Covid-19, Mental Health and Older People: Statements

I thank Members for another opportunity today to update the House on developments in the areas of mental health and older people.

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. Surveys have shown an increased number of people reporting symptoms of stress, anxiety and depression during the pandemic.

Many people are experiencing emotional difficulties, including boredom, sadness and loneliness. In anticipation of this, and early in the pandemic, a range of psychosocial responses was introduced, including self-help supports, which promote positive physical and mental health. The Keep Well campaign provides practical advice, empowering individuals to maintain and improve their overall well-being.

Digital initiatives were rapidly enhanced to enable services to meet not only current demand but new and emerging need. Technology has aided the provision of seven-day tele-mental health supports, including, the information line 1800 111 888, the crisis text line 50808 and NGO online supports. These include 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 and there is capacity for upsurges in demand.

The HSE already has a range of proactive responses for any increase in service need, including online and other telehealth and psychosocial supports. The HSE’s psychosocial framework, published in January 2021, recognises the impact of Covid on mental health and provides for five key levels of support, from mental health promotion to specialist services. The framework provides a co-ordinated, consistent and collaborative approach to the provision of mental health services and supports during and beyond the pandemic.

HSE mental health services have continued to operate throughout the Covid-19 pandemic. Early in the pandemic, the HSE moved rapidly, under public health guidelines, to deliver 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, community and acute, are operating at between 85% and 90% of pre-pandemic levels. While referral rates are below normal, the level of appointments offered and waiting times to access community services have remained consistent with previous years. This is despite adaptations to service delivery due to the considerable challenges posed by Covid.

There is no doubt that this shows the ongoing dedication of mental health staff to ensuring service continuity. I express my sincere thanks to all those working across the services for their hard work and dedication during what has been an incredibly challenging and difficult time.

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. Some €13.65 million has been allocated for this specific purpose.

Underlining the Government’s commitment to mental health, budget 2021 saw an increase of €50 million, bringing the total mental health budget to over 1.1 billion. This is the largest budget on record. Furthermore, it does not take account of additional funding allocated to mental health in other areas of the health system or through other Departments such as justice, education and social protection.

Of the additional funding for 2021, €23 million is for implementation of many of the short-term recommendations of Sharing the Vision - A Mental Health Policy for Everyone. This will fund 153 new staff in community mental health services, including 29 posts for child and adolescent mental health services, 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 last week.

I have also secured the availability of €3.94 million for the national clinical programme on eating disorders this year. This will fund the establishment of three new specialist eating disorder teams and complete the three existing teams. I am aware of the increase in numbers and acuity of people presenting with eating disorders and I am fully committed to ensuring this funding is invested in full in 2021 and that we also see a continuation of the funding until we have all 16 teams in post.

I am also actively working with the Department and the HSE to develop a targeted initiative to significantly reduce the number of children and young people under 18 waiting more than 12 months for psychology in primary care. To supplement this, an additional €150 million is being provided for the enhanced community care programme, which will include recruitment of over 2,000 front-line primary care staff, to support a new community health network model.

It would be remiss of me not to provide some assurances about the range of processes that have been put in place to review the care received by children and young people who attended south Kerry CAMHS between 2016 and 2020. In light of concerns raised about the care given in some cases, the HSE will review the details of a very large number of young people, 1,500, who engaged with the service during this time. A CAMHS consultant has been in direct contact with all young persons or their families where concerns have been raised to date, and this process will continue as the review is undertaken. As the team reviews cases and files, any urgent issues will be dealt with immediately.

It is expected that the look-back review process will take in the region of 16 weeks. The HSE will share the findings and recommendations once the process is completed. A helpline has been put in place until 30 April. However, demand has been low. I am keeping this matter under close review in consultation, as appropriate, with other relevant areas in the Department and the HSE.

While a range of post-pandemic mental health and psychosocial challenges are likely to arise, a negative mental health outcome for our population from the pandemic is avoidable if we respond to the challenge in a cohesive manner. As Minister of State with responsibility for mental health, I assure the House of my full dedication to addressing the challenges that this represents.

The pandemic has posed the biggest challenges for those most at risk, including our older people. We recognise that there is still a long road ahead. However, there is much cause for us to feel optimistic. The Government will continue to make every effort to ensure the vaccine roll-out is successful so that we can all look forward to the restrictions being lifted as we move into summer.

Administration of the vaccine is well advanced as the programme continues to prioritise those who are most at risk of severe illness and death from Covid-19. The positive impact of the vaccine roll-out to date has been significant.

Between January and last week, there had been a 98% reduction in cases among healthcare workers, a 99% reduction of incidence in those aged over 85 and a 100% reduction in the incidence in nursing homes. For the third week in a row, there have been no cases associated with outbreaks in nursing homes.

In recognition of the positive impact of the vaccine across nursing homes, new guidance on visiting will come into effect on 4 May allowing residents to receive four visits every week.

Work to progress the implementation of the expert panel report will continue as it provides an important framework for the ongoing response to Covid-19 and longer term reform. The availability of supports to all nursing homes continues, including financial assistance, staff accommodation, personal protective equipment, PPE, serial testing and HSE Covid-19 response teams, where needed.

A dedicated system has been established to ensure all those awaiting a vaccination at home will be contacted in the coming days. This has been ongoing all week. The National Ambulance Service has been working hard to process referrals received for the programme. It is currently undertaking approximately 400 appointments per week. Over 3,500 referrals have been received as part of the housebound programme. To date, there have been 1,800 first doses and 500 second doses of vaccine administered. Of the more than 3,500 people referred, not all may be deemed suitable for a vaccine on assessment. I reassure those who are still awaiting a vaccination that the HSE will make direct contact with them and will administer the vaccine within a three-week period. This is week one. Of note, there has been considerable progress on the vaccine roll-out among the over-70s, with more than 95% of this age cohort having received a first dose of the vaccine.

This year, an additional €150 million has been provided to deliver on the Government's commitment to increase home care hours. This includes €17 million to progress the development of a statutory scheme for the financing and regulation of home support services. This brings the total investment in home support, including winter funding, to €666.5 million in 2021.

I am pleased to advise the House that, on 27 April, the Government approved the drafting of a general scheme and heads of a Bill to establish a licensing framework for publicly funded, for-profit and not-for-profit home support providers. As part of the wider reform of the model of service delivery for home support, the Department is finalising business cases with the HSE on the key enablers of the statutory scheme.

A key priority for me currently is the resumption of day care services, and I will continue to engage with senior officials within the Department and HSE to ensure that as many services as possible can reopen as soon as it is safe. The HSE is focused on delivering on this priority, and a dedicated focus group is in place to drive and oversee a plan to resume these services as soon as possible.

The nursing homes support scheme continues to deliver affordable and accessible nursing home care for citizens with long-term care needs. Notwithstanding this, the programme for Government commits to introducing an amendment to the scheme to cap the financial assessment of family-owned and family-operated farms or businesses at three years when calculating the means to pay for nursing home care.

A finalised draft of the Bill has now been signed by the Attorney General and I expect to bring the Bill to the Cabinet for approval next week. I hope it will be before the House in four to six weeks.

A range of initiatives and resources is available through the Understand Together campaign to ensure that people living with dementia stay safe, well and connected. Primary care teams are referring people with dementia to community supports such as the local authority community response forums and the Alzheimer Society of Ireland dementia adviser service. I am particularly pleased that additional funding for 2021 will ensure the recruitment of 11 new dementia advisers, bringing the expected total to 29 by the end of this year. In line with the national dementia strategy, €5 million has been allocated to support those with dementia this year, with a focus on six key initiatives. A minimum of 5% of the 5 million home support hours for this year are allocated for people with dementia. Taking into account the increased investment in the dementia adviser service and the national dementia strategy, this brings the total investment in dementia services to €12.9 million this year.

I am fully committed to further enhancing mental health and older people's services and look forward to Members' contributions today on these important areas of work.

I thank the Minister of State. I welcome many of the initiatives she announced in her opening statement, particularly regarding surge capacity. We have been calling for an initiative on surge capacity for a while. It is very welcome. I acknowledge the Minister of State's commitment to addressing eating disorder services but I wonder whether surge capacity can be used for people who are currently suffering from eating disorders while services are being put in place. That would be very welcome.

I have three further questions. I will leave the Minister of State time at the end to get back to me. She mentioned Kerry. Recent disclosures that young people may have been prescribed adult doses of medication at a CAMH service in south Kerry are extremely concerning. The gravity of the alleged breaches of clinical guidelines in Kerry is such that a national review should be mandated. It should not just be a local review, as indicated in the Minister of State's opening statement. How could this have gone undetected for four years? Immense distress has been caused among the children and families directly involved but there is concern right across the State over whether this has happened in other areas. That is why a national review is needed to determine whether the incident was isolated or is systemic right across the State. Is the Minister of State going to institute an independent national review into this matter under her authority under the Mental Health Act 2001, which empowers her to direct the Inspector of Mental Health Services to take on such a task?

