Mental Health: Statements

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

I thank the Cathaoirleach for the opportunity to discuss the important topic of mental health today. It is fitting that mental health is one of the first themes for Dáil statements of this Government's term. It highlights the fact that this House recognises the importance of mental health and emphasises the well-known saying that there is no health without mental health. It was an absolute honour and privilege to be reappointed as Minister of State with responsibility for mental health last month and to be the first person to bring the mental health portfolio to the Cabinet table. This is a real milestone for mental health in Ireland and I am looking forward to continuing the significant work under way to transform our approach to mental health.

It is also positive to stand in the Dáil today, in the early weeks of 2025, to highlight the great opportunities available this year for the promotion of mental health. This year will see a number of important moments for mental health. In the coming weeks, the Mental Health Bill will continue its journey through the Houses of the Oireachtas. We will launch the second implementation plan for our national mental health policy, Sharing the Vision. The successor strategy to our national suicide reduction strategy, Connecting for Life, will be developed this year and launched. These important milestones speak to the work of this country and of this House to make mental health services in Ireland modern, person-centred, and accessible. It is my hope that 2025 will see us all work together, across all parties, to reduce the stigma associated with mental health difficulties, to promote the message that recovery is possible, and to emphasise the common message that there is no health without mental health.

These positive achievements have not happened overnight. We have come a long way over past years and decades to become a country that speaks more openly about our mental health and to become a society that champions investment in our mental health services, but we can always and should always do more. Too many men die by suicide in this country, with 78% of all deaths due to suicide occurring among men. We need to do much more to encourage men to seek support and avail of services. In this context, the Mental Health Bill 2024 is ambitious legislation that sets a roadmap for where we go next in mental health services and sets a high bar for how we, as a society, respect the human rights and lived experience of those living with a mental health disorder.

One of the most significant pieces of work in mental health last year, and a priority of mine since my appointment as Minister of State with responsibility for mental health in 2020, was the publication of the Mental Health Bill 2024 on 31 July. The enactment of this Bill has been a long-standing priority for me and for the Government, and I was delighted to bring the Bill to Second Stage last September, where there was a positive debate on its provisions. It was an honour to sit at the Cabinet table for the Government decision on the Bill, with one of my first actions as Chief Whip being to restore this legislation to the Dáil Order Paper. I am looking forward to bringing the Bill to Committee State as soon as committees are appointed and meeting, and to working with colleagues in the Dáil to progress the Bill through the remaining Stages.

The significant work over recent years to progress this vitally important Bill came on the back of the review of the Mental Health Act 2001. The Mental Health Bill has featured in successive programmes for Government and is a priority under Sharing the Vision and Sláintecare. While the 2001 Act was robust legislation and progressive for its time, the delivery of mental health services has progressed significantly since that time. The 2001 Act does not fully reflect our current approach to mental health services, such as the shift towards community-based services, the adoption of a recovery approach in service delivery, and the importance of listening to people with lived and living experience of mental health services in the development of those services.

Ireland ratified the UN Convention on the Rights of Persons with Disabilities in February 2018, and its rights-based approach to disability was particularly considered when drafting the Bill. With more than 200 sections, it is a lengthy Bill, containing a number of complex legal and ethical considerations, and it deserved and needed a number of years to bring it to fruition. The Bill will replace the existing 2001 Act with a more human rights-based and person-centred approach to mental health legislation and put in place a more robust legislative framework in which mental health services will be delivered and regulated. It will update the involuntary admission process, modernise provisions related to consent to treatment, provide enhanced safeguards for people accessing inpatient treatment, and provide a new, stand-alone Part that relates exclusively to the care and treatment of children and young people. The Bill will also introduce, for the first time, a robust system of registration, regulation and inspection of all community mental health services, including community child and adolescent mental health services, CAMHS.

Officials in the Department have been working diligently with the Office of the Parliamentary Counsel and the Office of the Attorney General, along with key stakeholders such as the HSE, the Mental Health Commission, the College of Psychiatrists of Ireland and other Departments, to prepare any necessary amendments to the published Bill, along with transitional provisions, ahead of Committee Stage. We need to enact this important Bill to modernise mental health legislation and to put in place the necessary safeguards to ensure the rights of people with mental health difficulties are protected in the decades to come.

The legislation that underpins and regulates our mental health services sets the standards we must all work to deliver and includes protections for those who use mental health services. The Mental Health Bill is not the only strand through which our services can be modernised and improved. Our national mental health policy, Sharing the Vision, takes a person-centred approach to delivering enhancements across the whole range of mental health supports, from mental health promotion to specialist service delivery, across a total of 100 policy recommendations. Our approach to delivering mental health policy is based on Sharing the Vision's core values of respect, compassion, equity and hope, to achieve better outcomes for people who need to access mental health services, to place the individual at the core of service delivery, to promote positive mental health in the whole population, and to support a message of recovery. Recovery is possible.

We have seen great achievements and improvements in mental health supports since the launch of Sharing the Vision in 2020. In the past three months, we have seen the launch of Pathways to Wellbeing - National Mental Health Promotion Plan, one of the key commitments in Sharing the Vision, which will run alongside the national policy in providing an even stronger basis for supports such as social prescribing, which counteracts social isolation and loneliness by providing links to community-based activities that have a positive impact on mental health. These services are now available in every county in Ireland. In recent weeks, we have seen the appointment of a deputy chief medical officer within the Department of Health with a specific remit for mental health policy. The appointment of Professor Philip Dodd to this role speaks to the Department's and the Government's commitment to embedding mental health policy and services within the wider spectrum of health policy. Professor Dodd has been a constant in the mental health unit in the Department over recent years and has been a great support to me and the entire team. This appointment moves us one step closer towards our goal of recognising mental health as a core component of overall health and well-being, and will support us as a country as we move away from the stigmatisation of mental health difficulties.

In December, we became the first country in Europe to launch our own national mental health research strategy aligned with national policy. In addition, the implementation of Sharing the Vision has seen the significant expansion of the national clinical programmes as well as the scaling up and improvement of delivery of services. Online cognitive behavioural therapy now benefits more than 10,000 people per year, while we continue to invest in counselling in primary care to improve access to vital talk therapies. April will see the launch of the second implementation plan for Sharing the Vision, which is being developed in partnership with key stakeholders, including the voice of lived experience, which remains central to the delivery of policy.

The next implementation phase will run to the end of 2027 and provides us with an excellent opportunity to build on the successes of the first implementation plan with renewed focus, including by investing in recovery education, peer-led and supported services and individual placement supports through the HSE office of mental health engagement and recovery; implementing a single point of access approach, initially focusing on children and young people, through a single integrated referral and care pathway; expanding access to social prescribing; delivering Pathways to Wellbeing - National Mental Health Promotion Plan; and developing an outcomes measurement framework for Sharing the Vision so that we can measure the real impact of policy delivery, to name but a few priority areas. To achieve our ambitious policy objectives, it is vital we support policy implementers and front-line staff with continued investment. I am committed to supporting the delivery of Sharing the Vision through the annual budgetary processes.

Continued investment and recruitment are critical to modernising a responsive mental health care service for those who require it, both in specialist mental health services and in the key areas of mental health promotion, prevention and early intervention. As I have noted in the House before, mental health funding has increased by over 44% since I took office in 2020 and I will be working to secure further significant increases in the coming years. We now have a mental health service budget of €1.5 billion, exemplifying our commitment to delivering vastly improved services for people. The investment is supporting the implementation of our national mental health policies across a broad continuum, from mental health promotion, prevention and early intervention through to specialist mental health services.

An area I have prioritised for investment as Minister of State have been our national clinical programmes. These are specialist and genuinely transformative mental health services for the people supported by them. For example, the additional funding allocated to mental health services since 2020 has allowed for significant expansion of the clinical programmes for eating disorders, ADHD in adults, early intervention in psychosis, dual diagnosis and the crisis resolution models of care. This year will see the completion of the roll-out of our adult ADHD teams nationally at HSE West and North West, HSE South West, HSE Dublin and North East, and HSE Dublin and South West, as well as two additional teams for eating disorders, which will bring it to 14 of the recommended 16, two additional teams for early intervention in psychosis, where we are at an earlier phase, and two additional teams for dual diagnosis.

We are also progressing the refresh of the model of care for the specialist perinatal mental health network, which has been fully rolled out across all our maternity hospitals, to see how this programme can even better support women with their mental health during the perinatal period. I have also funded additional suicide crisis assessment nurses, SCAN, for the national clinical programme on self-harm and suicide-related ideation, which is now in place across all our emergency departments. This will allow for better community-based suicidal crisis supports. These are valuable developments in services that have been experiencing increasing demand, and thanks to this investment more people throughout the country will have the opportunity to benefit from them. As I have said, however, there are huge demands for services.

It is important we use investment not only to target specific mental health clinical intervention but also to invest more broadly to transform how we, as a country, understand mental health. Ireland has made significant advances in recent years to promote recovery orientated care, with input from service users and carers and a co-ordinated approach to stigma reduction around mental health. Our current mental health policy, Sharing the Vision, and our suicide reduction strategy, Connecting for Life, both speak to these ambitions. The goal of our policies is to focus on the mental health needs of the whole population, framed by the underlining principles in Sharing the Vision, of trauma-informed care, a focus on recovery, respect for human rights, partnership and valuing and learning.

I regularly speak about the hard work and effort it takes to reflect these principles in policy delivery. It is essential that the people who use our services are at the heart of the design, development and delivery of these supports. As we build to serve them, lived experience must be central to all that we do. On my visits to local mental health facilities and peer support services as part of my work, I have seen the value of the service improvements achieved through including the voice of lived experience in service design. I look forward to continuing to meet with people and hear about their lived experience as well as the perspective of those who work in our mental health services. The HSE’s mental health engagement and recovery office was specifically set up to integrate lived experience expertise into the development, delivery and review of our mental health services. If we want our services to be really recovery focused, they must be built on the twin pillars of clinical expertise and lived experience expertise. In November 2024, further to a public expression of interest, I appointed a member to the national implementation monitoring committee to further enhance the voice of lived experience in policy implementation and monitoring. The inclusion of the whole of lived and living experience on the steering committee that oversees policy enhances the range of perspectives at this level of policy oversight, and I look forward to the positive impact this will have in strengthening the recovery approach in both policy implementation and new service design and delivery. I feel strongly that other policies throughout our country would benefit from a similar focus on co-design and lived experience.

