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Dáil Éireann debate -
Wednesday, 21 Apr 2021

Vol. 1005 No. 7

Mental Health Surge Capacity: Motion [Private Members]

I move:

“That Dáil Éireann:

acknowledges that:

— a mental health crisis demands an emergency response;

— the World Health Organization recommends that a minimum of 14 per cent of a country’s overall health budget be allocated for mental health;

— SláinteCare recommends a minimum mental health budget of 10 per cent;

— the Government’s mental health spend in 2020 was reduced to 5.2 per cent of the overall health budget; and

— the €10 million in additional funding committed to in the Government’s Covid-19 Resilience and Recovery 2021 – The Path Ahead plan falls far short of what is needed to provide the emergency care adults and children desperately need;

further acknowledges that:

— 2,551 children and young people are waiting for Child and Adolescent Mental Health Services (CAMHS) and 8,893 children are waiting for primary care psychology treatment;

— 1,553 adults are waiting on primary care psychology treatment with the Health Service Executive;

— there remains no State-wide provision of 24/7 crisis mental health care at a community level;

— waiting lists for mental health care within the public system were at crisis levels before the Covid-19 pandemic and are now at emergency levels; and

— the Mental Health Commission told the Oireachtas Special Committee on Covid-19 Response that Ireland’s mental health system is not fit for purpose and is out of date and that investment in it and the community is needed;

recognises that:

— community and voluntary front-line services are experiencing an unprecedented demand for mental health care;

— increased numbers of adults, children and young people are presenting to services for the first time;

— clinical and public mental health specialists have advised that Ireland is facing into a tsunami of mental health need; and

— the private sector has the capacity to provide emergency talk therapy and acute care;


— the commitment of public health staff, and the community and voluntary sector in maintaining mental health services throughout the Covid-19 pandemic; and

— the commitment of non-traditional mental health community organisations who are providing mental health supports to meet the emerging needs in our communities; and

calls on the Government to:

— establish an emergency talk therapy fund, to provide an additional 128,000 sessions with an accredited counsellor or therapist in the private system for those in need of immediate support on referral from a general practitioner (GP);

— remove the GP visit card and medical card accessibility barriers to deliver universal access to the Counselling in Primary Care service;

— recruit 138 additional child/adolescent psychologists and 138 additional adult psychologists, to provide additional capacity in every primary care facility;

— assist community organisations to continue to provide mental health supports;

— create two one-off funding streams to support trainee Counselling Psychologists during the Covid-19 pandemic;

— establish a 24/7 care public crisis de-escalation, multi-agency triage team ambulance service in every Community Healthcare Organisation area; and

— maximise surge capacity within all private hospitals with acute mental health beds in accordance with the ‘surge capacity’ agreement currently in place.”

The State is in the grip of a mental health crisis. The crisis demands an emergency response. Over recent months, Sinn Féin Deputies have met representative bodies and front-line community and voluntary mental health services throughout the State. We met those on the front line who provide mental health supports such as family resource centres, addiction centres, youth services and suicide prevention organisations, among others. They are working over capacity and have had to adapt their services to meet the demand. They have done this with little support from the Government. This is not sustainable; they need and deserve support. We also met national mental health organisations that stated that the inability of people to access mental health supports when they need it was at a critical level.

In February, the Taoiseach announced €10 million in funding that will be made available to meet increased demand for mental health supports. Front-line mental health services we have met will see very little of this money, and based on previous announcements, I have no confidence the money will reach the groups that really need it. We have been here before with this Government: big announcements about mental health, with very little substance. We were in a crisis in mental health provision pre-Covid, but the impacts of Covid have put us in a mental health emergency. Mental health services are experiencing unprecedented demand for mental healthcare. Many people using mental health services are doing so for the first time, and too many of them are being left out in the cold as services are just not there to meet the demand. This is a really frightening place to be. This increase is set against excessive pre-pandemic waiting lists for care, and the result is the perfect storm we are now experiencing.

Our already under-resourced mental health services, which were struggling to cope pre-Covid, are now operating over capacity. This is also not sustainable. Speaking at a meeting of the Oireachtas Special Committee on Covid-19 Response, the CEO of the Mental Health Commission told members our mental health system is not fit for purpose and is out of date. Sinn Féin wants to change this. It is unacceptable that in a year of national crisis, the Government chose not to increase investment in mental health in proportion to the overall health budget. We need to tackle the issue of mental health in a real and sustainable way, with a roadmap for capacity-building in the system. Right now, what we need more than anything else is an emergency response to the crisis we are currently in. This is what the motion sets out to do through a series of common sense and practical proposals that, if implemented now, will make a real difference in the lives of people who are struggling.

Sinn Féin proposes a significant emergency investment in mental health care for a six to 12-month period to allow for the provision of surge capacity by private practitioners who will provide urgent and immediate care. This emergency provision will address the issue of waiting lists and meet immediate demand through the provision of private care, thereby giving the public system the breathing space it needs to increase capacity for the long term.

Alongside this emergency provision, Sinn Féin recommends measures to be put in place which will have a positive long-term impact on mental health services. One of the measures specified in the motion is the provision of an emergency talk therapy fund. Such a fund would allow people access to an accredited counsellor or therapist on referral from a GP. The Irish College of General Practitioners has told us that many of its members would even be able to provide this service in their own practices. It would be a kind of one-stop shop. This is not aspirational. It is doable, achievable and realistic. With the right political will, it could be implemented very quickly.

We also call for an expansion of capacity in child and adolescent mental health services, CAMHS, and primary care mental health services to be meet the demands of the 10,000 children and adults who are waiting on public psychology appointments and the 2,500 children who are waiting for appointments with CAMHS. This will be achieved through the recruitment of additional psychologists to the public sector. The Psychological Society of Ireland, which has more than 3,500 members, has publicly endorsed this plan. It has said there is capacity within its ranks to provide these services. There would be no more long waiting lists and people would have the ability to access services when needed.

Sinn Féin would also remove the GP visit and medical card accessibility barriers to deliver universal access to counselling. We have been calling for this for a long time and have fully costed it in our alternative budget. As I said to the Minister of State before, one of the major gaps in the service relates to those who have a mental health emergency outside the hours of 9 a.m. to 5 p.m. At present, there is no State-wide provision of 24-7 crisis services at the community level. People must have access to mental health treatment as and when they need it. We aim to establish a 24-7 mental health crisis de-escalation team. Our proposal reflects a similar pilot scheme under way in the North. As we know, mental health issues do not occur only between 9 a.m. and 5 p.m., nor do they take a break at the weekend. This ambulance would include a mental health nurse who would call to the person who is having a mental health issue in the community. This nurse would then triage and treat the person before referring and bringing that person to an appropriate service. This would be a start in delivering 24-7 care.

From the outset of the latest lockdown, I have called on the Minister for Health to extend surge capacity in private hospitals to include acute care for mental health. The latest response I have was received last Friday and states that the HSE is currently in a tendering process with private mental health operators. We are more than a year into this pandemic and we are still in negotiations. This is not good enough and needs to change now. Mental health can no longer be the Cinderella of the health services.

One group of people who urgently need emergency treatment comprises those suffering from eating disorders. There are only three beds in the public sector for adults seeking treatment for eating disorders. This is not good enough. More beds could be provided as part of this surge capacity. Parents have told me that they are watching their adult children die before their eyes. I have spent all week on the phone talking to parents. In their words, community care is non-existent. We have heard the Government rhetoric that we are all in this together. Today is the Minister of State's chance to prove this. I ask that the Minister of State and all Deputies, regardless of party, get behind this motion and give it support so that people can get the care they need when and where they need it.

I commend Deputy Ward on identifying the need to bring this motion before the Dáil and on the work that has gone into compiling it. The measures he is bringing to the House are proposed as a six to 12-month emergency response to the needs that are building in our society, a society which has traditionally been served by an underfunded mental health sector.

I have been speaking to community and voluntary organisations and individuals about mental health service provision in my county of Tipperary, and this is what they are saying.

The State is relying heavily on the community and voluntary sectors. Yet in many cases, the funding provided to those sectors is meagre and short-term, like for three to six months. This tight and short-term view on the part of the Government means that many of these organisations spend inordinate amounts of time applying for the next funding allocation. It also means that some of these organisations remain uncertain as to whether the supports they provide now will be available to them and their clients in a few months' time. The Government must take note of this and act.

In a survey on mental health services in Tipperary, I have been told that the main obstacles in getting the help people need are as follows. First, there is a lack of services. Second, there is a lack of information about the availability of these services. Third, there is difficulty in travelling or getting supports nearby. The Government also needs to understand how much out-of-hours support services are needed and how stressful and upsetting it is for someone who is feeling suicidal to have to wait in an accident and emergency department for hours because of a lack of alternative out-of-hours services. What should also be of particular concern to this Government is that 48% of those who replied to us had been waiting more than six months for a mental healthcare appointment.

We are facing a crisis. I have been told of the following difficulties: people encountering different psychologists at each appointment; how travelling from south Tipperary to St. Luke’s General Hospital in Kilkenny is proving difficult for many and is a deterrent for others; how children with special needs are being left behind; how the families of people in need are left dealing with their loved ones alone; how the mental health aspect of addiction is largely ignored; and how the ongoing housing crisis is having a profound impact on people’s mental well-being. It is hard to believe that amid an unprecedented crisis, there has been no increase in the proportion of funding mental health services get from the overall health budget. We cannot just accept things like growing waiting lists for CAMHS. That is why we are proposing to expand capacity in CAMHS and primary care mental health services.

This motion provides for additional counselling and therapy sessions, as well as removing medical card accessibility barriers to counselling in primary care. I urge everyone here to support this motion today. Every family in this country deserves it. After that, however, we need long-term ambitions that can be acted upon immediately. If that is beyond the capability of this Government, maybe it is time for another one.

