Youth Mental Health: Statements

Minister of State at the Department of Health (Deputy Mary Butler)

I thank Deputies for the opportunity to speak to the House about the important topic of youth mental health. It is particularly timely and pertinent given the publication today of the independent report on the review of care provided in the child and adolescent mental health service, CAMHS, in south Kerry. The report sets out a catalogue of failures across multiple levels of the system in the care provided to young people accessing CAMHS in Kerry. I am sure Members of the House will be with me when I say my thoughts are with the families and children affected by this report. To learn of the systemic failings in their care is absolutely devastating.

The HSE has met 198 young people who have been affected, and their families, to discuss the deficits in the care they received and to provide them with key information and referral to any necessary services and supports. This includes counselling supports and appropriate services from within child and adult mental health services. The HSE apologised to each individual at these meetings, and subsequently in writing, for any harm caused.

It is important to acknowledge the significant and wide-ranging impact on the children and young people affected. There were 227 children identified where the diagnosis or treatment given to them by a junior doctor or non-consultant hospital doctor, NCHD, exposed them to risk of one or more of the following: sedation; emotional and cognitive blunting; growth disturbance and serious weight changes; metabolic and endocrine disturbance; and psychological distress.

The report clearly identifies that the medicalisation of ordinary emotional responses in children and their suppression by medication risks delaying or damaging the development of emotional self-regulation skills which normally happens as children mature. Thirteen other children were found to have been unnecessarily exposed to a risk of harm under the care of other doctors in the service. Very importantly, there was clear evidence of significant harm caused to 46 children in the files that were reviewed. This included the production of breast milk, considerable weight gain, sedation during the day and elevated blood pressure. This figure of 46 will change as new information becomes available from meetings with the children, young people and families affected.

The look-back review team also examined 34 files in north Kerry CAMHS where there was an indication the named junior doctor was involved in their care. There were concerns raised in regard to 20 children and young people in that service. The HSE has offered an apology to them and their families, and there is a process in place for any ongoing intervention that might be required. The HSE undertook the investigation using its incident management framework and is liaising with other bodies, including Tusla, An Garda Síochána and the Irish Medical Council, as appropriate and as required.

Overall, the report has made findings about failings in the care and clinical oversight provided to numerous children and young people and has made recommendations to improve that care.

These failings occurred at multiple levels of the system and over a protracted period.

The key factors that contributed to these failings are extensive and include, among others, the absence of a clinical lead and CAMHS consultant from 2016 for the CAMHS team. Another CAMHS consultant agreed to cover this vacant post until it was filled on the expectation it would be on a short-term basis. The potential risks involved with this arrangement were not effectively managed and there was no regular, effective oversight of the NCHD's work through formal supervision and frequent joint working with a senior doctor.

While concerns about the NCHD were first reported in 2018, no proof was found that these concerns were addressed after being reported. The most worrying part of it is that those extra two years could have been prevented. In 2019, concerns about prescribing medication were clearly identified. However, the supervisor at the time advised changes but did not insist that these be implemented. When a new senior medical manager started in the service in 2020, concerns were not raised in respect of the NCHD's practices. The report outlines a number of areas where the supervision of the NCHD failed and where effective action was not taken; where concerns were apparent; and where the opportunity to change the doctor's practice was not taken effectively.

Other contributory factors included that there was no system used by the doctor's supervisors to check the prescribing of medications or the quality of service; a lack of adherence to the national CAMHS operating procedure 2015 or the CAMHS operational guideline 2019; referral acceptance levels, including the high level of cases that were managed by the NCHD; the team not maintaining an electronic diary process to co-ordinate their work; and poor case record management processes. There are also concerns regarding governance and oversight of the team by line management and the effectiveness of the CAMHS oversight group.

The HSE acknowledges the extent of the failures that have occurred. It has considered the report locally and nationally and has accepted the recommendations. Work is under way to implement the full suite of recommendations as a matter of priority. Among the recommendations made are an assessment of a reconfiguration of the service and a full nationwide audit of compliance with existing CAMHS operational guidelines by all CAMHS teams. Furthermore, a prescribing audit will be conducted in each of the 72 CAMHS teams nationally. A further audit of case files in north Kerry will also be carried out.

With respect to reconfiguration of the service, and with the hope of instilling some comfort to all that services will be delivered in line with best practice, all governance and organisation structures will be reviewed with a view to assessing reconfiguration of the service to address the systemic failings that have occurred.

People will understandably be concerned about CAMHS in their own communities. That is why it is important there will be a full audit nationwide of compliance with CAMHS operational guidelines by all CAMHS teams. In addition, I have asked the HSE to provide assurances regarding prescribing practices in all CAMHS teams nationally. A prescribing audit will be conducted in each of the 72 teams to include a random selection of files, proportional to the medical caseload, from a continuous six-month predefined period in 2021.

There are 35 recommendations in the report, which cover other areas such as, among others, staff training, clinical oversight, recruitment, care planning, and involvement of children and families in governance structures. Beyond the recommendations set out in the report, I will also be calling for the reinstatement of a HSE national director for mental health, in line with our programme for Government. I would appreciate support in doing this. I believe this post is essential in driving the fundamental reforms needed across our mental health system, not least in our child and youth mental health services.

An information line is open on 1800 742 800 from 8 a.m. to 8 p.m., seven days a week for anyone affected by the report. I would also encourage anyone of any age, wherever they are in the country, to reach out for help if they are affected by any of the issues raised in this report.

I can assure the House that I will be staying in close contact with the HSE on the implementation of the recommendations set out in the Maskey report.

We are all part of a family and we were all young once. Many of us have children and most of us have young relatives. Our children are the most important thing and to read of the systemic failings in their care is devastating. This is not just about the clinical decisions taken by one person but about how staff and teams manage themselves, are supervised and overseen in terms of their practices, and identify risks to ensure issues are picked up early and addressed.

More broadly, given the prevalence of mental health difficulties among children and young people living in Ireland, in addition to the mounting pressures experienced by our mental health services, the scale of the challenges we face is significant. In response to this, a range of actions are under way in the areas of policy, legislation and practice to enhance the experiences of children, young people and families using our mental health services and ultimately to improve their mental health outcomes.

Regarding national mental health policy, the national implementation and monitoring committee tasked with overseeing and driving implementation of Sharing the Vision has established a specialist group on child and youth mental health. The work of this group will be critical to ensuring the specific child and youth recommendations of the policy are fully realised in practice. This includes necessary improvements in the areas of out-of-hours supports, transitioning from child to adult mental health services, and greater collaboration between different sectors and agencies to ensure the individual needs of children and young people are fully met.

Connecting for Life, our national suicide reduction strategy has been extended to 2024. The strategy identifies priority groups, including young people, and provides a further opportunity to enhance child and youth mental health service provision in Ireland. More than 20 partners are involved in the implementation of the strategy including Tusla, the Department of Children, Equality, Disability, Integration and Youth, and the Department of Education. They each lead on or support a range of actions with the aim of reducing suicide, promoting mental health and well-being and enhancing services for our children and young people.

Significant strides have been made to update Ireland's mental health legislation, in line with international human rights standards, including the UN Convention on the Rights of the Child. Reform of the Mental Health Act in full will enhance the rights and protections of people accessing specialist mental health services, including children and young people.

The general scheme of a Bill to amend the Mental Health Act contains a new Part specifically dedicated to the care and treatment of children. The general scheme also provides for the extension of the Mental Health Commission's system of regulation, registration and inspection to all community mental health services, including those for children and adolescents. This provision is critical in enhancing the protections of people using our services.

The general scheme is currently subject to pre-legislative scrutiny by the Oireachtas Joint Sub-Committee on Mental Health, which commenced in November 2021. I thank the members of the committee for all the work they are doing. The Office of the Parliamentary Counsel commenced the drafting of the Bill itself last week. I hope to introduce the Bill to the House as early as possible this year.

I take the opportunity today to highlight some of the recent developments in child and youth mental health service delivery. These initiatives seek to address the challenges we face across our system, including, for example, ongoing issues with increasing numbers of referrals, staff retention and difficulties with recruitment, with it taking on average nine to ten months to fill a post.

Budget 2022, which provided €1.149 billion for mental health, includes specific funding to continue the enhancement of CAMHS. More specifically, it will allow for the establishment of two new CAMHS tele-hubs and a dedicated €6 million to expand the capacity of community mental health teams nationally, with a particular emphasis on CAMHS.

Further investment will also be made in the national clinical mental health programmes this year, many of which are available to children and young people. One example is the national clinical programme on eating disorders, which has secured an additional €1.15 million in 2022 for the development of additional specialist eating disorder teams.

Funding for 2022 also includes €10 million for initiatives aimed at increasing mental health supports in response to the Covid-19 pandemic. This includes enhanced signposting and access to existing mental health services and supports; initiatives for children, young people and students; and additional psychosocial responses, recognising that people will require varying levels of support. The HSE is actively working on these initiatives to get them up and running as quickly as possible.

A further €10 million in once-off additional funding announced on budget day has been allocated to improve the experiences of individuals, including children and young people accessing specialist mental health services, in addition to community and voluntary mental supports. I was very conscious when allocating this funding that the service user would be front and centre.

Some €1.8 million of the €10 million fund is for vehicles and will support the transport needs of people using mental health services and promote their engagement within the community. This may include, for example, travel to and from medical and other personal appointments, employment and education programmes, day centres and social activities.

As part of the fund, €1 million will be distributed in partnership with Mental Health Ireland to support the work of smaller local voluntary groups providing vital mental health supports in communities nationwide. The fund will go live next Monday, 31 January, and I encourage any group with a proposal or project that meets the criteria to apply. A further €1 million of the overall €10 million is for MyMind to deliver approximately 16,000 counselling sessions, in over 15 languages, free of charge to people impacted negatively by the Covid-19 pandemic. Under 18-year-olds can access the sessions with parental supervision.

Other developments that seek to respond to the challenges and increasing pressures on our child and youth mental health system include significant advancements in the delivery of digital mental health supports, including the 50808 crisis text service; NGO online supports such as those provided by MyMind, SpunOut, SilverCloud, Turn2Me, Jigsaw and many more; and the national roll-out of digital cognitive behavioural therapy to address depression and anxiety in Ireland, enabling individuals, including young people, to access essential supports within 24 hours of referral. The commencement of two new Jigsaw services brings the total number of sites to 14 nationally and complements its digital services that are available nationwide. It now has 66% coverage of the whole country with regard to premises and 100% coverage in relation to online supports. There will be an investment of €6.85 million to progress the national clinical programme on eating disorders. Last year, I secured €3.94 million to complete the three existing teams, of which two are CAMHS teams, and three new teams which are nearing completion. Funding allocated in 2022 will provide an additional four specialist eating disorder teams, with one of these being dedicated for CAMHS.

In line with programme for Government commitments, there has been a year-on-year decrease in the number of child admissions to adult acute mental health units. In 2019, there were 50 such admissions, whereas in 2020 there were 27 such admissions. Latest data from the HSE for 2021 indicate that as of November, there were fewer than 27 admissions for last year. The vast majority of these admissions are among young people aged 17 and older, with some aged 16 years plus a number of months.

Last month, I announced a significant reduction of over 19% among children and young people under 18 waiting more than 12 months to be seen by primary care psychology services. This follows an allocation of €4 million that I secured last August to address such lists through targeted initiatives. I am fully committed to continuing to work with my colleagues in government to ensure the development of a sustainable primary care psychology service in the longer term. I am seeking funding to continue that roll-out. We were able to take 1,000 children off the list in a four-month period and if we could do that again, it would be very helpful. All the children who were taken off the list were waiting in excess of 12 months.

The HSE’s psychosocial framework, which was launched last year, will complement the changes needed to fundamentally reform our mental health system, as set out in Sharing the Vision, and in line with the current overhaul of our mental health legislation. This must also be supported by enhanced compliance with any existing or newly developed guidance to ensure consistency and standardisation in mental health service delivery.

In conclusion, I thank Deputies for participating in this debate, including those who are present in the Chamber. I am grateful for the opportunity to clarify how many of the concerns of Members of the House are being or will be addressed. There is no doubt that we all seek continued developments and improvements across our mental health system. I am fully committed to working with all Members to see this fundamental ambition realised. It is essential that all individuals, including our children and young people, accessing mental health services and supports receive a high-quality service, delivered in line with best practice, that is standardised in all parts of the country regardless of where people live. Finally, I thank mental health service staff and the community and voluntary sector for their immense work and ongoing dedication to supporting the mental health needs of people living in Ireland.

Minister of State at the Department of Health (Deputy Frankie Feighan)

I am pleased to address the House on this important subject and to outline the work being done in the area of public health and well-being and the national drug strategy to support our young people. Healthy Ireland: A Framework for Improved Health and Wellbeing 2013-2025, which was launched in March 2013, is a national framework action to improve the health and well-being of the country over the coming generation. Since last year, it has been further supported by Healthy Ireland's strategic action plan, which provides direction for implementation of Healthy Ireland's plan from 2021 to 2025. Healthy Ireland takes a whole-of-government and whole-of-society approach to improve health and well-being and to tackle the major lifestyle issues that lead to negative health outcomes, namely, smoking, alcohol, poor diet, physical inactivity and obesity. Positive mental health is a key element of health and well-being and of the work of Healthy Ireland.

The report of last year's Healthy Ireland survey presented key findings on social connectedness and mental health in the context of the ongoing Covid 19 pandemic. Needless to say, the necessary Covid-19 restrictions had a significant impact on people's social interactions and consequently on their mental health. While the restrictions were absolutely necessary to control the spread of the virus, social interaction is a very important part of our lives. Inevitably, there was a negative impact on people's mental well-being. Over 80% of respondents reported that they were less socially connected as a result of the restrictions. Almost one third of respondents reported that their mental health had worsened since the start of the public health restrictions.

As part of our response to these challenges, we have provided guidance and support for people to manage both their physical and mental well-being through public health information campaigns such as the In This Together and Keep Well campaigns, and through information networks including key organisations working with vulnerable people. Working with partner organisations, such as An Garda Síochána, NGOs and Volunteer Ireland, there was a particular emphasis on identifying and supporting those most at risk of isolation. I wish to mention the support provided by the HSE to a number of organisations working in the area of youth mental health, such as Jigsaw, Childline and SpunOut. The HSE website yourmentalhealth.ie provides information on a range of mental health support options available via phone, text and online.

The area of sexual health can be a source of anxiety for young people in particular, and counselling services are provided by a number of support organisations, such as SpunOut, and services are also provided by the LGBTI+ community, LGBT Ireland and BeLonGTo. These organisations are all supported by the HSE and further resources are available online through the HSE's website sexualwellbeing.ie and B4uDecide. I also wish to mention the great work being carried out by the children and young people's services committees, which have been developing and delivering youth-specific campaigns to support young people's physical and mental health and well-being.

One of the most exciting and growing areas of healthcare in recent years is social prescribing. Social prescribing is one of the means by which we can achieve a greater degree of social connectedness for people and counteract isolation, thereby improving mental health. Social prescribing is a simple but profound idea linking patients and primary care with sources of support within the community, which can include arts and creativity, physical activity, peer and group support, green activity and computerised therapy. It has been shown to result in positive emotional, cognitive and social outcomes, especially by reducing social exclusion for disadvantaged, isolated, lonely and vulnerable people, many of whom experience depression and anxiety.

The Sláintecare integration fund is supporting seven social prescribing programmes based in Dublin, Waterford, Cavan, Monaghan, Sligo, Leitrim, Wicklow, Cork and Kerry. I am pleased to inform the House that work is also under way on the development of a national mental health promotion plan. In the context of mental health and well-being, there is a growing body of evidence at international level of the benefits to individuals and society at large when positive mental health is promoted and integrated across the life course.

To inform the development of the plan, consultation with key stakeholders, including Government Departments, the HSE and the voluntary and charitable organisations that are broadly involved in mental health promotion, was required. This consultation has now been completed and a report is being finalised.

In addition to the consultation process, an evidence synthesis is also being undertaken. This will provide a summary of the international evidence on the impact of mental health promotion interventions to inform the new action plan and should be completed in February.

Last June, we launched the national healthy campus framework. This will help the higher education institutions across Ireland to embed health and well-being in the campus life of staff and students. Promoting positive mental health is a core element of all health and well-being activities on these campuses. A national co-ordinator will be appointed to drive the initial roll-out of the healthy campus framework and charter and to support institutions in sharing learning and good practice. This post will be advertised shortly.

One of the key priorities of the Healthy Ireland framework is the promotion of physical activity. Get Ireland Active!, the national physical activity plan published in 2016, contains 60 actions intended to promote increased physical activity levels across the population. Presentations at last year's Irish Physical Activity Research Collaboration conference made clear that regular physical activity can be effective in reducing the severity of symptoms associated with anxiety and depression. Research carried out by Dublin City University regarding the Department of Education's Active School Flag programme, which is co-sponsored by Healthy Ireland, indicates the positive effects of this programme on school activity levels, but also on attendance, behaviour and learning outcomes. I assure the House that Healthy Ireland will continue to work to improve the mental and physical health of our citizens.

