening everywhere. We have far more people dying by their own hands, sadly, in suicide, than have died that I know of with the virus. Where anybody dies with the virus or gets seriously ill - I had a constituent on to me this morning - it is a horrible situation. The family cannot grieve properly and they cannot have a proper funeral or send-off, or be with their loved ones. It is awful, but we must look at the knock-on consequences with people with mental health issues.

I salute Ms Trudi Lalor, a Laois girl now living in Tipperary. A renowned singer, Ms Lalor has a new scheme for country music, Reaching Out, where she is getting loved artists connected with patrons of theirs who really like them. It has been a great success. I thank Tipp FM as well for supporting it. It is a case of anything we can do.

I support Community Suicide Awareness Workers, C-SAW, in Clonmel, and Mr. Joe Leahy and Ms May Walsh there, and others, and the volunteers and the work they do. I was disappointed last week to read about the high salaries of the chief executives in charitable companies. That is not where we want to be. We all go out and support those walks etc. such as Darkness into Light, but when I see this, it is not necessary. Greed is everywhere.

What we want now is help and support for our people as a nation. We need to have more funding put into mental health. Our spending is only at 5% and 6% where other European countries are at 12%. Yesterday a €400 million budget that we did not spend last year was allowed be held onto this year. It is shocking to see the neglect in mental health and people cannot spend the money that is needed.

Is Deputy Connolly sharing time?

I am sharing two and half minutes with Deputy McNamara.

I am on record as saying that the Minister of State is taking a hands-on approach. I welcome that, but that hands-on approach must be within a context of recognition of what the Minister of State has inherited and where we are with mental health. We have the Mental Health Reform submission, which I am sure the Minister of State is aware of and which was already referred to, we have the Ombudsman commission's report in relation to it and we have, quite extraordinarily, many articles in the national and daily newspapers telling us the situation in relation to mental health. The article that left an impression on me was by a therapist who has been working for a number of years, who said, "We must confront painful truth: we are facing into a mental health crisis." and, "I have never known my work [and myself to be] so ineffective." I will not name her. She was in the national newspapers. That was also carried in an article by Mr. Patrick Freyne.

Let me go to what matters. We have any amount of documents. In 1984, in a different life, I was very familiar with it. I foolishly was hopeful, when the Planning for the Future report was published and I worked as a psychologist, that we were moving in the right direction. Unfortunately, it was never implemented. That was followed by A Vision for Change. That was very badly partly implemented. We did not need another document. Then we had an update of literature and then, finally, we got Sharing the Vision. What we have really got is a constant change of language and no implementation.

The Ombudsman's report is frightening in relation to mental health. The Ombudsman points out that we have the fourth highest suicide rate for teenagers in the EU-OECD region, 2,300 children waiting for an appointment to CAMHS, and all of the other figures that have been mentioned.

I have one minute left. I do not wish to quote figures. They are at pandemic levels but what is awfully important here is the independent monitoring commission. The Minister of State has made progress and I have taken the trouble of reading the minutes. First, I congratulate the Minister of State on pushing to set up that independent body. I do not wish to be negative but I have to say I worry about its independence. I worry about the gender breakdown. I worry that the health executive is very much represented on it. How will it function as an independent monitoring commission? Also, the chair of the Mental Health Commission, which has done tremendous work for mental health when it visits, is on it. There are serious questions here about independence and about the ability of that body to monitor implementation of the third document we have got, Sharing the Vision. I wish I could go on but I will not.

I addressed the Minister of State at the time the second lockdown was being announced stating that we needed to have comprehensive data on self-harm presentations and on suicide in Ireland before there was ever another lockdown considered. We do not, as it happens, have either. That is an insult to Dáil but it is also an insult to the victims of mental health problems of whom there are many. Do we know yet how many suicides there were last year in Ireland? We do not have that figure. I will not go on about it because I have spoken about it previously. Nothing has happened or, at least, nothing visibly has happened.

I appreciate that the Minister of State is working hard behind the scenes to advance the issue that she is responsible for - I want to make that clear - but all of us are working and living in an incredibly oppressive society at present. The feeling is entirely oppressive and it is largely driven by elements in the media. I questioned whether there was sufficient coverage of mental health and I was attacked by some public health doctors for doing that and told that, of course, the National Public Health Emergency Team, NPHET, is trained to take account of mental health data. I asked how can it take account of it if it is not there and a media outlet, instead of probing whether the data were there or not, ran, in what I would consider to be an attempt to discredit my probing of it, a line stating that the chief medical officer, CMO, stated that NPHET regularly takes account of mental health. However, if you look at the minutes of NPHET, no account was taken of mental health up to the time of that second lockdown. One sub-committee mentioned it but there was no mention otherwise. The HSE national clinical programme for awareness and management of patients presenting with self-harm came out and stated that I was wrong to say that there was not data and that it had data from every emergency department. When one looks for the data, one finds out that they have data from some emergency departments but no data from any of the children's hospitals. We know children are suffering and we know that there are emergency departments so that is a lie on behalf of a Government agency to discredit somebody who is probing stuff. That is not good. That is oppressive.

We have another arm of the Government practically going out to Dublin Airport to burn witches live on air. I am talking about RTÉ. It is a disgrace. It is oppressive. It is driving anxiety in the State what RTÉ is doing.

There are massive problems with free media in Ireland. The Irish Times had its hands out looking for money from the Government. God knows, it is entitled to it. It has been doing the Government's bidding for a year. Where is the free media to come from if the primary income source for media - I am not talking about all media - is the Department of Health and the Government? Of course, they are doing the Government's bidding. Of course, they are driving a narrative.

Of course, they are attacking those who question what is going on. It is not sustainable. It is oppressive and it is damaging the fabric of our society. I thank the Acting Chairman for the latitude he has given me to make those points.

Can I have 30 seconds, please?

I would like to give the Minister of State 30 seconds but I cannot. That concludes the debate.

Sitting suspended at 11.50 p.m. and resumed at 12 p.m.