I turn to the issue of suicide prevention and the work under way across every community in our country to better support people and reduce deaths by suicide. For a decade, Connecting for Life has provided us with a comprehensive plan for how we can reduce levels of suicide in our country. Reducing deaths by suicide is a very complex task, but evidence and experience internationally show that measurable improvements in suicide prevention can be made by involving the whole community, the whole of government and all of society working in unison. That is exactly what we have done in Ireland through our implementation structures, which go from the cross-sectoral group of key Departments and agencies right down to individual resource officers for suicide prevention co-ordinating local plans for their own areas. Permanent improvements to our approach to suicide reduction from Connecting for Life have included development of the model of care to manage self-harm presentations to emergency departments through the national clinical programme for self-harm and suicide-related ideation, enhanced bereavement and crisis support services, including culturally appropriate services for Travellers, and media monitoring activities to ensure safer media reporting of suicide. I also mention our NGO partners that do a huge amount of work on suicide prevention, and I welcome Ray Burke from Pieta, who is here today.

In the past year, we have launched bespoke suicide prevention training for Ireland, Let’s Talk About Suicide, established the national probable suicide monitoring system within the HRB and launched Safe Harbour, a world-leading resource for children bereaved by suicide. Earlier this month we launched a best practice toolkit to prevent suicide in public places, which is already being used by public agencies to take action to address specific locations of concern. The book, Safe Harbour, is world leading because it has been copied in many different languages across different countries and, unfortunately, it is needed. Connecting for Life is being formally evaluated at the moment and I look forward to receiving this evaluation and learning from it as we move to consider the future of Irish suicide reduction policy. We know already that suicide rates in Ireland are reducing, which is heartening. Even one death is one too many, however, and in absolute terms it remains the case that approximately 500 people in Ireland, mostly men, take their own lives every yea,r leaving communities and families absolutely devastated.

Men are a priority group under Connecting for Life, and particular focus will be placed on encouraging men to engage with counselling services through the increased investment in and expansion of counselling in primary care, CiPC, under budget 2025. Every death is devastating for that person, their loved ones, friends and communities. There is no greater tragedy than someone deciding that life is not worth living. As Minister of State, I never lose sight of this, and we must be even more ambitious in our next suicide reduction strategy. My Department, working with the HSE National Office for Suicide Prevention, is progressing our new strategy as a key priority, and it will be based on learnings from Connecting for Life, lessons from around the world on other successful reduction strategies, and a review of the latest research on effective suicide prevention. I will be announcing shortly details of the public consultation for the new strategy. All Oireachtas Members will be invited to take part, and I urge all colleagues to get involved.

My last years working as Minister of State with responsibility for mental health have highlighted that mental health is not just a health issue. The social determinants for our well-being span myriad across all of our lives, from poverty and associated financial and job security, our ability to have safe and secure housing, to our opportunities for good education, employment, and happiness. This is why it is so important that we work across sectors to embed mental health policies and promotion as a key enabler for our well-being. Positive examples of cross-departmental collaboration over recent years include the high-level task force, which focuses on the mental health and addiction challenges of those who come into contact with the criminal justice sector. This has involved extensive co-operation between the Departments of Justice and Health. On the back of this work, I was pleased to launch the community access support team, CAST, pilot project in Limerick late last year. This joint initiative between the HSE and An Garda Síochána will bring more focused interagency care, as envisaged under Sharing the Vision. A key priority of the project will be to divert a small but highly vulnerable group within our society away from prison and towards the healthcare sector.

I also welcome the launch in June 2023 by our colleagues in the Department of housing of the implementation plan of the national housing strategy for people with disabilities. This strategy directly improves outcomes for people with disabilities and, since 2017, has resulted in more than 3,300 people with a mental health-related disability being assisted to access housing in the local community, which provides an essential support to recovery. I have provided the HSE with additional funding to support the recruitment of housing co-ordinators to support people with a mental health difficulty to secure and retain independent tenancies. This is what policy should be about - making a real, positive and tangible difference in people’s lives.

Travellers are identified as a priority group within both Sharing the Vision and Connecting for Life and face many challenges relating to mental health and suicide. Significant additional ring-fenced funding of €365,000 has been provided in budget 2025 for Traveller mental health initiatives. In addition, funding of €200,000 for the national Traveller Counselling Service which was allocated on a once-off basis for 2024, has been mainstreamed under budget 2025, bringing the total funding for Traveller mental health to €565,000.

This will provide ring-fenced supports with oversight from the national Traveller mental health working group and will build on previous years to expand the national Traveller counselling service, ensuring that this culturally inclusive counselling service receives the support it needs.

I will take this opportunity to reiterate the Government’s commitment to further improvements across youth mental health services, including CAMHS. CAMHS provides specialist mental health supports to children and young people who are experiencing moderate to severe mental health difficulties. CAMHS now receives approximately €160 million in dedicated funding each year. In addition to this, approximately €110 million in funding is provided by the Government to community-based mental health organisations each year to deliver supports and services with much of this focused on supports for children and young people. I also secured an additional €2.9 million this year specifically to support CAMHS to increase core staffing, reduce waiting lists, develop a new CAMHS emergency liaison service and expand CAMHS hubs to improve crisis cover overall.

It is important to note that these figures do not include funding made available through other Departments to support the mental health of young people, for example, through the Department of Education and the Department of children to deliver services through the National Education Psychology Service, youth programmes, disability services or primary care.

It is important to state that there continues to be growing demand for CAMHS across the 77 community teams and four inpatient units. Last year, approximately 233,000 CAMHS appointments were delivered for children and young people across the country. Based on data provided to me by the HSE, I understand that 8% more referrals were accepted by CAMHS in 2024 than in 2023. Similarly, in 2024, approximately 62% of new or re-referred cases were seen within 12 weeks, which is a 12% increase on the same period in 2023. These figures highlight how the HSE is working hard to deliver more activity in the face of growing demand for CAMHS services.

I am still acutely aware that approximately 600 children have been waiting for longer than 12 months for an appointment with CAMHS. I met with HSE representatives last week to express my discomfort at that figure of more than 600 children. We have been steadily reducing the waiting list but, unfortunately, we saw an uplift in October, November and December. This often happens around Christmas. I am very conscious of those who have been waiting for that length of time.

I acknowledge that there are shortfalls in CAMHS services and that children and their families can experience long waiting times. This is an area being prioritised by the new national office for child and youth mental health in the HSE. The national office has taken full account of reports and audits into CAMHS and has developed a new youth mental health action plan, which was published yesterday. The three-year action plan sets out a roadmap to ensure all children and families have equitable and timely access to high-quality mental health services through identified, timely and measurable actions. This ambitious plan for comprehensive reform across all youth mental health services, including the specialist CAMHS service, identifies 16 priority improvement themes. The new action plan will not only improve consistency in how we deliver care, but will also ensure that every young person can better access appropriate and integrated services at the right time and in the right place, as envisaged under Sláintecare.

As I said at the outset, it is my firm belief that there is no health without mental health. We have overseen great improvements but there is much more to do. This Government and I have both shown our commitment to this statement through the provision of additional ring-fenced funding for mental health services and through our commitment to the introduction of a modern and fit-for-purpose legislative framework to provide human rights-based, person-centred and - something that is very important - recovery-focused care. This is the shared goal for all of us and we are collectively dedicated to achieving our legislative goals as well as delivering our national mental health policy objectives and the commitments of our national suicide reduction strategy.

I thank the Cathaoirleach Gníomhach for the opportunity to discuss mental health in the Dáil. I look forward to a collaborative and productive session. I look forward to hearing all of the contributions from colleagues. I thank them for their time here today.

Deputy Sorca Clarke

Statements and conversations on mental health are always welcome, no matter where they take place. However, we must be very clear and cut through the soundbites coming from Government not only since the election, but since 2020. There are many words that the parents of children who are not only not on a CAMHS waiting list, but who cannot even get in the door of CAMHS to be put on a waiting list, would use to describe this Government and previous Governments. This can be compared to Sinn Féin's commitment. Our position is very clear; regardless of where you live, if you have a mental health crisis, you will receive the right care. Our fully costed mental health action plan would transform services and give hope to those who need it by funding measures to two and a half the times the degree the previous Government did over the previous five years.

We propose universal counselling and integrated mental and well-being services; a new child and youth mental health service to replace CAMHS and provide integrated early intervention services; additional community CAMHS teams, CAMHS-ID teams, inpatient beds and early intervention in psychosis teams; multiannual funding certainty for the clinical programmes for eating disorders, ADHD in adults and self-harm and suicide reduction; 20 additional eating disorder inpatient beds and community-based services; the full emergency department roll-out of self-harm and suicide reduction programmes and embedding them across primary care and everyday clinical practice; an action plan to combat loneliness and isolation; the reopening of Keltoi, the residential dual-diagnosis facility; consultant liaison psychiatrists and suicide crisis assessment nurses in every emergency department and primary care centre; and importantly the development of an all-island mother and baby perinatal mental health unit.

In the lifetime of the last Government, there was an increase of 81% in the number of children waiting for a first-time appointment with CAMHS. There are 795 children waiting for a CAMHS appointment in CHO 8 area alone. There was an increase of 145% in the number of children waiting for longer than a year over the Minister of State's last term. In 2020, 9,689 children were on waiting lists for psychology. By 2024, that had grown to 18,368. On that same CAMHS, both the Maskey report and the Mental Health Commission reported children being misdiagnosed, mistreated and lost in the system.