With regard to the national drugs strategy, a lot has been done to tackle the issue of drug use among our young people. The consequences of drug use can affect a young person's health and undermine his or her academic engagement and, sadly, may result in serious injury or death. We know that young people are most likely to experiment with drugs. It is therefore important that we collectively address these issues. It is important to consider some of the clinical advice and data that are available regarding the use of drugs, including cannabis. Last year, information fact sheets made available by the College of Psychiatrists of Ireland showed that one in five adults who use cannabis is likely to have a dependence on it. However, the risk of dependence for our young people is even more pronounced, with one in three young people likely to become addicted if using cannabis weekly or more often. In addition, presentations to the child and adolescent addiction services indicate that cannabis is the main substance causing harm for those under the age of 18. This is a matter of serious concern.

Our national drugs strategy, Reducing Harm, Supporting Recovery, aims to promote prevention initiatives. It states that substance misuse prevention strategies need to be evidence-based and to target families, schools and communities in order to be an effective way of promoting health and well-being among the general population. The first strategic priority following the recently completed mid-term review of our national drugs strategy is focused on the protection of children and young people from the dangers posed by drug use. It is of utmost importance that we do everything in our power to protect young people by increasing their resilience, strengthening their life skills and promoting healthy life choices. The issue of harms caused to children by drug use is a priority for me. The newly identified strategic priority aligns with Article 33 of the UN Convention on the Rights of the Child, which sets out:

States Parties shall take all appropriate measures [...] to protect children from the illicit use of narcotic drugs and psychotropic substances [...] and to prevent the use of children in the illicit production and trafficking of such substances.

A multifaceted approach involving online resources, in-school interventions and targeted awareness campaigns can provide the necessary education to minimise the risk of substance misuse among young people. I recently approved the launch of the prevention and education strategic initiative and funding programme, which will increase the focused delivery of evidence-based prevention programmes among the school-aged population. There will be a number of funding streams within the programme through which we will focus on school-based interventions such as Know the Score, Ireland's first national evidence-based resource on alcohol and drugs for senior cycle students. The overall aim of the resource is to enable young people to make conscious and informed decisions about alcohol and drugs. The programme for Government commits to building on recent initiatives at junior and senior cycle and to supporting secondary schools in introducing drugs and alcohol awareness programmes such as Know the Score, with particular regard to the hazards of casual drugs use. Not only do we have national policy guidance in this area, but the EU drugs strategy also includes prevention and education for our younger people in its strategic priorities. It also recognises that families play a significant role in drug prevention and helping to keep young people safe from the misuse of drugs and alcohol. Recognising this, the HSE has created a guide for parents, which is available at drugs.ie, that helps parents to talk to their children about the risks associated with drug use in a proactive way.

Education and awareness programmes that are delivered alongside other measures and that build life skills and confidence are far more likely to be effective in encouraging protective and healthy behaviour than stand-alone measures. I am fully committed to supporting our young people and increasing the level of education on drugs and the dangers of drug use in Ireland.

Deputy Mark Ward

I welcome this opportunity to speak on youth mental health. During yesterday's meeting of the Joint Sub-Committee on Mental Health, we undertook prelegislative scrutiny of the Mental Health (Amendment) Bill 2021. This is an opportunity to change for the better how people with mental health issues are treated. However, the Government has left open a loophole that will continue to allow children to be admitted to adult psychiatric facilities. There is provision in the Bill for children to be sent to appropriate facilities, insofar as is practical. This loophole must be closed, plain and simple. No child should be admitted to an adult mental health facility. This is a symptom of a systemic failure on the part of the State. It is the Government admitting that it has failed to resource children's mental health services properly. We need to get rid of this draconian practice, which sees some of our most vulnerable children with acute mental health needs being admitted to adult psychiatric hospitals. It is a very frightening experience for any child to be admitted to a hospital for a mental health reason but this is exacerbated for those children who are placed in adult units. As we know, 27 children were admitted to adult facilities last year. While I acknowledge that this represents a decrease on previous years, it is still 27 children too many.

At yesterday's meeting of the Joint Sub-Committee on Mental Health, we heard from the Ombudsman for Children that children with mental health difficulties were also being admitted to inappropriate paediatric wards. He informed us of a case in which a child was in a paediatric unit for three or four months with no therapy, no education and no interaction with anybody except from an occasional visit from somebody who needed to adjust that child's medication. This is unacceptable. The Minister of State does not have to take my word for it, as these are the words of the Ombudsman for Children at yesterday's meeting. He said that the Government has become lazy and has allowed legislation to continue to permit children to be admitted to adult facilities. It has let the idea that we do not have resources in place rule the fact that the best interests of children are not paramount. I ask the Government to legislate for a zero option when it comes to admitting children to adult facilities. If it does not, Sinn Féin will be proposing amendments to this Bill.

As the Minister of State will know, all experts say that early intervention is key if a child is to reach his or her full potential and developmental milestones. Some 3,000 of our young people are currently waiting for appointments in CAMHS. More than 200 of them have been waiting longer than a year for an appointment. Last April, I raised my concerns about CAMHS, particularly the service in south Kerry, with the Minister of State after disclosures that young people might have been prescribed adult doses of medication. As the Minister of State has said, the report was published today. It is quite shocking. Children were being overprescribed medication and effectively put into chemical restraints. Not only was there no clinical lead, but there was also no consultant child and adolescent psychiatrist for south Kerry CAMHS since 2016. There is still none today. There was no system for the doctors' supervisors to check the medication prescribed or the quantity of service. Concerns were raised about the overprescription of medication in 2018 and again in 2019.

Despite this, when a new senior medical manager started in 2020, concerns about the doctor were not communicated to that new medical manager. There were ample opportunities to prevent these young people from having to experience such appalling treatment. I called on the Minister of State in April last year to conduct an independent national review of CAMHS across the State. The Minister of State failed to act then, so I ask her to commit today to a full and comprehensive review of all CAMHS teams, and that should happen immediately and not down the road. No more time should be wasted. The HSE has issued an apology to all the affected families, but it must do much more. People must be held accountable and the whistleblower who highlighted these failures must be commended.

I acknowledge and welcome that the Minister of State said in her opening statement that she would reinstate the national director for mental health in the HSE. It is something we have been calling for since I became the spokesperson on mental health, but it should not have required something like this to happen to bring about this reinstatement. The Minister of State could do some other things in the meantime to make it easier for children to access proper mental healthcare. Resources could be put in place to allow trainee psychologists to become fully qualified. Financial burdens exclude many psychologists from diverse socio-economic backgrounds from entering the workplace. More than 9,000 children are waiting for an appointment for primary care psychology services. The responses I receive from the HSE usually bemoan the lack of qualified psychologists to fill the vacant posts. There is a workforce available and ready to go, but impossible financial obstacles have been put in their way. We outlined in our alternative budget how we would go about this. I will send the Minister of State a copy if she wants. It might do her some good to have a read of it. I also ask the Minister and the Minister of State to meet with representatives of trainee psychologists after they have requested it.

Deputy Pearse Doherty

I welcome this debate. I will start by quoting the words of Dr. Anne Doherty, who is a psychiatric professional:

We all make decisions every day about who is sick enough to warrant that bed of the four people in front of us. Ideally, you would admit all four.

That deals with the reality faced by many people. I refer to the services simply not being there, whether those are inpatient beds in facilities that we need or community supports through CAMHS, autism or voluntary services. We have seen the pandemic expose many weaknesses across the State, not least in housing and health. We are also facing a serious problem in our mental health services. When the Taoiseach announced that restrictions were to be lifted, many of us went back to the way we used to behave and back to going to the pubs, greeting people by shaking hands and being able to visit people. No such switch is possible for many people affected by the mental health impact of these last two years. Indeed, things are very dark and grey for many people.

Unfortunately, when they extend a hand for help and seek the State to reach out and grab them, it is nowhere to be found. Therefore, I urge the Minister of State to examine bringing forward a real comprehensive strategy for mental health services. I and my colleagues, Deputies Mac Lochlainn and Ward, who has been doing Trojan work on this issue, had the opportunity to meet with many of the mental health advocacy groups, including those in the health organisations, those that are State-funded and those that are charities, and they all had a similar message for us: that far more needs to be done, that far more joined-up thinking is needed and that far more supports need to be provided at all levels.

I could talk to the Minister of State about constituents of mine and their experiences. We have seen a spike in numbers in this regard in recent years. One in five young people admitted to mental health institutions suffers from eating disorders. The reality, though, is that the beds are not there. When we look at the three public beds in the State, and the numerous reports in this regard, for how many years and how many times are we going to have headlines about this situation in newspapers? How many times are young people going to reach out to ask us to do more, only for those calls to fall on deaf ears? I welcome this opportunity, therefore, but what I would welcome far more is a real response to dealing with the most vulnerable people in our society and an acknowledgement of the impact of the pandemic on them.

Deputy Martin Browne

This week I received an email from a 16-year-old girl from County Tipperary concerning what she termed the mental health crisis in Ireland. Like so many others of her age, she has lost several friends to suicide. She related to me that when she was feeling that way as well, she presented to the hospital only to be sent home four hours later. She is still affected, and has since appealed to me to make the case on her behalf concerning the need for more funding to be allocated for mental health services and for more training for service providers.

What kind of country are we living in when a 16-year-old who should be enjoying her youth has instead to write to me to make this case for her and many other young people who feel abandoned? We spoke previously about setting up the Jigsaw project in Thurles, which ran over half a year late. I am waiting to hear if we will get physical hubs in other parts of the county. When I inquired about waiting times for the services as they stood on 31 October 2021, I was told that they were running at seven weeks. That is far too long for young people to have to wait.

Tipperary has seen the closure of St. Michael's psychiatric unit. People in urgent need now must present at an accident and emergency department. Centres that facilitate counselling services are living hand-to-mouth because of a lack of sustained funding. There must be an independent review of CAMHS after the surfacing of issues with the services in south Kerry. Children being overly prescribed medication is a major concern, as is the lack of a clinical lead and consultant child and adolescent psychiatrist for CAMHS in the south Kerry area. The services the young and the old can get are often determined by their postcode instead of by their needs.

Let us take the example of CAMHS in the CHO 3 health area, which includes north Tipperary. Some 355 young people were waiting near the end of the year. Of that total, 76 had been waiting for more than a year. In CHO 5, of which south Tipperary is a part, 221 young people were waiting, and 12 of them had been waiting for more than a year. Clearly the speed with which people are seen in Tipperary depends on where they live. The same problem exists with child primary care psychology waiting lists. This game of chance being played with the mental health of our children is the result of a chaotic strategy on the part of the Government, which cut additional funding by 50% recently. Serious change is needed for young people.

Our young people are saying this based on their experiences. I conclude with a passage from the email sent to me by the young girl I referred to earlier:

We need more funding for the mental health system. Please, it needs a change. I am looking towards you for help. I would love to chat to someone about what ideas I have to help because I think I can make a change and I’m willing to fight to make a difference. Please hear me and all of the other people in this country who NEED you to listen.

I urge the Minister of State to start listening to the words of this young girl and the other youngsters in this country who have taken the time to express their feelings.

Deputy Pat Buckley

I welcome the opportunity to speak on this topic. The report on the look-back review into CAMHS services in south Kerry is a damning one on a disgraceful situation. I commend the whistleblower on coming forward and on what that has done. We would not do what was done here to animals, and that is being honest. I also bring another situation in the youth mental health services to the attention of the Minister of State. If children have autism and mental health issues, there is nothing in this country to help them. They are on their own. One of the speakers mentioned early intervention. There is zero intervention for these people or their families.

I listened to Neil Prendeville's radio programme on Red FM this morning. I heard mothers speaking about their autistic children and how they have got zero help. Those children's mental health has not been addressed because they are not even getting assessments. The mental health of the families and the children's siblings has been destroyed. I have heard of cases where children were chewing dog leads and eating the bannisters of stairs. The Minister of State may not be aware of this, but during the last Dáil I worked with former Deputy Caoimhghín Ó Caoláin on disability issues as well as mental health matters. Families told me about situations where they put their own children into Alsatian dog cages in the kitchens of their houses when the mental health issues kicked off. That was for their safety and that of the rest of their family.

While we are focusing on this subject of youth, child and adolescent mental health services, there is a huge gap in our mental health and autism services that must be addressed. Regarding what is happening here, all children in this country have a right to the best life that a parent can give them. They need assistance at times, but the problem is that the State has failed us. I am blue in the face from coming in here to talk about mental health issues and the lack of services over the years. There must be a root-and-branch change in this area. I welcome the positive things that have been done, and I always will. The Minister of State will always get credit where it is due. She should listen back, however, to the parents who were speaking on that radio show this morning. Hundreds, if not thousands, of families are going through the same pain and suffering, but they will never get access to mental health services or assistance because their child has another disability. I hate using that word. Families feel that their children are being abused in their own homes, not by their families but by the Government because of its failure to provide the services.

Deputy Pa Daly

Over the past couple of months I have been dealing with a family whose teenage daughter is being fed through a tube. When they reached out in desperation due to her eating disorder, they found that Éist Linn, Linn Dara and Merlin Park were unavailable to them because there are not enough beds. The simplest answer is that there should be more beds but there should be more consultants. The report that came out today by Dr. Seán Maskey mentions the difficulties with finding consultants. It is not good enough to say this when the support structures, support staff and equipment are not in place for doctors. That is one of the reasons consultants cannot be found.

This report contains devastating findings and exposes a lot that is wrong in our health service or lack of health service for some people. I spoke to another father today who told me that his daughter had social anxiety when she was transitioning into secondary school and went to see a doctor through CAMHS. Having read the report today and having received his apology, he feels sickened. It is soul-destroying, he said, to read the report. The family is devastated, angry and upset, not only because the structures were not in place but there was no care plan, no psychologist, no cognitive behavioural therapy, no oversight, no organisation, not even a shared diary. Referring to the south Kerry group as a team is a complete misnomer. Quite clearly the doctor who had got a reference from somebody, I do not know who, was working solo.

Children who did not even have ADHD were put on risperidone, an antipsychotic medication. One child, I was told, did not even recognise her parents, did not establish reality and did not know whether she was dreaming or it was reality when her parents would come into her room. Another parent told me his child went from 9 stone to 18 stone from when he was 15 to 17. I remember meeting that child and wondering how he had put on so much weight. He was suffering from depression and his weight increased. The scandal here is why were so many children put on risperidone. Why was that being carried out across the board? We do not know how much was known. Still with some of the parents there has been no intervention and there is still no care plan. That should be worked on.

Deputy Sorca Clarke

The Minister of State and I could speak for the rest of the evening about the lack of adequate mental health services for young people in Longford-Westmeath. I want to give the Minister of State a specific example of the impact this has. Cillian is a 14-year-old boy in second year. When he was in third class he was given a psychology follow-on referral from his GP because of concerns raised by the school. He went to multiple appointments; his mam was told they would be in touch but that never happened. Today the HSE is categoric in its stance that those meetings never took place and that Cillian has been on their books since 2019, not 2016. Despite repeated pleading, Cillian has not received one psychology assessment in all of those years since he was in third class. The family has been told he is on a waiting list. This is actually contradicted by a reply to a parliamentary question that I received recently. This young man has a family who are doing all in their power to help him, a school that is doing all in its power to help him. What Cillian actually needs is urgent professional assistance. Literally years of this young man's life have passed him by. If this continues, Cillian will age out of the programme. What is going on here? It is absolutely detrimental to this family. If it was not so serious it could also be almost laughable because it just beggars belief.

In a reply I got back in November regarding a long-vacant psychology post in Longford, the HSE actually attempted to criticise potential candidates because they may want to live in more urban, larger areas. That is not an excuse for not being able to fill a post. It is certainly not a reasonable excuse. At the very core of this and of these waiting lists that are entirely unacceptable is the accompanying issue of staff resources and supports for those in the positions where we desperately need them.

Cillian is not alone. Thousands of young people are facing unacceptable delays in accessing care. Over 9,500 young people are awaiting psychology and 588 of them are in my constituency. The HSE cannot continue to use Covid as an excuse for the delays in treatment. This is reflective of years of underinvestment and a lack of priority and provision given to the mental health service. The system was in crisis before Covid; it is now much, much worse. I am asking the Minister of State to act urgently for children like Cillian and all those who require services.

Deputy Martin Kenny

This is an issue we have all been dealing with for the last number of years and we are well aware of it. I spoke to the Minister of State previously of a situation in Sligo-Leitrim, in CHO 1, where there are 280 children on the waiting list for CAMHS. That is almost 10% of the national figure. In most cases there is meant to be a multidisciplinary team in place. I understand the multidisciplinary team in the CHO 1 area is about 60% of what it should be. That is the case across the board and across the country. In many cases there are people working in these areas who do not have child-specific qualifications. That is another problem which is probably having its impact in much of these misdiagnoses and issues that come up for a whole range of young people. They go and seek help and families do their best for them, but they find they are up against a brick wall.

I recently had a family contact me. Their young daughter had gone to CAMHS and been diagnosed for a particular medication and everything was fine. She was supposed to be reassessed in six months. They rang and rang and rang but could never get an appointment. It was over a year before they got an appointment to re-examine the medication she was on. They were told to go to the GP. The GP said he did not diagnose and could not deal with it and that it had to be CAMHS that would do it. They continuously push people away rather than take them in. That is an issue across the entire country.