There is not a family in this State that has not been affected by mental health and, sadly, far too many families have also been impacted by the lack of mental health services available in this State. That lack of services has failed far too many of our people and sadly we have lost far too many people as a result. Make no mistake about it, mental health can turn to personal tragedy and it is incumbent on us to help our people and save lives. This crisis has been exacerbated by Covid-19 and we need an emergency response. Today's motion, brought forward by my colleague, Deputy Ward, is such a response. It is a complete and compassionate response that offers practical solutions. This is a real emergency and we need to act.

Sadly, my home city of Galway has also suffered greatly from this lack of services. I have conducted an anonymous survey to hear people’s experiences of this. One response that stuck out was from a person who said:

I see a different nurse or doctor every single time I have an appointment. They don’t have accurate knowledge of one’s individual case and therefore do not have much to offer in the way of useful support. I am repeatedly told to take walks and meditate when in actuality I need a therapist, I need eating disorder services (that don’t exist). I need trauma support.

The list goes on. I have spoken with people who have needed mental health services and with different organisations and one message comes back loud and clear. They say that we need 24-hour mental healthcare. The lack of care outside the hours of 9 a.m. to 5 p.m. reflects an attitude of a bygone age. We need better than that. Mental health challenges are 24-7, so our response needs to be 24-7.

I acknowledge this important motion brought forward by my colleague, Deputy Ward. We all know how Covid has taken its toll on mental health. Speaking to parents and young people, every one of them says they are in varying degrees of stress and anxiousness. Children have been missing their sports for more than a year. That void has had a huge impact on their mental health and placed increased stress on their siblings and parents. People who otherwise would have had good mental health are struggling and those who were previously struggling are in distress.

I heard William Cummings, who does fantastic work with the Be Aware Be Safe, BABS, listening service say recently: "It's only when we listen we truly understand, when we understand we can begin to help."

We need significant investment in non-medical support for talk therapy to reduce the numbers of those with poor mental health from becoming increasingly distressed. Sinn Féin would invest €10 million in a talk therapy fund, which would create 128,000 sessions with accredited counsellors or therapists in the private system for urgent care on referral from a GP. We would ensure that before individuals are in distress they are able to talk to a professional who engages with them. This fund and service would be really important and help to prevent individuals from entering emergency services. This emergency talk therapy fund must be a priority.

In line with this, there needs to be universal counselling within primary care services so that counselling services are not barred from individuals because they just missed out on qualifying for a medical card. Sending an individual who is suicidal to an emergency department has clearly not worked because we do not have the required services. We need to open private hospital care so that pressure is released within the public health system. I recently read that emergency departments are like ground zero for mental health patients.

We have one of the lowest proportions of hospital beds for psychiatric care in the developed world and the numbers drop each year. With every bed that is lost, the threshold to admit someone to hospital must rise. Patients need to be increasingly sicker before they can be admitted to hospital. This is 2021. We have had Fine Gael and Fianna Fáil working together for almost five years and a Fine Gael-led Government before that. They cannot wash their hands of the mental health emergency we have. Mental health is not a nine-to-five issue; it is a 24-7 issue and needs to be resourced to reflect this.

The past year has seen a global health emergency the likes of which none of us could have imagined. However, in the midst of this pandemic another health crisis has been spreading through every town and village in the country for which there is no vaccine: the crisis of mental health. Years of underfunding in the health service in general and the lack of focus on mental health issues in particular have created a backlog that has been exacerbated by this pandemic. Lockdowns have had a dramatic effect on people's psychological well-being while also limiting the provision of services available to them.

Some 2,500 children are waiting on CAMHS appointments. Those are merely the children on the waiting lists, not the ones waiting to be assessed. Almost 9,000 children await primary care psychology treatment, again only the names on the list. More than 1,500 adults are awaiting primary care psychology treatment with the HSE.

In recent weeks, I have been engaging with service users, service providers and even youth clubs in counties Longford and Westmeath to get their opinion on the state of mental health services at the moment. I believe that the motion will offer concrete solutions to that crisis, to deal with it effectively and to meet the growing demand for mental health services.

A recent survey found that almost 50% of young people under the age of 34 reported being disheartened or down most of the time, which is absolutely terrifying. We do not want people merely to survive in this country. We want them to live and to thrive, and there is a marked difference.

The motion proposes removing barriers relating to medical cards and income tests so that everyone can access these services. We propose additional resources and new services to both prevent and react to crisis situations; additional child and adult psychologists; acute mental health beds; funding for training for counselling psychologists; talk therapy; preventive measures of working with community groups; and de-escalation training. Mental health is not nine-to-five and it needs to be met with a service that is not nine-to-five. These measures are essential if we are to deal with the surge in demand.

We are nowhere near capacity or where we need to be. If we do not take urgent measures, more people will suffer and, ultimately, more people will not make it through. We need to act now and in a manner that ensures that nobody is left behind.

I thank Deputy Ward for bringing forth this motion today. I acknowledge the consistent interest of Deputies Ward and Buckley in mental health. This motion provides me with an opportunity to discuss mental health now and beyond Covid-19, to update the Dáil on the work of my Department, the HSE and the voluntary sector in this area, and to put on the record the work happening on the ground. I look forward to addressing many of the issues raised.

During Covid-19, the Government has focused on reducing infection numbers and ensuring a safe and effective vaccine roll-out. However, citizens' mental health needs, especially people at risk of or with existing mental health difficulties, remain a priority. This is demonstrated in the programme for Government and our commitments to developing high-quality, individualised care and supports for all.

In 2019, the mental health budget was 6.3% of HSE funding. The apparent reduction to 5.1% in 2021 arises from the vast increase in Covid resourcing for acute services. The mental health budget has increased by more than €400 million since 2012, from €711 million to in excess of €1.1 billion this year. This figure does not include funding for mental health supports in other areas of the health system or in such Departments as Social Protection, Justice or Education. If anything, the figure underestimates State mental health funding.

Of the €50 million increase in mental health this year, €23 million is for implementation of many of the short-term recommendations of Sharing the Vision. This will fund an additional 153 staff in community mental health services, including 29 new staff for CAMHS teams and telehealth hubs, bereavement counselling, employment supports and crisis resolution teams. It will also fund development of the national clinical programmes and models of care, including the talking therapies model of care, which I launched yesterday. This model of care outlines a collaborative, layered delivery approach as service users commonly move between different service tiers in their healthcare journey. It has been developed in line with clinical evidence and international best practice and in collaboration with service users, family members and service providers, among others.

I particularly welcome this pillar of the model. People who use the services and their families and carers are at the heart of our mental health system and must be empowered to be active partners in the design, development and delivery of mental health services. The model of care will ensure talking therapies are accessible, evidence-based, recovery-oriented, and provide clear pathways for service users, ensuring everyone gets the right support in a timely manner, regardless of their ability to pay or where they live. The introduction of the model of care is a significant milestone in improving access to, and enhancing the quality of mental health supports, ultimately seeking better outcomes for people using our services.

A significant concern for me is the waiting lists for psychology in primary care, especially the waiting list for children and young people, which has been already raised a number of times in the debate. I am actively working with the Department and HSE to develop a targeted initiative to reduce significantly the number of under-18s waiting more than 12 months to access these services. This initiative will supplement the enhanced community care programme, which has an additional €150 million in new development funding for recruitment of more than 2,000 front-line primary care staff to support a new community health network model.

While we do not yet fully understand the effects of Covid-19 on mental health, a range of post-pandemic mental health and psychosocial challenges are likely to arise. These may persist for months or years afterwards, perhaps compounded by economic impacts.

Despite this, a negative mental health outcome for our population from the pandemic is not inevitable, if we respond to the challenge in a cohesive manner.

Launched in January 2021, the HSE's psychosocial framework provides a co-ordinated, consistent and collaborative approach to the provision of mental health services and supports. Building on a range of psychosocial supports introduced last year, the framework provides for five key levels, from mental health promotion to specialist services, during and beyond Covid. Seven-day telehealth services include, the information line 1800 111 888, the crisis text line 50808 and NGO online supports. These comprise one-to-one counselling and group and peer supports delivered through MyMind and SilverCloud. MyMind provides free online counselling, in 15 languages, to people in communities nationwide. Online activity has increased since the introduction and enhancement of these services and there is capacity to cater for upsurges in demand. In line with the psychosocial framework, the HSE has a range of proactive responses for potential rises in service need, including online and other telehealth psychosocial supports.

Early in the pandemic, the HSE moved rapidly, under public health guidelines, to continue community mental health services where possible, with digital health models adopted for service user and staff safety. High-support residential placements have continued. Overall, specialist mental health services, both community and acute, are operating at 80% to 90% of pre-Covid levels. While referral rates are below normal, the level of appointments offered in all community services remained consistent with previous years, despite adaptations to service delivery.

With a target of 90%, 91.2% of adult accepted referrals were offered an appointment within 12 weeks in 2020. This compares with 92.9% in 2019. Similarly, with a 98% target, 96.8% of older people were offered an appointment within 12 weeks by psychiatry of later life teams. The community target of child and adolescent mental health services, CAMHS, of offering an appointment within 12 weeks was 78% in 2020. A total of 79.2% of children and young people were offered an appointment within 12 weeks last year, compared with 78.4% in 2019. These data show the ongoing dedication of mental health services to ensuring service continuity, despite the considerable challenges posed by Covid. I thank everybody working in mental health services the length and breadth of the country for the work they do on a daily basis.

To date, all consenting mental health staff and individuals in residential care have been vaccinated. Cohort 4, which includes high-risk mental health service users aged 16 to 64 in the community, is under way. In anticipation of a surge in requirement for mental health hospital beds, the HSE has worked with private hospitals on additional acute and longer-term beds, to free up public capacity. A total of €13.65 million has been allocated for this purpose. Of particular note, and taking account of the increased number and acuity of eating disorder presentations, I have secured the availability of €3.94 million to the national clinical programme for eating disorders this year. This will fund the establishment of three new specialist eating disorder teams and complete the three existing teams. I am fully committed to ensuring this funding is invested in full in 2021 and will continue thereafter.