While the Government is putting €9 million aside for mobile phone pouches, the Minister of State's speech references the €2.9 million in additional funding for CAMHS. Legislation to regulate CAMHS brought forward by my colleagues in Sinn Féin was kicked down the road by the Government, which then failed to deliver on its aims. The Bill to reform the Mental Health Act 2001 was put on the long finger and only introduced more than two years after pre-legislative scrutiny had been completed. The new programme for Government has less detail on mental health than the one presented five years ago.

The Government's legacy is one of heartbreak and of children being denied every opportunity to reach their full potential. A constituent of mine, following discharge from the adolescent mental health service at 18, was told that the adult service simply could not offer the services she needed. Overnight, her needs no longer existed, according to the assessment of her referral. The Minister of State is right that we are losing far too many people to suicide but that is the result of an understaffed, under-resourced and underfunded system.

Deputy David Cullinane

I will talk to the Minister of State about dual diagnosis and dual-diagnosis teams. As she will know, this is where a person has a mental health condition and an addiction. As has often been said in this Chamber, A Vision for Change and Sharing the Vision were very good on vision and on setting out what needs to be done. However, the implementation of both plans has unfortunately not been as good. A Vision for Change recommended general community mental health teams, which would have included addiction counsellors. Sharing the Vision expanded specialist mental health services to include people with an addiction who required shared case management. We now have the model of care for dual diagnosis, which is heavily linked to overall mental health services. It includes addiction, primary care, community mental health and specialist mental health services for all involved. The problem is that these services are very significantly under-resourced, understaffed and, at times, at cross-purposes. The model of care recommended 12 teams for adult services and four hubs for young adults and adolescents. I have been working with researchers for the Claire Byrne programme on RTÉ. The Minister of State might have heard some of the programmes they have done on this issue. They have been working with a charity that provides some of these services. To date, only two of those adult teams are in play. They are not even fully operational. There are also two adolescent teams. I put down a parliamentary question and the response I got back was that there is one adult team in the former CHO 3 area but that it will not be fully resourced until the end of 2025. It is the same for the former CHO 4 area, in Cork.

Again, it will not be fully resourced until 2025. Questions have to be asked. Where are the remaining teams? When will we see those teams rolled out? When will we see all those teams resourced? There is no point in having a vision and a strategy, and telling people we will put 12 teams in place, when only two teams are actually up and running and these are not fully resourced at all.

I will raise an issue in respect of CAMHS because the Minister of State mentioned it a number of times. In her constituency, which is the same as mine, two child and adolescent mental health teams cover Waterford, with two consultant psychiatrists. However, one of those posts is vacant and has been for some time. When will that post be filled? On the waiting times and the number of children who are waiting for CAMHS, 261 children in the Minister of State's constituency of Waterford are waiting for an appointment with CAMHS. It is simply not good enough. The fact of the matter is that all these plans are great, but they are only good and will only work if they are properly resourced. It can be seen that both the dual diagnosis teams and CAMHS are not getting the resources they need. We do not have the staff, which means that people are not getting the care they need.

Deputy Mark Ward

On a personal level, I congratulate the Minister of State on her appointment as Chief Whip. I welcome that the issue of mental health will have a seat at the Cabinet table but, to be honest, I do not have any confidence that things will improve. The past five years are evidence of that.

In 2020, since the Minister of State took over the role, there has been an 81% increase in the number of young people who are waiting for a first-time appointment with CAMHS. She cited an increase in referrals to CAMHS, but it has to be asked why. Why are more children being referred to CAMHS? It is because they are not getting the primary care mental health services they need. For example, at this very moment, 18,000 children are waiting for primary care psychology services. They are languishing on a waiting list. These are the children who will need the more acute CAMHS services. That is one of the reasons more children are going into CAMHS. There were 72 beds for CAMHS inpatients when the Minister of State was appointed. Only 51 of these are operational at the moment. When she was appointed five years ago, there were only three public beds for adults with eating disorders in the State. Guess what? Five years later, there are still only three adult eating disorder beds open for the public. This is simply not good enough. As the Minister of State knows, mental health is one of the most fatal health disorders we have. It is not getting the care it needs.

I read the programme for Government. As was stated, there is less mention of mental health in this programme for Government than in the previous one. The Government did commit to one thing; the regulation of CAMHS. Deputy Clarke, our new spokesperson on mental health, and I will help the Minister of State out on this one. As she knows, we introduced legislation in the last Dáil term. It passed Second Stage. The Government tabled a time-bound amendment to it and it was kicked down the road. We will reintroduce that legislation. The Government basically passed it so we will look for its support to let it proceed through the Houses. It was passed in the previous Dáil term. A time-bound amendment was placed on it, but the Government actually passed that legislation. We will bring it back in.

As the outgoing spokesperson on mental health, I thank all the stakeholders I engaged with over the past number of years. They gave me invaluable help. I acknowledge Ray Burke from Pieta House, who is in the Gallery. I also thank the parents who got in touch with me over the past number of years. They trusted me with some of the heartbreaking stories they had to face. Only today, I received a response from the HSE regarding a young eight-year-old boy called Seán. Seán's mam gave me permission to raise his case. I submitted a representation to the HSE in May of last year. The response I received today, nine months later, was unacceptable. Seán was aged only eight when he was referred for primary care psychology in 2022. Three years later, the psychology services are unable to give Seán an appointment. That is simply not good enough. There is no treatment for a young boy who was referred in 2022, and is now aged eight, for mental health treatment. This is not good enough. I will send the Minister of State a note on Seán. Hopefully, she can intervene.

Deputy Mary Butler

I thank the Deputy for his advocacy over the past five years.

Deputy Pat Buckley

I congratulate the Minister of State. We have been at this a while now-----

Deputy Mary Butler

We have.

Deputy Pat Buckley

-----and unfortunately it is still going at a very slow pace. In Cork city and county, 336 adults and 921 children and teenagers are currently waiting for mental health services. Some are waiting for 12 months, while some are waiting as much as four or five years. The Minister of State mentioned A Vision for Change. We definitely need to refresh that strategy. There is a recruitment crisis. We have had this over and over again. It is a bloody disaster. It has to be addressed. If we do not have the recruitment issues sorted, nothing will move forward.

I welcome the fact there is ring-fenced money for the Traveller community. I will always give credit where credit is due - I always say that. We do not have to be fighting across the floor all the time. The Minister of State mentioned the investment in mental health and well-being, which is a no-brainer. The fact is there are social and economic benefits to a healthy and happy society so it has to work. It also impacts on young people's development, which cannot be overstated. While we are doing apparently good things within the services, people are still coming to me. It is a long time since I was mental health spokesperson on this side of the House, and I congratulate our new lady beside me, Deputy Clarke, but things have not changed much. We still have the issue of the Owenacurra Centre. How many times have I battled the Minister of State on that? Nothing is happening there. We have lost 21 respite beds in mental health services.

The Minister of State mentioned community-led and community-focused. There is a brilliant place, the Midleton Hub, which is volunteer led, providing fabulous services. I encourage the Minister of State, and we can work together and improve services, to work with everybody and ask the questions. We will probably be able to give her some of the information that will help.

Deputy Louis O'Hara

The funeral of Adam Loughnane is taking place in Galway today. Adam made the decision to end his own life in the River Corrib in Galway city last week. I have been contacted by his family in relation to this, which has obviously had a devastating impact on them.

Adam had a very traumatic life and was registered with mental health services in Galway. He previously made an attempt to take his own life seven years ago. Adam's brother, Joe, was informed that Adam contacted his mental health support worker from COPE Galway on the morning of his death. It was clear that he was distressed while in the company of the support worker, so the decision was made to contact mental health services in University Hospital Galway. Once contact was made, Adam packed a bag and the support worker drove him to the hospital. Once he was at the hospital, he presented at accident and emergency where a triage nurse checked him out. Adam made it clear to hospital staff that he wanted to end his life. The hospital decided that he needed to be checked by the mental health team but they were otherwise occupied. Adam waited for a short period before leaving the hospital completely unsupervised. He then made his way to the river where he took his last breath. This was told to Adam's brother by a doctor from the hospital, who herself could not understand why Adam was not monitored. The questions the family have include why the hospital let him leave the premises unsupervised when he had clearly expressed suicidal thoughts, and why he was never advised by the various services that he was involved with to enter a mental health institution where he could have slowly recovered from a traumatic life.

This is a desperately sad case. It raises questions about our mental health services and the protocols our hospitals have in place to care for those with mental health issues, especially those who present with and express suicidal intentions. Will the Minister of State engage with the family on this case, assist them in getting answers to these very important questions, and work to ensure this does not happen again to somebody in a similar situation?

Deputy Marie Sherlock

I genuinely wish the Minister of State well on her reappointment. We all need her to succeed in her role.

To many of us, the decline in the mental health of our young people in this country is one of the biggest health, social and economic challenges of our time. The research states that approximately 50% of us will experience mental health difficulties at a particular point in our lives, but for young people the figures are truly terrifying. I am struck by surveys undertaken by the RCSI in 2021, which found that a quarter of all adolescents described their mental health as bad or very bad, more than a third reported self-harming in their lifetime, and one in ten or 10% had attempted suicide. Some of these results are related to the Covid-19 pandemic, but we know from talking to teachers and mental health professionals that those impacts are still being felt in our classrooms and communities. When we add in the housing crisis, there is a devastating impact on thousands of families and a ticking time bomb in terms of the mental health of so many of our young people.

In 2019, the Royal College of Physicians of Ireland published research that showed that 40% of homeless children experience clinically significant mental health and behavioural difficulties, are more likely to need clinical care and are at greater risk of bullying. As we all know, the number of homeless children has gone up dramatically since then, not down. From talking to so many families in my constituency, Dublin Central, I know overcrowding, cramped conditions, fear of eviction and eviction itself all have a ravaging, long-term impact on so many children, despite the brilliant efforts of parents and their wider families to try to shield them from the anxiety of it all.