In the justice portfolio that I am in, I continually come across people who end up falling foul of the law because ultimately at a young age they did not get the early intervention they needed in mental health services. We know that and we all acknowledge it. Both Ministers are aware of it as well. However, we continually come back to this problem. We cannot recruit the people and we have all these issues.

Under the last Government we were here five years ago and we had the same problem. Five years later we are still in the same problems. Why was nothing done in those intervening five years? It is beyond belief that as a society we cannot put the effort in to ensure that we train an adequate number of people to deal with the problems we know are going to be in our society. We have not got the impetus in place to ensure we can have the medical professionals in place in our country to be able to deal with the problems we know we are always going to have. There is always going to be that percentage of people unfortunately who will need these services. We need to ensure that we put the services in place for them.

Deputy Dessie Ellis

Mental ill health can have a considerable impact on those who experience a mental disorder and can result in destructive and damaging relationships between the individual and their friends and families. Before Covid, the mental health services for young people were a major problem. Now they are beyond crisis point. Expert evidence shows that the onset of mental disorders peaks during the adolescent and early adult years and is one of the leading causes of disability among many young people.

Risk factors associated with the experience of mental ill health among young people include family difficulties, health issues, employment or relationship stresses and coming to terms with sexual orientation. Adolescents experiencing mental ill health can be a risk factor for mental ill health and substance misuse on reaching adulthood. This in turn can be an obstacle to employment and an associated increased risk of unemployment in the young adult.

Studies show that there are significant numbers of young people who are deliberately harming themselves and that many young people experience suicidal ideation. For some young people misusing alcohol and other substances can result in them developing mental disorders. Unfortunately, the services available to help people especially with dual diagnosis are virtually non-existent. Young people have no other option than to present to the accident and emergency department or to their doctor's surgery, neither of which is trained or equipped to deal with individuals who have such complex needs.

This is a terrible situation for a young person to find himself or herself in when looking for help. The importance of having that help available is proved by studies showing that young people who accessed mental health supports early were less likely to continue to experience mental health issues into adulthood.

For the services that do exist, age can be a barrier to accessing them, especially for under-16s. Early intervention is crucial and CHO 9, which includes Dublin North-West, the constituency I represent, has 289 young people on the CAMHS waiting list.

This situation needs to be addressed as a matter of urgency or we will fail a generation of adolescents and young people in urgent need mental health treatment.

Deputy Duncan Smith

Something we say quite often - sometimes, we trot it out without thinking - is that it is access to health services that is the problem and that, once we get in, the services are great. We said this a great deal during Covid. However, what we have seen from CAMHS in south Kerry is that that is not always the case. Given the Taoiseach's response today, the Minister of State, Deputy Butler's response, which I watched from my office, the other contributions so far and the other contributions that will follow, this issue has cut to everyone's core.

With mental illness, there is an extra degree of trust that family members have when young people are being treated. It is not like other illnesses. It is not like going in with a broken leg or cut where someone can see the treatment. It is not an easy-to-understand procedure like an operation. There are degrees to which medication needs to be provided or withdrawn. It is delicately balanced and complex. A great deal of trust goes into this type of care. That trust is difficult to build up and easily pierced, which is what has happened in this case.

The necessary audit of CAMHS must be swift and thorough and there must be consequences for what has happened. The whistleblower who brought it to light must be commended. It was not an easy thing to do but it was important. Whatever the pathways the families and young people at the centre of this case now face, they require the full support of the State. The State needs to work hard to build their trust back up and ensure that it provides the best possible care.

We constantly discuss recruitment. There was no consultant psychiatrist in south Kerry for six years. There still is none. What is the problem? Why can we not get a handle on recruitment? Given all the university courses and degree programmes, why are we not recruiting and retaining all the young people who have, for as long as I can remember, had a great desire to work in our health services? Why are we not able to attract people from outside our jurisdiction into our health services to fill these roles? There is a large number of roles at all grades across the health services, particularly mental health services, that have gone unfilled for a long time.

In her opening statement, the Minister of State mentioned - I hope I heard her correctly - the reinstatement of the role of national director for mental health. Is that her desire?

Deputy Mary Butler

I am calling for it and would welcome any support.

Deputy Mark Ward

The Minister of State will have it.

Deputy Duncan Smith

Yes, it is something for which we will all be calling. I met representatives of Mental Health Reform yesterday. I commend them on the briefings they gave us and, I am sure, others in advance of this debate. They are always available to provide briefings and support. They made a strong case for the reinstatement of the role of national director for mental health. I asked why it was gone but no one could answer.

When people were asked during Covid what the most important issues to them that needed to be resolved were, they mentioned climate, housing and employment. The fourth issue they mentioned was mental health. It would not even have been in the top ten a decade ago. Now, people want to understand mental health. They want the supports to help themselves, their loved ones and others, including those in their social circles who may have mental health issues.

Yesterday, I shared a story from my experience of ten years of taking advice clinics and meeting people. Ten years ago, people would have come to an advice clinic and said they had a housing issue. Through the course of that conversation or dealing with them down the line, they may have then mentioned issues with their mental health. Perhaps they had a letter from their GPs. Now, mental health is among the first issues they mention. This is a positive in terms of where the country is now compared to where it was. We are talking about it and want to deal with it, but we need the services to do that. I hope that, given Deputy Butler's role as Minister of State with responsibility for mental health, her call for the reinstatement will result in it being delivered. I do not know where the resistance to it would be. I would be surprised if the Minister for Health was resistant to it. I would be surprised if there were budgetary constraints. It has to happen. If it is one of the things that come out of this tragic series of events in south Kerry, at least that will be something.

I will move beyond the case and its outcome now because we will discuss it again. We are coming out of nearly two years of Covid and we have seen an increase in the number of presentations at mental health services by young people. The true impact of the past couple of years on young people and their mental health will become more apparent over the next year or two because we have been living through extraordinary times. I hope that we will not have to live through them again. Young people are raising their hands and saying they need help and want to talk about it. We need to ensure that there are services in primary and secondary schools.

Under the UN Convention on the Rights of the Child, every child has the right to the highest attainable standard of physical and mental health. This right covers the full spectrum of health and well-being and guaranteeing it requires a comprehensive multisectoral response through an integrated system that involves parents, peers, the wider family, schools and the provision of support and assistance via trained staff. These are wonderful words. Delivering on them will not be easy, but they must be delivered. We need a sea change in how we approach mental health and deliver mental health services. We need to make that delivery a norm in our system, including our schooling system, and in how our peer groups and families operate. We have a great deal to do to catch up. Our country is distinct from others, in that we have a particular condition and we have been doing great work in trying to bring mental health and our discussions on same to the fore, but we need to back that up not just with resources, but with whole-of-system changes in how we approach the matter. That includes our schools.

Minister of State at the Department of Housing, Local Government and Heritage (Deputy Malcolm Noonan)

I acknowledge the trauma and hurt of the young people and their families impacted by appalling failings of CAMHS in south County Kerry. They have been badly let down and harmed by a service in which they should have felt safe and that was trusted by the families. It is unacceptable that such failures of clinical governance failed young people so badly.

I was involved in a collaborative mental health project in County Kilkenny for a number of years. Partners included Foróige, GROW, Ossory Youth, the Samaritans, Shine and may others. We embarked on a participative planning process that led to the development of one of the first suicide prevention plans in the county and, indeed, country. That template subsequently informed HSE approaches to county suicide prevention plans, which were supported by the National Office for Suicide Prevention. In formulating the plan, we held workshops with young people, led by Comhairle na nÓg, Foróige and Ossory Youth, from which it became clear that there was a need to integrate youth services into the available supports for young people's mental health, establish LGBT+ peer support groups, make support material readily available online and set up youth cafés and other facilities. Comhairle na nÓg in Kilkenny later led on a more immersive youth mental health initiative that advocated for more resources for counselling, greater interaction of voluntary and youth services with CAMHS, and supports for families of young people experiencing mental health difficulties.

Through my involvement in these projects, I was consistently impressed by the work of the young people participating in them. As they now emerge from the Covid-19 pandemic, they face many additional challenges in life, but those who are already vulnerable are at risk of being lost in a system that needs to be led by the voices of youth. Many of our young people feel lost and abandoned in a world that is becoming increasingly materialistic and uncaring. Families of young people who are experiencing severe mental health challenges, are self-harming or have alcohol or drug dependency or eating disorders often find accessing services difficult. We heard yesterday during the leaving certificate debate about the real apprehension and confusion over the sitting of examinations following two years of disruption.

Eco-anxiety is a more recent development sparked by the climate crisis. We should not doubt that the uncertainty of the future of our very existence as a species is causing a deeply felt sense of despair among our young people. We need only look at the burden we have placed on their shoulders.

Young people from minority backgrounds experience an additional burden, but very often mental health challenges go unseen, particularly among those who have fled conflict or persecution in another country and those who are Travellers or Roma. There need to be specific targeted programmes for such young people too. I heard the contribution of the Minister of State, Deputy Butler, on that and welcome her intervention in that regard. I also welcome her commitment to addressing the challenges of listening to and resourcing young people's mental health services and youth services. My colleague, the Minister, Deputy O'Gorman, is engaged in just that, resourcing youth services such as Ossary Youth, in Kilkenny, to continue to provide safe and welcoming spaces for young people in projects such as Open Door for LGBT+ youth and for vulnerable children and adolescents generally.

I welcome too the introduction of minimum unit pricing on alcohol. It will have a positive impact in reducing alcohol consumption among people. I remain concerned about the potency of the cannabis currently being sold on our streets. I think it is having a detrimental impact on mental health.

For young people with acute mental health challenges, we must ensure there is accredited, integrated, interdisciplinary, robust, safe and well-resourced counselling and psychotherapy services available to meet their needs and to support their families.

I will close my comments by saying once again that I really feel for the families and young people so badly let down by CAMHS in south Kerry. We have community or State-run mental health services. There must be a rigorous monitoring of the effectiveness and safety of such services. Earlier today, in this Chamber, An Taoiseach said there had been a systematic collapse in clinical governance. This is truly a damning indictment of a service that is in place to protect and care for young people's mental well-being. Investing in our young people, early childhood development, education, early intervention and diagnosis and in families by addressing poverty and exclusion and, critically, listening to the voices of youth will ensure that, as a State, we cherish and value them and listen and respond to their needs.

Deputy Pádraig O'Sullivan

Since the Minister of State, Deputy Butler, assumed office, I know she has fought tooth and nail for every resource she can get: material, personnel - the whole lot. She has done her best. It goes without saying, however, that the news that has come from Kerry in the past while will dominate my contribution.

I came off a call with Michael Fitzgerald from the South/South West Hospital Group about half an hour ago, and the picture he painted us and what was contained in the report was quite bleak. I have listened to what the HSE has had to say and can safely say that what happened in Kerry with the provision of CAMHS was appalling. The independent review of almost 1,500 children found that 240 young people were adversely affected or identified as having received deficits in their care. That is an alarming number of people and a significant percentage of the 1,500 files reviewed. My thoughts tonight are with all those children and families who were neglected and adversely affected in a variety of ways. I note that some children received "unreliable diagnoses, inappropriate prescriptions and poor monitoring of treatment and potential adverse effects" which "exposed many children unnecessarily to the risk of significant harm". The report continues that significant harm was caused to 46 children and young people, including weight gain, sedation, elevated blood pressure and galactorrhoea, so there have been significant adverse effects on many young people but not what the HSE has described as catastrophic failings. I am not sure what the difference is between significant adverse effects and catastrophic failings. If the Minister of State could ask the HSE what the difference is, I would appreciate feedback. As a father, I know that if my child were misdiagnosed, prescribed incorrect medication, with varying side effects, and not adequately monitored, I would find that to be a catastrophic breach.

In one respect I am glad we have the report. I would now like to know what we will do to improve the services. I note the 35 recommendations. I read through them all this evening and hope they will be followed up on. I implore the Minister of State to do a quarterly review, if possible, on the progress made and the implementation of the recommendations.

I also note that the HSE has unequivocally apologised and has been transparent in the report, and I welcome that, but many questions remain. Are we confident a clinical lead psychiatrist can actually be hired? The HSE has tried to hire one for the Kerry area since 2016 and failed to fill that post. A locum has operated with support to fill the gap, but if we have failed to fill that post for over four years, how confident are we of attracting somebody via normal competition to the post, particularly now, since the successful applicant will have to go in and try to address the situation in south Kerry? If we cannot fill the post through normal competition, the HSE will need to look seriously at redirecting somebody from some other CHO that is performing adequately to south Kerry, rebuilding faith and confidence in the services there. I imagine the people in Kerry are questioning the level of service there at present.

The Minister of State might not be able to speak about the doctor at the centre of all this, but is there any clarification as to whether he is still practising, whether he has been referred to the Medical Council or whether he is subject to any type of investigation or disciplinary action? People need to be aware of the repercussions and the consequences that are there for the person at the centre of all this.

As for the services provided, is the HSE now ploughing resources into this CHO to compensate for years of mistreatment and misdiagnosis? If that is the case, will that have adverse or knock-on effects on adjoining CHOs? As many Deputies here will attest, there is a difficulty in that the waiting lists are quite lengthy and we would be conscious of any potential knock-on effects for adjoining CHOs. I hope the Kerry CHO will get the additional resources it needs to catch up. I hate to use the phrase "catch up", but in this case it has to catch up because it has failed these 240 young people. If that is the case, I know that many of those people will have aged out of CAMHS and possibly progressed to adult mental health services. I would like to know if additional resources will also be ploughed into the area of adult mental health in that CHO.

My last remark is on the Taoiseach's commitment today in respect of a full review across the country. It has to be done. It is necessary. Many of us in our CHOs have concerns, and I welcome the Taoiseach's words in that regard. I just hope and pray that what people are discussing here regarding Kerry is not replicated in other parts of the country.

Deputy Maurice Quinlivan

Now that we are exiting the period of restrictions related to the Covid-19 pandemic, I fear we could soon face a deluge of people seeking assistance for issues related to mental health. The period of the pandemic has challenged us all but, as we are all aware, has been particularly keenly felt by our young people. With such long periods of isolation and remote learning, it is really a credit to the youth of the State how well they coped with restricted living over the past two years. The pandemic placed huge pressures on mental health services which, prior to Covid-19, had suffered years of underinvestment and, as a result, were wholly unprepared and totally under-resourced in both funding and staff to deal with this emergency.

Too often in Limerick it has fallen on volunteers to deal with the consequences. I acknowledge the vital role played by many mental health organisations in Limerick. We have a branch of Jigsaw. It does incredible work in the area of youth mental health. The volunteers of the Haven Hub and the suicide watch teams in Limerick should also be commended. These folks give up their time, including their weekends, to be available to those who are suffering. Without their operating, particularly in the early mornings, I fear how much worse the mental health crisis in Limerick would have been.

The stark reality is that, due to years of underinvestment, CAMHS simply does not have the resources to deal with the influx of contacts in the mid-west region. The wait time for child and adult mental health services has doubled in the past few years. In the past five years the number of young people waiting to access critical community-based mental health services has not dropped below 2,500. This is a damning indictment of the attitude of this Government and the previous Fine Gael Government. I, like many other Deputies, have been contacted by parents facing huge behavioural challenges with their children. Half the battle for parents is simply getting access to mental health services, and the pattern is only getting worse. By the end of quarter 4 of 2019, 188 children and teens were waiting in the mid-west region. By quarter 3 of 2021, that figure had escalated to 364 youths. This is simply not good enough. These are young people in their formative years who need support. The failure to intervene early should concern us all. Issues will manifest and, without early intervention, will escalate and accompany these children into their adult life.

In April 2021 Sinn Féin brought forward a motion on the mental health emergency. One of the key recommendations we made was the establishment of a crisis de-escalation team in every CHO area. It is welcome that such a unit will be trialled in Limerick later in 2022. The scheme will allow for the triaging of contacts relating to mental health by a professional team of paramedics through An Garda Síochána and mental health services. I welcome that very much and I welcome this discussion. Sinn Féin will not be found wanting in supporting the Government if and when it treats youth mental health as a priority.

Deputy Réada Cronin

We call it mental health, but the news from County Kerry shows there is a sickness in the operation of our youth mental services. Dr. Ankur Sharma opened up to public scrutiny what could be serious systemic failures in the youth mental health services and their operation, perhaps at considerable cost to himself. Instead of being commended, it was reported he was asked to take leave, stripped of his role as clinical lead and reassigned to administration. While young people and their families were desperate for help, there was appalling treatment of families and of the doctor who blew the whistle on the system. The treatment of Dr. Sharma would not surprise any whistleblower in Ireland, given this State's treatment of whistleblowers.

I know apologies have been offered to the families. I also know how easy and handy it is to sideline or scapegoat a whistleblower to save a system. I hope the Minister of State is not going to do that. I am glad the Taoiseach has heeded the call of my colleague, Deputy Ward, and has ordered a review. It must be made public how the doctor in question and all doctors in the CAMHS system were recruited and selected. This is public work. The services are funded by public money that is paid for by the public, and the services treat members of the public, particularly those who are extremely fragile and vulnerable. I watched the Minister of State's speech earlier. I know she is aware we are not talking about people with broken fingernails here. We are talking about people who sometimes have broken hearts and broken lives. They need proven expertise.