Since coming to office, I have met many of the key organisations and personnel who deliver services, including HSE corporate staff, community healthcare organisation, CHO, heads of service, clinical leads, healthcare workers, partner NGOs and, importantly, service users and families. Last week, I met each of the nine CHO mental health leads to examine collective challenges, with a particular focus on CAMHS, improving residential standards and Covid-related challenges. These issues, and others we covered, are being addressed through Sharing the Vision, our national mental health policy, and the HSE service plan. Sharing the Vision seeks to enhance services across a broad continuum from mental health promotion, prevention and early intervention to specialist supports. It focuses on outcomes for people using our services, by taking a person-centred approach, and outlines principles of trauma-informed care.

In terms of recent developments, I am delighted that the formal handover of the new 170-bed hospital in Portrane to the national forensic mental health service took place in March.

The HSE is now equipping and commissioning the facility. This is a major step forward in providing a world-class service. Another positive step is the establishment this month of a high-level task force to consider the mental health and addiction challenges for people interacting with the criminal justice system.

I thank the Deputies for raising this motion. I am grateful for the opportunity to clarify how many of the concerns raised are being or will be addressed. This motion is not being opposed and much of the content is welcome. There is no doubt we all seek continued developments across the mental health system, and I am fully committed to working with all Deputies to see this fundamental ambition realised. I thank mental health service staff and those in the community and voluntary sectors for their immense work and dedication in supporting the mental health needs of people living in Ireland during this challenging time.

Almost six in ten people who responded to the recent Central Statistics Office Social Impact of Covid-19 survey believe Covid-19 has impacted negatively on their mental health and well-being. In the 18 to 34 age group, one in five reported being downhearted or depressed all or most of the time.

In Wicklow, service providers tell me the greatest increase in demand for mental health services is for those in the 12 to 14 age bracket. These increases are set against excessive pre-pandemic waiting lists for care. As a result, we have moved from a crisis in mental health to an emergency, with many workers saying there is a tsunami coming at them. In Wicklow, the waiting time for children to access child and adolescent mental health services is now 12 months. Service providers I have spoken to say they are under so much pressure that mental health workers are being forced almost to triage patients as they would following a major incident. In some instances, they are unable to accept children or young people unless they are very serious cases. Even then, they are forced to pass the children on to other child health services that are not equipped to deal with the severity of the problems. In turn, those services refer the children back to the GPs and the merry-go-round can recommence.

Some young people are turning to alcohol and smoking weed and other illegal drugs as they think this is the solution. This is adding to the issue of dual diagnosis, which is another major issue and failing within the system. Mental health services simply cannot manage the numbers of children and young people who need services now, rather than in 12 months' time. Some teenagers are facing an even worse scenario. I am aware of situations where, due to the waiting lists, children aged 17 years have been denied appointments because, by the time they get an appointment, they will have become adults. Yet, at 17 years, they are too young to be placed on an adult waiting list and are simply left with no supports. We are in a mental health emergency. We need action now rather than before this situation spirals further out of control.

Gabhaim buíochas don Teachta Mark Ward, Joanna Kelly agus an fhoireann go léir i Sinn Féin. I also thank the public health staff, community and voluntary sector workers and those working in family resource centres whom I have spoken to in the past week. They have spoken of a major increase in demand for services to address issues such as anxiety, drug and alcohol misuse and concerns over sexuality, education, employment, poor self-esteem and behavioural issues. They mentioned the need for extra outreach community-based staff and upstreaming for those under 18 and over 65 years in particular, where services are practically non-existent. Were it not for the work of the Kerry Diocesan Youth Service, which works with some of the most vulnerable young people, and the Southwest Counselling Service, there would be little or no prevention, early diagnosis or counselling.

Residential and inpatient services are difficult to secure. Those I spoke to mentioned the need for funding, which is severely lacking and typically insecure or targeted at a specific area and cannot be used to fulfil demand. They mentioned the lack of respite care, poor awareness of resources and the need for a multidisciplinary approach.

The announcement by the HSE last night that a review of 1,500 cases in south Kerry alone regarding the possible over-prescribing of medication for young people is deeply troubling. Given that two students in an average class are now seen by or referred to CAMHS, we must have confidence that young people are getting the best medical mental health care possible. Serious questions will arise regarding oversight and how long this was known to the HSE. While we must wait for the review, we must consider did the lack of the services mentioned by the people that I spoke to in the last week such as the lack of auxiliary services, talk therapies, early intervention, social work and the lack of home help lead to a rush to chemical intervention.

The motion calls for a public crisis de-escalation team and an ambulance service in every CHO. There was but currently there is no day care centre in the town of Tralee where the chronically ill can call in, and a referral centre is not enough. If someone can attend a primary care centre in a Covid-19-compliant way, why can he or she not attend a day care centre. One needs to open on a 24-hour basis if the Government are serious. While GP referrals decreased, there is a concern about a flood of referrals. I call on the Minister of State to act now and to heed these warnings. How confident can we be that the requirements of those on the front line will be met when the list forwarded for vaccination and sent from psychiatric services to the vaccine roll-out team one month ago remains unanswered?

I was glad the Minister of State said that she was not opposing the motion. However, there were some things in her speech that were quite alarming if one sits down to think about them. She said that within 12 weeks somebody will have an appointment. This is 12 weeks of a family watching a family member in distress with worry and anxiety waiting to get an appointment. That that is what we have established in this country as the norm is a poor reflection on the health service that we had pre-Covid-19. Now we have the Covid-19 situation which has exacerbated all of those problems. I think the Minister of State would acknowledge that but the Government also needs to do so. The only way we can deal with this is to heavily invest to ensure that we provide for the very significant surge that is going to come and that is practically already there in many cases.

We have people who because of the lockdown and the restrictions feel very stressed and anxious in respect of all of this which will have an impact. There will also be an impact of the people who have contracted Covid-19 and we come across them all of the time. These are people who cannot sleep at night, who have lost energy, and who have great stress in their lives and will undoubtedly present with anxiousness in respect of all of that. This is a situation that is going to get worse in the coming days and weeks.

We all need to recognise the system that is there. In fairness, I have spoken to the Minister of State on many occasions about this, particularly in respect of CAMHS in counties Sligo and Leitrim and on other issues there, where we need to get the investment and the additional people in place. CAMHS in Sligo-Leitrim is at half-capacity because it is so understaffed. That has a very significant impact on families across the entire area. That is not just confined to Sligo-Leitrim but it is the case practically everywhere throughout the country. We need to put the effort in to deliver on this.

In the past number of days I have spoken to people from various agencies and organisations across my constituency. I spoke to North West STOP, which is a community organisation that emerged from the community to provide services for suicide prevention. It gets no funding from Government and yet it is there to stop the gap that Government leaves because of the underfunding of mental health services. We also see the same situation in respect of the Irish Advocacy Network and the Sligo Centre for Independent Living. All of these organisations are doing their best to try to assist people who are under stress. At the same time Government is not investing in the mental health services and this needs to happen now.

I implore the Minister of State not just to accept the motion but to invest in the provisions that it puts forward.

Recently, myself and Deputy Ó Laoghaire conducted an online survey in Cork on people’s mental health. We got some very worrying figures. Some 86% of people felt downhearted or depressed recently, 90% felt that there were not enough mental health services in Cork, and 47% said that they had been waiting for more than six months for services. On Monday night, we held a town hall meeting with these people and others to discuss their mental health. The stories were harrowing. I thank the people for their honesty and for sharing their personal experience. One person described how his GP had to beg to get him into mental health services and when he got in there, before he was discharged, the psychiatrist gave him a leaflet and said that an emergency team would be in contact.

Three weeks later, that person was contacted by telephone. It is only by the grace of God he was there to answer the call. One lady who works in childcare and early education described how she believes that vulnerable children are falling through the cracks due to a lack of resources and co-ordination.

I have before me a list of stories from people. People want to talk. They want help now. For years, mental health was brushed under the carpet and people were ashamed. We have to realise that it is a crisis that has been worsened by Covid-19 and support is needed. I ask the Minister of State, Deputy Butler, to support the motion tabled by my colleague, Deputy Ward, because it will make a difference in people's lives.

My final point is that the Cork and Kerry region has the highest waiting list for CAMHS , with 69 children on the list for more than a year.

I thank Sinn Féin for tabling the motion. I wish to raise an issue that is the subject of a report by Shane Phelan in this morning's edition of the Irish Independent. It relates to services in south Kerry and I am sure the Minister of State is well aware of it. It is a very disturbing report regarding a part of the country that is very close to my heart for personal reasons. People are sincerely worried about this issue because they do not know the scale of what they will be dealing with. What is the scale of this issue which has been spotted and with which we will have to deal in terms of dangerous amounts of medication possibly having been given to adolescents and children? What is the Minister of State aware of in the context of this issue? When did the HSE become aware of it?

The reply issued to Shane Phelan and quoted in the Irish Independent today indicates that it will take 16 weeks for an analysis to be carried. To me, that seems to be an extraordinarily long period for that to be done. It will be four months of anxiety for many young people, adolescents and their families. Some of the people in question do not even know they are affected. I ask the Minister of State to update the House on this issue, please. It is a very worrying situation. I am worried about the impacts on the young people in question, but also about how this happened in the first place. Furthermore, I am now worried about the length of time it will take to get to a first base of an analysis of what happened and what will be done. I note that the reply from the HSE states, "Most of the children whose files are being reviewed will have received appropriate care and clinical interventions." How does the HSE know that is the case? It does not know the scale of the issue and it does not know what has happened here. A line like that gives me worry that there was some level of awareness of this issue before it was brought to our attention through the media. I ask the Minister of State to respond to my questions on this issue.