Last week, we had a good debate on the Sinn Féin motion on mental health. It was passed. One of our asks, which was not mentioned in the Minister of State's opening statement, was for the Government to introduce a crisis de-escalation team. This would involve a multi-agency approach that would include a mental health nurse and specially trained gardaí. They would call to persons having mental health difficulties in the community, triage them, treat them, refer them and bring them to the appropriate service where they can get the care they need when they need it. Could I have an update on whether, or when, the Minister of State will be introducing this service? Will it be a pilot? Has she considered any locations?

My last question is also on the motion last week. Another objective of the motion was to ease access to talk therapy for people who need to talk about their mental health circumstances. Especially because of Covid, many people are experiencing mental health difficulties for the very first time. It is imperative that people have access to supports when and where they need them. One of the barriers that general practitioners are telling me they face when referring patients to counsellors and psychotherapists is the Government's failure to regulate. The therapists are fully qualified and accredited but they are waiting on CORU, which stated it will be at least five years before the counselling and psychotherapy professions will see any advance at all in the registration process. Does the Minister of State have any update on the CORU registration process? Will it just be put on the long finger?

I thank the Deputy for his continued interest in mental health and his constructive approach. He welcomed the surge capacity, especially in regard to eating disorders. There is no doubt but that, in respect of these disorders, we have seen an increase in referrals over the past year. Four out of every five of those referred are young girls. There are major issues with eating disorders and self-harm of which I have become aware. I was delighted to reinstate the funding of €3.94 million to populate the three existing teams and put three new teams in place this year. We cannot stop there, however, as we have to make sure the full roll-out agreed in 2018 happens.

On Kerry CAMHS, as referred to by the Deputy, it is important that we wait for the results of the review. We can certainly consider whether a national review is required but the most important thing we can do is await the outcome of the review, which will take 16 weeks. We will certainly consider it when it is issued. I was very concerned when I heard of the scale, that there had to be a look-back in respect of 1,500 children and that what occurred went on for four years. I look forward to seeing the results of the review. We can discuss this matter again when the results are available.

Regarding the issues raised by Sinn Féin in its motion last week on the crisis teams and a pilot, we have not considered the matter since. It was only a few short days ago.

On the registration of psychotherapists, I will have to get the Deputy a note on CORU and the current position.

To return to the issue of eating disorders, will the Minister of State commit to examining the use of surge capacity in private mental healthcare on an interim basis while the Department is getting its ducks in a row in respect of all the other services that are coming down the road? That would be really welcome. Mothers and fathers have told me they are watching their adult children die in front of them. If something could be done, it would be fantastic.

On the crisis de-escalation service, I attended a meeting of the Sub-Committee on Mental Health last week. A member of the Garda Síochána has stated that a pilot scheme of the service is to be introduced in Limerick soon. I do not want to eat into my colleagues' time, so will the Minister of State correspond with me on the issue after the debate?

I have had a number of meetings in recent weeks with groups representing older people, including a round table discussion on the mental health of older people in particular. All the groups raised the issue of funding, not just in regard to the amount available but also the consistency and reliability of funding. The lack of multi-annual funding is a major obstacle to their planning. When will we be in a position to commit multi-annual funding for these groups? The groups also raised the issue of the significant degree of red tape that their organisations have to navigate to achieve even small sums of funding. I am all for accountability but there is too much red tape for small pockets of money. We need to make the process easier for repeat applicants who have had prior approval. These groups are saving lives. One older person told me their self-isolation during Covid was spent looking out the window, waiting to die. The groups have given older people some hope and a reason to live. Will the Minister of State commit that something will be done about the red tape for repeat applicants please?

Another issue that arose was that of housing for older people. I know from personal experience that when someone's housing circumstances are precarious, his or her mental health will suffer. I commend my colleagues Councillor Aidan Mullins in Laois and Councillor Noel Connolly in Kildare on recent motions they brought to their respective councils relating to housing for older people. The Government needs to do more to provide suitable homes for older people. Will the Minister of State support or bring forward proposals to deal with the provision of housing for older people?

On the final issue, the completion of works on the Monasterevin day care centre, the Minister of State might be able to find out the answer or she might already know it herself. The works are well overdue are and much needed for the town where I live. The centre will be fantastic for the community. Could we get some answers on that please?

I thank Deputy Patricia Ryan for her continued interest in older people. On the first question, on mental health supports for older people, there are 1,000 mental health organisations throughout the country. We work closely with many such NGOs and fund them to provide supports for us. Nevertheless, it will always be the case that funding is made available at different times. We have to ensure that anybody who applies for funding ticks the boxes because this is taxpayers' money. There are so many different organisations and we want to avoid a duplication of services in different areas. I will take on board the Deputy's comments on the red tape in the case of organisations that apply every year.

On housing for older people, I had a meeting on the issue only a couple of weeks ago with the Department of Housing, Local Government and Heritage, while the Minister, Deputy Donnelly, has met the Minister at that Department, Deputy Darragh O'Brien. There are considerable opportunities to provide suitable housing for older people. Many older people's families have grown up and there might be one older person living in perhaps a three-bedroom semi-detached home. If such people had the opportunity to downsize to a small ground-floor home with the correct wraparound supports, they would give that consideration. I agree we definitely need to move on that.

I will have to get the Deputy a written response on the Monasterevin day care centre.

I am very concerned about older people who live on their own, and there is a big issue with single men, in particular, getting housed. Perhaps something could be done in that regard for elderly men.

I am happy we are dealing with this issue today. It is quite timely, on the day that is in it and also because of the volume of older people who have been vaccinated. I will run through a few issues and, as I have little time, the Minister of State might respond to me separately. I have direct experience of this issue, with very elderly parents in their 80s. The past year and a half has been the worst of their lives, although they have been through tough times in the past. My mother, who is my hero, turned 80 last March but, obviously, could not celebrate that. A few weeks later, she was meant to complete her 15th year in a row working at the orphanages in Belarus but, obviously, that did not materialise.

I had the misfortune to lose my mother-in-law suddenly a few months ago - not from Covid but suddenly. I always remember what she said to me. We were messing with her about her 80th birthday approaching, and she said she would not celebrate it until the time was right because she felt she was really only 79 years old because the previous year had not counted. That is a summary of how many elderly people feel because the past year has been so difficult and did not count.

We talk an awful lot in this country about catch-up programmes for this, that and the other. We need some such programme for the elderly towards the end of this year to reignite social interactions, to celebrate what they have come through and to plot a way forward for reintegration or resocialisation. I do not even know how we will do it but I know we have to, and I will work with the Minister of State on that. We should set aside a month, perhaps December or January, in which we put in place a programme that all communities and society work towards. It will bring together elderly people and reignite all they do, with opportunities in communities. Sporting and community organisations can help out. It will almost be a restart. I hope the Minister of State will support that because it is critical. I echo what the CEO of Alone, Seán Moynihan, has said about setting up a high-level, cross-society group to devise a new strategy for older people. In advance of that, I do not think it would be beyond the bounds of possibility in this House to come up with a strategy for one month to reignite how elderly people can interact in society. They have lost so much.

Communities have helped. I come from the little village of Portroe, where the local shop and the Gleeson family have been amazing. The shop has been almost a social outlet, delivering food to people and helping them out. A local publican, James Seymour, is doing the same and visiting people because he has spare time. All communities have helped elderly people throughout all this but collectively, we need to ensure there will be a period in which we put forward a plan to reintegrate and restimulate the elderly.

I raise the issue of those who are over the age of 60, in the context of the vaccine roll-out. I am concerned that 220,000 people in the 60 to 69 age group, who are not old but are going in that direction, have not registered for vaccination. How will we ensure they do so? It is a huge number, and while it will decrease all the time, there is obviously a quantity of people who are not going to register for some reason. I do not know why that is but we need to do something about it because it is a real issue.

Over-70s are getting the Pfizer and Moderna vaccines, with the second jabs in four weeks, while over-50s are going to get the Janssen vaccine, so they will be vaccinated. In between, the 60 to 69 group are getting the AstraZeneca vaccine, with a 12-week gap between doses, and we all know there is a plan for a green certificate to enable travel. The group in their 50s and the plus-70s, therefore, will be able to travel, but the group in their 60s will not.

Other conditions may be introduced as this is rolled out. It may not be anyone's fault but it is an issue. It is discriminatory. How are we going to deal with that and ensure that this cohort is treated fairly?

Moving back to the Government, there are a number of speakers. Will Deputy Murnane O'Connor let me know the breakdown between speakers?

We will each take three minutes. I am sure Deputy Cathal Crowe will be here shortly. I thank the Minister of State. First, I congratulate the Minister for Justice, Deputy McEntee, and her husband, Paul, on the birth of their baby son this morning. That is really good and I congratulate both of them.

Today gives us great hope. Restrictions on inter-county travel, masses, hospitality, click-and-collect services, barbers and hairdressers are to be loosened soon. This is really positive. For people's mental health, it is important that we now look forward. From listening to the radio as I drove here this morning, things seem to be really positive. It is to be hoped that the Taoiseach will announce all these measures this evening. I also welcome the fact that, from next Tuesday, families will be able to schedule four visits to a nursing home per week.