Unfortunately, it is up to the Minister of State, her Ministry and her Department to make proper provision to deal with the psychological impact of the failure of the previous Government and, indeed, some of its predecessors to provide adequate housing and put services in place to deal with the overall deterioration of mental health services. Unfortunately, we currently have a system that is under-resourced, overstretched and, to my mind, in need of immediate reform. The waiting times are scandalously long. The Minister of State referred to a figure of over 600. I did a quick tot. The figures we had available for the period up to August last year show 941 children were waiting 12 months or more for a CAMHS appointment. The eligibility criteria for CAMHS are often too narrow. We see that interagency integration and co-operation are piecemeal. I have encountered families whose children's needs are too great for primary care but they do not meet the criteria for CAMHS. They are left with nowhere to go. The Minister of State knows this as well as we do. Behind all this is a model of care that fails to adequately recognise the value and potential of early intervention. We all very much recognise the need for better functioning and much better resourced CAMHS. I absolutely understand that we have to fix the parts of the broken system in parts of the country; however, the eye has been taken off the ball in recent years in ensuring a more comprehensive system of early interventions. While I hear what the Minister of State said about more funding, the reality is that we are still very far from where we need to be with early interventions across every county and community. Consequently, we are condemning young people and their families to unnecessary mental distress and, of course, preventable mental health circumstances that become crises. This requires more investment in mental health in schools, communities and higher education settings. We absolutely need more investment in community-based mental health services.

I pay tribute to Jigsaw and Spunout, in particular, and the other community-based mental health services, which are doing brilliant work across this country. However, we need more of this work in our communities. When I examine the breakdown of the mental health budget – I am the new spokesperson on health for the Labour Party and am still trying to find my way around it – and when it appears that 12.2% or so is spent on CAMHS, I conclude we do not seem to have any great clarity as to how the rest of the budget is being spent. That needs to change.

With regard to CAMHS itself and its regulation, I want to put on record our very firm and clear support for the mental health bill and its necessity and urgency. We urge the Minister of State to press on with it as fast as possible. We all know the existing legislation is badly in need of reform. It is 24 years old and in need of updating, so we will not be found wanting in trying to progress it through the Houses. However, as we all know, the legislative reform will have very limited meaningful impact if our mental health services are not properly staffed.

I sincerely welcome the introduction of the mental health clinical programmes over recent years, but the reality, certainly from late last year – I do not know whether my figures are as up to date as they should be – is that we know we were about 40 teams short across mental health clinical programmes, ADHD, dual diagnosis, early intervention for psychosis, and eating disorders. That points to a series of major issues with regard to how professionals in this area are recruited and retained. It is an issue the Government has failed on right across the health sector. I am thinking, in particular, of a psychologist I met about six months ago who works in one of the biggest mental health providers in the State. She is 55 and has considerable experience but is burnt out because of the massive waiting lists and the enormous toll and strain of knowing, day in, day out, that she cannot meet the demand that exists because she operates in a service that is under-resourced. She loves her job and is totally committed to doing what she has done for the past 30 years. She wants to work part-time so she can sustainably continue working, but she has been refused this. She has been denied because the reality of the HSE pay and numbers strategy it that it has imposed an appalling chill effect on any type of flexibility and innovation with regard to managing existing staff.

I am aware that the recruitment restrictions have been lifted, in theory, but we are not seeing the results in practice. We know that about 700 psychiatric nurse vacancies were effectively wiped out or disappeared because of the pay and numbers strategy. That is wrong. It is wrong in a sector in which we know there are major shortages. Let me give a specific example. Linn Dara, which operates out of Cherry Orchard, Ballyfermot, got a derogation in May 2024 for 14 posts. A significant number of those posts have been filled but there are no contracts forthcoming. What is happening? We are being told publicly by the HSE that the recruitment freeze has been lifted, and on the ground we are hearing about a very different context.

The second key issue I want to raise with regard to recruitment concerns the section 39 workers. We know that the backbone of mental health services in this country is comprised of section 39 organisations. They feel a real sense of disrespect because of the lack of pay parity between them and workers doing the exact same job in section 38 organisations. I very much welcome that the pay negotiations are going to recommence but there is concern over whether the Government will really push for pay parity. We had a very clear statement in Fianna Fáil's manifesto that it would pursue pay parity. Fine Gael did the same but the concept disappeared from the programme for Government. I asked the Taoiseach about it earlier and asked him whether he was committed to pay parity. He said he was, but section 39 workers need to be convinced of that. We need to ensure the pay rates of section 39 workers are tied to those of section 38 workers, such that we do not have the nonsense that happens every few years whereby a pay negotiation must happen to let section 39 workers catch up. The reality is that care workers who do overnight shifts earn less than the minimum wage. I ask the Minister of State to put her political heft behind ensuring section 39 workers are given the dignity and respect they deserve for the crucial work they undertake, because we need every single mental health worker to stay in his or her job and to be looked after. With regard to recruitment and retention, we cannot afford the exodus we are seeing in so many parts of our health sector.

Deputy Martin Daly

I am grateful for the opportunity to speak as a TD and GP about an issue of deep concern to my constituents in Roscommon–Galway and, indeed, people across the country, namely the status of our mental health services.

While I fully acknowledge the very significant personal commitment of the Minister of State, Deputy Butler, and that of the Government in prioritising mental health care, delivering the Sharing the Vision and Connecting for Life strategies, introducing the new Mental Health Bill, and having provided additional funding of almost 40% since 2020, bringing the figure to €1.5 billion, it is clear that significant challenges remain. We must be honest about the gaps in the system and take decisive action to address them.

Mental health professionals, GPs and families on the front lines are raising serious concerns. Mental health services now receive a smaller proportion of the health budget, at just 6%, than they did over three decades ago.

That is significantly lower than the UK spend of 9%. This long-term decline in proportional funding has made it increasingly difficult to provide timely and accessible care, even as demand continues to rise. Even then, the Government must ensure that current funding is effectively targeted.

We do not have enough community or inpatient capacity. In the Roscommon acute unit, there are 24 acute beds. Eight of those are taken by people ready for discharge for the want of appropriate accommodation in the community. Some are in those beds for years rather than months. In my constituency of Roscommon-Galway, care has become increasingly inaccessible. GP psychiatry referrals, both adult and child and adolescent, are returned without actual assessment or a recommended pathway. In no other part of the health service is an experienced GP's referral for a second opinion bounced back without assessment. Acute and chronic services are overstretched, and patients in crisis are struggling to get the care they need.

We cannot ignore the impact of modern lifestyle factors on mental health. Social media are contributing to rising levels of anxiety, depression and low self-esteem, particularly among younger people. Children and adults who have had mental health issues associated with neurosensory disorders or ADHD have until now had no adequate pathways for assessment and treatment. I welcome the Minister of State's statement on the establishment of that service.

Increasing prevalence of substance abuse is leading to increased anxiety, depressive disorders and psychosis. Our services must be resourced not only to treat those in crisis but also to provide early intervention and prevention strategies.

Eating disorder hubs have been either not rolled out or inadequately rolled out, denying young people, especially young women, timely intervention for a disease that has such a high morbidity and mortality, causing untold misery to sufferers and their families. I welcome the Minister of State's statement of the expansion to 14 units. I hope that they are fully operational and that the additional two units will be established forthwith.

Capacity is the issue. There are not enough inpatient beds, meaning that people in severe distress often cannot be admitted. We have approximately 24 beds per 100,000 people. The European average is 75 per 100,000. We have moved away from institutional inpatient care to the community, but there is always a need for inpatient treatment for people. The stark reality remains that one needs to be exceptionally ill to get into hospital. Staffing shortages across psychiatric services continue to place immense strain on the system. In the community, we do not have enough fully resourced multidisciplinary teams to provide early intervention. Without adequate staffing, prevention becomes impossible and more people end up in crisis.

I know this Government is committed to improving mental healthcare. The expansion of the national clinical programmes for specialist mental health services is a welcome development, and I acknowledge the significant efforts to roll out self-harm and suicide-related services across all emergency departments. However, we must ensure that these services are properly staffed and extended into the community, where they are equally needed. When we moved from the institutional care model for mental health services, we promised people reinvestment into community psychiatric services. It was never going to be less expensive, just a more appropriate, humane delivery of care in people's own communities. The investment has not happened as intended. We see a third of patients in inpatient beds for more than 12 months and high rates of readmission. That reflects a failing community sector. We must have capacity in the community sector, whether it is supported living or robust community support for people in their own homes.

I know that the Minister of State and this Government share my commitment to improving mental health services. We have taken important steps but we must continue to listen to the concerns of patients, families and mental health professionals. By working together, we can deliver-----

An Ceann Comhairle

Thank you, Deputy. Leave your colleagues time.

Deputy Martin Daly

-----a system that is truly accessible, effective and responsive to all the needs of our constituents.

Deputy Ryan O'Meara

I congratulate Deputy Butler on her reappointment as Minister of State with responsibility for mental health and her new position as Government Chief Whip. I welcome the opportunity to speak on this very important subject in this Chamber. It is personally very important to me. I also acknowledge the Government's work in placing this on the schedule so early in this new Dáil term and giving us the chance to speak on mental health. In this country we need an open and honest discussion on mental health, and it is a very good thing, both in terms of policy and law governing the area and for us as a society, to see our politicians stand up and speak on this issue in the Dáil, possibly de-stigmatising it for people sitting at home who may see this or who may be experiencing mental health difficulties.

On policy, law and legislation in this area, while it is the Minister of State's and her Department's responsibility, we need to acknowledge that mental health and the issues around it are far beyond one Minister, one Bill or one section of Government. It is something that every Department, every agency and every Minister in this State needs to be cognisant of. While access to services is so important, it is a matter of mental health across a broad sector of society for those coming to my office who are struggling to get payments to which they should be entitled, those who are waiting on appeals and farmers who are waiting for payments under serious pressure. I do not believe mental health across all those aspects is seen across all sectors of the Government, and we need to work on how things are being siloed in this country.