On the broader issue of mental health that is before the House, issues relating to mental health are exacerbated by the fact that such an unequal society is developing in this country. That is at the root of many issues people face, no matter what age group they belong to. There will be extra issues in the context of service provision as a result of Covid. It is obvious that such issues are being experienced. Certain categories of people are particularly impacted, such as younger people and more elderly people. Younger people are affected by the direct impact on their everyday lives in terms of what they have been going through with regard to education or services. Elderly people have suffered as a result of isolation and the impact on their social lives towards the end of their lifespan. As we know a range of other issues will arise, and particularly in light of the high percentage of people who are and will be seeking to access services for the first time, what are the plans of the HSE in this regard?

A number of people, including the Minister of State, have mentioned waiting times. It is not good for the Minister of State to be standing up here and referring to patients receiving appointments within 12 weeks. It is just not good. That 12 weeks is a benchmark timeline for the provision of services is, frankly, scandalous. I am not saying the Minister of State is happy about the situation but she said we could get to that timeline. She has an urgent review and I wish her the best of luck with it but the situation is not good.

It is obvious we need a catch-up programme. Will the Minister of State outline what her plans are in that regard across all service provision? The fundamental problem is we do not have enough professionals, particularly in the public service. What are the Minister of State's plans to recruit providers of services into the provision of public health? Wrap-around services that extend beyond the immediate provision of mental health services need to be part of the public health system because otherwise there is a chain that can break down, and often does. What are the Minister of State's plans to launch a recruitment drive to ensure we can do this? That is going to take a considerable time because getting people into the public service in a professional capacity can, at times, be difficult.

That brings to me the issue of the bureaucracy around service provision. Many people who are looking for services are being forced to go to private providers. That causes issues and people should not have to go there in the first place. However, when they do and thereafter must engage with public provision, there is a bureaucratic chain that means there is a breakdown. That is unacceptable and must be addressed.

Services need to be provided 24 hours a day, 365 days a year. I do not need to remind the Minister of State of the scandalous situations where people end up waiting in accident and emergency departments at weekends because there is no service provision for them.

I also have a serious issue relating to information provision. The process by which we communicate to all the various cohorts, especially young people, needs to be improved dramatically. The most common cause of death from non-natural causes among 15- to 24-year-olds is suicide. How we reach out into schools, third level institutions and other forms of social areas in which young people are interacting needs to improve dramatically. Online outreach needs to improve dramatically because that is where most communication is now necessary.

Face-to-face counselling and interventions are always the best but I also believe that, in the world in which we live, we must dramatically improve how we reach the people using new technologies. I would like to see a special focus on that, including the use of video technologies. That can save time because it can be done at great speed. It prevents geographical issues and can be done over weekends. It is important we consider how that technology can be used.

I have an issue about the organisations under sections 38 and 39 of the Health Act 2004 and how they are going to be provided with the funding and supports to continue their work. We all know the State has abdicated certain amounts of geographical or other responsibilities for mental health services, as it has also done in many other sectors. Organisations, through goodwill, have operated and filled the gaps. The Minister of State has acknowledged that. In my town of Nenagh, Carmha has been offering excellent services over recent years because the services required had not been provided. Carmha is providing fantastic services on addiction and mental health but it is limited to fundraising.

It is not even a recognised section 38 or 39 organisation. This should not be the way it is. It is through sheer goodwill and community support that these services are operating, and Carmha is not alone around the country.

Furthermore, as regards Covid and how we come out of it, there is one issue we really need to examine. So many people have changed their lifestyle as regards working from home, the use of technology and the environment in which they work. That has sometimes brought additional pressures that are not acknowledged. As part of a holistic approach to how we ensure people's mental health is protected, collectively as a Parliament we must deal with issues concerning working from home. The working from home legislation, which we in the Labour Party have drafted and proposed, must be introduced to ensure that the always-on culture, which pressurises employees, is addressed, because there is no doubt that such attitudes and behaviour impacts on people way beyond their workplace.

I will share four minutes with Deputy Cairns.

Is that agreed? Agreed.

I move amendment No. 2:

(a) To insert the following after “waiting lists for mental health care within the public system were at crisis levels before the Covid-19 pandemic and are now at emergency levels”:

“—eating disorders are mental health disorders, which can lead to psychological and physical complications, and which require specialist treatment;


(b) To insert the following after “calls on the Government to”:

“—set up a taskforce dedicated to youth recovery, which should at a minimum have representation from the following:

—Department of Health;

—Department of Education;

—Department of Social Protection;

—Department of Children, Equality, Disability, Integration and Youth;

—Department of Tourism, Culture, Arts, Gaeltacht, Sport and Media; and

—experts in child development, research and service deliverers to assess the extent of mental health need and support for young people and children and to create a trauma informed plan for youth recovery following on from the pandemic;

—expedite the implementation of the Pathfinder inter-departmental unit on youth mental health, as committed to under the Programme for Government: Our Shared Future;

—dedicate ring-fenced funding for eating disorders to ensure all eating disorder hubs are operating and ensure there is a community eating disorder team accessible in every Community Healthcare Organisation area.”

I commend Deputy Ward and Sinn Féin on introducing the motion, which is timely and hugely relevant. We have tabled an amendment, which has a specific ask within it. It is welcome that the Minister of State is not opposing the motion. My amendment has a very specific ask, that is, that we would have an interdepartmental task force to examine and address youth mental health trauma. If the Minister of State does not oppose the amendment, I ask that she would take action to deliver upon it because to do otherwise would lead to accusations of being a little bit cute in how we approach this parliamentary engagement.

Our amendment seeks to illuminate the shadow pandemic, which is the wave of trauma, poor mental health and the negative impact and experiences that have been felt by young people all over this country. The mental health burden associated with the Covid-19 pandemic is likely to be profound and to be felt for many years to come. Today may be one of the final opportunities to speak of what we need and deserve as we start, hopefully, to begin to ascend towards a recovery. However, recovery will not just be economic and it will not happen by reopening schools alone. Recovery will happen when we acknowledge the fact that people, in particular young people, have suffered and when we seek to address it but to address it, we must first seek to identify it. We have not put any budgetary demands in our amendment. We have not set out exactly what needs to happen; what we have asked for is an interdepartmental task force that includes experts in child and adolescent experiences and children and young people themselves. Such involvement has been demonstrated by the secondary schools' student union, which campaigned on the leaving certificate and was around the table over the course of weeks and months and able to identify the problem and set a pathway by which we can deliver a solution.

There has been some research into children's experience of traumatic events such as following natural disasters and it indicates long-lasting effects on psychological well-being. The effects are often greater for those who are most vulnerable. We cannot unsee the experiences that have been felt. We have heard about an increase in domestic violence and substance misuse. The Government has set up task forces for the recovery of the tourism industry and the arts. Many recovery task forces have been set up and we believe this one is of the most fundamental importance.

While young people are less susceptible to severe Covid-19 infection, they are more at risk in respect of the negative psychosocial effects of the pandemic, including experiencing bereavement due to the deaths of people who have died as a result of Covid, as the age pattern of bereavement does not mirror the age pattern of Covid mortality. We have seen the closure of school buildings, the loss of extracurricular activities such as sport, music, dance and decreased contact with peers and all that will have a profound effect on young people.

Simply to offer words is simply to offer tokenism that will lead to nothing unless we deliver meaningful actions.

To be very clear, none of us knows the extent of the problem. We can talk about it and say there is a wave of youth mental health trauma but we do not know the full extent of it, and we cannot unless we begin to try to engage with and peer into it. For example, we do not know how many young people have disengaged from education during the pandemic. We do not know how many children or young people are struggling with their mental health due to issues that have been amplified by or are a result of the pandemic. We do not know how many children or young people have had adverse childhood experiences over the past 14 months.

There have been well documented shadow pandemics of domestic violence and increased alcohol consumption and violence in the home, which may result in serious emotional and behavioural problems in the future. We have known all of this anecdotally, but we do not have the figures or a pathway to identify the extent of the problem.

In March 2021 the national clinical programme for eating disorders experienced a 66% increase in referrals compared with 2020, one in four of which was deemed to be urgent. Yet, just three of the 16 proposed community teams for those suffering from eating disorders have been established. That is simply unacceptable.

Our amendment also highlights outstanding commitments in the national youth mental health task force in 2017, including the pathfinder unit which I added to the amendment to the motion to expedite its implementation. This previous task force does not answer the extent of trauma emerging from Covid. We need a task force that is interdepartmental and with expert voices to assess the extent of need and create a trauma-informed recovery plan. The phrase "trauma-informed" is probably the most important aspect of what we are asking for.

Speaking to the Northern Ireland Assembly committee for health in March 2021, interim mental health champion Professor Siobhán O'Neill spoke of the need for a trauma-informed recovery plan to address the stress and trauma caused by the pandemic. The phrase "trauma-informed" recognises that while our well-being can be impacted by our normal emotional responses to what has happened over the past year, for most of us the pandemic will not have caused increased trauma or mental illness. It also recognises that several population groups have been disproportionately affected and have suffered very real trauma, which comes on top of previous traumas. These are the groups we need to target in our preventative interventions and treatments, if treatments are necessary.

I thank Deputy Ward for tabling this motion. Put simply, we cannot continue to ignore the reality of mental illness. We do not tolerate waiting lists for passports, driving licences or, indeed, vaccinations. Yet, for mental health treatment, waiting lists are normal and accepted.

Mr. John Farrelly, chief executive of the Mental Health Commission, last month identified the issue at the centre of today’s motion. The pandemic has highlighted the results of continued underinvestment in our mental health services: increased waiting lists, an over-reliance on GPs and communities to provide care, and assigned money going unspent.

Thanks to figures secured by the Social Democrats co-leader, Deputy Shortall, we know that, as of December, 2,736 children are waiting on an appointment with community CAMHS. That includes 448 in the Cork-Kerry region, with 98 children and adolescents waiting more than a year. Unfortunately, the HSE does not have national data on waiting lists for adults and older adult mental health teams, which is an issue in itself.