People's mental health has been significantly impacted by this pandemic. As the number of people vaccinated increases, are we going to see the reopening of day services in the mental health sector? There have been virtual sessions and some one-to-one visits but it is very important to get back to services in person. I commend Alone, its staff and volunteers and those who operate its national support line, which was set up in collaboration with the Department and the HSE. Alone reports that, in the past year, the helpline has received 49,000 calls and that the service has made more than 138,000 phone calls to older people who needed support. Alone highlights the negative impacts of this pandemic on the mental and physical health of older people. It has called for a stakeholder group of older adults to inform the Government on ways to support older people now as we have supported them during the pandemic. Is this something into which the Minister of State is looking?

As we cautiously reopen - and I know we have to be very cautious - what are we doing to support those older people who report continued anxiety? When will the messaging tell them that they are safe? Many community services for older people are still closed and, in some cases, home care has been stopped while families have been unable to visit because of continued restrictions. The Minister of State spoke about day services. I welcome that but what is the roadmap? What campaign are we to run or what information is to be provided? Communication is key. Perhaps the Minister of State can come back to me with some answers.

I thank the Minister of State for her presentation. I join with my colleague in congratulating the Deputy McEntee and her husband, Paul, on the birth of their son this morning.

I will raise my concern about the number of people who are bed bound. I was given figures at a meeting of the Joint Committee on Health three weeks ago which indicated that 1,600 bed bound people had received vaccination and that a further 300 were awaiting vaccination. Those figures seem to be totally incorrect. How did we arrive at those misinformed figures? We are now talking about 3,500 people. Surely the HSE should have had a serious idea of what it was expecting in this area. Even if the figure of 3,500 the Minister of State has mentioned is correct, we should be given a detailed statement as to why this earlier figure was so out of synch with what was really happening on the ground.

I published the Health (Amendment) (Professional Home Care) Bill 2020 last July. It was debate in the Dáil in September but the Second Reading was adjourned for 12 months. I understand that proposals were made to Cabinet in the last week as regards how we intend to register those who provide home care. Will the Minister of State provide a detailed update in writing at to how we intend to progress on this issue? This ties in the with the issue I raised earlier, the need for a really comprehensive set of guidelines, rules and information with regard to the provision of home care, because the number of people who require home care will continue to increase.

The final issue I will raise relates to ophthalmology and cataract services, especially in the southern region. In excess of €10 million has now been made available for outpatient facilities in the South Infirmary-Victoria University Hospital and a new theatre. There will, however, be a waiting period. What additional work can be done to help those who are on the waiting list? My understanding is that those who are on the waiting list will wait a maximum of a six months but there is the matter of getting on the waiting list. How can we assist the professionals providing this service, the nurses and doctors, and ensure that people can get on the waiting list in a timely manner rather than having to wait two or three years? Will the Minister of State provide an update on that issue?

I will respond as briefly as I can. With regard to the housebound, the figures provided are the same as those I was given last week. The reason there have been more referrals than the Deputy had heard about three weeks ago is that we left it open to GPs to continue referring people. I assume that some older people initially decided that they did not want the vaccine but later decided that they did. As of last night, the number of referrals stood at 3,500.

I thank the Minister of State, Deputy Butler, for her engagement over recent days. Last week, in this Chamber, I told her the sad story of Margaret Morgan, who is 101 years of age and probably one of the oldest citizens in County Clare. She comes from the small west Clare village of Kilmurry McMahon. She had not received her Covid vaccination. She is bed bound. The Minister of State was very engaged, both in the Chamber and afterwards, and told me that the capacity of the National Ambulance Service to call out to such households had been doubled. The number of families with members in this situation is being whittled down but those that remain want to know whether there is a portal through which they can track how the vaccination of their loved one, their elderly family member, is going. That is my first question.

I hope there will be time for both Ministers of State, Deputy Butler and Deputy Feighan, to respond to my second question. It relates to the black cloud which Covid will inevitably leave behind. I refer to immeasurable damage Covid will have done to society, beyond its impacts on physical health. I am speaking about depression and alcohol dependency. Some people who were on the dry for many years are now reverting to alcoholism. I am also speaking about domestic violence and the dark places to which some people have gone because they have been cut off from social interaction and kept apart from their families and work colleagues. Over recent days, we have seen the Revised Estimate for the Department of Health. A tremendous amount of money is going into protecting the physical health of the country. Will the Ministers of State briefly detail any roadmap or plan that exists to boost or give a shot of adrenaline to the mental health services and addiction support services of our country when we get beyond the period in which the incidence of Covid is high?

I thank all three Deputies for their constructive approach. To refer back to Deputy Murnane O'Connor's comments, although all three Deputies raised their concerns about older people and day care centres, I am particularly anxious to see the likes of the men's sheds, women's groups and active retirement groups back open. We are actively looking at that at the moment. I met with Seán Moynihan, the CEO of Alone, last week. Alone has done fabulous work. We are very conscious of the loneliness task force and supports for older people.

In response to Deputy Cathal Crowe, we are very aware of the mental health issues and other related issues Covid-19 has caused for many families. That is why we brought in the Keep Well campaign, which is about keeping active. There are many issues we need to address. As the Deputy has rightly said, alcohol has been an issue. We welcome the fact that, over the last year, there has been a 6% reduction in the intake of alcohol, although that is a bit concerning because the retail premises, pubs, restaurants and so on, were closed. We hope to progress that.

I thank the Minister of State for her opening speech and for her honesty.

We can sometimes have a fairly heated debate in here, but when progress of any kind is made it must be welcomed.

It would be remiss of me not to congratulate the Minister without Portfolio, Deputy McEntee, on the birth of her baby boy this morning.

I wish to touch on the surge capacity requirements in mental health hospitals and the €13.5 million in additional funding that will be allocated for that purpose. I welcome that funding. I also welcome that the CAMHS investigation is going ahead.

There were WikiLeaks. Now there are "Aire-leaks" when it comes to good news on coming out of lockdown.

There are still families in desperate trouble. I spoke to two yesterday and asked them for permission to use their cases to highlight the isolation caused by Covid. Families are in desperate need, older people have never been so isolated, which has a knock-on effect, and people with disabilities have practically been written off.

I wish to raise a specific case. Obviously, I have edited it. Mrs. X has been a carer for her 81-year-old mother for a number of years. She also has a brother in his 50s who was in appropriate day care for five days per week, but when Covid arrived, that service closed down. She took it upon herself to assume caring responsibilities for him as well. After a number of months, she wrote to the Department - she was inquiring more than anything else - to see whether she would be entitled to additional financial or physical supports. Unfortunately, the Department wrote back and docked €34 per week from her payment for looking after her mother. The Ministers of State can imagine the stress that can cause for people who are at the pin of their collar trying to do the best they can.

A second case involves a family of a child with severe autism. Since Covid started, the family has received no respite care, speech and language therapy or just about any other support. They are taking it in shifts. The husband normally gets three hours of sleep per night. When I spoke to him, I said that we could bring their case directly to a Minister. He said that what was happening was not fair and that, as a principle, people in such circumstances – he knows many families in the same situation or worse – should be treated fairly. He wanted me to bring that point to the floor today. He also told me that, last weekend, he met a couple of his friends who were in a similar situation and that, although they started the conversation, they had to stop because it was so depressing. Unfortunately, some parents in this situation were not strong enough and took their own lives. The pressures are enormous. He told me that he and his friends were still here to help where others had found it too much and had taken their own lives because they could not cope. He told me that that was the conversation he and his friends had and that they had to stop because it was getting so depressing. Those were his words, not mine.

I welcome any progress in mental health services, but let us not forget anyone. We must remember that, when we come out of Covid, we will still have a health problem, a mental health problem, a housing problem, people losing their jobs and a problem with disability services. Let us plan for the future.

I join others in congratulating the Minister, Deputy McEntee.

I am seeking an update, albeit not on the funding that is to be allocated for the treatment of eating disorders. That has already been announced and is funding that was not spent previously. Rather, I am seeking an update on the number of beds for inpatient care. There are only three currently. Has there been any work on addressing this situation?

The challenge of Covid-19 has reminded us that personal health and well-being are no longer solo pursuits, but ones that require cohesion, collective effort and mutual respect across all life stages. In his submission to the health committee last October, Mr. Martin Rogan, CEO of Mental Health Ireland, highlighted that mental health issues affected people of all ages. I welcome this session focused on the mental well-being of older adults, who are often overlooked in these conversations. The elderly have been identified as a group especially impacted by the pandemic. Although necessary, cocooning and the closure of social outlets have increased isolation. A volunteer on ALONE's support line reported to RTÉ that "A lot of the issues that people would ring with, would stem from loneliness." The difficulty of bereavement at this time has taken its toll and the clusters of Covid in nursing homes was a major source of distress.