In north Kildare, parents cannot get a mental health appointment for their children for love nor money. I have spoken to parents and they are petrified. There is a terror that comes into your heart if you are worried about one of your kids. When the parents get that help, they need to know the professional into whose care they are putting their child is properly qualified, recruited, selected and supervised, if necessary. In response to a parliamentary question I submitted last March, I was told by the HSE that vacant posts in Kildare and Kilcock would be filled imminently. I have queried it since because the posts were not filled. Today, it was announced that appointments made to these two posts will be taken up in a few months' time. I do not call that imminent. Where is the urgency? If the appointments have been made, I am relieved for my constituents who are waiting, watching their children suffering. I wish whoever takes up the posts the best. They will be very welcome because they are very much needed.

Deputy Róisín Shortall

From almost two years, our lives have been on pause. We have all been in a kind of limbo and it has been exceptionally difficult. However, for children and young people, this pause has had an especially profound effect. While milestones were missed and the freedom to play and socialise was severely curbed, the crisis in youth mental health accelerated. In fact, it is now at a serious crisis point. Last year, almost 12,000 children and teenagers were referred again or were newly referred to CAMHS community teams. Some 3,357 of them were still waiting to access CAMHS by the end of November. According to the HSE, 1,686 of them were expected to be seen within three months, while the wait time for the remaining 1,671 was completely unknown. There is no plan there to manage the waiting lists. It has been said that having a mental health issue is not like having a broken toe or something like that. A young person with a serious mental health issue needs attention fairly urgently. The idea that more than half of the young people waiting for services have been waiting more than three months, and many of them for much longer than that, is an absolute scandal. We have to face up to it.

We know early intervention is of the utmost importance. All the professionals say early intervention is critical, before the situation becomes much more serious. The kind of numbers I mentioned just cannot be tolerated. While we all appreciate the pandemic and the cyberattack had an impact on all waiting lists, we know the problems in CAMHS predate both of them. For years, these waiting lists have been stubbornly stuck at at least 2,500. That is standard. In some cases, the lists were even longer than that. We cannot make excuses that it was the pandemic or the cyberattack. There is a systemic problem there. Staff shortages, a rise in demand and poor geographical coverage have created a perfect storm, forcing children to desperately seek help in emergency departments, which is probably the worst place they could go. There is simply nowhere else for them to go. According to Children's Health Ireland, CHI, attendances at emergency departments for mental health issues jumped by an incredible 58% over the second half of 2020 compared with the same period the previous year. There is a clear indication the system is fundamentally broken when we have that level of increase in young people desperately needing help and support, and attendance at emergency departments rises by almost 60%. Even when children do attend emergency departments, we know most departments do not provide any assistance. They might keep a patient in for a while but no referral is made. There is certainly no out-of-hours referral for people who find themselves in a crisis. When a young person is brought to an emergency department, it is an absolute crisis. Unfortunately, it seems the country has nothing to offer them in those circumstances. That is the reality for so many young people.

We know that this situation is replicated throughout the country. Some areas are worse hit than others. For many years it has been obvious there is something very wrong in how funding for community psychology services in particular is balanced, or not balanced, and managed across the State. In September 2021, for example, those in community healthcare organisation, CHO, 3, CHO 4 and CHO 8 accounted for 85% of the children waiting more than a year for CAMHS appointments. There is a systems problem there. This raises a point I bring up regularly, which is very important and is highlighted in Sláintecare, namely, that an objective resource allocation model must be pursued. We cannot continue with the practice of allocating resources to whoever shouts the loudest or to an area that is represented by a Minister in government. Resources have to be allocated on the basis of objective measurement. That is why we need the regionalisation of the HSE. We need to know what is actually happening and the level of demand for services in different areas. Nowhere is that more necessary than in youth mental health services.

In CHO 9, which is my own area and includes the communities of Ballymun, Finglas and Blanchardstown, areas of high need, 66% of children have been waiting for more than three months for an appointment. I ask the Minister of State to imagine being a parent in that situation with a child in crisis and having to wait more than three months to get an appointment. It is shocking. We are very much failing these children. What is even worse is the true scale of the crisis is not even fully reflected in the figures. For the countless children and teens growing up in areas where precursors to marginalisation already existed, the situation is far worse. They are at the sharp end of the crisis.

Last year, in my own constituency in Finglas, the Finglas child and family support network published a report that highlighted the considerable impact of Covid-19 on young people locally. It found many young people had lost sight of what was normal between not being able to go to school, see their friends, take part in sports and hobbies or attend youth clubs, not to mention, of course, the challenges many families faced to pay bills and simply to put food on the table. Several professionals working on the ground in Finglas reported that boredom and isolation had led to increased levels of antisocial behaviour and membership of gangs among children as young as 12. It will certainly be an uphill battle to address these types of behaviours. However, one thing is for certain: our approach has to be trauma-informed. The report also flagged concerns about the impact of school closures, especially in instances where school was the only thing providing any sort of structure and consistency in a child's life.

This leads me to the ongoing leaving certificate debacle and the effect it is having on young people throughout the country. It is unconscionable we are having the same conversations for the third year in a row.

This year's leaving certificate students have lived in flux for two years, constantly uncertain and confused about the manner in which their examinations will take place, as if the leaving certificate was not stressful enough already. A 2019 survey of almost 2,700 students found that 75% of leaving certificate students reported suffering extreme stress over the course of the two-year cycle, anxiety being the chief issue for 71%. This was before Covid wreaked havoc on the State examinations and the lives of children. We must accept that running the gauntlet of the leaving certificate is harming our young people's mental health. Meaningful and long-term reform is needed to remove the burden of stress and anxiety built into the traditional model. It is a relic of the past no longer fit for purpose, particularly in a world that is arguably more difficult to navigate than the one many of us grew up in.

This generation of children and young people are the most digitally connected but a CyberSafeKids survey published last September found that 84% of Irish pre-teens between the ages of eight and 12 use at least one social media platform. The research also shows that 93% of pre-teens have some kind of phone, tablet or other smart device. It is clear we as legislators and policymakers are failing to keep up with this pace of change. Young people are digital natives while we are still learning the new language of technology, or at least many of us are. Despite the ease with which they use technology, it does not mean they inherently possess anything like the skills needed for safe and healthy use, especially when social media giants are preying on their insecurities. An investigation last year by The Wall Street Journal into internal research by Instagram's parent company, Facebook, showed worrying links between Instagram use and depression in teenage girls. There is a litany of information that shows the very negative impact many social media platforms have on young people. There is a combination of issues, not least of which is the impact of the past two years. We cannot continue with a system that is not fit for purpose. The Taoiseach said it himself this morning. There are systemic failures and we have to address them as a matter of urgency.

Deputy Bernard J. Durkan

It is very appropriate we are having this debate. We all know from our constituency work the degree to which young people have been in need of attention, support and service support of a mental nature as well as an educational nature in recent years. Remember that we were hit by an economic crash followed by Covid, all of which put a serious dent on society. We tend to forget everything except the most pressing issue of the moment. Young people are at the age when, having come through their childhood, they are looking forward to the future. If they have had a stable home, they look forward with confidence. If they have not had a stable home, they are not so confident.

They then meet challenges and the challenges are many and varied. Poor self-esteem is a regular issue. There are eating disorders and various other pressures referred to by other speakers. Deputy Shortall mentioned social media and the bullying that takes place among both sexes. The extent to which society has time to address these issues is something to which we have to pay attention before it is too late. Young people look for security. They look for something to hang onto. They look for an anchor. Those anchors have not been there. They need to be there and need to be put there as a matter of considerable urgency. It is fine for people to say there are other pressing issues. There are, but these are equally pressing issues. Young people are being beset by drug barons. This has been referred to by other speakers and the Minister of State. The drug barons are ever-present, pushing their wares, ensuring they have a market for their product and bringing young people into that loop. Once they are in the loop, they cannot get out.

I am glad to have had an opportunity to speak. The Ceann Comhairle and I could speak for quite a long time on this subject. Much as I would like to I cannot do so other than to say I am glad to have had an opportunity to speak and I hope we can do something about the issues.

Deputy John Lahart

When the evaluation of the period of Covid gets under way, young people, in fairness to them, will have more questions to ask than any other age cohort, and justifiably so. When they look at the restrictions put on their lives, they will have the most questions to ask. What is interesting with regard to what some of the previous speakers have said is what we would have done without social media over the past two years. We can decry it and deride it and it has serious downsides, but I wonder how our young people would have survived without the ability to interconnect that social media provides. I am not downplaying its downsides or its negatives. The Minister of State should consider instituting a young person's citizens' assembly. It ought to become a regular feature of Irish life and an annual occasion where young people get to tell us what they think rather than us articulating what we think they think. It should be instituted quickly.

An issue I have felt very strongly about for a long time is that there should be a gap year between the ages of 18 and 25. Students should be able to exercise an option to take this and the State could provide meaningful alternatives to college, apprenticeship or work for that period. Those young people could choose to do whatever they wanted to do that year but we should facilitate them taking a year out. I use as an example people I know. Many of them graduated from a college course that was not the first course they began. They discovered after a year what they were doing was not what they wanted to do and that they wanted to do something else. We owe this to them. Over the period of the ages 18 to 25 young people should be able to take a year out to de-stress and see the world. They should be able to take time out to consider and reflect on their future and what they might be able to do. These are two practical suggestions I can give the Minister of State.

Deputy Cathal Crowe

As are all Members of the House, I am appalled at what we have discovered in County Kerry. The Minister of State is a good person with a good team around her. She is securing a lot of funding for mental health and this needs to happen. Two years ago, all of us on this side of the House signed up to the programme for Government. Something I would like to see the Minister of State push in government is the commitment to have a national director for mental health. In 2016, the previous iteration of the Government pulled it. It needs to be there. We need a man or woman leading on mental health in the Department of Health so it is not the poor relation of physical health and that it is up there at all times with full parity and someone leading on it. I ask the Minister of State to champion this in the Department. If the officials are listening, this should go all the way up to Secretary General. This needs to be listened to. We need someone who always has his or her eyes on mental health to ensure there are no slippages.

I was a primary school teacher prior to my election to Dáil Éireann. Year on year the principal would go around to each classroom in the school to ask whether any child was in need of referral, usually to the National Educational Psychological Service, NEPS. In that moment I would have to tell the children to work on the next few pages, scan the classroom and make a decision there and then, knowing what I did about the children and knowing that only three or four could be referred. I and teachers throughout the country are part of the slippage because we allow only a trickle through each and every time. I appeal to the Government I support every week to fund and resource properly the Department so that NEPS and CAMHS have enough therapeutic hours and people so that children do not slip through the net and I do not have to look at John and Mary in my class to choose one over the other and in that moment set their life on an entirely different pathway. It is wrong. Lessons will be learned from this. The Department needs more funding from Government so that we properly put mental health on full parity.

Deputy Alan Dillon

The Minister of State is aware that youth is a time when incidence of mental health disorder peaks, be it anxiety, depression, psychological distress or suicide, but it also is a time at which access to coherent and user-friendly primary care services is largely absent. The key principle underpinning the implementation of youth mental health care is early intervention.

Organisations and individuals have highlighted to me how children and young people have been greatly impacted by delays in access and lack of resources in mental health services throughout Ireland. This is particularly the case at a time when waiting lists for mental health services in the country are very high. In County Mayo we have a two-year waiting list for primary care psychology and a 20-week waiting period for Mindspace Mayo, which is a primary care youth mental health service for 12 to 25-year-olds. This is simply unacceptable. We must be thinking about these and other services children and young people will need to access in a post-pandemic era.

Five years on from the publication of the report on the task force on youth mental health, I strongly advocate that the recommendations be implemented in full. This should include, most importantly, the recruitment of a national lead for youth mental health and a lead for youth mental health for each of the community healthcare organisations, and that includes CHO 2. The high degree of unmet mental health needs in our young people nationwide demands that youth mental health be elevated to a top priority within the healthcare portfolio. National reform and adequate investment in youth mental health will not only substantially improve the health and lives of young people but will also pay for itself and promote mental wealth in all of our society.

Deputy Jennifer Carroll MacNeill

This is a very important debate, especially as we come out of the pandemic but also in the context of what we are hearing in regard to the child and adolescent mental health services, CAMHS, throughout the country. We know as Deputies there have been long-term problems with CAMHS for many years. If anything, this is an opportunity to step in and make the changes that are needed in the long term.

Back in July 2020, the Special Committee on Covid-19 Response met with Jigsaw and other stakeholders to discuss the mental health impact of the pandemic and we heard about the hardship young people are experiencing, primarily because of their isolation, their disruption from school and the isolation from their friends. We discussed the pressures they were under in going back to school, and the leaving certificate pressure in particular. This is one that continues to this day, and we need a resolution on the leaving certificate for this year because this group has been disrupted just as much as groups before them.

I would like to highlight one group of young people in particular, namely, those with epilepsy, who need a backup system for the leaving certificate. If they have a seizure immediately beforehand, they are often required to repeat the whole year to do the examination. It is very important this is resolved.

More specifically in my role as spokesperson for equality for Fine Gael, I have raised an ongoing particular concern about the mental health of young people in the LGBTQI+ community. I am thinking of young people, in particular, who were living at home throughout the pandemic, who did not have their usual outlets for seeing their friends, and who may or may not have come out. If they had come out, they may not have been welcome, as such. They may have lived with particular difficulties where that had not been accepted by their family. That is a very important issue.

I also want to note the ongoing Government commitment to ban, as France did yesterday, conversion therapy. That is a commitment in the programme for Government that I know is being worked on. It needs to be cemented and just simply done.

I also want to highlight the particular mental health challenges and access to services for young people in the Traveller community and for those in direct provision who, in addition to having other structural difficulties through education, which we know of and have spoken about in this House, are also othered or bullied in different ways. It is important that access to services is made particularly easy for them where there have been additional documented difficulties.

I met with a group today about online safety. I am aware the legislation on the online safety commissioner is progressing through the House. It is essential, however, there is a complaints mechanism within that legislation and that it is clear to young people who are flagging problems of bullying and other abuse material that they can see this can be addressed and redressed through that mechanism, and that when they flag problems, they will be taken seriously and addressed.

A gentleman in my constituency contacted me recently in the wake of the tragic death of Shane Lunny to share his own story, which involved at least one hospital visit where, while he sat in the hospital on suicide watch, he literally had to beg for support to be committed to the psychiatric ward. He was discharged at 1.30 in the morning with no money and nowhere to go. Following that, at just 21 years of age he ended up in a treatment centre for addiction issues, which is something. Now, having been three years sober and with those difficult days behind him, it is hoped, he still has a daily struggle with chronic anxiety. Despite that, he considers himself one of the lucky ones because he had been able to access appropriate treatment when he ultimately needed it, albeit with the difficulties he had when initially going into hospital. He is exhausted from battling mental health issues while having to continue to fight and advocate for himself and to navigate long waiting lists along with the financial issues that come with going private and being out of work because of mental health issues.

This is not an acceptable standard for our country and I do not believe the Ministers of State in attendance believe that is the case either. I know of the Ministers of State’s commitment to resolving this. The State has done very well in many different ways, with political and economic stability and recovering through the pandemic, but mental health is one of those areas which we have never got right. We have an opportunity to change that now and to put the investment into it. As my colleague. Deputy Dillon, said, this pays for itself over time. Whether it is perinatal or youth mental health, we know there are particular moments of vulnerability in people’s lives and we know the impact of failure to catch and treat these. Youth mental health is especially acute and important. We are becoming much more aware of that as a community, as a society and as a Parliament. I wish the Ministers of State every success in what I know is their completely committed work to try to resolve as much as possible for our young people.

An Ceann Comhairle

Deputy Tully is sharing time with Deputy Paul Donnelly.

Deputy Pauline Tully

Mental health services prior to Covid-19 were in crisis but it is now an emergency situation. The child and adolescent mental health services and Jigsaw both report an increase in demand of over 40%. Similar increases are relayed to me by community and voluntary organisations working in this area in Cavan and Monaghan. There is an over-reliance on community and voluntary services, with the HSE routinely signposting people while neglecting to increase their funding or not providing funding at all to some organisations.

Poor geographic coverage, a chronic staff shortage, and the fact most CAMHS services still operate from 9 a.m. to 5 p.m., Monday to Friday have led to long waiting lists and to children with complex needs unable to access timely support. One child with anxiety returning to school after the lockdown this time last year was referred by his GP to CAMHS. The services dithered about whose responsibility it was to see this child. This went on for months, with the child’s anxiety worsening all the time before the child was finally admitted into their services, I believe in September. It was from April until September before he was admitted into their services. That caused a build-up of anxiety and waiting time.

Young people have missed so much in the past two years, with many of the services they frequent drastically reduced or closed altogether. These services need to be expanded and better resourced.

Mental health services still rely heavily on the medical model and this does not align with the public health and the psychosocial support approach underpinned in the United Nations Convention on the Rights of the Child.

A child with a diagnosis of autism is being refused access to mental health services. What is that about? I am hearing from parents who are not informing CAMHS their child has autism because they will not be seen. The child cannot then get the proper treatment because the services do not know everything about that child that they need to know. The rate of suicide among adults with autism is higher in society than among those who do not have this condition. Suicidal ideation among children with autism is also regular.