This motion articulates many of the major issues in the State’s response to mental health, especially at a time when community and voluntary front-line services are experiencing an unprecedented demand for mental health services. There are two particular issues which I want to focus on today.

In February, I raised the shocking situation whereby no funding was allocated under the national eating disorder treatment plan for 2020 and none of the €1.6 million allocated in 2019 was spent. Responses to my parliamentary questions revealed the decision to pause temporarily the nationally planned development of eating disorder services was made for operational rather than clinical reasons and that funding was diverted to meet existing demands to provide additional clinical supports such as agency staffing. We need clear assurances this will not happen again. Bureaucratic decisions cannot be allowed to affect the treatment of vulnerable groups.

My colleague, Deputy Gannon, has tabled an amendment to ensure dedicated, ring-fenced funding for eating disorders annually and to ensure a community eating disorder team is deployed in every community healthcare organisation area. I ask all Members to support this vital amendment.

In February, I also highlighted the fact eating disorders, which disproportionately present among young women, are among the psychiatric conditions most associated with mortality.

The Minister of State assured me then that she was aware of the issues and was working with HSE clinical programme leaders to spend the money this year. However, in the meantime there has been several cases of young women having difficulties accessing appropriate medical care for severe eating disorders. These cases indicate that there is still a significant gap between the Government’s intentions and healthcare services on the ground for people who need them. The HSE currently provides three inpatient beds for eating disorders. People who desperately need care simply cannot get it. If the Minister of State has not read the piece in the Evening Echo on one woman's experience, I hope that she will today. I beg her to please intervene and do something about this.

Second, I want to raise counselling services. The system of professional low-cost community-based counselling services in Ireland has had its funding cut by 50% since 2011. These are front-line community, voluntary and non-profit agencies who have continued to deliver counselling through the pandemic. State agencies, including Tusla, CAMHS, and the Garda, often refer people to these counselling services, yet their funding does not reflect the crucial role they play. This sector represents incredible value for money. In 2018, member organisations of the Association of Agency-based Counselling & Psychotherapy in Ireland provided more than 70,000 hours of therapy for €2.8 million. This community-based, not-for-profit sector needs its funding restored, and needs a commitment to multi-annual funding. In addition, the Government must make a commitment to review the current model of funding of sections 38 and 39 Tusla-funded organisations.

I presume the motion’s call for an emergency talk therapy fund for sessions in the private system will allow for funding to go to the community-based, not-for-profit sector also. If one of the proposers could clarify that in their closing statement, it would be appreciated.

I commend Deputy Ward and Sinn Féin on this motion on mental health. I am sure everyone agrees that we are living in unprecedented times, which call for unprecedented measures, especially around our mental and physical well-being. The past 14 months has shown us that we are all vulnerable and we can be touched by any mental health issue. It has shown the desperate situations in which people have found themselves in experiencing isolation, fear, loneliness and despair, but there is also hope which is the main thing we want the debate. We have seen amazing human solidarity not only in Ireland but across the world, particularly with our front-line workers. We have seen hope, unity and togetherness that we have not seen for generations as people pulled together. When people pull together and there is a sense of togetherness, that is great for everyone's mental and physical health. That is good but we need to be better.

A Vision for Change was quite visionary in 2006. It was a critique of mental health services in Ireland. What we are discussing here is resources. That strategy said we needed to spend 12% of our overall health budget on mental health services. We spend less than that now. Mental Health Reform says there are fewer staff working in mental health services now than in 2008 even though a lot of money has gone into mental and physical health. When there are fewer staff, there are fewer resources. Intervention is key when someone presents themselves with difficulties. It is very important that the Government addresses that.

Others have spoken about CAMHS. In certain CHOs - my constituency is in CHO 7 - some children have to wait up to a year and a half before they can avail of any sort of intervention service.

It is absolutely unforgivable in that children need the intervention not in 18 months or even 12 weeks but in 12 days. Addressing this need is the key to changing fundamentally our CAMH services and so forth.

The pandemic has shown there have been major inadequacies regarding public health services and a schism. Throughout numerous decades, the underfunding of our health service, particularly the mental health service, has been hugely detrimental for those who wanted to access services. Some of us may need to access the services, and when we need them, they are not there for us.

Will the Minister of State answer a question on talk therapy? It is very good. There is overprescription of medication, especially antidepressants, for mental health issues in this country. Nobody has mentioned social prescribing. It is very beneficial and we should do more of it rather than going down the line of overmedicating people. Social prescribing is going to be very beneficial.

On the overall picture, I really believe, for numerous reasons, there is a mental health crisis. That society is so driven by competition is absolutely detrimental to people. That is a political analysis but we live in a capitalist world that is driven by competition, individualism and profit. If you cannot get the resources, capitalism is really bad for your health.

I thank Deputy Ward for raising this important motion and addressing this important issue. Many have cited the enormous need, mostly unmet, for mental health services and the unacceptable circumstances in which thousands of people are waiting for assessments of need much longer than the three months within which they are supposed to be assessed by right and the three months thereafter, within which they are supposed to get services. People are waiting many months and sometimes for more than a year to get the services. Indeed, they do not get them at all in some cases.

Two thousand five hundred children are waiting for CAMH services and 8,893 children are waiting for primary care psychology. As of January 2021, 3,345 adults have been waiting for counselling treatment. There is a lack of 24-7 emergency services. Reports indicate the effects of the lack of services, staff and so on. There is a report in one newspaper today — I have heard many stories of this — that refers to the overmedicating of children to compensate for the lack of psychology services, occupational therapy, and speech and language therapy. These problems become worse because there is no early intervention. Without assessment and services at a young age, these problems become intractable, permanent problems that cost the individuals affected far more when they get older and cost our society in general far more.

The point on eating disorders has been made by others. My office was talking to one of the young women whose story has been circulated. Her eating disorder is so severe and she is begging to get into hospital but you literally cannot do so unless you are at death's door or have the money to go private. Shockingly, millions of euro are allocated but not actually spent. The money for eating disorder services, not having been spent initially, has been suspended. The point I want to make on all this, which others have rehearsed, is that there is a desperate, urgent need for these services that has been magnified by Covid, resulting in a 66% increase in eating disorders, for example.

What do we need to address these issues? We need trained professionals. One would think, given the desperate need for these services, that we would be doing everything to train professionals.

I made this point to the Taoiseach a couple of weeks ago in regard to psychologists in particular. Are we making it easier for people to become qualified and to get doctorates in psychology? No, quite the opposite. We are making it very difficult, with MA fees of between €8,000 and €15,000, such that many people who study for MA degrees do so in the Netherlands because it is cheaper to do it there. Then, when a student has got through that, he or she has to complete a certain number of placement hours, which is very difficult to do, and there is the cost of travelling on placement, which may be unpaid such as in the case of student nurses and midwives. If someone wants to study for a doctorate in counselling and educational psychology, there is no funding whatsoever. Students have to pay €15,000 in fees per year for three years and work an unpaid placement, which is nearly full time, as well as doing all the study, seeing clients and so on. People who are trying to study educational and counselling psychology are living in poverty and many of them drop out. About 45% of students training to be psychologists say they want to leave the country altogether, such are the horrendous conditions.

In clinical psychology, there is some funding but the number of places is pathetic. In 2020, there were 52 placements for doctorates in psychology, with hundreds of students who have undergraduate degrees, MA degrees and loads of training under their belt chasing only 52 places. They cannot get on the courses because there are not enough places. Furthermore, there are 402 fewer psychologists than was recommended in A Vision for Change in 2006. We are not putting the resources into supporting young people who want to become psychologists and to help address the mental health crisis. We are making it difficult for them and we are grossly understaffed and under-resourced to meet the desperate needs that exist in this area.

We have tabled amendment No. 1 to the motion.

The Covid-19 pandemic has played havoc with the mental health of people of all ages. The brightest glimmer of light we have is the Covid vaccine. At present, the vaccine roll-out is gathering pace and a consistent supply of vaccines seems guaranteed. This should be a time of optimism, but almost every day the media have a story of conflict, confusion or contradiction. This undermines public confidence. Releasing vague information on undecided issues is doing a grave and unhealthy disservice to people. It causes unnecessary worry and anxiety. It is a practice that should be curtailed

Every age group has suffered during the past year. Only the very strongest have escaped some form of damage to their mental health. Loss has been the biggest factor: loss of a loved one, of a job, of companionship, of social activities, of education and, for all, of freedom. The closure of schools has led to many health conditions. Children have missed out on personal contact with their friends, family members, classmates, teachers and school communities. The impact of trauma due to this pandemic and the lack of supports available is affecting children's academic, emotional and behavioural development. A total of 2,550 children and young people are awaiting access to CAMHS, while almost 9,000 children are awaiting primary care psychology treatment. These numbers are increasing at an alarming rate. Our younger generation has been through the type of trauma that previously did not exist. They have watched their parents struggle, their independence vanish. The pandemic has forced teens to be removed from normal social, physical and educational interactions. It is estimated that one in three adolescents will match the criteria for an anxiety disorder by the age of 18. This is a shocking and very worrying prediction.

We can learn from international best practice. Many trauma-informed school strategies and restorative practices that address chronic stress and build resilience in our children can be implemented in schools. The Minister for Education should provide the necessary training and supports and be ready to implement these strategies in September. We need a cross-party, cross-departmental and interdisciplinary approach to address mental health issues and access to supports and services. The Government must address the long-term effects of stress and trauma caused by this pandemic. It must initiate and implement policies and actions to counteract the mounting pressures on young people. Our personal ability to recover from this pandemic lies in the strength of our mental health, and the strength of our mental health lies in the support we receive. The Government must not be found wanting in providing that support.