As regards the Mental Health Bill, reform in this area is long overdue. I know the Minister of State is aware of that, and I acknowledge her work on the Mental Health Bill to date. I appreciate the fact that it got to Second Stage in the last Dáil before its dissolution. I also welcome the fact that on page 95 of the programme for Government we have stated that this is a priority for us and that the passage of the Bill is essential in modernising our mental health services. It is a once-in-a-generation opportunity to reform legislation in this area, and it is the first major overhaul of policy in this area in 20 years in the State. I had intended on coming in here today, when I had written this contribution, seeking an update on the Government's spring legislative programme. I see the Minister of State has managed to do work on that from her seat here in the Chamber today. I welcome that the Bill is now placed on Committee Stage on our legislative programme. That is very important.

I wish to discuss social media in this country, which Deputy Daly touched on. The major social media platforms that are both operating and based in this country and this city are failing many of our young people. They are hiding from their responsibilities when it comes to the regulation of their platforms. Bot and anonymous accounts, in particular, are doing untold damage in being allowed to say what they want whenever they want and about whomever they want. The allowance of threatening, abusive and intimidatory behaviour online is doing untold damage, particularly to young people in this country - but not just to young people. We are looking at anxiety rates and depression rates rising among young people. We deserve a lot better from our social media companies and we should demand a lot better. As regards the allowance of bot and anonymous accounts in this country, we see it as politicians who are posting on social media and in the abuse we get, which should not be acceptable. It seems a norm in society today. It is young people in particular who are so susceptible to that and so easily influenced by that. They are being let down by those social media companies.

Finally, as regards the likes of ASIST and safeTALK training, there is massive space in this country for the roll-out of those programmes on a wider scale within our communities. I was trained in applied suicide intervention skills in a previous job I had working in student accommodation. I had to use that training on quite a number of occasions doing suicide interventions with people who were my peers at the time, the same age group as me. These suicide first aid courses are desperately needed in our communities. My own community, Nenagh, is experiencing a very difficult time at the moment, with a number of suicides in recent times. It impacts a community desperately. The feeling or sense of despair in our communities when this happens is atrocious. We need to encourage our community organisations to roll out these suicide first aid courses, similar to how we have first aid responders in other walks of life. If the HSE could work with communities in doing that on a much larger scale, it would be really beneficial on a community level.

An Ceann Comhairle

Thank you, Deputy. I know you were left a few seconds short thanks to Martin.

Deputy Denise Mitchell

It is very welcome to see the issue of mental health up for discussion again in this House. However, one thing I have noticed over the years of being in here is that there has been a lot of talk about mental health and very little action. Plenty of people are sick and tired of the talk. They want the Government to provide the services that they need and that should be in place for them, particularly in a wealthy State like ours. They do not want to be stuck on waiting lists for months and months while their mental health deteriorates.

In the most recent European Commission report on mental health, 44% of people surveyed in Ireland said either they or their family members had encountered issues when it came to accessing mental health services here.

That was the highest in the EU. The most common issue was being stuck on long waiting lists. I am sure we are going to hear a lot talk again about the progress that has been made on the provision of mental health services, yet compared with five years ago we still have fewer CAMHS inpatient beds. We do not have any extra. What we have more of is children waiting for their first appointment with CAMHS, children waiting over a year and children waiting on psychology waiting lists. I think the Minister will agree the list is way too long.

Next week is Irish Eating Disorders Awareness Week and I was pretty shocked to hear we only have three adult eating disorder beds in this State. Between 2018 and 2023 there were supposed to be 20 new beds opened. This never happened so I ask the Minister of State where the extra beds are. As she knows, I do not just come in here to criticise. My party has solutions and we also have proposals. Our team published a fully-costed five-year mental health action plan. All of us in the House are interested in ensuring people get their treatment in a timely fashion and we all agree people should be able to reach their best potential. We want to work with the Minister of State and the Government to make a real difference in this area. I am hopeful and I really hope the Government and others will stop the talking and get down to action to deliver for people who are really in need.

Deputy Liam Quaide

I congratulate the Minister of State on her reappointment as Minister of State with responsibility for mental health. We hear so many stories about what is going wrong with our mental health services and as public representatives advocating for our constituents it is difficult not to fall into a position of perpetual complaint and outrage at times because there is so much unmet need out there and sometimes decisions are made that are not in the interests of people attending our services. It is important to acknowledge there are also very fine examples of services from which we can draw inspiration and learning. I visited one of these last Friday in Midleton. It was the launch of the Coolmine east Cork hub. The hub is a joint venture between the HSE’s social inclusion team and Coolmine itself and provides community-based support for people with addiction. We heard from a woman attending the service whose life has been transformed by the support and connection she experiences there.

A focus for me over this Dáil term will be services for people with severe and enduring mental health difficulties, who are among the most vulnerable attending our services. They have often suffered greatly throughout their lives and may require ongoing intensive multidisciplinary support and sometimes residential placement in order to attain stability and a decent quality of life.

When I joined the north Cork mental health services as a psychologist in 2013 the rehabilitation and recovery team in that location was helping many long stay patients of St. Stephen’s hospital in Glanmire to reintegrate back into their communities. It was painstaking, complex and ultimately transformative work. That north Cork team and its three 24 hour-staffed community residences in Kanturk, Mallow and Fermoy remain an exemplar for the direction we need to take towards community integration for people with the highest level of mental health need. Unfortunately, the HSE’s current proposal to invest €64 million to develop a 50-bed residential mental health service on the grounds of St. Stephen’s is entirely at odds with that progressive trend and national mental health policy. It will lock vast amounts of public money into a centralised, isolated service when it should be spent on community-integrated settings in towns such as Cobh and Clonakilty where none currently exist. The HSE has responded to concerns I have raised about this proposal by emphasising the buildings, which will be five bungalows, will not be institutional in design. However, a home is about much more than a building; it is about the broader community in which a person is embedded. When residents of the Owenacurra Centre in Midleton were being uprooted in 2021 they were not concerned about the size of their bedrooms but devastated at the loss of community connections formed over years or in some cases decades. This relationship with their community was a core part of their identity, as it is for all of us. The land around St. Stephen’s is zoned for agricultural use and the land directly across from it for light industry, namely, an online warehouse. The nearest shop of any description to St. Stephen’s is a service station a 1.7 km walk from the hospital’s entrance. The first kilometre of that route has no footpath and Cork City Council has no plans to develop one. The nearest grocery shop is in Riverstown, which is 3 km walk from the hospital and again there is no footpath for the first kilometre. There are no community amenities within walking distance of St. Stephen’s and no plans to develop any. These residents typically do not drive, some have mobility issues and the distances cited above may be considerably longer depending on the exact location of the proposed residences within the large hospital campus.

This proposal, therefore, does not remotely reflect the kind of community integration espoused by A Vision for Change, Sharing the Vision or the HSE’s policy for people with severe and enduring mental illness and complex needs. It is also at odds with the UN Convention on the Rights of People with Disabilities, which enshrines the right of people with disabilities to live in their community. St. Stephen’s is a fine location for an elective hospital but it is not a suitable place for people to live over a period of years and in some cases for the rest of their lives. Centralising these residential placements in St. Stephen’s will necessarily disconnect people from their communities because a service of that size will take people in from a broad catchment area. Let us not go back in time with this proposal and misdirect lots of money in the process.

I also appeal to the Minister of State to engage intensively with front-line staff in mental health services that are in serious difficulty. Consulting senior management is obviously necessary in the Minister of State’s role, but senior managers are one group amid several key stakeholders. They often have their own pressures and are usually operating at a significant remove from the day-to-day running of services. Engaging with front-line staff in a confidential format would be invaluable to understanding where we are going wrong with service provision in some areas. I make the same suggestion to the Minister of State, Deputy Moynihan. The crises in primary care, psychology and child disability network teams are interrelated and staff on the ground will quickly inform the Minister of State of what needs to be done.

For the most part the answers relate to recruitment. Installing another layer of management to implement the retrograde pay and numbers strategy by redeploying existing staff will not solve the out-of-control waiting lists in primary care, psychology and CDNTs. It will lead to a plummeting of morale and drive clinicians out of the health service. There is no HSE service with an excess of psychologists. Some are doing relatively well with their waiting times, but this is something we should be striving to emulate rather than undermining it through a race-to-the-bottom redeployment strategy. In primary care psychology the problems with recruitment are primarily to do with insufficient efforts to recruit qualified staff on secure contracts and this is further hampered by the pay and numbers strategy. There is an overreliance on assistant psychologists who are not fully qualified and therefore are very limited in what they can provide clients.

I wish the Minister of State well in her post. Though we are on different sides of the House I hope to work in partnership with her, the HSE and other agencies for the betterment of services over the coming years.

Deputy Pádraig Rice

I too congratulate the Minister of State on her reappointment as Minister of State with responsibility for mental health and also her appointment as Government Chief Whip.

I will talk about funding, policy and the law. On funding, for far too long mental health services have been the Cinderella of our health services. Decades of underinvestment have left us with understaffed and underresourced services. The system needs a major overhaul to shift the focus towards proactive and community-based services, but this kind of reform requires real investment. We simply cannot have another five years of stagnated budget allocations. By now the mental health budget should represent about 10% of the overall health budget. This was a target set under Sláintecare but Governments over the last number of years have failed to meet this commitment and the new programme for Government is silent on it. In the 2025 budget it represents 5.8% of the total, which is a mere 0.1% increase on 2024. Since 2020 the allocations have fluctuated between 5% and 6%. It is not good enough. Will the Minister reaffirm this Government’s commitment to reach 10%, as set out, and set a pathway to achieving that goal? This perpetual failure to reach the 10% target is not good enough in terms of funding.

The implementation of the national mental health policy, Sharing the Vision, is simply not happening quickly enough. I was looking at the report from the monitoring group from November 2024. The progress report for the national implementation and monitoring committee, the body responsible for driving and overseeing the implementation of Sharing the Vision, revealed just 50 of 100 targets are on track. This is a stark finding and cannot be ignored. It must be an impetus for change and we need to get these targets on track, get them implemented and get the policy delivered. The Minister of State will have our full support in trying to do that.