I also want to highlight the lacuna that was pointed out by the Mental Health Commission between the heads of the Bills to reform the Mental Health Act and the Assisted Decision Making (Capacity) Act. The mental health Bill is set to provide for 16- and 17-year-olds to give or withdraw consent to treatment in mental health service if they are deemed to have capacity. The heads of the Bill state the Assisted Decision Making (Capacity) Act would apply for the purpose of conducting the necessary capacity assessment. However, the Act does not provide for decision supports for those under 18 years of age. This needs to be addressed promptly because the Assisted Decision Making (Capacity) Act is vital for the ratification of the optional protocol of the United Nations Convention on the Rights of Persons with Disabilities.

Deputy Paul Donnelly

I welcome the Taoiseach’s call for a nationwide audit of CAMHS because the report today makes for shocking reading indeed. Thankfully, the stigma around mental health is lessening in recent years, thanks to societal changes and organisations in my own area such as Jigsaw Dublin 15, Suicide Awareness Dublin 15, and other similar organisations throughout the State. Emergency medical services are 24-7 and we must have mental health services that are 24-7.

We also need to assist community organisations to provide mental health supports and facilities. It is about getting that first responder support and ongoing support but they also need connections outside in the community, and that is why dance, music classes, youth clubs and sports facilities all add to this. I have repeatedly asked for extra funding for Genesis Psychotherapy & Family Therapy Service in Corduff. This serves the entire Dublin West community. For a small investment, it could provide an extra 4,500 hours per year, bringing the service up to 9,000 hours. It has a capacity at the moment and a waiting list of about six to eight weeks which could be easily solved by a relatively small amount of money.

I will also mention another simple change that could help parents and supports. I am aware of a family who were waiting years to get a service for their child with autism. After great worry and stress they eventually got the service. Unfortunately, however, they lived on the boundary between two different services areas and they were told, just as they were about to get the long-awaited supports, that they were not in the catchment area, a mistake had been made and they had to go to another area. They were then put on the waiting list for the other area after waiting years on the previous one. It was not the fault of the family. They did what they were supposed to do and they waited. Unfortunately, they had to wait again for that service, and are still waiting for it. That is just bureaucracy gone mad.

The other situation I will describe involves a young lad I worked with, and I worked for Tusla for many years. He went to his local hospital three times. Each time he was sent away with an appointment for three weeks in the future, after waiting up to 14 hours on some occasions. The third time he left the hospital he went to the local park and died by suicide. I am sure every community has a similar story. We are talking about youth mental health and we just have to do better. We have to invest and support these young people because they are in a serious crisis.

Deputy Gino Kenny

We all were young once. Growing up is a difficult business in some ways. Some of us breeze through it and some of us do not.

An Ceann Comhairle

Some of us never get there.

Deputy Gino Kenny

Okay. Sometimes it is a generational thing. It is difficult, especially now. Being young now is very difficult. It brings its own challenges. One of them is in regard to intervention. We say that when a young person needs intervention it has to be there because early intervention is key. Most of us would say that intervention by mental health services for young people in this country is very arbitrary. If one is waiting more than three months for intervention, and in some cases for six months or a year, there is something very wrong.

I was a member of the Oireachtas Joint Committee on the Future of Mental Health Care in the last Dáil. It issued a report in 2018. Like most things, reports can gather dust. However, I looked over it before I came to the Chamber and one of the recommendations was with regard to the domination of medication as a treatment option. This is very pertinent given what is happening in south Kerry. Overmedication was compensating for the lack of services. That is key to what we are discussing today because there are many other interventions young people can get aside from medication. In the last 25 years, the prescribing of medication, particularly for young people, has quadrupled. That is very worrying.

With regard to primary care psychological services, and I will have to be very careful here, they are not meeting the needs of young people at present. In the last year those interventions in CAMHS have increased by at least one third, so there is a demand. Obviously, the pandemic has caused quite detrimental things for all of us. Young people have shaped that in their own way, but intervention is key.

Finally, the key thing in this debate is resources. The Minister of State knows that Ireland spends 5.2% on mental healthcare. The European Union, the WHO and Sláintecare say that should be doubled. To do that it would be necessary to invest an extra €1 billion in mental healthcare. The current €1 billion is welcome but it needs to be much more.

Deputy Mick Barry

I was reading some of the online debate about the situation with CAMHS in south Kerry. One comment struck me as if I had been punched on the nose. The person said that if anybody had listened to the teenagers subjected to CAMHS, this would have been discovered years ago. There was significant harm to 46 children. The harm included putting on a lot of weight, increased blood pressure, the production of breast milk and sleepiness during the day. According to the report there were unreliable diagnoses, inappropriate prescriptions, poor monitoring of treatment and poor monitoring of potential adverse effects. According to reports, a staff member reported having heard that the person in question was running a private treatment service from the person's home, sometimes seeing people privately up to midnight, and was also working in a private clinic in another country. The report said that the doctor worked extra hours and was observed to be very tired at work, but this issue was not addressed. If that is true, it shows the madness of a two-tier health system where doctors try to hold down a job in the public health service and a job or jobs in the private sector at the same time.

Second, there were clearly major issues with supervision and oversight. The review states that no system was used to check the prescribing of medication or the quality of service. Clearly, a far more radical review and change are necessary. I want to highlight that the review recommended that children and their families should be invited to be part of the governance structure of CAMHS. I strongly support that recommendation.

Mental health services have been described as the Cinderella of the health services with 6% of the public spend, compared to more than double that in some EU countries. We have to double the spend immediately in mental health services and in youth mental health services. It is unacceptable that there were 3,357 young people waiting to access CAMHS last November, with 221 waiting for a year and more. It is not all about finance, although finance is a huge part of it. The spend must be doubled immediately.

Deputy Richard Boyd Barrett

The scandal that has been revealed in Kerry, involving overmedication, losing files and children and young people with mental health issues not being looked after properly, is not at all unique to Kerry. In 2018, psychiatrists in Wexford, including the consultant in CAMHS, resigned, saying the service was totally unsafe. Dr. Sharma said he was sidelined because he expressed concerns about the overmedication of children. I know of other people, and I will not mention their names, who were witch-hunted in CAMHS by the HSE because they protested at the level of overmedication. Overmedication was compensating for the lack of staff and resources. That is what is happening, and it is a scandal. We have to monitor this.

It is self-evident that there has been a stratospheric increase in the medication of children in this country and across the world over recent years. That is what is happening. If one wants to help young people with mental health problems, one starts, as Deputy Barry said, by talking to them. That is the essence of psychology, psychotherapy and proper psychiatry - talking to them and asking what is wrong. However, one needs qualified people to do that, and we do not have the qualified people. That is the problem. It starts at primary care. If a young person is having difficulties, he or she goes to the GP. What does the GP do? Effectively, there are no primary care services to which the young person can be referred. We do not have enough psychologists. We do not have psychology departments in our schools, which we should have. Many other countries have them, including the United States. We do not have a staffed primary care mental health service, and CAMHS are nowhere near what was promised in A Vision for Change years ago. We have failed so spectacularly on A Vision for Change that we revised it down in terms of staff numbers to cover up our failure.

We removed the original targets for psychology in A Vision for Change completely. That is what is going on. It is a running scandal and those who raise that scandal are witch-hunted in the HSE because nobody wants to admit the truth. Children are suffering because we have failed.

We might then think about what we must do but perhaps we should start getting some of the psychologists, occupational therapists and speech and language therapists we need. However, we make it as difficult as possible for people to qualify with doctorates in psychology. We charge them €15,000 in fees so they drop out. We give no funding whatever to educational and counselling psychology. We give a little bit to clinical but none to educational and counselling psychology. All our young psychologists, after getting their basic degrees, go to Utrecht in the Netherlands. They get proper jobs over there and do not have to pay massive fees to qualify in psychology.

That is the essence of the problem, which has been known for years. It was identified in A Vision for Change more than a decade ago. We have failed and failed again, and as a result we end up overmedicating our young people. We have seen the terrible consequences of that in Kerry. We must get real and start having psychologists in schools. We must staff the primary care mental health services and the CAMHS we need. We must of course address some of the big issues by listening to young people; they would tell us what matters affect them.

Deputy Emer Higgins

If we definitely know one thing, it is that our local and national services would not be able to provide the life-changing and life-saving services they do without investment and funding. We need more funding in order to give them more means to help more people, particularly more young people. We know the Covid-19 pandemic has led to a spike in young people accessing mental health services and I welcome the €10 million mental health budget intervention in response to Covid-19. With that rise in people accessing mental health services, we have seen a further increase in waiting lists.

Waiting lists are often part of the struggle cited by young people looking to access mental health supports. Those waiting lists are a by-product of demand on an already overloaded service but in the case of mental health, when people need help, the last thing they need to hear is that they must wait to get help. It takes much courage to ask for help when a person is suffering with his or her mental health. It breaks my heart when I speak to parents who see their children going through this process, suffering with mental health problems and lost somewhere on a waiting list. They feel hopeless.

It is in this regard that I welcome the specific funding to continue the enhancement of CAMHS and the provision of two new CAMHS mental health hubs, along with the dedication of €6 million to expand the capacity of community mental health teams nationally. I hope this reduces waiting lists and improves access to our out-of-hours supports.

I know many people have raised another area today and we should all continue to do so. This is the need for better access to eating disorder supports for young people. We have seen a really dramatic increase in the number of people requiring support for eating disorders since the pandemic began and we know the matter is particularly relevant for young people. Last year almost €4 million was secured for the national clinical programme on eating disorders. There was a commitment to establish three new specialist eating disorder teams and the completion of three existing teams, and that will make such a big difference in treatment capacity. In budget 2022, the national clinical programme on eating disorders secured an additional €1 million for the development of extra eating disorder teams. That is a really good start but we must continue to invest further.

Many parents and young people find difficulties in the transition from child to adult when accessing services for mental health. It is a major problem because, sadly, that is where young people fall through the cracks and become even more vulnerable. Getting a young person the help he or she needs when he or she is seven years old or 17 years old should be straightforward. The priority should always be placing them in a programme or providing them with treatment which is suitable for their age and, more important, does not put such people at further risk.

This year, we have a record budget of €1.15 billion for mental health. That includes an historic increase of €47 million on last year and it is so welcome for organisations working on the ground. It is needed for people accessing services. I will take a moment to acknowledge the services on the ground in my area that are doing amazing work with young people. These are organisations like CAMHS, Pieta House, Archways, safeTALK, Aspen, the Beacon of Light, Somers and the Clondalkin Addiction Support Programme, to name just a few. In recent years, unfortunately, we have seen the withdrawal of some services. I am thinking particularly of Jigsaw in Clondalkin and I really hope the Minister of State might look at that further because we must support our young people.

Deputy Paul McAuliffe

Like the previous speaker, I welcome the Minister of State's leadership in the area of mental health. I know it is something she understands and has championed while making changes within the Department. Looking at the figure of €1.1 billion, one might think it a huge amount but this is a huge and challenging problem.

There is a commitment in the programme for Government to have a director of mental health within the HSE and €1 billion deserves a director in the area. That €1 billion deserves somebody with clinical and administrative responsibilities. Not only would such a person be a champion to join the Minister of State on mental health but he or she would also work for the delivery of services.

For too long we have relied on charities and voluntary groups. We must get back into the business of mental health being really core to the primary care services we deliver. Both the Minister of State, Deputy Butler, and her colleague the Minister of State, Deputy Feighan, in some ways represent the spectrum that exists, taking in everything from wellness to really acute mental health problems. We have lifted the stigma on mental resilience but I am not sure we have lifted the stigma on really acute mental illness. We have a long way to go.

I welcome the €1 million community fund and there will be plenty of groups in my area, including the Finglas Support and Suicide Prevention Network, Finglas wellness groups and groups in Ballymun that will apply for that. There are two areas we must consider. The school inclusion model in education is bringing therapies into our schools and we must think about how we can fit mental health into that. The second area is the ambulance service, which should have 24-hour access to support for mental health. It is provided in the mainstream health service through the ambulance service and it is a key link. If we go to the Dublin Fire Brigade and the National Ambulance Service, they could play a role as a bridge in the accessing of mental health services. I thank the Minister of State for the work she has done.

Deputy Neale Richmond

I greatly appreciate the opportunity to speak, albeit briefly, in this extremely important debate. There are many areas from which one could approach this debate but there is only one I will raise. Following my colleague Deputy Higgins, I will speak to eating disorders, which predominantly affect women and young people. The average age for the onset of anorexia is 16 and for bulimia is 18. The Minister of State and I have corresponded on this topic many times and dealt with a number of harrowing cases. The cases we have spoken about highlight my concern in the area and a crucial factor.

We have spoken about the need for funding, which is absolutely correct, but additional funding is absolutely pointless if services are not joined and there is a lack of joined-up thinking when it comes to dealing with eating disorders in this country. There is a lack of joined-up thinking when it comes to geographic assessment and the fact that everything is set in urban areas. We are dealing with young people who need to be close to their parents, family support groups and the resources they need. Adding two or three hours of travel or a residential stay two or three hours from home will not help.

Additionally, people may be caught in the bind of being too young to be considered an adult but too old to be considered a child and they cannot get admission to a hospital, which they need. These are the types of cases presenting every day to all our offices, regardless of party. It is not just the individuals who are suffering because, most cruelly, parents are looking - usually at their daughter - wasting away in front of them. They are wasting away because they cannot get a bed or somebody on the other end of the phone.

We have spoken about the monetary allocation, which is welcome, and none of us will refuse to welcome that additional bed space, hours or funding. It will be all for nothing, however, if we lose yet another young person to death arising from an eating disorder. The numbers suffering from eating disorders increase every year, particularly since the onset of the pandemic. Sadly, eating disorders have the highest mortality rate among mental health illnesses.

In closing, my appeal is to make sure that between the HSE, primary care and all services, there is an actual genuine clarity, so when the distressed parent makes the call or the young person approaches the doctor, there is a rapid plan to get them the care they need as quickly as possible, because as soon as they get that care it gives them a much better chance of recovering and, more importantly, living.

Deputy James O'Connor

In the very limited time I have, I want to outline some of my own concerns as a young person of 24 years of age. I have discussed this issue with both Ministers of State previously. I have a strong degree of concern about the rapid increase in cocaine consumption in Ireland, and the knock-on impact this is having on the mental health of so many young people. Within this debate there are many different factors that feed into people's mental health and their self-esteem that can cause increased anxiety and pressures on young people. Something that absolutely rings true to me is that throughout the pandemic many younger people have been using drugs more often, from what I have seen. I have a deep concern about this. In bringing this issue to the House I also want to bring some degree of a solution. I believe that we need to see a strong national campaign on the airwaves, in the media and on social media that targets this particular issue and tries to increase awareness about it among younger people and their parents. If there is anything I would like to see being taken away from the debate, it is this. This problem will cause more issues in the future. I commend the Minister of State, Deputy Butler, on the work she has been doing in the Department. It has not gone unnoticed. I am aware of how much she is committed to this issue. The Minister of State has worked very closely with me. Perhaps the Ministers of State, Deputies Butler and Feighan, could take that issue away from the debate today.

Deputy Patrick Costello

While I agree with the calls by many of the Deputies here about the importance of increased funding, much of the increased funding going into CAMHS will not make a blind bit of difference if we do not fix many of the structural problems that are there. In my experience as a child protection social worker trying to interact with CAMHS, the services are just not fit for purpose as they are currently put together. I have heard other GPs complain about standard operating procedures being inconsistently enforced and needlessly restrictive. They are drawn in such a way that they can be used as a gatekeeper to stop young people coming in through the doors and to keep people off these waiting lists.

I have seen, dealt with and supported constituents who have had referrals to CAMHS refused, with no reason given. When I go looking for a reason, all of a sudden they get offered an appointment. As a social worker I have dealt with young people who are experiencing very real pain and trauma, and they have been told by CAMHS "No, no, this is simply behavioural. It does not fit the profile of this service." I have seen cases where young people are referred on to community services that do not exist. If CAMHS is not there to support young people in need in a time of trauma and a time of mental health difficulty, what the hell is it there for? In my experience, and I have no doubt that this is also the experience of social workers across the State, CAMHS is simply gatekeeping and trying to keep referrals away from the service. In the past I would have said that if one could not use medication, they did not want to take it. Now, this recent report in Kerry is very worrying particularly in that vein.

There are other problems. CAMHS provides automatic discharges if a young person does not engage. This is a terrible policy because it ignores homeless children who may have difficulty engaging in geographically based services when they do not have any geographic home. It ignores the difficulty of young people in trauma and mental health difficulty who cannot leave their room. CAMHS has refused to meet with them. I have been on the phone begging CAMHS staff to leave their offices and to come to meet a young person, whether in their home or at a neutral third venue, just to start building that relationship and to bring them into the therapeutic clinic, but CAMHS has refused to do so.

Even if one can overcome all of these things and overcome all of this gatekeeping and attempts to restrict people, there are huge waiting lists, as other Members have spoken about. If one can get through the waiting lists, quite often at the end of them there is no service. I look back at my own time as a student social worker when I worked briefly in CAMHS. A lot of the work I did was around autism spectrum disorder assessments. At the end of it, we would present the diagnosis to the family and the family would ask "What services do we get now?". We would shrug and say "Well, we do not do that, here's the community service." Again, the community services just do not exist. The joined-up services referred to by Deputy Richmond are just not there. The standard operating procedure, the referrals process and the gatekeeping by CAMHS render CAMHS as it is currently operating simply not fit for purpose. All the money in the world will not change that unless we drill into those issues too.