While the vaccine roll-out and safe reopening of society will make a significant difference, we cannot let the lessons of Covid slip away. First, we need to fund mental health. The World Health Organization recommends that countries dedicate 12% of health spending to mental health care. In Ireland, the figure is less than 7%. Not only must the Minister of State, Deputy Butler, ensure adequate resources are allocated, but she must also secure special interventions to treat the pandemic's legacies. For example, reduced activities for older adults living with dementia has caused distress and exacerbated behavioural and psychological symptoms, and nursing home residents have experienced relapses in their mental health due to restrictions on visitors and therapies. While these measures were necessary to save lives, we must act quickly to alleviate any regression.

Now that increasing numbers of older people and healthcare professionals are vaccinated, we need safe ways for them to interact as soon as possible. A multidisciplinary approach needs to be at the centre of this response. Increases in depression and anxiety are strongly related to declines in activity - this is a crucial factor in the well-being of older adults - as well as sleep quality and cognitive functioning. Geriatric psychiatrists, psychiatric nurses and psychologists can drive medical treatments, but we also need occupational therapists, physiotherapists and other therapists to help provide holistic care. I know from community hospitals in west Cork that music and art therapists have a positive effect. We need to ensure that these professionals are facilitated in getting into hospitals and nursing homes as soon as possible.

Second, who cares for the carers? The difficulties faced by our older cohort are also experienced by their carers and families. Carers are consistently undervalued by Governments. The amount of supports and payments offered to them compared to the work they do and care they give is disgraceful. They receive plaudits from Ministers, but they need much more. Family Carers Ireland's budget submission, entitled "Life After Lockdown", outlines the measures they need, such as an increase in the carer's support grant and increased home care hours. We need the Government to implement these proposals. An holistic response to the mental health of older people will recognise the vital role that carers play.

Third, the Mental Health Commission's report on services for older people, released in December, is sombre reading. It states:

Despite the increasing elderly population, we are currently not providing a nation-wide, comprehensive mental health service for older people. We have highly-trained and committed specialist clinicians, yet we have only 66% of the recommended number of specialist teams, which themselves are only staffed at an overall level of 54%.

The report's author, Dr. Susan Finnerty, highlighted an "alarming" underprovision of acute mental health beds for the elderly and "serious under-resourcing" of community mental health services for the same population. She also explained that "Older people's mental health is an increasingly important area of public policy that does not get the attention it deserves." This needs to change now. The Government must vigorously address the issues raised in that report.

The World Health Organization has stressed two interconnected elements to help improve the mental health of older people by alleviating feelings of anxiousness, anger, stress, agitation and withdrawal. The first element is practical and emotional support through connections with family and community and the second is the role of healthcare professionals in providing the expert help that individuals need. Over the past year, we have seen families, neighbours, volunteers and whole communities provide this first type of support. Now we need the State to deploy all of its resources to address the second.

I join colleagues in extending my heartiest congratulations to the Minister, Deputy McEntee, and her husband.

As we know, Covid has presented myriad challenges and difficulties for the past 15 months. Once the virus is suppressed, there will be many other problems and legacy issues to be addressed. We must now put in place the necessary supports. People of all age groups losing their routines, be those work, learning, sport or social contact, has had a damaging impact on the mental health of many. Supporting positive mental health must be a continuing priority for the Government. We need much-improved State services and additional supports for voluntary organisations that provide professional services. I know from speaking to a number of GPs that there is a large amount of anxiety and panic disorders in all age groups, especially among teenagers. Some GPs have outlined to me that some young people are presenting with physical symptoms that turn out to be manifestations of stress.

We need adequate psychological assessments and follow-up support. Far too often, families need to source that support privately, imposing unnecessary financial burdens on people.

I welcome the continued roll-out of the vaccine programme but there are still difficulties for some GPs. I ask the two Ministers of State to provide more certainty and clarity on the roll-out. Overall, it is a very successful programme with people working very hard, but whenever there is lack of clarity, it presents difficulties for everybody.

As we work through this pandemic, we have an opportunity for further co-operation between North and South on a public health basis. There is potential for GPs to work on a North-South initiative. Unfortunately, far too often, our regulations have not run in parallel with the Northern Ireland restrictions and vice versa. We need to work together much more. We need to have the same approach as much as possible. We need to continue to work towards achieving a better level of co-operation between North and South with more co-ordination at all levels. We will only be as successful as we need to be by addressing this very serious pandemic on an all-Ireland basis.

The Covid pandemic has brought enormous challenges in the mental health sector. I acknowledge the considerable effort the Minister of State, Deputy Butler, has put into the Jigsaw centre in Thurles since she took office in July 2020. I have been working on this issue since I was first elected in 2016 and it is extremely important for our county. Although the date for opening the centre has been delayed, that is completely outside the Minister of State's control; unfortunately, Covid has played a large part in that. I ask for an update on the status of the Jigsaw project and when that centre can be opened. I know that premises have been acquired and contracts have been signed. I ask for an update on the crisis house in Clonmel.

Many people are under significant financial pressure and we need better counselling services for those people. I have put considerable work into the forestry sector in recent months, as Chairman of the Joint Committee on Agriculture and Marine. Representatives of the forestry sector have appeared before the committee on numerous occasions. That sector is completely malfunctioning at the moment and still has not got its house in order. I am very friendly with a particular forestry contractor, who contacted me yesterday. He is under serious financial pressure, has been forced to let men go and is unable to meet the repayments on his machinery. People in the hospitality sector, the construction sector and the retail sector are also under significant financial pressure. Counselling needs to be available to them on a confidential basis. These people are in a place they never were before with enormous pressure on them.

Thankfully, today we will hear of an easing of restrictions but unfortunately the financial pressure on those people will not disappear with the easing of restrictions. They have repayment problems and enormous financial liabilities built up over the course of the pandemic. Those people need help urgently. Appropriate resources need to be put in place so that these people can get counselling and advice. Mental health advice is one thing, but they also need to be able to talk to someone to allow them to see a way out of their financial difficulties.

Despite its size, County Tipperary has no psychiatric beds available. I plead with the Minister of State to investigate the feasibility of having psychiatric beds both in the north and the south of the county which are urgently needed. People in Tipperary have to travel too far for psychiatric beds.

I extend my congratulations to the Minister, Deputy McEntee, her husband, Paul, and their extended family on the arrival of their new baby boy.

Covid-19 has had an enormous impact on the mental health of the nation. In a year filled with so much isolation, how could our mental health not be affected? In a year of restricted funerals, how could there not be a tailback of grief? The Irish Medical Journal recently reported on an Irish study that found significant increases in depression, anxiety and stress among Irish people between March and June of last year. That was just a couple of months into restrictions. Sadly, we are now a year into this pandemic, and I have no doubt that the number of people struggling with their mental health has only increased. The past year has tested us like no other and it has been a very dark time for many people. That is why it is so important to remember the reasons for hope. We all expect good news and hope later today from the Government. With the vaccine roll-out reaching more people every day and normal life gradually resuming, I truly believe there are many reasons to hope.

I am part of a volunteer-led Corkagh Park Darkness Into Light committee, a group of amazing volunteers. We were due to have our first Darkness Into Light fund-raising walk last year in Corkagh Park. However, for a second year running, instead we will be celebrating virtually by watching the sun rise on 8 May. We will turn all our volunteers' villages, Lucan, Clondalkin and Rathcoole, yellow to mark the occasion to and to spread the message that after darkness comes light, a message more apt today than ever before. I take this opportunity to reassure all those who are suffering now that this will end. We are seeing the light at the end of the tunnel. It is okay not to be okay, but the most important thing is to ask for help.

I also add my congratulations to the Minister, Deputy McEntee, and her family on the birth of her baby this morning.

I want to talk about isolation and to put two issues to the Minister of State. Since the restrictions came into effect last year, for many older people, particularly those in rural areas, their existing sense of isolation has increased, and their mental health has suffered. Some of them are suffering in silence. For some, their only contact with the outside world in the past year has been HSE workers, home helps or the volunteers who have dedicated themselves to bring medication and groceries to them. Those volunteers have spoken about how some older people who live with isolation in rural areas every day are less likely to present with any mental health issues they may have. There is a real danger that this will not just be an issue during this pandemic but may become a habit that will be hard to break. If they were to seek help, where would they go?

I was involved in a survey which showed that 40% of respondents believed that a lack of available mental health services was the main obstacle in seeking support for mental health problems. A further 38% believed that the lack of information was a contributory factor, while 23% said it was because of a difficulty in travelling. What is the Minister of State doing to address rural isolation and to reach those who feel they cannot reach out?

I also want to hear the Minister of State's thoughts on the following matters. The Government used the Covid crisis as an opportunity to close St. Brigid's in Carrick-on-Suir, which provided palliative respite care for people in the local community. In March 2020, it was designated as a step-down unit for recovering Covid-19 patients in south Tipperary, but that was a pretext for closure. We have since been given flimsy reasons as to why it should not reopen. Elderly and infirm people who are at their most vulnerable now face the prospect of no longer being able to stay within their community as they once could. What impact is that having on their mental health and that of their families?