I welcome the opportunity to speak to the motion. I thank those responsible for bringing it before the House and raising this very important issue. I have long advocated that mental health needs to be treated more seriously. Time and again, we hear those in government talk about the challenges of tackling mental health and the many actions they will bring to deal with the issue. The truth is that the Government is not taking the issue seriously enough. Mental health issues, particularly among our younger generation, is getting worse. Stress, anxiety and fear are growing among our younger generation and we must put in place measures that will prevent this from getting worse.

While I welcome the motion before the House, I support my colleagues in the Regional Group, who have tabled an amendment that my colleagues will address. The statistics are truly shocking. At present, 2,551 children and young people are awaiting child and adolescent mental health services and, shockingly, 8,893 children are awaiting primary care psychological treatment. In addition, 1,553 adults are awaiting primary care psychological treatment from the HSE. These are shocking statistics of which we must all be ashamed.

The World Health Organization recommends that a minimum of 14% of a country's overall health budget be allocated to mental health challenges, while Sláintecare recommends a minimum mental health budget of 10%. The Government's spend on mental health in 2020 accounted for only 5.2% of the overall health budget, almost two thirds less than what is recommended by the World Health Organization. Will the Government please explain this? The bottom line is waiting lists for mental health services prior to Covid were at crisis levels and, to put it mildly, are now at emergency levels. The Mental Health Commission even told the Oireachtas Special Committee on Covid-19 Response that Ireland's mental healthcare system is not fit for purpose and is out of date and, furthermore, that substantial additional investment is needed to address this. The bottom line is we need to act now.

I have dealt with numerous issues with the Crosslanes centre in Drogheda and we have seen at first hand how inadequate this service is. It is simply not fit for purpose. The Minister of State stated that mental health difficulties remain a priority. The HSE website states that one in four people will experience some mental health difficulties in his or her lifetime, that mental health treatment will usually come from one's GP and that mental health services must be provided via a referral from a GP. Doctors need help. A doctor in Dundalk referred a patient numerous times to the Crosslanes centre and the patient was sent back each time. The doctor could not do any more and the patient needed someone with more experience. That young person ultimately committed suicide. Will the Minister of State please investigate what is happening in Crosslanes? The building was completed in 2016 and looks fantastic. People in the area need help. Will the Minister of State please look into the matter?

I thank Sinn Féin for bringing forward the motion, which I will support as well as our amendment, tabled by the Regional Group. I wish I could say I welcome the fact I am going to speak on mental health for the tenth time in my 14-month political career. I commend the medical staff in Wexford who deal with mental health, particularly those in CAMHS and at Wexford General Hospital, who are all under severe pressure because of the staffing levels and the inadequate resources received. I thank the Minister of State for her intervention on Monday last in a very serious situation that arose, one we should not be dealing with in emergency cases. I thank her and the Minister of State, Deputy James Browne, who, while his intervention was not required, tried to address the matter.

There is no child psychologist in the CAMHS unit in Arden House in Wexford. This has been the case for three years. The Minister has informed me that a child psychologist is about to be appointed. There are two applicants for this position, which has been vacant for more than three years. Neither of these applicants has yet been formally offered the position, allowing them to either accept or reject the offer. This leaves us in limbo. The children and families of Wexford are being let down by what seems to be a lack of administrative engagement in making an offer to these two applicants. I ask the Minister of State and all of her party colleagues in Government to address that issue. They should make someone in the HSE accountable for making an offer so that children in Wexford will no longer be disregarded and left without a child psychologist.

We have heard many Deputies talk today about the increased incidence of anorexia. Wexford has seen a serious increase but there is no paediatric dietician attached to either the hospital or to CAMHS. I am informed we are entitled to half a dietician. I ask that this be reviewed. Nobody should have to deal with half a dietician. The CAMHS team has acknowledged there has been an increase. Instead of half a dietician being appointed to Waterford and half a dietician to Wexford, I ask that this be reviewed because a full-time dietician is required in each area. I ask the Minister of State to treat this as a matter of urgency. Both situations need to be addressed. The Government cannot continue to launch campaigns without providing the staff required to allow them to meet the needs of the people. I appeal to the Minister of State and to the Government not to let this situation continue and not to continue to disregard the families, children, parents and people of County Wexford. We are as entitled to our services as the rest of the country.

I am grateful for this opportunity. Each and every one of us knows there is not a man, woman or child who has not been affected by this pandemic whether mentally, financially or in another way. I refer especially to the mental effects. I will highlight one special thing to the Minister of State, Deputy Butler, and the other Minister of State, although Deputy Butler would have an advantage in this regard as she was very good in fighting the abortion Bill which affected unborn babies.

The St. John of God group has been operating a very valuable service in St. Mary of the Angels in mid-Kerry, which has been looking after children with mental and physical disabilities since 1965. The property was donated free of charge to the Franciscan Sisters by the Doyle family in 1965. The congregation operated it up until 2005 when it was handed over to the St. John of God group. This group is now giving up saying that, as it was not properly funded by the HSE, it cannot continue. A rumour has gone out, however, that the property will now be sold by the St. John of God group. It would be particularly hurtful to the patients in the centre and their parents if it was to be sold. I ask the Minister of State to ensure it is never sold and that it will be kept by the HSE, or whatever Department or group is put in charge, when the Saint John of God group gives up at the end of the year. There are 64 patients in the centre at present in addition to the trained staff who look after them. I appeal to the Minister of State not to let this property be sold to anyone and for it to be kept for the patients who need care.

I thank Sinn Féin very much for bringing this motion with regard to mental health surge capacity requirements before the Dáil. It is very important. There is going to be a look back with regard to 1,500 children who were under the care of CAMHS in Kerry. I have a number of questions for the HSE. When did it become aware of the overmedication of children receiving care from CAMHS? How long did it take to notify the parents of these children? How long will the look back take and what measures will be put in place to make sure a situation like this never arises again?

I will also raise the situation in respect of the St. Mary of the Angels home in Beaufort in County Kerry because it has to do with different types of both mental and physical health. I have been a lifelong supporter of the service, first of all as a representative of the Killorglin electoral area for many years when I worked daily with the parents from around Kerry and beyond who have availed of the excellent service provided in St. Mary of the Angels. To be very clear, St. Mary of the Angels is a centre of excellence when it comes to taking care of people's mental, intellectual and physical problems and difficulties. There are parents and families who dearly appreciate the care they have been getting there. There is a worry in County Kerry that the centre is going to be closed down by stealth. This worry arises from the fact that new admissions to the centre are not being allowed. It is a beautiful facility. I know every single solitary one of the staff members who work there and their families. It is a vocation for them, and was a vocation for those before them, to take care of the residents of that home.

This Government has a policy of not allowing congregated settings and that one shoe fits all sizes. It believes it is good for people to be taken out of this centre of excellence and to be put out into the community, but that is not necessarily so. It can actually be bad for them. I am pleading on my knees for the Government not to allow St. Mary of the Angels to be closed down by stealth. It must be kept open. It is the right thing to do.

I will raise a number of issues, the first of which is that I am deeply concerned that the share of funding for mental health services is to fall dramatically to 5.2% in 2021. Given the pandemic, people are suffering greatly. I see that all of the time. I take phone calls from people who are in a desperate state. These calls come from all age groups. We need to do more. Provision must be made for more funding and more services.

I am also very concerned about the lack of psychologists for school-aged teenagers and so on. I am also concerned about CAMHS, that children are not being seen quickly, and the lack of a system for reports to be made to Deputies when we make representations to CAMHS with the consent of parents. These parents only come to us when there is a desperate need and when they are concerned. There needs to be more communication and collaboration with CAMHS. It needs to communicate with representatives who are trying to do their best for families in their constituencies. I appeal for that to happen. Children need to be seen quickly. Were it not for organisations such as Jigsaw and the great organisation, Accessible Counselling Tullamore, in County Offaly in my own constituency, things would be far worse. These organisations cannot, however, fill the gaps that are there. Those gaps need to be filled by Government, although the organisations will play their part. Government definitely needs to look at the funding, which is falling far short of the objectives of Sláintecare, which recommend that 10% of health moneys be allocated to mental health. I ask for that to be looked at.

A new research report on suicide has said that the mental health of young people has been disproportionately affected during the Covid pandemic.

Factors such as loneliness, jobs and income losses, bereavement and the impact of Covid affected people's mental health. There has been a complete lack of resourcing of mental health services, which will affect generations for years to come.

It is difficult to give figures on mental health change during Covid but demand on the services of the likes of Aware has increased by 100%. There is evidence, however, that the mental health of one person in five has been affected during Covid. Pieta House confirmed to me earlier that 7,000 people received more than 52 hours of one-to-one suicide intervention and bereavement consultation. It confirmed that it received more than 70,000 crisis calls and texts and some 50% of its clients were under the age of 25.

I would particularly like to pay tribute to our volunteers who work in Limerick Suicide Watch. They have been involved in interventions in incidents, which have increased by 30% in two years. The group's main focus is to keep eyes on the river and identify people who are in need. As part of the group's suicide awareness and community outreach programmes, volunteers visit schools to talk to the younger people and to let them know it is okay for them to come out and talk and that there is somebody there to talk to.

Like it or not, working from home is a reality and a UK survey detailed that more than 80% of people are working from home. The statistics show that people who are working from home suffer a negative impact. Working from home can be hugely beneficial for some people but it is not for everyone. If one looks at people who have families it can work but not everyone has a family and there are people who are single. From a mental health point of view, we are increasingly seeing that women are suffering from mental health the most due to working from home. We have to get this right. If people want to work from home let them do so but it does not fit everyone and we need to work with that. I ask the Minister of State to make sure that everyone has the equal right that if they want to work from home they can do so but that if they do not want to they can go to their workplace.

I always preface my remarks by saying the Minister of State inherited the situation. In that context, I welcome this opportunity, although like another speaker said, I do not know whether the word "welcome" is appropriate in relation to what I am about to say. I will start with the statement of the chairperson of the Mental Health Commission, John Saunders, who said: "The current Covid-19 pandemic has highlighted in stark terms the need for a modern, well-staffed, holistic community-based mental health service." That was on the publication of the 2019 annual report of the commission, which was published midway through 2020, and we are waiting on the updated annual report. I will refer to some of that report.