Deputy Mairéad Farrell

Galway, like every other county in Ireland, has been deeply affected by the mental health crisis in our young people. This is probably the biggest issue that young people raise with me personally, which is a good thing in the sense that young people are being very vocal in relation to mental health services, or the lack thereof, and are looking to engage with us in that debate.

After being elected to the Dáil I took a particular interest in and focus on the crisis in the mental health services in Galway, as the Minister of State is aware. I conducted a survey of young people and people across Galway who have used, and indeed not used, the mental health services in Galway. I have met and spoken to a number of mental health service providers in Galway. One thing that came to the fore among the people who engaged directly with myself, through the survey or in other ways, was the availability of mental health services outside of normal business hours. There was a particular focus on this, and a lot of people felt that they had no option other than to attend at an accident and emergency department, when they felt that perhaps the accident and emergency department was not the appropriate place for them to go at that time.

There were a variety of different responses from the people who spoke to me. One person said that in multiple instances they were turned away from the accident and emergency department after the GP had recommended them to go there. Another person reported that the accident and emergency department advised them to wait until the mental health clinic opened, but they left and felt vulnerable without support. Others said that they went to the accident and emergency department and that they had a great experience. The wide array of experiences is not surprising, but the reality is that people felt they had no other option at that point.

Figures recently released by my party colleague Deputy Ward indicate that there were not sufficient levels of staff such as liaison psychiatrists in our emergency departments. This adds more to those concerns and the fact that people do not have any other option, the concern being that a relevantly qualified person may not be available to assist the person who walks through the door.

Another issue that concerns me is the fact that young people in Galway had the highest waiting times in the State for an appointment with Jigsaw, with some people waiting up to 20 weeks. The Minister of State will be aware that as an adult 20 weeks is a very long time - it is five months - but for children that feels a lot longer. It can take a significant amount of time for a person to come forward to say that they need help, but to have to wait that length of time really adds to it. This really needs to be tackled.

Deputy Ruairí Ó Murchú

Whether we are dealing with youth mental health services or adult mental health services, it only works if we have every slot in the process that is necessary. We have all spoken about our own constituencies and constituents who have come to us and cannot get appointments, assessments or follow-up services. Some of them will have had difficulties in how they were treated by the service, and the services will have their own difficulties in that they do not have the positions. Members have spoken about clinical psychologists and the fact that there is a difficulty in them getting the qualification. There has been no facilitation from the State in looking at filling a need where it is there. The State does not go out of its way to facilitate people who want to get there so we can provide the services that are absolutely required by our young people. Most speakers here tonight have referred to the disaster in the mental health services in Kerry, and unfortunately there is a question mark for those who work in CAMHS altogether.

My greatest difficulty has always been for those people who could not access services. As Deputy Farrell said, people do not know whether they should go directly to a psychiatric unit or directly to an accident and emergency department. Generally, the result is not what it should be. This is not to take away from these services. We all know that we are failing, at a community level, to deal with it and that we are not providing those initial services.

We have talked about eating disorders and what services we do not have. Sometimes, it is a lottery in terms of where one lives and what services one can access. Sometimes, the relationship between various parts of the health service is not always what we would like it to be. We need an overhaul of that.

I will not deal with the issue of addiction and the fact there was a recent report on colleges, but it happens a hell of a lot earlier. Children can get access to drugs, from cannabis right through to cocaine. We need to provide a service that is fit for purpose.

Deputy Cathal Berry

I thank the Ministers of State for their detailed opening statements. I am very grateful for the opportunity to speak on this important topic. Considering what we have all been through as a people over the past the past two years, I cannot think of a more appropriate topic to discuss tonight because it is a crosscutting issue that affects every party in the House and every home in this country. We all know where the problems are. Rather than listing all of the problems, I will focus on solutions which, if implemented, would have a disproportionately positive effect on the situation regarding mental health, in particular youth mental health.

My first point relates to parity of esteem. There have been improvements over the past few years, but mental health and, in particular, youth mental health, still does not enjoy the same status as physical and general health in our public health system. It was mentioned that €1.15 billion is going into mental health services this year alone, which is a substantial amount of money. However, it is less than 6% of our health budget. The view of the WHO is that 12% of a national health budget should go towards mental health. The Sláintecare report recommended 10%. I am conscious of some of the comments made during this debate. The health budget is substantial. I am not asking for more money for health. Rather, I am asking for a greater pro rata prioritisation for mental health. That is a reasonable thing to ask for. Again, this is not about income, but rather outcomes.

If there is extra money for mental health services, the first thing we have to do is, as colleagues mentioned, focus on mental health infrastructure in this country. Young people who present in crisis to an emergency department should be treated like a paediatric patient in that there should be a separate channel for assessment and waiting for psychiatric patients. The idea of having someone who is experiencing an acute psychotic episode mingling with general patients for four or five hours on a trolley is asking for trouble. We need a discreet and separate channel to deal with psychiatric patients from an emergency health point of view.

We need properly resourced crisis teams in our hospitals. Other Deputies mentioned the need for liaison psychiatry. When I talk about a crisis team, I am not talking about a single exhausted clinical nurse specialist, but rather a fully staffed multidisciplinary team working 24-7. That is the standard of care that is needed.

My next point concerns the mental health lead for the HSE, on which I agree with the Ministers of State. They asked for, and have, our full support. The Regional Group proposed in a motion last summer, which was accepted, to create a new appointment in the HSE for a dedicated lead. I have an open question. I do not think the Ministers of State need our support. I do not think primary legislation is required, but the Ministers of State can correct me in their reply to this debate. It is entirely within the gift of Paul Reid and the HSE to create this appointment and give those working in mental health a seat at the top table to make sure they get their just desserts. That is what we would do with the additional money.

We also need to focus on community mental health. I am happy to hear the Minister of State, Deputy Feighan, mention social prescribing, which I am a big believer in. We should not over-medicalise everything. There are serious mental health issues and diagnoses, but a sizeable minority of mental health presentations can be dealt with in the community. Social prescribing is about encouraging people to join clubs, art societies and engage in physical fitness, and also de-medicalise and de-stigmatise mental illness. It is all about building up people's resilience and confidence. Very few people mention the key component, namely, self assurance and people being happy in their own skin, which is their real armour against physical and cyber bullying and anything else that is thrown at them. From a community perspective that is important.

I am glad Jigsaw and SpunOut will establish additional teams around the country. The Minister of State, Deputy Butler, mentioned that those services have 66% coverage across the country, which begs a follow-up question. When does she envisage that we will hit 100%? Is there a plan to get from 66% to 100%? Perhaps she could comment on that in her closing statement.

My last point concerns recruitment and retention. We have not had time to read in detail Dr. Maskey's report on the CAMHS service in south Kerry. He deserves much credit for it, as does his team. There were a multitude of factors at play, which I totally accept, but by far the most dominant was a lack of clinical governance, oversight and supervision. If we do not have clinical consultant psychiatrists on site we will have problems. If we get the people right, the problems will melt away. We cannot have supervision if we have no supervisors.

One takeaway that is deliverable is the establishment of a clinical lead in the HSE from a mental health point of view. People are well capable of speaking for themselves, but I do not detect any resistance to that in the Chamber. Can the Ministers of State indicate in their closing statements when they envisage this person could be in place?

Deputy Michael Lowry

The stories of growing up in Ireland in the 1960s and 1970s sound like fables to the young people of today. Life in those times revolved around the home and school, which were not always safe places. It was the era of children being seen but not heard. Poverty and hardship were rife and young people bore a significant brunt of the suffering. It was uncommon for young people to receive any form of help for mental health problems during their formative years. In reality, the form of help available was not something anyone would willingly seek out. The result was that the mental health scars inflicted on young lives during that era were carried through to adulthood, where they manifest themselves in myriad problems people carried with them throughout their adult lives. The damage done to people in their youth became the foundation for the future. Ireland has come a very long way since the 1960s and 1970s. Thankfully, the young people of today do not have to battle alone. They are seen and heard. They have a growing support system, but the fact is that the support is not capable of reaching many of the places where young people need it most. Across Tipperary, an area with which I am familiar, there is a serious problem in accessing mental health services.

The information contained in the mental health reform document makes for stark and distressing reading. The number of children living in abject poverty without access to education, unable to receive vital medical care for physical health issues or without a secure and safe place to call home should make every one of us in the House and everyone involved in public life hang their heads in shame. Saying that there is still more we can do is a major understatement. Until we have helped to improve the lives of all of these children and those who come after them, our duty of care and work will never be done.

If they have not already done so, every elected representative should be encouraged to read the Pathfinder project on youth mental health. The aim of the project is to establish, on a statutory basis, a cross-governmental unit. The objective of the unit would be to evaluate and assess the full spectrum of youth mental health issues. It would need to examine the appropriateness of a number of issues, ranging from assisted decision-making to the use of electroconvulsive therapy for young people. It also needs to examine the propriety of treating young people in adult psychiatric settings and the adequacy and suitability of existing services. In short, the project aims to bring our services for the treatment of mental health up to date and in line with countries that excel in providing services for their children and young people. It is nothing less than the young people of this country deserve and need.

Youth mental health is a bigger issue now than ever before. It is estimated that one in three of our young people in Ireland will meet the criteria for an anxiety disorder by the time they reach the age of 18. This is a shocking and frightening statistics. It suggests that every home in this country will have a young family member suffering from some level of unmanageable stress or some form of anxiety that could potentially impact on their future lives.

We have these predictions and we have the awareness. We also have some wonderful support systems already in place which are continuing to grow and expand. Furthermore, we have the opportunity to address the issue by means of a united approach and a statutory solution. We can do much more to support our young people. As adults, we must take time to see the world from their perspective. Unless we do, we will never understand it.

Many young people suffer trauma and mental health problems because of pressure to succeed at school. Not every child is academically inclined. Many grapple with some subjects. Class sizes in Ireland remain above of the European Union average. Teachers are not superhuman and cannot ensure that all pupils stay at the same level. Feelings of inadequacy begin to take hold in young people. Confidence in their own abilities is shaken. Anxiety and stress take root. Parents and teachers must be conscious of this and advise that help is sought if the need is seen.

Outside school, the pressure can continue. Mobile phones have become a weapon in the hands of some young people. Bullying and shaming are rife. This can be carried out anonymously which makes an impressionable young person suspect that everyone is targeting them. They begin to feel worthless and different. Feeling different as a young person is detrimental to their mental health. At home, there can be pressures within the family - financial pressures, social pressures and family problems. Their home which should be their safe haven from the world becomes a cauldron of pressure and unhappiness. These are some of the reasons that one in three of our young people will develop an anxiety disorder.

Thankfully, we have excellent service providers in Childline, Jigsaw, BeLonG To , Reachout, SpunOut and CAMHS. The report into the south Kerry CAMHS operation is disturbing and undermines much excellent work by CAMHS teams across the country. I welcome the national audit of all those mental health services which is to be undertaken by Government. These services need our continued support. Demand for services is increasing exponentially. Without them, our young people would be cast adrift.

I pay a special tribute to Comhairle na nÓg. The Thurles sub-group has been designated with the theme of mental health. Recently, members of that group took the initiative to invite local Deputies to join their meetings to discuss local and national events, and ways in which to reach and engage young people in our community. Unfortunately, Covid restrictions prevented their participation in an awareness video to mark the very welcome opening of Jigsaw in Thurles. However, their willingness to reach out and address matters of importance to young people is to be applauded. We should all share the objectives of Jigsaw. Our vision is for an Ireland where every young person's mental health is valued and supported.

An Ceann Comhairle

I call Deputy O'Dowd, who is sharing time with Deputies Ó Cathasaigh, Murnane O'Connor, Brendan Smith and Christopher O'Sullivan.

Deputy Fergus O'Dowd

This is an extremely important debate. There are very serious charges here. It shows an absolute failure of the system to protect and to look after these children and their parents. Significant harm was suffered by 46 children over a four-year period, which is a lifetime for somebody with a mental health issue and their family. I question the supervision. Who is ensuring that the prescriptions are right? Who is watching them? What are the pharmacists and GPs doing?

A friend of mine who is a pharmacist told me that most of the medicine now comes already filled up and all he needs to do is put in distilled water. He said that his job is to ensure that doctors are providing the right prescriptions. That did not happen in this case. That is a serious charge and it needs to be dealt with. GPs also needed to answer for this, as do politicians here in the Oireachtas. This is a serious issue and it is not acceptable that it went on for so long, and was not identified and acted upon.

I agree with much of Deputy Lowry's analysis. Young people in my town are growing up in an area where there is a very serious drug problem and serious violence. A person who was a minor was murdered and his body was dismembered in our own town. There is enormous trauma for young people. This is not just in Drogheda, but throughout the country. We need a state-of-the-art system that works for them so that they can get support and get help. The professionals need to reach out to families and ensure they are looked after.

I acknowledge the work Government has done regarding the criminality and other serious problems in Drogheda. I refer to the Guerin report. That has been dealt with very effectively by the Minister for Justice, Deputy McEntee, the Minister for Education and so on. People in communities are suffering as a result of drug abuse and crime. There are serious mental health issues arising in young families. The normality for young people is a hell because they have nowhere to go. They cannot even say where they are from because in many cases their communities have such a bad name.

If anything comes out of this, it needs to be change on the part of the professional bodies. They all need to tell the Minister of State what their plans are to deal with this in the future. These things need to be reviewed, either on a quarterly or whatever is deemed an appropriate basis. Most importantly, we must reach out to the communities where mental health problems are growing and not reducing, where crime is rampant and drugs are the order of the day. We need to change it practically. I hope this debate will help that change.

Deputy Marc Ó Cathasaigh

It is important and timely to have this debate on youth mental health, particularly as we emerge from the Covid pandemic. It is a tough time to be a young person. I made what I hope are the majority of my mistakes at a time before social media and before digital cameras were ubiquitous. How difficult it must be now growing up when young people are constantly trying to compare themselves against unrealistic norms that are constantly presented to them. Even though it was there before the emergence of Covid, the pandemic has exacerbated matters because children and young people have not had the level of social engagement that would be normal for people of that age. They have retreated to their bedrooms and retreated to social media.

We need to realise and address the fact that the algorithm is nobody's friend. The algorithm just feeds on the users' attention. It will just show them more and never tell them that they need some sleep. It will never be concerned about what they are viewing. It will never take them aside for a chat. It will never worry that they our increasingly entering an echo chamber where they are just hearing the same views back. We have all experienced this: it has a polarising effect and it hardens our language. At such a vulnerable time for young people, we need to address that. We need to acknowledge the level of difficulty and the level of scarring that will have occurred over the period of the pandemic.

We have got better at talking about mental health. Our young people have a vocabulary that I would not have had at their age. However, we are still not great and we still need to provide services.

There is an urban-rural divide here. For young people growing up in the city, it is easier for them to find their tribe and they have more choices. The Minister of State knows the area around Dungarvan, Tallow and Cappoquin very well. It is more difficult for people living in those areas to access the services they need. Even in a physical sense there are not as many services. If people need to travel to access services, it makes it more difficult and it is more difficult for them to find their tribe in that way. In addition to addressing the scarring caused by Covid, we need to invest in mental health services, not just in our cities but also in rural locations where it might be more difficult for young people.

Deputy Jennifer Murnane O'Connor

I am very happy to see us returning to normal. As we see the pandemic in the past, evidence is emerging of another pandemic: one in mental health. We need inclusive and responsive mental health services. I welcome the energy the Minister of State has brought to this matter. I know she is prioritising mental health. I am fully aware of the work she is doing. This year will see another record budget of €1.15 billion for mental health, an increase of €47 million on 2021. That specific funding is to enhance child and adolescent mental health services and I cannot overemphasise how vital this is.

Before the pandemic, children and young adults with mental health difficulties were already struggling to access the basic supports needed in order to stay well. Covid-19 has made this worse and those who work in the area report how thousands more people have come forward to access mental health services during this difficult period. Jigsaw, Ireland's main youth mental health charity, has seen a 400% increase in demand since the pandemic began. Children's Mental Health Week takes place from 4 to 11 February. It will be a week in which we recognise how mental health has come to the forefront for children during the pandemic.

The 19% reduction in the number of young people under 18 years waiting more than 12 months to be seen by primary care psychology services, which followed the allocation of €4 million in funding last August, is welcome but much more needs to be done. I agree with the Ombudsman for Children. Placing children and young adults into mental health facilities designed for adults must stop and must never be an option. I know the Minister of State is working on this issue. In 2019, there were 50 such admissions while in 2020, there was 27 such admissions. The latest data from the HSE for 2021 indicate that this year the number of such admissions will be lower than the 2020 rate. We should have no such admissions, but I note this matter is a priority for the Minister of State.

Members have spoken about CAMHS, which has serious issues that need to be addressed. The HSE partnership with SilverCloud on a national roll-out of digital cognitive behaviour therapy is very welcome. While speaking about youth mental-health, I cannot but mention the leaving certificate. While I could not attend the protest organised by the Irish Second-Level Students Union last week, I support the students. Their voices are important. This is about their lives. Significant disruption has been experienced by students who were due to take their leaving certificate examinations in 2022 and we need to engage on this issue as best we can. I welcome the Minister of State's commitment. I know she has done a lot of work in this area but there is more to do.