I agree with Deputy O’Meara who spoke earlier about the importance of SafeTALK and ASIST.

These are courses I did myself and I too have had to use those skills. They are vitally important. It is crucial we get those out to communities and train as many people as possible. There are particular concerns in respect of some of the minority communities, such as the Traveller and LGBT communities, which need a particular focus and a tailored response.

In the context of the law, while I welcome the fact that the mental health Bill has been restored to the Thirty-fourth Dáil, it should have gone through the legislative process long ago and be enacted by now. Looking at the timeline for this Bill, an expert group was appointed in 2012 to review the Act. It is now ten years since that expert group provided recommendations. It recommended 165 changes to the 2001 Act. It is a very long time from 2012 until now for that expert review. The then-Minister of State with responsibility for mental health and older people, Deputy McEntee, promised a first draft of the Bill by the end of 2016, but it took until 2021 for the heads of Bill to be published and another three years before it got to the House. It is not good enough.

Although the existing Act is at odds with international human rights law, it remains on the Statute Book. Time and again, the language of human rights has been used and embraced by governments but the policies and the laws required simply are not. The new mental health Bill represents a real opportunity to change that and to provide a person-centred, human rights-compliant approach to mental healthcare. This is why the Bill must be prioritised once committees are back in place. I look forward to working with the Minister of State to ensure the Bill is enacted as quickly as possible.

Deputy Maeve O'Connell

As this is my first time addressing the Dáil, I beg the indulgence of the Ceann Comhairle before I move to the substantive statement of the day. First, I thank the people of Dublin-Rathdown for their confidence in electing me to this Dáil. I thank in particular the residents of Clonskeagh, Kilmacud, Stillorgan, Mount Merrion, Leopardstown, Foxrock and Cabinteely who supported me not only in the general election but also in the local elections held earlier in the year. I also thank my friends, family and supporters who campaigned with me through two elections and all types of weather. I could not have done it without them. I specifically thank the former Minister, Josepha Madigan, in whose footsteps I am following here today. She was very much a mentor to me throughout all my elected years. Finally, I thank my husband, Colm, who has always been a constant supporter and advocate for me.

Before I was elected, I was a lecturer in TU Dublin, and, therefore, I have been working with young people on a day-to-day basis for the past number of years. As a result, I have seen at first hand the importance of mental health to both personal and professional success. I have also seen, unfortunately, over the past number of years the continuing legacy of Covid-19 among our young people. It is why the issue of mental health among young people is something that is particularly important to me. Supporting people from an early age with support and resources is important, but that also needs to be continued through their adolescent and post-adolescent years to ensure they can live fulfilling and joyful lives, to which we are all perfectly entitled.

An area of mental health about which I wish to speak today is one that was raised repeatedly by many parents, friends, family and young people directly with me while I was working in TU Dublin, namely, the issue of eating disorders. A report of the Health Research Board found that up to 25% of hospital admissions for under-18s related to such illnesses. That is how prevalent it is. It is, unfortunately, one of the mental health illnesses that can be terminal. It has one of the highest terminal rates and, therefore, is a very serious disease and not one to be treated lightly. I acknowledge the Minister of State, Deputy Butler, for raising the issue of eating disorders in the last term of Government. She did a lot to raise awareness of the issue and worked to improve services in this area. I appreciate all of that.

One of the largest concerns that parents raised with me, as acknowledged by the Minister of State, is the waiting list to access CAMHS. Parents can quite easily recognise an eating disorder but trying to access support for it is increasingly frustrating. I have spoken to many parents who have had to try to manage the situation themselves. It is very challenging and frustrating for them. I welcome the Minister of State's efforts to try to reduce those waiting lists in order to get parents and their children the supports they urgently need.

The other key concern those parents have is what happens when their children turn 18 and are no longer able to access the services in CAMHS. The goals of the national clinical programme for eating disorders for 2025 are to develop transition pathways between CAMHS and adult eating disorder teams. Creating those linkages is absolutely vital in ensuring young people can continue with that support. It will mean those young people who are on the path to recovery can continue to be supported and can continue to improve their mental and physical health and live those joyful and fulfilling lives.

With early intervention, eating disorders can be prevented from becoming a lifetime illness. That is why it is so important. It is one of the things on which we can actually do something and turn people's lives around.

I welcome that we have an eating disorder treatment hub in Mount Carmel Community Hospital in my own constituency of Dublin-Rathdown. I visited it last week with the Minister for Health, Deputy Jennifer Carroll MacNeill, to open the first of six new surgical hubs in the country. Those sorts of facilities within the community are vital in order to provide surgical treatment and mental health treatments as well. I very much welcome them. I also welcome the commitment in the programme for Government to enhance provision for adult and youth inpatient beds for eating disorders, as has been addressed by several speakers today. We need more beds and inpatient and outpatient services. Every person is different. Every person is on a different journey and that range of services is absolutely essential in order to help them on their pathway to recovery.

I also want to acknowledge that the mental health Bill is coming back to us. I look forward to it helping to address some of the issues I have raised today and to improve the mental health service and champion the needs of those who rely on its services. I look forward to continuing to champion these issues for the people of Rathdown throughout my term in the Dáil.

Deputy Dessie Ellis

There is clearly a crisis in mental health, the provision of mental health services and the resourcing of these services. Many of these problems are a consequence of insufficient staffing levels in such services. For many years, mental health services have haemorrhaged highly qualified staff without them being replaced. Mental health services in Ireland have had a big staff retention problem for many years. It comes as no surprise, therefore, that Ireland is ranked as one of the worst countries in the world for mental health. The State of Health in the EU reports, which are published every two years, compare Ireland with other countries in the EU across a range of different categories, including mental health. The most recent report confirmed that the rate of mental health disorder in Ireland is higher than the EU average.

One of the areas of mental health in which I have a particular interest and have advocated for is dual diagnosis. This simply means that a person can have both a mental disorder and a substance use disorder involving alcohol or drugs, or both. People presenting with dual diagnosis have faced barriers that have excluded them from the appropriate care needed. It can be a struggle for many to get proper care and supports for their mental health problems. The bar for admission to mental health services is set very high and there seems to be a reluctance in making decisions where people with severe mental health issues who also have addiction problems are admitted to the service. This also applies to situations where a person presents at a Garda station with mental health issues. In such cases, a psychiatrist is supposed to be available to assess the individual. In my experience, during the time such individuals wait to see the psychiatrist, their condition may have changed, perhaps improved, which can lead to them being sent home after being seen by the psychiatrist rather than the assessment being based on their original distressed condition. This leads to a false analysis of the individual's true mental state.

For those who get a level of support, they find that when they leave the services, there is no proper aftercare or follow-up for them. There is a lack of outreach and follow-up programmes for those who have been brought through the mental health service and are integrating back into the community.

Mental health staff work very hard and do a great job with the resources they have. Many of them go above and beyond the call of duty. They deserve better. They deserve a better working environment that is fully resourced and fit for purpose. Too many people have lost their lives having been turned away from our hospitals and services. Resources are badly needed to help address this.

Deputy Catherine Connolly

The Minister of State and I have been here before and I have already congratulated her. There is an urgent need for the mental health Bill to be enacted. It was an absolute damming indictment of the last Government that it failed. I have praised the Minister of State for her work and I fully supported her with that Bill, but it fell. That Bill was the culmination of years of consultation and recognition that the system had utterly failed in respect of mental health.

We go forward from the eighties and Planning for the Future. Then we go forward to A Vision for Change and then Sharing the Vision. What did not change was the system on the ground, which is the revolving door we see in Galway and in other institutions in the context of suicide, and then the failure to provide beds for people with eating disorders.

On a general level, the mental health Bill was to take us onto a new level with a human rights-based approach in recognition of our international obligations in respect of how we treat people with what are now being referred to as psychosocial disorders, moving away from involuntary detentions, which are at an all-time high, how we treat young people aged between 17 and 18, and regarding an increased monitoring role for the Mental Health Commission to take in community care facilities and so on.

I notice there is going to be a second implementation plan. As the previous speaker for the Labour Party or the Social Democrats pointed out, the first one has failed to reach its targets. I will be closely monitoring the enactment of the Bill and then the implementation plan meaning something.

Deputy Charles Ward

There is a severe mental health crisis in Donegal which only continues to get worse as the defective concrete crisis continues to impact families across our county. New scientific mental health research conducted by the University of Ulster surveyed 393 families living in defective concrete homes across Ireland. The findings were devastating but not surprising. The research found that more than a third of individuals have experienced thoughts of suicide after being affected by defective concrete. A total of 15.5% of the response meets the criteria of complex post-traumatic stress disorder, which is twice as high as the level among the general population in Ireland. Some 30.4% of respondents reported severe levels of depression, a rate nearly three times higher than that among the national population. Some 26.2% have reported severe levels of anxiety, which is nearly four times higher than the Irish general population. The rates of these mental health issues are similar to, and in some cases even higher than, those seen following natural disasters, such as displaced populations, earthquakes, refugees and flooding.

The independent scientific evidence confirms defective concrete homeowners are significantly psychologically stressed or, at worst, clinically traumatised. The Minister of State must address this current and very threatening ongoing situation for families living in such distressed states. The defective concrete crisis is one that affects more than bricks and mortar. It affects families, marriages and people's physical and mental health.

Deputy Roderic O'Gorman

I welcome the opportunity to discuss mental health and how our State responds. We all know the historic position that mental health services had in this country during the last century. There was little investment and a damaging institutional approach, all reflective of attitudes at the time. Thankfully, today attitudes are different and the State's response is different. We now have a problem of prioritisation, however. The State is seemingly in perpetual catch-up mode to try to provide the services to reach everybody who needs support. For too many, it simply does not happen and that is unacceptable. I think of course, of CAMHS and the urgent need for services to be regulated and for coverage to be expanded.

Much of the focus in today's debate is on the high-level critical interventions, the need to recruit and resource into CAMHS and the need to rapidly pass the mental health (amendment) Bill. I wish to put a focus, however, on the State's ability to direct early interventions. For young people, early intervention is absolutely crucial to avoid issues escalating and the need for more significant treatment later on. I think specifically of Jigsaw in Dublin 15, in my own constituency. The work it does saves lives.