At the other end of the county, in Roscrea, long-stay beds will no longer be available in the Dean Maxwell facility. Instead the HSE wants people to start travelling to Nenagh. At a meeting on the matter with the Minister, Deputy Stephen Donnelly, local Deputies were told that this was part of the HSE's plan to improve care in the community. How on earth can moving someone, who is at their most vulnerable, out of their own locality to somewhere where they have no family be seen as care within the community, especially at a time when there are limitations on how far people can travel?

I also seek an update on the Jigsaw centre for Thurles and the hubs in Nenagh and Clonmel. Services online have been suggested, but they do not work which comes across when talking to people. Will the Minister of State admit that the policy is more damaging than progressive? Our older people are being failed here. They have fallen victim to a campaign of centralisation that the Department of Health and the HSE seem intent on pursuing. This shows little regard for the mental well-being of older and infirm people, who need specific care and who would like to spend their days near the people they love. This disastrous policy must stop immediately, or we will be facing a situation where families become fractured, the elderly will become isolated from the people and places they know, and their sense of togetherness will be irreparably damaged. We must learn from Covid and we must learn about isolation.

I am sure the Minister of State, Deputy Butler, will agree that older people have paid a terrible price over the past 14 months. The pandemic has robbed some of them of their lives and final moments they should have had with their families. Bonding and togetherness have been temporarily stolen, but this generation is resilient and will overcome. We will all meet again very soon.

My question is in regard to a call from the Irish Society of Chartered Physiotherapists, ISCP. The pandemic has impacted on older people's routine and knocked it out of kilter. According to the ISCP, isolation and inactivity leads to a deterioration in bone and muscle strength and, thus, older people are at greater risk of falling and so on. It has asked for a reorientation of services for older people. This is important. According to the ISCP, its services have been inundated. I ask the Minister of State to comment on that.

I thank the Deputy for his comments. He is correct that our older people have proven to be very resilient and that they have done everything asked of them. We are concerned about older people who, restrictions aside, are not in a position to leave their homes and are housebound or bed bound. In response, an additional 5 million home care support hours has been put in place this year to support those people in their homes, bringing the total number to 23 million. For those people who require reablement, particularly in the home, support packages have been provided.

I take on board the Deputy's points. We are looking forward to the reopening of day care centres, active retirement groups, men's sheds and women's groups very soon. That will be a positive step forward.

I want to raise the issue of nursing homes. The four-visits-per-week rule comes into force next Tuesday. Under the restrictions in place for the last while, two visits per week were permitted. The organisation, Care Champions, says it is aware that at least 70 of the 580 nursing homes in this State, more than 10%, have not applied the two-visits-per-week rule. In many cases, this was not done for strictly public health reasons. The stated reason was staff shortages in the nursing home. I can only imagine how a husband who has not seen his wife who has been in a nursing home for some time or a wife who has not seen her husband who has been in a nursing home for some time would feel if told that they could not have their visits because of staff shortages in a nursing home. I would like the Minister of State, Deputy Butler, to comment on that situation, which I believe is not uncommon. It would be good to hear what she has to say on this matter.

During the third wave, almost 1,000 nursing home residents died as a result of Covid in the space of 100 days. In my area, namely, the Cork-Kerry area, 190 died, which was the highest of all of the regions in the State. There are some who are scratching their heads and asking how it can be that almost as many nursing home residents died in the recent third wave as died in the first and second waves, despite all the lessons that were there to be learned from both. This strengthens the case for a public inquiry into the events in our nursing homes over the past 15 months. I know the Minister of State will not have time to reply to this question, so it is an issue I will return to again. The Government cannot keep kicking the can down the road on this issue and saying it will answer the question mañana. The case for this is growing stronger by the day.

I thank the Ministers of State, Deputies Butler and Feighan, for all of their efforts in respect of mental health. I do not in any way doubt their commitment but, as with all of their predecessors, they are starved of the adequate resources and structures to do what I know they need to do and could achieve in the battle against our nation's silent crisis.

In the coming weeks, I will publish the results of research I undertook with my team. We surveyed various healthcare professionals, including general practitioners, psychotherapists, gardaí, coroners, student unions, charities involved in the sector and so on. I will give some of the headlines of that research: 91% agreed that Covid has had a detrimental impact on the mental health and well-being of Irish society; 86% believe that the pandemic will have along-term impact on mental health, 88% feel that the Government has not done enough on the mental health side during the pandemic - this is not the fault of the Minister of State, who, as I said, is starved of the resources she requires; 91% agree that mental health services will require more funding and, among gardaí specifically, 100% of respondents reported an increase in calls relating to mental health issues and domestic violence and 80% reported an increase in calls relating to suicide. The average for all of these increases was around 30%. Particular criticisms in terms of additional comments included woefully underfunded mental health service nationwide, a lack of long-term consideration of the Covid-19 mental health impact in Government policy to date - a point I have made to the Minister for Health many times - lip service being paid to mental health workers and charities with little in the way of actual Government support. Another point raised, which we can perhaps discuss another day, was the relentless media coverage of bad news stories. I am not shooting the messengers, I am focusing on how we portray the facts.

This research is consistent with findings from other research. In 2020, Burke et al found that Covid-19 lockdowns are associated with marked increases in depression, anxiety and stress across all demographics. Maynooth and Trinity universities found that one in four Irish people are current experiencing clinically, meaningful levels of depression, with close to one in five experiencing anxiety or PTSD-related issues. In the 1980s, 16% of the overall health budget was devoted to the mental health services. This year, unfortunately, the Minister of State, Deputy Butler, is expected to put up with 5.2%. I do not doubt her commitment to the task at hand, but, unfortunately, as with so many consecutive Governments, the Departments of Finance, Public Expenditure and Reform and Health and their senior Ministers are starving her of the resources she requires to really tackle the issue of mental health nationally.

Covid has affected many people, but the pandemic has affected many more. Mental health and stress affected people across all age groups. This morning, I want to speak about older people and their families who have raised concerns with me.

Social networks and human interaction was severely curtailed, be that meeting for coffee, dancing, bingo, mass, matches, marts and the pubs. The isolation and disconnection from family and friends hit people hard, particularly those who had maintained their independence only to find themselves cut off from family and friends and dependent on others. There is a saying, "mens sano in corpore sano". Being unable to get out and about, be that dancing, sports or exercise, and being housebound put pressure on people's minds. In addition, there was the constant negativity of the media.

While some people found online outlets, such as family Zoom or FaceTime meetings, that may also have drawn them into conspiracy theory rabbit holes and put more pressure on them. For many people who have had the vaccine, they still have very real worries and a reluctance, for example, to have friends over or go about their ordinary business. There is a comfort in being in one's own familiar space.

It is important to emphasise that it is okay to not feel okay. There was good support in the earliest stages of the pandemic, with efforts to get people online and sports clubs delivering people's shopping. There is a different need now. In the same way that the well-being of children was prioritised with the reopening of schools, there is a need now for a strong focus on the well-being of older people. Will the Minister of State indicate whether there are specific measures in place to promote their well-being?

I welcome that mental health services have continued throughout the pandemic, albeit in a restructured and restricted manner. Specialist mental health services have continued to operate at 85% to 90% of pre-Covid levels. While that continuation of service is welcome, it is undeniable that the impact of the Covid-19 crisis will be felt for many years to come. Recent analysis in the UK found that those who suffered most throughout the pandemic in financial terms were also most likely to suffer some form of mental illness. On the other hand, those whose incomes increased or remained the same were noted to have suffered less. There are two points to be taken from that research. First, as the Minister for Finance, Deputy Donohoe, has assured us, there can be no cliff-edge removal of the pandemic unemployment payment, PUP, and other Covid-related supports. The second point is that getting people back to work as quickly and safely as possible is likely to yield positive mental health impacts.

In that context, I welcome much of the leaked news today about different industries being reopened. Listening to the radio this morning, one could hear the relief in people's voices, in some cases, and, in others, the excitement. If all the reports we are hearing are true, the reopening plans are very welcome. How quickly will all mental health support services resume in person and in safe environments? It is as important as the resumption of retail and other services, if not more so, that people get access to relevant mental supports.

I join colleagues in congratulating the Minister, Deputy McEntee, and her husband, Paul, on the birth this morning of their baby son.

I welcome the Minister of State, Deputy Butler, to the House and thank her for her contribution. As we are all aware, Covid-19 has had a huge impact on our country, adding significant pressure to the nation's mental heath services. I thank the Minister of State for her comprehensive update on service provision and, indeed, her dedication since she took office, particularly in respect of nursing homes in my constituency. Fortunately, we can see that the vaccination programme in nursing homes has been successful and the incidence of Covid in those facilities has been all but eliminated.

However, it is worrying that we have seen a significant increase in eating disorder referrals over the past year. Four out of five young people accessing those services are young women. I particularly welcome the Minister of State's indication that there will be an increase in capacity for people with eating disorders. Equally, I welcome the investment in telehealth services and online services such as the national crisis text line and the support for NGOs that assist people directly. Organisations like SpunOut and Jigsaw have developed fantastic campaigns aimed at younger people, which is very welcome.