Deputy Brendan Smith

On 21 October last, I spoke in the House about a young man who at that time had recently lost his life. That fine young man was Eden Heaslip, who was 18 years of age. He lost his life following persistent bullying. At the time, Eden's parents, brother and sister spoke on our local radio station about how their family member had been subjected to persistent and different forms of bullying and that they were anxious for the statutory agencies and Departments to take a new approach to the whole crime of bullying. They appealed to the Government to put in place measures across Departments to ensure a cross-government and cross-agency approach which would properly address this serious issue. Sadly, many young people are bullied persistently. They need support.

Last week, Eden's parents, brother and sister spoke with grace and dignity on the “Prime Time” programme on national television. They spoke movingly and it was heartbreaking to listen to their story about a fine young man and what Eden and his family had been subjected to. They outlined the trauma that Eden experienced. On this evening last week, I spoke to An Taoiseach, the Minister for Education, Deputy Foley, and the Minister of State, Deputy Butler, about the need to listen to families and family members who have, unfortunately, gone through such trauma and suffered so much. What they want is that no other family will have to go through the suffering, hardship and trauma they have gone through and are going through.

Agencies and politicians learn by listening to people who have suffered and gone through the grieving process. Fr. Jason Murphy, a noted chaplain and deputy principal of a large second level school, also spoke movingly on the "Prime Time" programme. He has experience of dealing with young people who have been going through trauma. I appeal to the Minister that at cross-government level, we listen to the families who have, unfortunately, gone through so much. Their one ask is that measures are put in place to ensure no other family will be subject to the suffering they have gone through.

Deputy Christopher O'Sullivan

The Minister of State will not be surprised to hear that west Cork is not immune to youth mental health issues. Young people today amaze me. They are bright, intelligent and incredibly good at opening up and speaking about issues. The level of anxiety out there is phenomenal and it is brought about by bullying, be that physical bullying, cyberbullying, pressures of social media, pressures of school, or circumstances in the home. This is causing significant anxiety, which has been highlighted and further exacerbated by the pandemic. We need interventions.

The findings of the report into south Kerry CAMHS were shocking and appalling. Those events should never have happened. In west Cork, there is an opportunity to expand CAMHS and provide a better service. I hope the Minister of State will take note of that. The CAMHS facility in west Cork, which is located in Dunmanway, is too small. Young people who come for consultations may be in the same room, which is divided by a partition. That is not ideal. There is a drive and push for clinical expansion based on the needs in the area. While keeping the current facility in Dunmanway, there is also an opportunity to open a new facility in the St. David's centre in Clonakilty to complement the Dunmanway facility. West Cork is a huge area and the CAMHS service extends from the Beara Peninsula to Bandon. Having a second hub is incredibly important. People have been told for some time that one is coming. The pandemic was used as an excuse and we should now drive on with that facility. I ask that the Minister of State look into this matter.

An Ceann Comhairle

Deputy Andrews is sharing time with Deputy Gould.

Deputy Chris Andrews

This is an opportunity to speak about mental health, which is important to us all. We were in a mental health crisis pre-Covid and now this crisis has evolved into a mental health emergency. Jigsaw, an organisation which we all agree carries out amazing work on mental health among young people, has seen the realities of this at first hand. It has experienced a 42% increase in demand for services. It is well documented that participation in sport is beneficial for our mental health and overall well-being. There is a definite link between the positive benefits of physical activity and mental health. We need to explore and take a more in-depth approach to linking sport with tackling mental health.

Every week, thousands of children across Ireland go to their local sports grounds for matches and training. Many of them will be active in their local clubs up to their late teens and beyond. They will develop strong connections and friendships with fellow players, coaches and volunteers. As a previous speaker said, it is about finding their tribe and young people very often do that through sport. I know sport is not for everyone but for those for whom it is, it is very important. Coaches and volunteers are in a prime position to promote a positive culture of well-being among teammates in their club. We need to provide them with the tools and resources to promote this positive culture of well-being and positive mental health. We also need to provide them with the supports and know-how to be able to identify people who are experiencing difficulty with their mental health.

Under Sport Ireland, sporting organisations develop their own approach to well-being in sport, and some of these approaches are more in-depth than others. Over the years, the GAA has taken a proactive role in developing a strong culture of well-being in the organisation and should be commended on that. Now is the time to develop a uniform approach to well-being and mental health across all sporting organisations under Sport Ireland. Sports clubs are unique in that they are in a position to intervene early when a member is feeling unwell or having difficulties. They are on the front line and we need to resource them.

Last year, Brian Murphy, a kind and generous young man who was a member of St. Patrick's Rowing Club in Ringsend, died by suicide. If sports clubs and organisations took a uniform approach and had structures and resources to identify people with mental health issues, I am certain there would be fewer people feeling as Brian Murphy did.

Deputy Thomas Gould

I welcome the opportunity to speak on youth mental health. It is an issue we need to focus on because I believe we are at a turning point. With the lifting of Covid-19 restrictions, young people will finally be able to socialise and experience their teenage years after a long and tough two years. We must bear in mind the many young people on whom Covid has had a very negative effect.

This will be especially hard for those who have not socialised at all in the two years. It must be remembered that many families stuck rigidly to the rules. Their kids were looking out windows when they should have been out meeting friends and playing. Some of these teenagers and young people have not had an opportunity to make close friends while some have lost friends because of the Covid-19 restrictions and lockdowns. Young people who are not involved with sports or clubs or who have not built strong bonds with their peers will really struggle in the coming months and years. The return to normality is going to be extremely difficult for these young people. There are young people who have missed a very significant portion of their teenage lives. They have missed out on really important formative experiences that other people have had. It is really important that we now invest in youth mental health services. I listened really carefully to the points the Minister of State made earlier. I hope everything she said will be delivered upon but, at the moment, parents do not believe in or have faith in the system. Anyone who is in the system at the moment will have no trust in the Government or the HSE to deliver because of the waiting lists, the backlogs and having been let down. We need to deliver because we need to let people know that young people will be listened to and supported.

Outside of mental health services, we need to support community groups and youth workers, who do phenomenal work in reaching out to young people. I am looking for more investment not only in mental health services, but in youth services more generally so that young people can get the supports they need. Some people now have huge gaps in their teenage years which, unfortunately, will affect them for their whole lives. The least we can do is to support young people at this really difficult time. I know there is a lot of need out there but I ask the Minister of State and the Government to focus resources and funding on this area.

Deputy Michael Collins

Mental health must become a national priority as Ireland moves to a space where the pandemic has subsided. In its pre-budget submission, the Rural Independent Group sought an increase in funding of at least €85 million for mental health services this year to deal with the emerging mental health crisis in Ireland. Historical underinvestment has left us with mental health services that are subpar, if people can even access them at all. Unfortunately, the Government's increase in the allocation for 2022 is only half of what is required at €47 million. Only €24 million of that allocation is to go towards developing new services, as opposed to the €65 million sought by Mental Health Reform.

Across the country, many individuals were struggling to access the basic supports needed to stay well even before the pandemic but Covid-19 has further adversely affected the physical and mental well-being of many. I meet many people who are struggling in my clinics every week, as do my staff every day. We hear harrowing stories from people who have sought to access mental health services but have been unable to do so. Now more than ever, it is absolutely essential that Ireland has a fit-for-purpose, inclusive and responsive mental health system in which people can access the care they need when they need it.

Ireland's mental health services were under considerable pressure before the pandemic and are now experiencing unprecedented challenges. It is highly likely that these pressures will continue. Indeed, evidence from other countries indicates that they are only at the beginning of this surge. However, those other countries across the EU and elsewhere allocate a much greater percentage of their health budgets to mental health services. Ireland's mental health budget is approximately half that of most northern European countries. This is truly a shocking indictment of this Government's failure to fund our mental health services and look after people with mental health illnesses. The lack of proper services means that a tsunami of young people in Ireland are now seeking mental health care due to a lack of available beds.

Deputy Richard O'Donoghue

With regard to mental health services in Limerick, if the Minister of State looks it up online, she will see that the Limerick CAMHS is open from 9.30 a.m. to 5 p.m., Monday to Friday. Mental health issues do not stop at 5 p.m. or on a Friday evening. Where have the HSE and Government gone wrong on this? What have they done with the funding that should be coming into CAMHS and organisations such as Jigsaw to put the right people in place? Has all the money gone towards paying Paul Reid a salary of €420,000 or giving an increase of €81,000 to the Secretary General, Robert Watt, who is now on €294,000? Is the money going into front-line services? All the money seems to be going into the top shelf of the HSE. All of the money the Government has put in has got us nowhere in fixing the problem. Where is the accountability for mental health services? Where is the money the Government needs to give to Limerick Suicide Watch or the search and rescue service in Limerick, both of which are staffed by volunteers? Instead, the Government gives out €80,000 here and €90,000 there on salaries. The money does not go to the volunteers that are actually doing the job the Government should be doing. Where is the mental health funding for people seeking places in respite centres? The Minister of State has now made three attempts to come to Dromcolliher in Limerick. I believe she is supposed to be coming this Friday. I hope it is a case of third time lucky and that I will see her in Dromcolliher on Friday. I was told she would be there.

Deputy Mattie McGrath

There is nothing personal in what I am going to say but the hypocrisy on display here tonight is quite rank. In Clonmel, we have an organisation called Clonmel Suicide Awareness Workers, C-SAW, with which Joe Leahy, Elma Walsh and many others volunteer. We also have a River Suir rescue team and there are many other voluntary groups across the country. I thank my own staff in the office for dealing with problems every day that neither they nor I have the skills to deal with. I know a lady in Clonmel, Bernadette Hughes, whose son is now in prison. She fell through the cracks and was knocked back and dismissed at every turn. Her son, with whom my late brother, a paediatrician, dealt as a child, is now languishing in prison. The services are scandalous. They are not there.

Deputy O'Donoghue is right; the money is going towards the top. It is spent on big agencies, brass plates, CEOs and chief executives. Compassion is not there to be seen. We are here talking about youth mental health tonight while we are forcing children in schools to wear masks. Any child who does not wear one is intimidated, bullied and destroyed. School boards of management and principals are ordered to enforce this. It is causing intimidation and mental health problems. That is the hypocrisy here. I asked the Taoiseach today to remove this requirement because masks are not proven to be safe. What will be the legacy of this victimisation of children? We have enough problems with sexual violence and bullying and intimidation online. This is the greatest scandal that has ever beset us. We are all talking about the post-pandemic situation. The pandemic has been a total disaster as regards the intimidation of children, forcing them to do things and socially isolating them. I am talking about little boys of eight years. My own grandchild was in school one day and was victimised because someone said her mother was not vaccinated or something. It is a scandal perpetrated by Paul Reid, Tony Holohan, the Government and everybody else. It is a scandal and we then have the cheek to talk about these problems. The legacy of this will be unimaginable. We have no services either. We have plenty of CEOs and money going the wrong way but we have no compassion.

Deputy Danny Healy-Rae

We have all heard about the damning report on CAMHS that was published this morning. It is public now. The parents and children involved have known about this for much longer. As an elected Member from Kerry, I apologise to the families, the parents and the children. They did nothing wrong and everything right. They went to seek help and they did not get proper help. They were let down badly. We learned that 1,332 files were reviewed and that the treatment of 227 children was considered risky. These children suffered one or more of sleepiness, dulled feelings, slowed thinking, serious weight gain and distress. Significant harm was done to 46 children. These children experienced effects such as the production of breast milk, weight gain, being sleepy during the day and raised blood pressure. As boys and girls become men and women, they will always have little problems but pumping drugs into them is not the answer.

We need more workers. The HSE said it had no senior consultant child psychiatrist. We need psychologists at the start as well. There are good people in the HSE, but there are also some fairly useless people in there.

Acting Chairman (Deputy Joe Carey)

I ask the Deputy to conclude.

Deputy Danny Healy-Rae

I apologise again to the children and their parents as a Deputy from Kerry. They are my friends and neighbours, and it is very sad what has been done to them. I tell the Minister of State that this can never happen again.

Deputy Carol Nolan

It is shocking to see the CAMHS services in such disarray. It is no different in Laois-Offaly than in any other constituency or region. It is troubling that we have a serious tsunami of cases. In November 2021, some 3,357 children were awaiting CAMHS services. Of those, more than 221 had been waiting for more than a year. What is happening is very serious. I know from my offices, which are no different to those of any other Deputy, that parents are coming in crying in desperation and looking for help and support. It is wrong that we cannot give them the required help and support.

Look at the millions of euro lashed on advertising during the Covid-19 pandemic and on contracts with firms such as Kensington, for example, in respect of services in the context of people's documents and statements. I refer to the money spent on such activities, and yet we cannot help our own people. There is something seriously wrong. This country, this nation, is broken and there is absolutely no compassion, fairness, help or support for people. If we do not get to these children in time and, unfortunately, many of them have not been reached in time, then they are going to suffer more as adults.

What sort of a society are we if we cannot reach out and help those people by giving them the basic services? I do not need to repeat that CAMHS is chronically underfunded and that there is a lack of specialist care. I am deeply shocked, however, that the Birr community mental health service has been closed since the beginning of the pandemic. There is no justification for that. Many adults have come to me with desperate situations. The Minister of State is familiar with Birr and the area. We have had nothing. This is a basic and vital service, but it has been closed since the beginning of the pandemic. Therefore, I call on the Minister of State to look at this situation, and I would appreciate any help and any intervention she might be able to make in this regard. It is a serious situation. The people of Birr and the surrounding areas deserve better. Our children in Laois-Offaly and in every constituency deserve better as well.

Acting Chairman (Deputy Joe Carey)

We now move to-----

Deputy Danny Healy-Rae

There is not a shadow of doubt that suicide is linked to insufficient mental health care services. I ask the Minister of State to acknowledge that point.

Acting Chairman (Deputy Joe Carey)

I am sure she will address that point in her contribution. I call Deputy Colm Burke.

Deputy Colm Burke

I thank the Minister of State for the work she is doing in this area. It is extremely challenging in that it is not just about money but also about recruiting an adequate number of staff. That is where the challenge is posed across the healthcare system. For instance, last year more than €1.1 billion was provided for mental health care, while the figure this year is €1.49 billion. It is a substantial budget, but this is about ensuring that we can get staff in place in all the areas they are required. Mental health is not just about providing care for the people who need it, but also about providing care for the people who themselves provide care in that setting. That is one of the issues. Let us take the example of accredited counsellors and psychotherapists. A supervisor is in place to ensure there is what we would call a gatekeeper in that context. Unfortunately, given what we have heard in respect of the report from Kerry, there was no such gatekeeper in the context of the person who was prescribing drugs.

In the context of people who are inpatients, the mental health tribunals provide checks and balances. The same level of checks and balances is not in place for those attending day care services and we must examine this aspect. Mental Health Ireland, MHI, has clearly detailed that one in ten children and young people will require some level of care because of depression, anxiety or a conduct disorder. That could be because of what is happening in their lives or what is happening around them. It is important that we put in place the necessary support for them. The important thing to take from this report published this morning is the need for a clinical lead in each of the CAMHS areas. It is important that those posts are put in place.

I came across someone dealing with my legal office who was on medication for more than 15 years. The person was admitted to hospital, and one of the doctors advised that person to stay off all medication for some time. He went cold turkey because of the amount of medication he had been on. That is why it is important to ensure there are checks and balances in the system.

Dr. Seán Maskey, the consultant child and adolescent psychiatrist who produced this report, made 35 recommendations. I will quote from four of them that I think are important. He refers to the need to develop clear written guides for the use of antipsychotic medication. He also states that the way medications for mental health illnesses in CAMHS are used should be checked every year. Equally, doctors who want blood tests for patients should ask for them, but they should then check the results themselves. Finally, Dr. Maskey recommends that the clinical reports from the team should be shared with GPs and others who may refer children. Dr. Maskey has set out those 35 recommendations, and our target must now be the fast and efficient delivery of those recommendations. We must ensure they are implemented in full at an early date to enable us to provide the requisite level of care to young people who need it and also to support their families.

Deputy Jackie Cahill

Youth mental health is one of the greatest challenges faced by our society. I thank the Minister of State for allocating a Jigsaw centre to Thurles. It is operating and is a great help to people experiencing mental health issues. Hopefully, we can extend that service when the Covid-19 restrictions are over to spokes all around the county and continue to develop that worthwhile service.

This House is not nearly focused enough on addiction and the role it plays in mental health issues among young people. Talk to a group of young people and they will point out that the dealers are operating openly where they socialise and play. It could be a GAA, soccer or badminton club, or whatever. Dealers are operating openly. We must put more resources into dealing with this issue. We must tackle the problem of addiction. Unfortunately, addiction leads to mental health issues, and to suicide in a serious percentage of cases.