I was disappointed there was not a lot on that early intervention piece in the programme for Government. I would welcome the Minister of State addressing this in her concluding remarks because I know she gets it. She might speak to what she and the Government intend to do in the area of early intervention.

Deputy Richard Boyd Barrett

We are not allowed use the word "lies" in here, so instead we will have to say the Government is systematically misleading people about why we have a recruitment and retention crisis in our health services in general and, specifically, in our mental health services. It fails to acknowledge the reason we cannot recruit or are not recruiting the staff we need - psychologists, psychiatrists, psychiatric nurses, occupational therapists and speech and language therapists - is because of the pay and numbers strategy restricting the ability of different health areas to recruit people.

I have a letter from the Psychiatric Nurses Association of Ireland, PNA, which came to me yesterday. It points out there are 700 too few psychiatric nurses in the country because of the pay and numbers strategy. A personal anecdote sums it up for me more generally. I know a young woman who has a Master's degree in psychology. She had to go to the Netherlands to do that course because it is too expensive to study psychology here. Where is she now? She is working in the psychology department of an international school in Thailand where they have a department full of psychologists and young graduates from this country. She likes Thailand but she would also like to be working here. However, you have to do a PhD here and she will not be able to afford to live here. This is the problem. The Government is not recruiting people because of pay and numbers. We have massively understaffed resources. We should have psychologists, and indeed psychology departments, in every school but we do not have them because the Government will not recruit them and it is too expensive for them to live here anyway.

One of the most stressful things I have ever come across - it happens fairly regularly in my clinic - is people coming in with mental health crisis situations and threatening to take their own lives. I am not qualified to deal with that and neither are my staff. When there was a briefing in the Oireachtas a while ago, and we asked what we should do about this, we were told to call the Garda. We were told to call the Garda because we do not have 24-hour emergency services we ought to have to respond to those sort of situations.

Deputy Seamus Healy

First, I congratulate the Minister of State on her appointment and I wish her well for this Dáil term.

The programme for Government, under the mental health section, commits the Government to ensuring access to appropriate supports when and where people need them. The emphasis on when and where is very important because it is widely accepted that mental health services should be provided to patients as close as possible to their locality. This is because contact with and support from family and friends plays such a vital role in recovery.

The whole of County Tipperary is without a single inpatient bed in the mental health services. South Tipperary patients must travel to Kilkenny and north Tipperary patients must travel to Ennis. That situation is completely unsatisfactory and unacceptable. The former Fine Gael Minister of State for mental health services, Jim Daly, had agreed with all stakeholders, including the Department of Health, the Health Service Executive, consultant psychiatrists and the local community to construct a 20-bed inpatient unit at Tipperary University Hospital. Possible locations had even been identified. For whatever reason, however, this development never went ahead. I appeal to the Minister of State to recommence that process to construct that unit at Tipperary University Hospital and to provide the people of Tipperary with adequate, reasonable inpatient mental health services into the future.

Deputy Séamus McGrath

First, like other speakers, I welcome this discussion so early on in the lifetime of this Government. It signals an intent by the Government to address the issue of mental health once and for all. The Minister of State was a strong advocate in the area of mental health in the previous Government and I have no doubt will be such in this Government. Her efforts ensured that it received strong recognition in the programme for Government as well, which is vitally important.

The word "Cinderella" is one I have heard used often in the context of mental health. Despite the best efforts of the Minister, unfortunately the treatment of mental health is severely under-resourced. That is something we have to correct incrementally insofar as we can as a Government. A sum of 6% of the budget is simply not enough and that is replicated across the country. As public representatives, we see the lack of services and the difficulty for people to access the services that are there. We hear their stories on a daily and weekly basis.

As we know, mental health, or, more to the point, the inadequate treatment of mental health, is the root cause of so many issues in our society. Certainly, we have an acute housing crisis and homelessness situation but I have no doubt that in many cases the root cause of rough sleeping is inadequate treatment for mental health. There is no question about that. The whole area of addiction is very much linked to mental health and the lack of treatment for it. We all know how destructive addiction can be but, again, inadequate treatment for mental health is very often the root cause of that.

In many cases, it leads to criminality and people entering the criminal world, often to feed an addiction or simply because they have not received treatment for mental health problems and it is a way out for them, so that is a very significant issue. No doubt, mental health problems very often result in severe physical health problems emerging after a while if there is undertreatment. For a wide variety of reasons, it is extremely short-sighted for any Government not to prioritise and adequately resource mental health services.

One area I will focus on is the lack of housing provision for people with mental health problems. Very often, as public representatives, family members trying to provide housing for those with mental health problems will come to us. Often these involve mild mental health problems but involve people who are patients of mental health services in some shape or form. We do not have housing options for them to provide them with independent living with some wrap-around services. Wrap-around services simply are not in place, which is not good enough. Very often, people end up in accommodation that is not suitable for them. I know of one case where someone is in long-term accommodation in a homeless service because there is no proper accommodation is available. That is something about which this individual's family is very concerned but there does not seem to be a way out through an alternative.

We have heard how difficult it is to get inpatient treatment but that is not the solution for everybody. There need to be more community services at local level. There is a significant deficit in this at primary care level that we must address.

Another area I will focus on is the mental health of young people and children. It is a significant issue, the extent of which is under-recognised. It has been referred to in terms of CAMHS waiting lists. Anxiety is widespread, particularly among children and young people. We live in a stressful, difficult and tough world. Social media has amplified this to a very large extent. Unfortunately, this puts ferocious pressure on young people, pressure we did not have when we were growing up, so we must recognise this and, at Government level, there has to be significant recognition of treatment for things like anxiety in young people because, God knows, it leads to something far worse if it is untreated.

I welcome the recognition regarding the Mental Health Bill. We must progress that, but as we know full well, if we do not adequately resource it, it will not provide the solutions we need. Giving something a strong footing from a statutory point of view is very welcome but it has to be adequately resourced so that we can provide the services that are so badly needed across society.

Deputy Thomas Gould

There is a crisis in children's mental health services in Cork and Kerry. A total of 60% of all children on waiting lists for CAMHS appointments for more than one year are in Cork and Kerry - 60% in just two counties. Hundreds of children experiencing severe mental health issues are on a waiting list while their parents and loved ones watch their condition deteriorate. A mother contacted me recently. Her child was refused access to CAMHS twice. In December, she was finally accepted and was told that she would be waiting 13 months to get an appointment on the priority list. Her child has not attended school for two years. She wrote "I am begging ye". She is at her wits' end. Could someone help her and her child? Could someone help and support them? Another lady contacted me whose child was refused access to CAMHS three times. When she was eventually accepted on to the list, she was told that it would take two and a half years to be seen. When she contacted me, she wrote that her family was in crisis.

These are just examples of the countless cases with which I and others are dealing. These children will be adults some day. What will happen to them after they have been failed? Often the initial referral is for a minor issue, but because there is no support and nobody to help them, their anxiety escalates and their depression grows.

Parents fight tooth and nail for their children but they are meeting a dead end when it comes to CAMHS in Cork and Kerry because the waiting list is so long. More than 1,000 children are on the CAMHS waiting list in Cork and Kerry and one third have been waiting more than a year. Do the Ministers of State realise how long a year is for a child in crisis? Do they realise how distraught the parents are when they look at their children and cannot help them? This Government is talking about early intervention and providing resources, but they need it now. They need it today.

We need an urgent intervention in CAMHS in Cork and Kerry. We have seen scandals and apologies but this Government has failed to deliver. It has failed the children of Cork and Kerry 100% when it comes to CAMHS. People do not want apologies. They want this Government to put the money, therapists and supports in because, God forbid, there are children who are at serious risk.

Deputy Michael Collins

I welcome both Ministers of State to their positions and wish them the very best. One of the most significant criticisms concerns the persistent underdevelopment of mental health infrastructure. While the Government has announced initiatives such as the expansion of child and adolescent mental health services, CAMHS, and the development of new specialist teams, the reality on the ground often tells a different story. Long waiting lists, insufficient staffing and inadequate facilities continue to plague the system, leaving many without the timely support they desperately need. Children suspected by teachers of having autism are having to wait 27 months to get an assessment. This is a serious issue for families left in limbo for 27 months and it also prevents the child from getting the help needed at an early stage. This affects their educational, mental and physical development.

The Government's approach to mental health has also been criticised for its lack of a comprehensive long-term strategy. While funding increases are welcome, they must be part of a broader cohesive plan that addresses the root causes of mental health issues and ensures sustainable support for those affected.

Suicide rates in Ireland remain a grave concern. In 2019, 2020 and 2021, Ireland's suicide rate was approximately 9.6 per 100,000 people. Although this is lower than some other European countries like Germany and France, it is still a significant issue that requires urgent attention. The impact on families and communities is profound and more must be done to provide support to prevent these tragedies.

While I have the floor, I must commend the Minister of State, Deputy Butler, on the mental health unit in Bantry. I fought the battle here to make sure we had a proper mental health unit and it has been built. I was given a tour. It is a fantastic facility. Mental health issues affect so many families, including my own, and today is the first anniversary of my nephew's suicide. That said, I want to touch on the concerns I have about the number of beds in the Bantry mental health unit. Maybe we lost a bed but it is not just that. The mental health unit in Bantry covers a vast area and this must be taken into account. While we must praise the efforts by everyone, including the Minister of State, that put that new state-of-the-art mental health unit in place and the staff are fantastic, we need a stand-alone mental health unit in Bantry because it looks to me as if everybody wants to treat the patient outside the unit. In the world in which we live, that might suit some people but it does not suit all. The unfortunate situation is that there are not enough bed spaces in the unit and this needs to be looked at.