As we exit the pandemic, it is critical that supports for people facing personal mental health challenges, whether relating to addiction or other issues, are available. In regard to senior citizens, I welcome the Minister of State's comments on day care centres. I am involved in a day care centre in Dún Laoghaire and it is really reassuring to know there are plans afoot to open it and other centres. I commend her on her commitment to increase services and look forward to engaging with her as they reopen.

I thank Deputies for raising these issues relating to older people and mental health supports. The HSE has a range of proactive responses to any rise in service need, including online and other telehealth and psychosocial supports. In January 2021, we put in place a psychosocial framework for mental health promotion. The main thing we have to do is make sure older people, especially, know those supports are there and they can avail of them. We are really concentrating now on the signposting and getting the message out there, to ensure people are aware the supports exist.

I want to raise the case of a 13-year-old girl in Dundalk who has been in Our Lady of Lourdes Hospital for approximately seven weeks. She is under the care of CAMHS and Louth Meath mental health services, which have done all they can to help her. It is an acute situation. She has what I will call an eating disorder, possibly combined with other factors. She has been awaiting acute residential care, which has been promised but not delivered. She was released from hospital on two previous occasions. Once, she was returned in hypoglycaemic shock and, on the other occasion, she was brought back to hospital because she refused point-blank to eat.

This child's situation has got worse and worse and it really needs a solution. She has also engaged in self-harm. She and her family are particularly worried about her health and why it is taking so long to get the care she needs. Deputy Ward has raised in the House the issue of the lack of services for people with eating disorders and related issues. The situation of my constituent must be dealt with. I left it a number of weeks before raising it as I understood her case was being dealt with at the highest levels. I am now at my wit's end. The situation must be dealt with as quickly as possible.

As the Deputy knows, I cannot comment on any individual case. If he sends the details to my office, we certainly will look at them. A similar case, which had got newspaper headlines, was raised by another Deputy last week. However, the Deputy did not send me the details. It is very difficult to answer questions in the Chamber about such critical cases, where young people need support for eating disorders, if we are not made aware of them. I cannot discuss any individual case on the floor of the Dáil but my officials certainly will check out the matter.

I am very conscious of the number of eating disorder and self-harm referrals in the past 12 months, especially concerning young girls. As I indicated, I have moved to reinstate funding of €3.94 million for the national clinical programme for eating disorders. There are inpatient supports available for young people with eating disorders, including in Galway, Cork and at the two inpatient units in Dublin. We also, on occasion, have a service level agreement with private providers. If the Deputy forwards the details of this particular case, we will have a look at it.

I appreciate that. I have sent on the details of the case and they should have landed in the Minister of State's office. I was dealing with the HSE and, in particular, Louth Meath mental health services. My understanding is that they have done everything they can and there is a level of frustration on their part. I would really appreciate it if the Minister of State could bring any pressure she can to bear in this matter, with a view to finding a solution. This is a really difficult and acute situation and we are very worried about the young person's health. I appreciate anything the Minister of State can do for us.

The Deputy indicated that the details may have arrived in my office today. We certainly will look into the matter. It is important to note that decisions on all such issues are not political. They will always be made from a clinical and medical perspective.

I do not expect the Airí Stáit to be able to give me a response to my questions today but I would appreciate if someone would come back to me with a detailed response after this debate. What sometimes happens is that commitments are given in the House that we will get replies but no such replies are forthcoming. I have three specific issues I want to raise, two of which, sadly, relate to bureaucracy.

First, patients who are undergoing hospital procedures must have a negative Covid test in advance of going into hospital. That is completely understandable. However, in some instances, hospitals are not accepting a negative PCR test result from the HSE's community testing service. Instead, patients are being asked to make a preliminary journey into the acute hospital for a pre-Covid test, which exposes those hospitals to additional and unnecessary risk in regard to Covid infection.

I have already raised this with some hospital managers. The justification is that the computer systems are not talking to each other. Since the test carried out in the community by the HSE is not accessible by the hospital, the hospital is insisting on a separate test being carried out. Hospitals will not accept the text message that comes back from the HSE. This is a procedural bureaucratic issue that is putting additional hardship on patients in advance of going in for a hospital procedure. It is exposing our acute hospitals to unnecessary and additional risk in the context of Covid-19 infection. I want to see this issue addressed.

I have another comment on the issue of bureaucracy. On 21 April, the Minister for Health replied to Parliamentary Question No. 2083 with a the list of vaccines that would mean people who are fully vaccinated have an exemption from mandatory hotel quarantine. Included in that list is the Oxford-AstraZeneca vaccine. If a person has it in advance of coming into the country, then 15 days after the second dose the person is exempt from mandatory hotel quarantine. Nowhere in the reply to which I refer is there a reference to where the vaccine is manufactured. It is only when we get into the detail that we find out. The Department of Foreign Affairs has informed an Irish citizen that four versions of European Medicines Agency approved vaccines are manufactured under licence by other companies and that these do not qualify for exemption in the context of the mandatory quarantine. We are saying that these vaccines are good enough to be used in this country to inoculate people. However, versions that are manufactured in facilities elsewhere will not be accepted for the purposes of mandatory quarantine. For example, the manufacture of the AstraZeneca vaccine by the Serum Institute will not be accepted as exempt in the context of mandatory quarantine, even though anyone inoculated with it is considered fully vaccinated against Covid-19. As a result of the location in which the vaccine is manufactured, it is not being accepted. That needs to be changed in the context of mandatory quarantine.

There is a third issue I want to raise. On Friday night last, a constituent of mine who was in mandatory quarantine was in unbearable pain. The person contacted reception at the quarantine facility seeking medical help. A nurse called to the room but told the person she would be unable to issue any medicine, including paracetamol. The person was informed that a nurse would call the following morning to facilitate the ordering of pain relief. Eventually, after contacting reception again on Saturday morning, the medicine was ordered at 2 p.m. It was only after further calls to reception seeking the assistance of a doctor that the medicine arrived at 9.40 p.m. That was 24 hours after the person first reported being in unbearable pain. No doctor ever arrived and no vital signs were checked. The person was told that the nurse would be back later that night to check the vital signs. It is 110 hours since the commitment was given but no doctor has arrived and no vital signs have been checked. What medical service is available to people who are being quarantined? The constituent in question came here from quarantine in New Zealand, where they were checked on every day by nursing staff. The person's temperature was checked every day. Yet, this person could not access paracetamol or get access to a doctor in quarantine here and their vital signs were not checked. There is something wrong with the system.

There is a final point that I would like to bring to the attention of the Government. It relates to the trauma report approved this week by Cabinet designating the Mater Misericordiae University Hospital as the major trauma centre in this country, something I very much welcome. However, there is a fundamental issue here. How do we get patients to the trauma centres in the Mater Hospital or in Cork? We have not been investing in our ambulance service. The Minister of State, Deputy Butler, has already said that ten ambulances are involved in the vaccination of the housebound. That number is being doubled to 20. This means 20 ambulances are being taken off our roads. We do not have an effective air ambulance service. We are centralising the trauma services but not figuring out how we are going to get ill patients into those hospitals.

Can I have a few minutes to respond?

The Minister of State will have time at the end.

Unfortunately, the Deputies are asking many questions and I will have no time to respond.

I know that but the Minister of State will have time.

Unfortunately, the senior Minister is not here.

I wish to make a point of order. We are dealing with Dáil statements on the impact of Covid-19 on mental health and older people. That is what is happening today.

It has been agreed by the Business Committee that all issues relevant to Covid-19 can be raised here. The Ceann Comhairle can clarify that for the House.

The Acting Chairman can clarify that Deputy Niamh Smyth is the next speaker.

I begin by congratulating our colleague, the Minister for Justice, and her husband, Paul, on the birth of their new baby boy. It is wonderful news and of course she is making history.

I thank the Minister of State, Deputy Butler, for all the tremendous work she is doing for mental health and older people. She has hit the ground running in her Department and the areas under her remit and delivery. I can vouch for that. I think that the tenor of the previous contribution was most unfair.

I would like to speak today about mental health, especially mental health services for Cavan and Monaghan. I wish to draw the attention of the Minister of State to the fact that we are lucky to have seen a new SOSAD branch open in Monaghan town. I acknowledge the work of Margaret McGowan and her team in SOSAD in Monaghan. A new service is open this week and I know that will be a terrific advancement in services in Cavan and Monaghan. We have the service in Cavan as well. The Minister of State kindly joined a Zoom meeting last October with all the stakeholders within Cavan and Monaghan. It involved those who are at the coalface of delivering a service and, more important, support for those affected by suicide and mental health issues. As the Minister of State knows, we have a great team of people there. At that meeting, some issues were raised with her and I hope we can progress them a little.

I listened to my colleague, Deputy Cahill, earlier. He talked about the delivery by the Minister of State of the Jigsaw service for Tipperary. Will the Minister of State assist in ensuring that we get the delivery of that type of service for Cavan and Monaghan? I am not exaggerating when I say we have an acute need for the service, especially for young people across the constituency.