I plead with the Minister of State to put pressure on the Garda to clamp down on these dealers. I do not see nearly enough enforcement. If teenagers and young adults can tell us where to go to find people supplying tablets, or this, that or the other, surely that information must be available to the Garda. Drugs were only freely available in major urban areas before, but they are now at every crossroads. It is the greatest scourge in modern society. We see instances of young people running up a drugs debt. The drug barons then knock on the parents' door and demand payment of a significant amount of money. Out of fear for the safety of their child, those parents will pay that money. This is a vicious circle that must be stopped. We must tackle this situation. It is happening in every nook and cranny of our country. I do not see enough resources being devoted to addressing this issue. I do not see enough attention being given to it. Until we tackle the drug issue, we will not be able to get to the root of the mental health problems among people.

Therefore, I appeal to the Minister of State to use her influence. She has done great work in the mental health area since she took office just one and three quarter years ago. She has brought great energy and vigour to the role. The tackling of addiction, however, is something that we must address and we must put more resources into this endeavour.

Deputy John McGuinness

It seems like another week, another scandal of outrageous proportions. Everybody in this House will speak about it and will demand action of one kind or another. It is a reflection on the system itself. I agree with Deputy Nolan when she said that the State is broken. It is true. The administration of this State is broken, and particularly the administration of the HSE. We have to come to a point in this House where we agree that it has to be reformed. The 1926 Act and the other amending Acts associated with the Ministers and Secretaries Act have to be reformed. In the Minister of State's statement she went down through the vast amounts of money that have been allocated to the HSE for all sorts of purposes, yet we have all of these issues that have emerged during the course of time and that show the system in complete disarray.

I will not ask the Minister of State tonight what she is going to do about it. She has done it. She has allocated the money. I am going to ask the Secretary General of the Department of Health and all of the HSE managers what they are doing about it. How much of this happens on their watch? They must not give me the excuse that we cannot get professionals to come in. That is a lame excuse. Managers who are good and decent and being paid well do not put forward that excuse. They plan ahead; they have a strategy. They know the issue they are dealing with and they respond.

In every single CAMHS area, and I can speak for Kilkenny and Carlow, there is a crisis. Young people are not being afforded the services that have been demanded for them. Then we have the community groups, the not-for-profits, being funded to step in where the HSE has failed. If it was successful we would not have the likes of Teac Tom filling the gap and providing the services. How can we tell someone who is on a waiting list for a mental health disorder that it will take a few months or a year? That is what is happening. Those who are in management positions are looking on.

The department of psychiatry in Kilkenny is simply not fit for purpose. In it there are excessive amounts of drugs being administered to patients who are unfortunate enough to be there. When they are released into the community there are no supports for them, none. One autistic teenager was lying on the couch in his own home for 28 months because he could not get services. Other services are not withdrawn by the HSE, but poorly funded and poorly managed. One allocation of €54,000 in supports for a child with autism is not being fulfilled. Where is the €54,000 going? What is the case manager doing? What is the manager within the region doing? I have a good colleague, Councillor Joe Malone, who intervenes with families and helps them. He does not go to the HSE; he goes to Teac Tom and other organisations like that to get the support that is needed.

The State should be ashamed of itself. Those who hold these positions of management, responsibility and obligation should be ashamed of themselves. They are getting the money from Government. They have the policies in place. Why are they not delivering? Why is someone not coming forward and telling us that the department of psychiatry in Kilkenny is simply not fit for purpose and we need to replace it with a modern, state-of-the-art building? Why are we not planning ahead? Other speakers have said it. There will be a tsunami of health issues among our young people and those who have been affected by Covid heaped on top of all of those who have been affected by the financial crash, the loss of their home and the break-up of their families.

Meanwhile, we articulate all of that here. The Minister of State, Deputy Butler is doing her best. What are the rest of them doing? Why is it that we cannot name someone in the House and say, "You are responsible for this area and this is what you should be doing. Shame on you. If you cannot do your job then get out of the system." Pass it over to somebody who can do it. Let us have a recruitment drive. Let us change the 1926 Act. Let us have a plan for the department of psychiatry in Kilkenny. Let us help our young people to help themselves. They are quite capable of doing that. I ask the Minister of State to turn up the heat on the Department and insist on the best paid Secretary General in the system finding out what exactly is going on and what can be done about it. We have to deal with the community issues. Where we lack the services we have to put them in place. We have to put action to our words in this House or we are never going to get real results.

In the private hospital it is also true that if a young person goes in there, he or she is likely to be stuffed with drugs and locked up from one end of the day to the other. I know of a case where they did not even see the person they were under, the psychologist or whatever who was looking after them, yet they were there for three months at a cost of nearly €45,000 a month. All they got out of it was drugs. They were saved by the community in their own county. Where is the management in our system? It is a health issue and a management issue; it is not a financial issue. Let us root out those who are not managing and get down to the real brass tacks of supporting community initiatives and good management. That in turn will support the young people we are talking about here and others.

Acting Chairman (Deputy Joe Carey)

Next is the Independent Group. The time is split evenly between Deputies Connolly and Fitzmaurice.

Deputy Catherine Connolly

The Minister of State is here again and there is no senior Minister. As we are discussing one of the most important and devastating reports, it is unacceptable again that she has been put in that position. I had intended to speak on what all other Deputies have spoken about in terms of waiting lists for the very good Jigsaw programme in Galway and CAMHS in Galway. I was going to refer to the mental health reform group that represents 76 member organisations on the ground and what they tell us in terms of the deficits. Consent for young people to procedures has already been mentioned. They are treated differently in respect of physical and mental health. I refer to the level of self-harm, particularly among young girls, with a clear connection with suicide. I am saying all of that in less than one minute, not to diminish any of it but to say that I have repeatedly raised it. Like domestic violence and gender-based violence, from the day I came in I have focused on issues.

We had A Vision for Change, Sharing the Vision and an implementation body that was deprived of its function because it functioned so well. All along I have asked not to have any more statements but to look at the implementation body and look at implementing. Then we came along with Sharing the Vision. Tonight we are sharing the horror in relation to this report, are we not? I have done my best to read it in the time allowed. Really, if we do not put this down on the agenda for discussion in here then we should all resign. This is not specific to Kerry. It has serious implications for all of the facilities around the country. It is just devastating. Governance has utterly failed here. Of course resources are an issue as is clearly identified. The report sets out 35 recommendations. It sets out the background, key contributory factors and so on and they are all worth looking at. Certainly there was tiredness and over-work. There are still two positions vacant. There was an absence of a clinical lead - all of that. Where was the governance? The governance was in place and utterly failed to do a risk assessment, first in respect of the vacancy itself and then as the issues arose. Then we have the whistleblower once again. How many times have we stood here from Sergeant McCabe to the whistleblowers from Limerick, from Waterford in the Grace case and so on? One whistleblower after another and their lives made a misery.

Allegedly - I believe the reports - the doctor whistleblower has suffered greatly for raising these matters.

The doctor had courage, was good and did his duty, but what has happened? Nothing. The system was alerted to this issue in 2018. Nothing happened in 2019 either. In 2020, there was an audit of a select few cases, which found that there were problems. There was then what appeared to be an independent investigation. I have been through this in Galway. I will never believe the word "independent" again. The doctor who was brought in was independent. He talked about the investigation being essentially independent. What does the word "essentially" mean in this instance? On a different page, though, we can see that the persons involved all worked for the HSE and the only independent element was the chairperson. The rest were not involved in the events but were all involved in the HSE. At eight, there was no shortage of them either. Apparently, the doctor was pulling his hair out at the lack of resources as well as many other issues relating to governance whereas there was no problem getting a minimum of eight staff, with any amount of backup, to perform an investigation. This is going to be repeated.

I have many questions but I only have a minute left. Will the Minister of State put this report down on the clár oibre of the Dáil? It has serious implications. It shows how governance has failed time and again. Governance in this case repeatedly failed to comply with the 2015 guidelines. One of the basic recommendations is that these institutions comply with those guidelines.

We could focus on many issues but I will focus on the list of upset. There is a statement of findings. The report puts them in context. It starts off by saying that there was no extreme or catastrophic harm. So, no one died or was catastrophically injured. Imagine including that in the report? It then sets out three findings that 227 children suffered, 13 others were found to have been exposed unnecessarily to harm and there was clear evidence of significant harm caused to 46 children. Notwithstanding the independent chairperson, HSE speak dominates this report if it has to put what happened in the context of there being no catastrophic harm done. What relevance has that?

I will be fair to my colleague and stop mid-sentence.

Deputy Michael Fitzmaurice

I have known the Minister of State for a while and am not blaming her for any of this, but she is dealing with an elephant, in that she is in the Department of Health but the HSE does its own thing. A few years ago, elderly people with different needs were in the Rosalie unit in Castlerea. People right across the board - Fine Gael, Fianna Fáil, Sinn Féin and Independents - did everything in their power to fight against Mr. Tony Canavan and his team and keep it open. Unfortunately, many of the residents passed away after they were moved. I remember the battle that Mr. Liam Walsh fought for his mother and the other residents but the HSE had to close it because the HSE was going to do new things with it.

CAMHS was going to be a whole new thing. During Covid, we were brought down and kept apart from one another at a big launch to set out what was going to be done with mental health services for young people in Roscommon. We were going to have the most sophisticated system. In fairness to the Minister of State, she visited a few months ago. It was a launch with a lot of hoo-ha. It was a political stunt. Approximately six or nine months later, I raised the matter with the then Taoiseach, who is the current Tánaiste, during Leaders' Questions in the convention centre. In fairness to him, he was stunned that the service was not open. It was not his fault for a simple reason, that being, the HSE does its own thing. A building has been done up and there is a television the size of a room. Sadly, however, the services are not there. This is what is going on. It is no fault of the Department of Health or the Minister for Health. I am not blaming them. They have an out-of-control elephant in the form of the HSE.

Unfortunately, we have seen cases involving children in our counties. We have seen reports being done and claims that what happened will never happen again. Through the courts, I have read about what happened in certain parts of the country. Does anyone ever learn?

Deputy McGuinness said that people needed to be accountable. Let us be clear and not BS the public - there is no sacking or getting rid of these people. That is the bottom line. We have to be honest with the public. No matter what these people do in any Department, we cannot get rid of them. The best we can hope for is that they will be moved sideways to somewhere else.

Time and again, I have rang trying to help children only to be told that someone or other was on holidays. As far as I can see, everyone seems to be on holidays. You might eventually be able to get in contact with them. The children will go for an assessment and then see someone after a month or two. If a child has depression or another psychiatric problem, though, it should be dealt with straight away. It does not hold for two, three or six months. That is the problem. Some of the parents in question are on very low incomes and unfortunately have to scrape together money to get private consultants and other private professionals to try to help their children.

I have listened to various Deputies. They mean what they say and I am not having a go at anyone, but there is a reality, in that when we ask a question of a Minister, we get a nice reply to the effect that the HSE will respond in two weeks' time. The HSE is out there doing what it wants and we have no say about it. We have to be honest with the public. Back when politicians had a say, everyone gave out, including journalists. Now, it has gone too far the other way and affairs are in a sad state. It is sad that I have to tell people that there is not a great deal of hope for youngsters at the moment in terms of the services that are being provided.

That is all I am going to say. I do not have a lot of faith in statements in this place anymore.

Minister of State at the Department of Health (Deputy Mary Butler)

I thank Deputies for their constructive contributions, of which there were 51. It has been an excellent debate from that point of view. Fifty-one Deputies, which is a lot, came to speak about the important issue of youth mental health. I have listened closely to what has been said and taken copious notes. I will continue to work closely with all sides of the House to ensure developments and improvements in the delivery of our child and youth mental health services.

As I have indicated many times since becoming Minister of State, protecting the mental health of all our population, including young people, has never been more critical. To achieve this and effectively meet the mental health needs of all children and young people, fundamental reforms are needed in many areas of mental health service delivery. Unfortunately, the report published today shows that, despite the progress of recent years, our services failed our children and young people in Kerry, with serious impacts on them, their families and their communities. My thoughts are with those children, young people and their families. Through hearing each of the Deputies' contributions, I know that they all feel for these families, too.

The systematic failings in the young people's care is devastating and unacceptable. All measures will be taken to ensure that such an extreme failure, which occurred at multiple levels of the system over a protracted period, does not happen again. I take this opportunity to stress once again that any young person who has concerns should seek help without delay. Our wide range of care services provide help. They make a real difference to many young people day in and day out.

A couple of Deputies raised an issue concerning the 35 recommendations. I read the report on Sunday evening. I received a copy of it at around 6 o'clock that evening. I read the full report again on Monday and then read all of the subsequent shorter versions. There are 35 recommendations. To update the House, six of the recommendations are complete, 13 are in progress and 16 have yet to commence. Some of them are longer-term recommendations, for example, whether children and young people who receive support for mental illness should be able to remain in CAMHS up until 25 years of age as is the case with Jigsaw. The national implementation monitoring committee has put in place a sub-committee on CAMHS and this is one matter that we are examining. I am not convinced that it should be 25 years. We should look at all ages - 21, 23 and 25 years.

I am open to persuasion but I believe that for a young person of 18 who might be in the care of CAMHS for five or six years, at a time when they may be going on to college or doing their leaving certificate, the transfer over is very traumatic. At those ages, 18, 19 and 20, I would like to see people have the option of being able to stay within CAMHS. That is where we are in that regard.

Several people raised my call for the reinstatement of a HSE national director for mental health, in line with our programme for Government. This post is essential in driving the fundamental reforms needed across our mental health service, not least in our child and youth mental health services. To be frank and honest, to date I have been unsuccessful in reinstating this post, but I do have the support of the Minister, Deputy Donnelly, and the Taoiseach - I discussed the matter with them again last night - and I welcome that, across the House, everybody seems to be in agreement. I would appreciate any support Members can give me on this and in raising the issue. It is extremely important at a time when "mental health" has been probably one of the terms most used during the pandemic apart from the word "vaccine". I think "mental health" might have been the second most used words, especially in respect of young people. Having a national director for mental health would send out a clear signal, and now is the best time for us to do that.

I will not be able to touch on all the matters raised but I will try to touch on some of them. Eating disorders come up constantly. Our clinical programme for eating disorders was launched in 2018, but the rise in cases in recent years has been very significant, so I have put more funding into treatment of eating disorders in the past two years than any other clinical programme. By the end of this year we should have ten teams in place. We started from a very low base of three teams. I will not say there is no issue with recruitment because there is, but the funding is there and the posts are funded, and that is the important thing.

As for bed capacity for young people, we have Éist Linn, in Cork, where we have 16 beds; Merlin Park, in Galway, where we have 20 beds; Linn Dara, in west Dublin, where we have 24 beds, including two high observation beds; and St. Joseph's, Fairview, where we have 12 beds. I have visited all those locations. We therefore have 70 beds plus two high observation beds. In fairness, a lot of those beds are specifically for young people with eating disorders.

One of the issues that was raised quite a bit - Deputy Dillon raises it with me constantly - was the pathfinder project. The implementation of the project is a priority for me and I will continue to keep the matter under close review. It has stalled over the past few years because of Covid, but now is a really good time to put the pressure on. There is quite a bit involved with it because it comes under the Department of Health, the Department of Education and the Department of Children, Equality, Disability, Integration and Youth. Coupled with that, there is a significant budget involved, and significant administration, governance and legal arrangements will have to be put in place. You have to start someplace, however. In light of so many calls for the pathfinder project to be put in place, I think now is a really good time to start working on it.

As for the mental health legislation, about which a couple of issues were raised, no legislation, when it starts out, is perfect. That is why it goes for pre-legislative scrutiny and that is why that legislation will come before the Dáil, the Seanad and the committee and amendments will be tabled. I will be open to any amendments. This legislation is a long time in the making. I am delighted to say that, under the Office of the Attorney General, last week two drafters were put in place to draft the legislation. It is a priority of mine. It is unlikely I will get it in before Easter, but it will certainly be in in the next term. A huge amount of work is going into it.

I know that the issue of the admission of young people was raised in the health committee during the week. Sometimes you could have a male aged 17 and a half who might be suffering from psychosis. We had a case of a person up in Donegal, a very rural county. For his own safety, it was decided he would be admitted to an adult facility for 24 hours because he needed to sleep. Then he was brought to Merlin Park. Sometimes such clinical decisions are made because you cannot have an inpatient facility everywhere. We do have 56 departments of psychiatry throughout the country. We have four inpatient units for our under-18s. Sometimes, not always, there are capacity issues and the decision is taken purely from a medical or clinical point of view by the consultant psychiatrist. My fear is that if we close the gap completely, it might have a detrimental effect on people. I do not want to see any child, teenager or young person go into an adult mental health facility. I am happy we are going in the right direction. If, however, I were to be asked whether I could stand here and say that no young person or adolescent will ever be admitted into an adult mental health facility again, at the moment I could not say "no". I am not a clinician or a consultant psychiatrist. When a psychiatrist takes such a decision, I am not in a position to overrule that because it is done in the best interest of the patient. We will tease that out when the time comes and discuss it at the committee. We can discuss all that. A lot of work is being done on this.

Today has been something of a watershed as we have learned of the failures down in Kerry, and everybody is very upset and distressed, but this was a really good debate. Members were very respectful and open and they have all had their say. I have listened intently and I am happy to discuss any of the issues again.

Dáil Éireann debate - Wednesday, 26 Jan 2022

Youth Mental Health: Statements

Dáil Éireann debate -
Wednesday, 26 Jan 2022