I am someone who has a privileged background in my working career. I foolishly thought that things were improving in the 1980s with the publication of Planning for the Future in 1984. That was followed by A Vision for Change, which was followed by Sharing the Vision. The independent panel, which the Minister of State has worked hard to set up, will be the measuring stick of how serious this Government is about mental health.

I thank Sinn Féin for using its Private Members' time for this issue and I welcome this opportunity, although I despair of the words used. Like Deputy Verona Murphy, I cannot say how many times I have spoken on mental health since 2016. First, we were trying to ascertain where A Vision for Change was at and then we were told there was an update review of the literature. When it was done, it was done quickly and effectively by the professionals who did it but it took forever to make that decision. Then A Vision for Change came along. All the time, the implementation body was gone, although the Government is in the process of re-establishing it. We should not need to talk about mental health in this Chamber. There should be a policy and legislation and they should be implemented. That is why we had an independent panel monitoring body to take it out of our hands and come back with reports to us. We should be discussing the reports of that independent monitoring body, not discussing the Minister of State's speech in which she is obliged to say what the Government is spending, which is not detailed in context. We should be looking at the reports of the independent monitoring body. That is the step I would like to see taken in the future.

It is truly upsetting to read this report. I will take a pen picture of what the Mental Health Commission found when it looked at the 65 approved centres. There are also lots of centres that are not approved so somebody might deal with that and outline what the Government's plans are in that regard. While the commission's staff can go into those facilities, they cannot make them change or comply with the recommendations. That is a serious gap. We can look at the number of deaths of people using mental health services alone. Unfortunately, we are all familiar with the revolving door in emergency departments and the distress it is causing. I am from Galway and, unfortunately, we have a suicide patrol watch, which I pay tribute to. That is where we are in Galway with helicopters in the sky and we all tremble and say a prayer if we believe and if we do not believe we say something else. In that context, in 2019, some 563 people died. That was the number of deaths of people who were using the mental health services. Some 166 deaths related to approved centres and 397 deaths related to community mental health services. Of those, 168 were suspected suicides of people who were attending the mental health services.

I mention the context of the report that has been mentioned by a number of Deputies on child mental health cases due to excessive medication doses and I will come to that in a minute. I am looking at the report of Dr. Susan Finnerty, inspector of mental health services at the Mental Health Commission, and it is worth looking at. It is not an onerous chapter in the sense of the number of pages in it but it captures is what I would love to hear from a Government and a Minister when they come in to talk to us. The report poses the question: "What did we find?". It goes on to answer: "We found a number of issues of concern" when the 65 approved centres were inspected. It states that they found "poor quality in monitoring the physical health of residents" and mentions "the impact of staffing shortages". That absence of staff has been mentioned by many. The report mentions "the failure to provide all residents with a meaningful individual care plan." Something as basic as an individual care plan was missing, which Mr. Saunders has pointed out should be the blueprint of care. The figure for something as basic as that was a 52% non-compliance rate but I am subject to correction. I might have that figure wrong but it was an extremely high non-compliance rate.

What is also worrying is the level of compliance generally and again the Mental Health Commission is fair. It does not zone in on one particular criterion but it takes an overall approach. Some of the percentage compliance rates in 2009 were 56%, 57% and 59%. In Galway, quite shockingly, there was 70% compliance. I would expect 95%, 96% or 97% compliance. The Galway centre is a brand new one, relatively speaking. Dr. Finnerty and Mr. Saunders stated:

The patient’s individual care plan should be ... the blueprint for their care pathway. It should be viewed as the patient's care plan, not the clinician's.

Then they go onto physical care for persons with severe mental illness, stating: "It remains a fact that in the 21st century people with a mental illness will die between 15-20 years earlier than their peers in the general community, in many cases due to preventable physical illnesses."

They further state that the system has:

...lost sight of the ‘whole’ patient and the need to consider both mental and physical factors in the genesis and continuation of mental illness ... While not unique to mental illness, there is a now well documented association between the use of antipsychotics... and the development of metabolic syndrome. It is estimated that over a third of patients with schizophrenia will develop metabolic syndrome with detrimental effect on their health and life span.

It goes on and on.

In my remaining two minutes I will deal with one specific issue relating to the review. Urgent clarification is needed on the review of the excessive medication doses for children. The question is whether that applies in the west of Ireland, in Galway. What are the implications throughout the country?

The Mental Health Commission refers to parity of esteem for mental health. We have not even gone near to having parity of esteem. When the Minister of State comes into the House in the future, I would like her to address that. I know she inherited the situation, but the blueprint is there from all the documents. There was nothing wrong with A Vision for Change. The time span was from 2006 to 2016; the date was out of date but nothing else was. It was visionary. As I have said before, it set out all the problems and inadequacies on the ground, and what we needed. Successive governments delayed on that. Not alone did they delay, but they abolished the independent monitoring panel. The Minister of State has inherited that. She has an opportunity to say this is out of her hands and that she will be guided by the independent monitoring body regarding the progress or lack of progress.

Instead of that, successive governments have delayed, and we got the ridiculous update of literature which could have been done in parallel with the implementation of it. All the time on the ground the services have been creaking at the seams. I say that reluctantly. I am a positive person. I come from a wonderful city. I also come from a city where there is a revolving door in respect of mental health. The report identified that services are operating over capacity. There is overcrowding, lack of privacy and so many other defects. Why is this? It is simply that we have failed to treat it with a parity of esteem. We do not have appropriate staff on the ground. We have made too much use of medication as a way of dealing with issues, as appears to be confirmed in the report in today's Irish Independent.

I do not wish to stand up here again and speak on mental health to outline my opinion or anecdotes on the ground. I want to see the implementation of what is now the policy document, Sharing the Vision. I want to see updated reports on how far we are progressing with that and what we need to be doing. That is where my energy and the energy of other Deputies should be directed.

I thank the Ministers of State for allowing me the opportunity to speak on the debate. As public representatives, we meet people in a very distressed state from time to time. The anxiety in our communities is at an all-time high following the very difficult year we have had with the Covid pandemic and everything else. We need to accept the real challenges that we will be facing with the effects the pandemic has had on mental health.

Much good work has been done to try to reduce the waiting lists for CAMHS, which I welcome. I ask the Ministers of State present today to adopt a whole-of-government approach to how we deal with the post-pandemic mental health issues that will present in communities. On a daily basis, as public representatives, we hear people, from the very young right through to older people, crying on the phone over some issue they want dealt with. We need to focus clearly on the decongregated settings to ensure the update to A Vision for Change is being implemented and evolving as society is evolving.

Teenagers and younger people who are attending national school and post-primary school are presenting with mental health issues. That needs to be dealt with, but it is very hard to find help. We need to do more and need to be conscious of the existing challenge which will only build a head of steam as they get older.

I thank the Minister of State for her presentation this morning and I thank all my colleagues who have contributed to the debate. It is extremely important that we have a detailed debate on this issue on an ongoing basis because mental illness is not like any other illness. It is something that can continue on for people and it is not easily resolved. The Covid-19 pandemic has brought forward new challenges in that people are adversely affected by their loss of business, loss of jobs and new challenges within their own families.

Mental health is not just about health services. It is also about the other support services such as housing and the justice system within the community. I have occasionally come across mental health problems where there is not that joined-up follow through from the health services to the housing services and the justice system. At some stage we need to start looking at that where somebody is discharged from a mental health facility but then there is not that same connection with family or in their care thereafter. It is an area where we face a new challenge.

One of the big issues we have with mental health services now relates to getting the appropriate staffing levels. It is a really difficult job and some people might not want to get into the area. The important thing is that the people who are in it and the people who have an interest in getting into it are given every possible support to ensure they get adequate training and retraining as changes come about. It is important to keep upgrading the level of training and education in this area.

A number of colleagues have spoken about the long-stay facilities for mental health. Intensive work needs to be done in this area. For instance, I have come across a facility with six residents per room. That is no longer a feasible option bearing in mind the challenges of Covid. We now need to have that review and ensure that adequate funding is put in place in a timely manner to upgrade those facilities. If the facilities are good, we can also ensure we can hold onto the staff who provide the care.

I again thank the Minister of State and all of the people involved in the mental health services for the work they are doing.

I thank all the Deputies for their interesting, valuable and informative comments on this Private Members' motion on mental health. I support the opening remarks of my colleague, the Minister of State, Deputy Butler, about the opportunity we have today to discuss mental health.

People’s physical and mental well-being has been a priority for the Government at all times during the pandemic. This is reflected in the policies introduced to safeguard the well-being of the whole population, including targeted initiatives for priority groups.

The Government and mental health services have been particularly active in response to the pressures placed on people’s mental health due to Covid-19. In doing this, we recognise the importance of dealing with any non-specialist mental health issues, such as mild anxiety, before they become bigger issues. With this in mind, the cross-Government well-being campaign, Keep Well, promotes resilience and minding our physical and mental health. Some €7 million has been invested in this campaign, to support initiatives with a range of partners, including "Keeping in Contact", with the Community Call programme aimed at people who might be experiencing isolation and offering befriending services.

The interdependencies between physical and mental health are well known. The need for a whole-person approach to achieving good standards of physical and mental health and well-being has been recognised in formulating our mental health policy, as has the need to support the wider psychological aspects of physical health challenges.

The HSE service plan reflects a balance of prioritised new developments across the health sector. These include initiatives to improve national mental health through well-being programmes. In addition, the implementation of Sharing the Vision will have increased impact across all age groups, focusing on mental health promotion, early intervention, acute care, forensic inpatient care and postvention supports in the community. It is recognised that vulnerable groups, such as mental health service users, have been disproportionately affected by Covid-19. The cross-government group, chaired by Department of the Taoiseach, was established to co-ordinate support for these vulnerable groups.