My time is limited. I wanted to mention the suicide crisis assessment nurse post. I believe the role is very useful and helpful for people in community healthcare organisations. I am also asking for more primary care. I wish to remind the Minister of State that I have written to her on the matter. I am seeking a reply on the jigsaw element and I would appreciate a response.

I wish to raise a point of order. I have two minutes. Can I ask the Minister of State to answer my question in those two minutes?

I will use one minute and leave one minute for the Minister of State to respond. I want to bring up one specific matter. Mental health issues cross every age group and cohort. I want to zone in on a particular group. I am referring to the young students and office workers who are working from their bedrooms. I am certain that this is a hidden mental health issue. I want to know what the Minister of State is doing to ensure that when this cohort - the students and workers who are operating from their bedrooms - come out of the pandemic, they will be able to go back into the office environment. Social interaction is vital. What specific policy initiative is the Minister of State pursuing to ensure that this issue is addressed?

The Deputy raises a valid point. I have a 23-year-old daughter who has been working from the bedroom for the past 14 months. She is looking forward to getting back into the workplace.

On the issue of students, last October I put in place a leaflet outlining all of these supports that are specifically there for young people in second and third level so that they are aware that there are vital supports. MyMind, for example, provides counselling in 15 different languages, and is providing us with 5,000 sessions a month. We also have a five-point plan and a psycho-social framework to support people when they start moving back into the workforce. Hopefully, that will be very soon. We all await the Taoiseach's announcement today.

Gabhaim buíochas leis an gCathaoirleach Gníomhach. I thank both Ministers of State, Deputies Feighan and Butler, for facilitating today’s question-and-answer session. Four years on from the publication of the report of the task force on youth mental health, I requested information on when the report recommendations will be implemented in full and I am still unclear on their implementation. The Youth Mental Health Pathfinder Project is crucial in opening up a more collective approach to youth mental health in facilitating the working together of several key Departments, including the Departments of Health; of Children, Equality, Disability, Integration and Youth; of Education; and of an Taoiseach. It is imperative that the pathfinder project be established as a matter of priority in order to facilitate the progress, with further significant recommendations of the task force, including the national lead for youth mental health and leads for youth mental health for each community health organisation, CHO, to be appointed. I was on a call last Monday with CHO 2 and it still has not appointed a lead for that area. I ask for clarity and assurance that this will be prioritised within her remit.

I thank Deputy Dillon for raising this issue. The proposal to establish a cross-governmental Youth Mental Health Pathfinder Project with participation from the Departments of Health; Education; and Children, Equality, Disability, Integration and Youth received ministerial approval during the previous Government. The Department of Health has engaged extensively with the Department of Public Expenditure and Reform and continues to do so with the objective of agreeing an implementation option that fully addresses the above issues. The demands on both Departments during the pandemic have presented challenges to progressing the proposals. There are various administrative, budgetary, governance and legal arrangements that need to be developed and agreed to ensure a robust and workable model for the pathfinder unit but I agree with the Deputy and this is something that we are looking at at the moment.

I will yield my final minute to the Minister of State to respond. I thank the Minister of State and the Department of Health for their assistance in the past number of days regarding the Covid-19 outbreak in the Youghal area which affects my constituency, that of the Minister of State, and west Waterford. This was very unfortunate and serious given the number of young people, in particular, who tested positive for Covid-19. I am happy to confirm to the House, however, that we have received confirmation from the Minister of State’s Department that the Covid-19 walk-in centre will be established in Youghal next week. Can the Minister of State confirm for the people of Youghal, west Waterford and east Cork that are affected by this as to where the location of that facility will be? My understanding is that there are a number of locations under consideration, including Youghal GAA, St. Raphael’s Centre HSE facility in Youghal. Can the Minister of State kindly respond? I thank her again most sincerely for her assistance with this matter.

I thank the Deputy very much for those kind comments. I am very much aware of the outbreak in the school in Youghal. As we all know, this can be very traumatic for the pupils and staff alike. The Deputy is correct that a walk-in centre will be facilitated. I am not sure of the exact details of where it will be but I will revert to the Deputy in writing on that point. We have seen these walk-in centres all over the country and they are very effective. We are finding asymptomatic people in various communities who do not realise that they have Covid-19 and these centres have been very effective. If it is okay with the Deputy I will revert in writing to him with the exact location when the details emerge.

I have two and a half minutes to speak and I will use one minute for questions and the Minister of State might use the remaining time to reply, please. I asked the Minister, Deputy Donnelly, this question last week and he promised to come back to me but never did and perhaps the Minister of State may have the answer. If a person is over 60 years of age and is offered the AstraZeneca vaccine and the person’s family has a history of clotting - so many people in the Minister of State’s constituency as well as my own are seriously concerned about this - the person may refuse to take the vaccine. He or she may genuinely want a vaccine but refuse to take the AstraZeneca one. The Tánaiste said that such people will be put at the bottom of the list. Is this a fact or not?

Second, as to people with Parkinson’s disease, in a zoom call with the Parkinson’s Association of Ireland, it stated that it is greatly worried and upset that this illness is not categorised in a more serious manner. Many of these sufferers are young. Can these sufferers be brought up the list for vaccines?

Regarding those over 60 years who are accepting that they have no choice but to use the AstraZeneca vaccine, some will be able to get it in the next number of days but will have to wait 16 weeks for the second jab. Some of these people have not seen their grandchildren for well over a year and are very upset as they were hoping, like those getting the Pfizer vaccine, they might be vaccinated within a month. Is it possible to push that 16 weeks into a five, six, seven or eight week period? I ask that the Minister of State might answer those questions.

In answering the Deputy, some of those questions fall under the remit of the senior Minister, Deputy Donnelly. My remit is more for older people and mental health.

As to the over 60-year-old people, as the Deputy is aware, this was changed again yesterday or the day before. Now, for example, anybody over 50 years of age will be able to receive AstraZeneca or the new Janssen vaccine that was passed by the European Medicines Agency, EMA, and the national immunisation advisory committee, NIAC, here. My understanding is that it is under 50-year-old people who would have received the first dose of the AstraZeneca vaccine who have now gone to 16 weeks because the younger people may be more averse and have a bad outcome from it. My understanding is, and I stand open to correction on this and I will reply to the Deputy in writing with the proper answer, that those over 60 years of age will have a 12 week wait for the AstraZeneca dose.

As to Parkinson’s disease, I worked very closely with the Parkinson’s Association of Ireland in Waterford and I will bring the Deputy’s request forward. From what I can see, the roll-out of the over sixties vaccine with the portal has proven to be very successful. We will get to people more quickly in that respect but I will respond in writing to the Deputy.

I acknowledge the Minister of State’s hard work and sincerity in addressing her many responsibilities, with more being added by the unprecedented event of the pandemic. I wish to raise a number of issues and would be grateful for any consideration that the Minister of State can give to these issues.

All of us here know and accept that the entire Covid-19 experience has been traumatic and disproportionately burdensome for our older people. Last year, Dr. Martin Feeley, former clinical director of the Dublin Midlands Hospital Group, which includes the hospitals in Portlaoise and Tullamore, described many of the Covid-19 measures around the elderly as draconian. Professor Ronan Collins, the director of stroke services in Tallaght University Hospital, has also previously called for pubs to be reopened as they are a lifeline for many elderly people in rural communities. Professor Collins also said that cocooning was a mistake that left many older people feeling like life was not worth living any longer. I am also aware that researchers at the Irish Longitudinal Study on Ageing in Trinity College Dublin are analysing the Covid-19 outbreak and subsequent measures to flatten the curve and how these measures have impacted on adults over 50 years of age in Ireland. I am further aware that the analysis of confirmed deaths by the Central Statistics Office shows that Covid-19 has the greatest impact on people aged 65 years of age or over. This age group accounted for almost 92% of confirmed deaths between 11 March and 15 May 2020. People aged 70 years of age and over were directed to stay indoors, curtail social visits from friends and family and to halt outdoor exercise, activities that shape everyday routine and indeed their quality of life. Ageist terminology was sometimes employed by the media and others.

There is also the issue of ongoing restrictions around physical access to Mass which I hope will be eased and that we will hear announcements to that effect. The sacraments are extremely important for many older people in particular.

Older people are one of the most responsible groups in our society. They respect the law but has the law respected them?

My last question relates to the fair deal scheme. Will we have the fair deal reforms in place before the summer recess or will it be in the autumn?

I have two and half minutes as I am sharing time.

I thank the Minister of State for her detailed speech and I thank both Ministers of State for sitting through this debate which is a very important issue and which I appreciate.

Last week or the week before I had more time and I went into detail on the Mental Health Commission and where I stand on mental health which I will not repeat. The importance of the independent monitoring body is crucial for me.

I ask that the Minister of State look at the report of the Mental Health Commission and come back to me on it.