Budget 2021 provided €175,000 for initiatives for victims of domestic violence and for the LGBTI community, and €5.5 million has been provided to enhance health services for people who are homeless and in addiction. Additionally, more than 1,400 additional beds were provided as part of the winter plan and in response to Covid.

It is acknowledged there are aspects of mental health services that require improvement. I would like to recap some of the comments made by the Minister of State, Deputy Butler and the Government’s commitments. Enormous work has been undertaken to improve our mental health services. Sharing the Vision has been published and the national implementation monitoring committee is driving its implementation. The suicide reduction strategy, Connecting for Life, has been extended by four years to 2024 to enable its continued implementation. The National Forensic Mental Health Service will relocate to a purpose-built new facility in Portrane and will open this year. The Mental Health Act 2001 is undergoing a major overhaul. The significant allocation of in excess of €1.1 billion for mental health in budget 2021 not only will enable us to continue to run our mental health services but also will allow us to enhance and develop new services and supports.

I thank Members for the opportunity to discuss the very important issue of mental health and for their input, which will assist us in improving services.

We know that mental health was in crisis pre-Covid. We know also the crisis has escalated throughout Covid, but what does this mean? It means people are suffering and experiencing great trauma and loss, huge change and anxiety, financial strain and pressure, and home insecurity. The Government's response to mental health has fallen short for many years. I note the Mental Health Commission told the Oireachtas Special Committee on Covid-19 Response that Ireland's mental health system is not fit for purpose, it is out of date and investment in it and the community is needed. On behalf of my constituents in County Clare, I am asking if the Government will take stock now. Will it respond to the needs of its people? They hope so.

There is still no State-wide provision of 24-7 crisis mental health care at community level. This is a significant failure and the issue on which I want to focus today. I want to stand up for the many in County Clare who have made great attempts at reaching out for help, especially the constituents who live in rural and isolated areas. Unfortunately, until we have 24-7 crisis mental health care in the community, we run the risk of our people experiencing further trauma and negativity, with some who have reached out to me describing it as a complete rejection. In their experience, to ask for help when in distress is an incredibly difficult step to take. This needs to be reflected on by those in power. Unless you have the personal experience, there is no appreciation of that overwhelming feeling when you knock on a door and it goes unanswered. That is a feeling that you just do not exist.

This week I held a discussion via Zoom with community and service representatives within County Clare, who spoke about the high levels of demand on the ground and the rise in the number of people reaching out for support for the first time. I commend them on the great work they have been doing. The reality is people are losing loved ones, jobs, relationships, cars and homes and they are gripped with fear.

Sinn Féin has called for the establishment of a 24-7 care public crisis de-escalation multi-agency triage team ambulance service. People do not control how and when mental health crisis will impact them. We call on all Deputies to support this motion and thus send out the message to our people who need it most that they are heard, their needs are important and politics will no longer fail them.

I thank the Minister of State, Deputy Butler and Minister of State, Deputy Feighan for their responses to the motion. My only disappointment is that while they said they will not oppose it, they are not supporting it.

A great deal has been already said so I do not propose to get into the nitty-gritty of the issues. It was mentioned earlier that the Government inherited this crisis and I accept that is extremely difficult. This Private Members' motion tabled by Deputy Ward, whom I commend on bringing it forward, sets out a number of measures such as the establishment of a talk therapy fund, emergency care within the private healthcare system to take the pressure off the public system, universal counselling in primary care services, address of the capacity issues in CAMHS and primary care, the training and education for counselling psychologists, 24-7 mental health services, and the multi-agency triage team ambulance service. These asks are reflective of the asks of Mental Health Reform, which has also called for an increase in the staffing levels of front-line and primary care specialist care, improved capacity and access to community care and special mental health services, and the Government to resource voluntary service providers that are struggling owing to reduced funding and so on.

As mentioned by many speakers today, we have debated mental health services many times. We are in bad place at the moment and there is the possibility of a major mental health tsunami coming down the road. We are a reactive rather than proactive society. We need to pool our resources and put in place preventative and proactive measures such that we will not be here talking about this again in six months' time.

I would like to comment on the Mental Health Commission report. While reading it, I had cause to shake my head a number of times. The level of non-compliance is disappointing. I recognise the work of those on the front line, including An Garda Síochána, the National Ambulance Service, the fire service and front-line staff and management within the mental health service, all of whom are overstretched and doing their best. Let this not be a talking shop. I appeal to everyone to get this done. It will cost in the region of €60 million, which is not a lot of money, but it will be a start in terms of saving people's lives. I urge all Deputies to support Deputy Ward's motion.

Since I was first elected in 2016, I have spoken on the issue of mental health countless number of times. Unfortunately, my own city of Limerick has the highest number of suicides. Limerick is almost always ranked the highest in the State in terms of suicides, and that has not changed in recent years. The Covid crisis has exacerbated the situation. I met recently with representatives from a number of services and with whom I speak almost daily. They might be dealing with different aspects of the mental health crisis, but they all say that the numbers presenting are increasing, waiting lists are getting longer and, while they are doing their best, they are overwhelmed. We need urgent intervention. It is a crisis. In Limerick, suicide can be very public. The trauma of the helicopter flying over the city while a search for a loved one is under way is not just traumatic for the family but for the community as a whole. It is very upsetting. As I mentioned, local services are stretched and under pressure, and Covid has exacerbated the situation.

In the mid-west, the waiting list for psychological services for adults was 505. There are also 243 children between the ages of five and seven who have been waiting for services for more than a year. That is scandalous and it needs to be addressed. We need a particular intervention in that regard. If anything comes out of today's debate, I hope it will be the establishment of a de-escalation team in Limerick to deal with the emergency. We are failing people. I commend the local services in Limerick, including Limerick Suicide Watch and Limerick Treaty Suicide Prevention, who patrol the bridges and city at night-time.

I have been out with the people involved and I told them that they are the last defence where the services have failed and, unfortunately, people may take their own lives. I do not want to be here again next year or the year after talking about the same issue. My own city, as I said, is particularly affected, and it the highest number of suicides. I appeal to the Minister of State, if she is looking at de-escalation teams, to look at the situation in Limerick as soon as she can and to open the services there.

I thank all Deputies who contributed to the debate. The Minister of State said she will not oppose the motion. That is all fine and well but what is needed is action. In response to her maiden speech as Minister of State, I said that I would work with her in opposition in a real, tangible and solution-focused way. I was talking about motions like this when I said that. It is time for her to stand up and be counted and to put the actions in place that are laid out in the motion. I am putting her on notice that I will be holding her to account in regard to this motion for the duration of her term as Minister of State.

I welcome some of the initiatives she mentioned in her contribution that may be coming on board. However, we need to see fast improvements for the 10,000 people waiting on the public psychology lists and we need to see additional capacity put into CAMHS. It is incumbent on the Minister of State to put in place a 24-7 emergency mental healthcare service in order that people can get the care they need, where and when they need it. As Deputy Quinlivan said, a crisis de-escalation team must be put in place to meet the need that exists in the State.

During the Covid crisis, many people are experiencing mental health issues for the first time. It is a really frightening place to be. The Minister of State is not opposing this motion but I ask, in particular, that she support the proposal to put in place immediate access to talk therapy for patients from GP referrals, without the medical card barrier. Deputy Cairns mentioned community service providers. They can be resourced to provide this service. It is a win-win situation. Community services will get the resources they need and people who need mental health services will get the care they need. I will call the Minister of State out every chance I get if this provision is not implemented. I really hope I will not have to do so.

There is an onus on her to place additional capacity in our private mental health hospitals. I ask that she prioritise people with eating disorders. She referred to funding of €3.9 million coming down the road. People need help here and now. Some of them are dying right in front of us. The motion outlines a roadmap for mental health supports in the here and now. I will watch intently for progress on its proposals. When Deputy McDonald said that Sinn Féin would be the most effective Opposition in the history of the State, she was not lying.

Amendment agreed to.

I move amendment No. 1:

(a) To insert the following after “acknowledges that”:

“— positive mental health is fundamental to overall health and well-being;

— mental health is central in building a healthy, inclusive and productive society;”

(b) To insert the following after “8,893 children are waiting for primary care psychology treatment”:

“— bereavement, isolation, family financial loss, economic hardship, trauma, chronic stress and fear are triggering mental health conditions or exacerbating existing ones;

— following the Covid-19 pandemic, children are experiencing different emotional and behavioural reactions such as anxiety, depression, post-traumatic stress, behavioural problems, somatic complaints, fear and traumatic grief;

— the pandemic may compound pre-existing trauma, adversities and inequalities for some children;

— many children have faced trauma and chronic stress due to increased levels of alcohol and drug use, domestic abuse and anxiety in the home during this pandemic;

— due to the pandemic and school closures, children have missed out on in-person contact with friends, family members, classmates, teachers and their school communities;”


(c) To insert the following after “calls on the Government to”:

“— include mental health and psychosocial considerations in national response plans to Covid-19 across relevant sectors;

— re-establish a dedicated lead for mental health within the HSE that reports directly to the Chief Executive Officer;

— support recovery from the Covid-19 pandemic by building mental health services for the future, recognising that all affected communities will need quality mental health services to support society’s recovery;

— develop and fund the implementation of national services’ re-organisation strategies that shift care away from institutions to community services;

— ensure the Department of Health conducts a comparative study as to which countries perform well in the area of mental health and assess how Ireland compares;

— ensure the Department of Education conducts a comparative study as to which countries perform well in the area of trauma informed school strategies for students, educators and school communities and assess how Ireland compares;

— increase training of trauma informed school strategies and restorative practices for all educators and school communities commencing immediately;

— support and implement trauma informed school strategies and restorative practices for all students, educators and school communities commencing in the new school year 2021/2022;”

Amendment agreed to.
Motion, as amended, agreed to.