There are a number of practical issues I wish to highlight. The Ministers of State may not have time to respond on them. Last week, I raised the issue of respite service. No respite service is being provided by Merlin Park University Hospital, Galway. I do not think it is the job of the Minister, Deputy Donnelly, to respond to me on an individual case. In the end, Deputies go to the Minister with cases. However, it is his responsibility to tell the House when respite services will recommence, more than a year after the pandemic was declared. It is simply unacceptable. We are talking about mental health and carers. I do not know how they are surviving.

The next issue to which I wish to draw to the attention of the Ministers of State is the number of late discharges of those in psychiatric hospitals. I have the details of one such case but I will certainly not go into it. However, I know that case is not unique. The person in question has been in the psychiatric hospital for many years. I am not exaggerating by saying that. I followed up on it. I will probably eventually come back to the Minister on that case if I do not get anywhere with it. It involves a person who, years after admission to a psychiatric hospital, should not be in there.

I also wish to highlight the issue of wards of court. Very little progress is being made on it.

I refer to the issue raised earlier by Deputy Alan Kelly and relating to people aged between 60 and 69 and the number of vaccines not being taken up. The comments by two senior politicians regarding that group of people were absolutely shameful. Those politicians should come back and apologise. If we wish to build confidence, politicians should not be telling people in that age group that if they do not do what they are told to do, they will go to the bottom of the list. It is simply unacceptable to do so. I will leave it at that.

I am happy to start my contribution by wishing the very best to the Minister for Justice, Deputy McEntee, and her lovely new family.

My time is brief and I have a specific question for the Minister of State but I will first make a brief comment. I am really pleased to hear of the new investments and allocations in mental health provision. They are all very welcome. However, all Members recognise that mental health provision has been chronically underfunded for many years. The report of the Mental Health Commission on older people, which was published last year, was clear that mental health services for older people are seriously under-resourced. We do not have a comprehensive service for older people. This week, the Irish Society of Chartered Physiotherapists warned of a tsunami of health problems facing older people.

In that context, my question relates to the Covid-19 nursing homes expert panel report. It contains 86 measures to be implemented in 12 to 18 months. The report was published nine months ago. What cost analysis has been undertaken by the HSE and the Department? Have resources been allocated to implement any of the measures?

I ask the Deputy to clarify to which report she is referring. I missed that line.

I am referring to the report of the Covid-19 nursing homes expert panel. It was published last August and contains 86 recommendations.

I thank the Deputy for that clarification and for raising the matter. I will meet the expert panel this afternoon. It was an absolute game-changer. We have the support of Nursing Homes Ireland. There are 575 nursing homes and they are all buying into this. We received short, medium and long-term recommendations and we took all 86 of them on board. The short-term recommendations have been implemented. They relate to infection prevention and control, staffing levels and avoiding the cross-over of staff between nursing homes to prevent Covid. We are currently working towards implementing the medium-term recommendations and the long-term recommendations are being costed. The work that has happened in nursing homes in the past few weeks has been phenomenal. There have not been any Covid cases in nursing homes in the past three weeks. From next Monday, 4 May, residents will be able to receive four visits in their nursing home, which is very positive.

I thank Deputies for their contributions on such a wide-ranging topic. Several significant issues have been raised. I thank the Minister of State, Deputy Butler, for her response. I am sure she wishes to respond to as many more of the issues that were raised as possible.

The physical and mental health well-being of people has been a Government priority throughout the pandemic. The Government has funded a range of Covid-specific responses to allow specialist community and residential mental health services to remain open and operating near capacity while ensuring the safety of service users and staff, including €15 million in budget 2021 specifically to meet these challenges.

Mental health services have been particularly active in response to the pandemic and we have sought to be proactive through the cross-government well-being campaign entitled Keep Well, which has been promoting and supporting resilience and minding our physical and mental health. We are also supporting a range of telehealth and psychosocial support services which provide advice, help, reassurance and contact for people in what are very challenging times.

Within mental services, while we have acted to safeguard the well-being of the whole population, we have also targeted initiatives for priority groups. Measures include infection prevention and control measures in residential settings, the sole aim of which is to keep infection rates as low as possible and thereby save lives. In specialist community services, there has been a significant shift to online and telehealth provision to ensure that as much service delivery as possible can be maintained as safely as possible for everyone involved.

The spread of Covid-19 in communities has posed significant challenges for many areas of our services. We continue to progress through the pre-recovery phase of the Covid-19 pandemic with the planned easing of restrictions during March and April now complete. Through our collective efforts, we are keeping the virus under control as the vaccine programme is gaining momentum. It is vital that we ensure our overall approach continues to be cautious and sustainable over the immediate, medium and longer terms. However, our clear message is that the vaccine programme is a key enabler to the reopening of society and the economy. It is continuing to progress well, with more than 1 million people now having received the first dose of the vaccine and more than 1.4 million doses administered overall. Our continued focus must be to protect the most vulnerable through an efficient roll-out of the vaccination programme.

I thank Members for their valuable contributions and will reflect closely on all statements relating to mental health and older people. Many of the issues highlighted are already being addressed through programme for Government commitments, our national policies and strategies and the HSE national service plan. We have achieved much in recent years through new developments and improvements to existing services. We are fully committed to a broad programme of reform to enhance both mental health and older people’s services into the future.

I will try to answer some of the questions raised. As the Acting Chairman will be aware, some Members decide to make statements and ask quite a lot of questions, so it is difficult to come back in. Deputy Kelly raised the issue of the vaccination of those aged over 60. The Johnson & Johnson vaccine, as well as the AstraZeneca vaccine, will be available to those aged over 60 and those aged over 50. Deputy Kelly stated that he was concerned that those aged 50 to 59 may receive a vaccine before those aged 60 to 69. It all depends on supply and delivery.

Deputy Cairns made several statements. She stated that home care was suspended for many people. It is fair to say that while 2,846 home care packages were suspended, 2,446 of those suspensions were requested by the clients or their families as they did not want a person coming into their house during Covid. It is only fair to put that on the record. An additional €150 million was allocated, resulting in 500 million extra home care support hours being in place at the moment. Some Members may remember that I raised this issue constantly in the previous Dáil. I am delighted that we are able to put in place 23 million home care supports, which is really important.

Deputy Cairns also raised the issue of the dementia budget.

That issue was close to my heart in the previous Dáil. I worked with Senator Colette Kelleher at the time. We co-chaired the all-party Oireachtas group on dementia. For the first time in the history of the State, €12.9 million was allocated for dementia services this year. By the end of this year, we will have 29 dementia advisers. It is only a short couple of years ago that we had only eight dementia advisers in the whole country. By the end of this year, we will have 29 of them. There will be a dementia adviser in every county, which is great to see, and more than one in some big counties.

Deputies Cahill and Martin Browne raised the issue of Jigsaw. Jigsaw has been in touch with stakeholders in the local areas and has confirmed a date for referrals once building works are confirmed.

A question was raised on mental health acute beds in the Tipperary area. As I said previously, there will be a review of mental health bed capacity throughout the country and its recommendations will be put in place.

Deputy Denis Naughten made a few points on specific issues related to mandatory hotel quarantine. I am not in a position to answer his questions, especially those relating to individual cases. The Deputy also raised the issue of the housebound and those receiving vaccines. He stated during the week that there seemed to be a discrepancy in the figures, as 600 people who were on the list no longer seemed to be on it. More than 3,500 referrals have been received. GPs refer to the HSE certain patients who they believe are housebound and would like the vaccine. As part of the housebound programme, to date 1,800 people have received the first dose and 500 people have received the second dose of the vaccine. The HSE is currently contacting everybody on the list who has requested a vaccine.

Last week, Deputy Naughten expressed criticism that the ambulance service was reaching people who are housebound fast enough. We have decided to double the number of ambulances visiting people at home. The vehicles are not ambulances but ambulance jeeps. These ambulance jeeps will continue to go to people's homes to allow people to be vaccinated. It is hard to win in this instance. Last week, we were criticised for not having enough ambulances; this week, I am criticised because we have too many ambulances. My priority is to make sure that every elderly person who requires a vaccine will get one in a timely manner and no older person will be left behind. The most important message today is that anyone who wants a vaccine will receive it in a timely manner.

I thank the Cathaoirleach Gníomhach for his time and patience. I thank colleagues and Members of both Houses for their continued support and suggestions for improving our mental health and older persons services. By working together, identifying problems and, most important, providing solutions, we can and will improve our services.

I welcome the news that the Minister, Deputy McEntee, and her husband Paul had a baby today. We have broken the glass ceiling. The Minister is the first Minister in the history of the State to have a baby while serving in office and the first to be able to take maternity leave. I hope she and her husband are happy. I know everybody wishes to congratulate the Minister on the arrival of her new baby.

I extend my sincere congratulations to my colleague, the Minister, Deputy McEntee, and her husband, Paul Hickey. It is a wonderfully exciting time for them and we are so pleased that she is the first Minister to have a baby in office.

I add my words of congratulation to the congratulations other Members have offered to the Minister without Portfolio, who became a mother today for the first time, and to her husband, Paul. I wish them health above all, safety in these current times and happiness. They have the best wishes of the House.

Sitting suspended at 11.55 a.m. and resumed at 12.02 p.m.