Deputy Ken O'Flynn

I welcome and congratulate both Ministers of State on their positions. From reading the reply, I note that the goal of this policy is to focus on the mental health of the whole population, which is a very welcome statement. Perhaps something that has not been addressed in this working document is the mental health of a certain sector of society, namely, carers. Who is looking after the carers? When I started in politics a long time ago - 20-something years ago - I went to a carers' conference in UCC. I listened to a lady talking about her life caring for her husband. What she said always stuck with me. In fact, it left an indelible mark.

She told me she met her neighbour every day and for 22 years, he would ask, "How is John today?", but nobody ever asked, "How is Mary?" I do not think we are concentrating on the mental health and needs of those who are caring for their children, siblings or parents. I note that, according to a Healthy Ireland survey, 17% of parents who are caring for children are suffering with mental health issues. It is also worth noting that the survey reported that 15% of people who are caring for elderly parents, which is a percentage well above the international norm, have registered as having mental health problems. This is not being looked after. We must realise that people are under tremendous stress. It is not just about getting a break from looking after somebody for one week out of the 52 weeks of the year. It is a 24-7 job. To care for somebody is an active role that requires inner strength. The Government is not giving enough wrap-around services and we are not asking who is caring for the carers.

Deputy Peadar Tóibín

I wish the Ministers of State good luck in their roles in this important space. I will detail the experience of Damien. He has had schizophrenia for the past eight years and has been in hospital for a number of months in those years. In the past year, things have got worse for the family and they have gone to great lengths to get help. Their son is in the fields until 3 a.m., up to his eyes in muck and battling demons and devils. The family have found Damien eating his own excrement and vomiting. They tried to get him into a day hospital but he cannot cope in such a setting. They have been getting very little sleep. The mother had a stroke and the father is now on antidepressants. They are told nothing by doctors because Damien is an adult. They ask what medicine he gets or whether he has had his injections but are told absolutely nothing.

He was sectioned twice in the run-up to Christmas. Each time, his overnight admission was made voluntary so he could sign himself out. The family were very disappointed about that. On 3 February, he was again sectioned and brought into hospital but he was signed out when he assaulted somebody in the hospital. The family collected him from the Garda the next day and brought him for a walk in the grounds of Maynooth University, where he seriously assaulted a number of individuals, one of whom is still in hospital and may lose the sight in his eye. Damien is now in the medical wing of Cloverhill Prison. The family feel that not enough was done to help this situation and that much of this was preventable if they got the help they needed.

I also want to make reference to another individual who has been spoken about in this debate, namely, the young man who lost his life after entering a river in Galway. The series of events surrounding that particular night are incredibly concerning. We often hear stories of people who present themselves seeking help but do not get the help and, unfortunately, go on to commit suicide. We must get to grips with what is happening.

CAMHS are crumbling around the country. There is no doubt we are suffering from a lack of recruitment as a result of the lack of proper pay, terms and conditions. We must ask ourselves why there is such pressure on children in modern society. We must start to tackle the causes of the mental health issues in our society.

Deputy Paul Nicholas Gogarty

Why is it that despite investment, we seem to be, at best, running to stand still in respect of our mental health services? There are many things to cover, but I will focus on some of the matters that are getting worse despite a record allocation of €1.48 billion in budget 2024. Of particular concern to me and my constituents, and the topic I wish to concentrate on in my brief contribution, is the alarming increase in waiting times for CAMHS. I recently submitted a parliamentary question on the issue and await the reply. Before the election, according to the HSE, more than 4,500 children were awaiting an initial appointment and 750 of them had been waiting for more than a year. That is totally unacceptable. I know there has been movement on the issue of inpatient beds, but the enormous delay in intervention makes mental health issues worse. They are often exacerbated by social media use outside of school hours.

There is also a persistent shortage of mental health professionals, which hampers service delivery. My colleague mentioned the recent ending of embargoes and the terms and conditions. Despite plans to recruit nearly 3,000 staff in 2024, there are other barriers, including low pay and inadequate housing. In that context, I will, on behalf of public health nurses, raise the issue of the Dublin allowance. It applies to staff in this sector.

Deputy John Connolly

Like other Members of the House who spoke previously, I wish the Minister of State, Deputy Butler, well in her role and congratulate her on her reappointment. It is a difficult portfolio but the Minister of State will have the support of the House in all earnest efforts to try to improve services for patients in this area. I compliment the Business Committee on enabling this debate.

I am familiar with the case outlined by Deputy Tóibín, which was also outlined earlier by Deputy O'Hara, of the young man who presented at the accident and emergency department of University Hospital Galway last week. Unfortunately, he was in a position to leave the facility without receiving care and attention, and subsequently died by suicide. I offer my sympathies to the family of that young man. Resourcing front-line services for people who present with mental health difficulties at accident and emergency departments seems to be an ongoing issue. I agree with Deputy Tóibín. We seem to hear about these instances quite frequently. The challenge is that there does not appear to be a sufficient presence at accident and emergency departments of those who can intervene in a crisis situation. Of course, the challenge is that most of the staff in accident and emergency departments are busy and run off their feet. When these circumstances can result in what happened in Galway last week, it is something we need to look at carefully.

Another major infrastructural challenge is the absence of inpatient beds. The acute mental health facility in University Hospital Galway has 50 beds. The data highlights that the facility is consistently full, leading to my concern that it is difficult to get access to the facility. This must present a great dilemma to psychiatric teams in terms of the necessity of admission, and while there is a welcome emphasis on the provision of facilities within the community, we must ensure a sufficient number of acute beds. Ireland's psychiatric bed rate per 100,000 of population has declined from 78 in 2008 to 33 in 2019. The European Union average rate is 73 per 100,000, which we are some way below. We must be worried that the absence of acute beds is exacerbating problems within the community. That is something we should examine.

Many people have mentioned CAMHS. Despite attention deficit hyperactivity disorder, ADHD, referrals for assessment and intervention being the reason for the majority of referrals for CAMHS, children must often await assessment and the availability of interventions and therapies is limited. As was mentioned, 4,500 children are on the existing waiting list for CAMHS. It is likely that many of those patients were referred to CAMHS as a result concerns about ADHD and are seeking further intervention. The impact of not intervening at the earliest point is that there are difficulties and challenges later in life. I compliment the Minister of State because I know that in the past year, for the first time, a service for adult ADHD sufferers has been established in Galway, Mayo and Roscommon. That service is to begin this year and I hope it begins soon. Adults with ADHD cite increasing challenges in life that present as mental health difficulties. We need to provide care for adults. If we can enhance care in CAMHS for the children who present with ADHD, it will reduce the burden of the disorder as children move into adulthood.

As I said, ADHD is the commonest cause of a referral to CAMHS but there are only two CAMHS facilities in the country that provide specialist ADHD clinics. The current system means children with concerns who are referred for assessment for ADHD often must wait due to urgent cases being unavoidably prioritised. The Linn Dara CAMHS facility in Dublin, which I am sure the Minister of State and other Deputies are aware of, recognised in 2019 the urgent need for a standardised approach to the assessment and treatment of children with ADHD. That was the first HSE specialist service for the assessment and management of childhood ADHD. Over the past five years, its ADMiRE service has developed a structured, standardised and evidence-based clinical pathway for the assessment and management of ADHD. We should roll out that approach throughout the country to facilitate a greater service for those children and lead to better life outcomes for them. That would streamline referrals to CAMHS in a better manner. There would be a specific service for children with ADHD and an alternative service for children who present with other mental health issues, such as eating disorders and other such ailments.

It is a model we should look at expanding.

Deputy Erin McGreehan

I am glad we have this opportunity to speak about mental health so soon in the term. It shows the Minister of State’s conviction and the importance she places on this. This is something I am very worried about. Like the Minister of State, I have regular constituency clinics and I know it is a huge issue. We knocked on doors from last summer until November. I do not know how many doors opened where, door after door, I spoke to parents, wives, husbands, sons and daughters who are struggling desperately with their mental health. They are struggling for various reasons. Some are struggling to access help and trying to get out of a situation. Some are stuck in a place where they may be self-medicating because they do not understand their condition or they might not be getting the help or therapies they need. I feel as though we are on the edge of a cliff hanging off. So many young people, older people and people of every age are struggling.

We heard in the House about young men and women who have taken their lives and died by suicide. It would be remiss of me not to mention one person in particular. I have been dealing with his family and a group that has grown up to support the family and fight for improved mental health services. I speak of Mark Kavanagh. He died by suicide last year. He was an incredibly popular, well-known young man who was synonymous with Dundalk Football Club and the town of Dundalk. That put shockwaves through Dundalk, whether it was people who knew him, people who had heard of him and people who could see themselves in him and saw their families in him.

If there is one thing we in this House, the Departments and the HSE must do in the next couple of years, it is that we must ensure that when those crisis trauma moments come along in a person’s life, there is a safe place for them to go to which is signposted and the person is taken care of, minded and not let go out to take their own life. That has happened so many times. Very often, I hear from people who have been patients in mental health services who feel they were not heard and there was a lack of kindness. They were seen as a number on a sheet. They were discharged and put in taxis to be sent home, even if it was not known whether there was someone at home for them. There was not even a care for them as they left the hospital where they were asked if they felt suicidal. They might not have but what about five or ten minutes later? Very often it happens very soon after.

If we are to change things, there are things we can improve on. One is signposting. Anyone looking up the HSE website for crisis mental health will find emergency services, of course, but then it is GP services. Where can a person go? The emergency department will not be a safe place for them. They cannot go there and sit in all that chaos. They need a place where they can go and be taken care of. I am a mammy of four young boys. My eldest is 12 and I am afraid. I see so many young boys and young men struggling for many different reasons. We can bring it back to early years where we have to build in that resilience. That is not something for the Department of Health but it is something for society, education and parents to build that resilience into our children and young people so they are fit for the craziness of this world. However, many of us need treatment and therapies and support and we must help people there and then when it happens.

I wish the Minister of State the very best of luck.

Deputy Maurice Quinlivan

I wish the Minister of State the best in her new role. I hope she and the Government will treat mental health as a priority. I think all of us in this Chamber are agreed that a lot of work needs to be done. A person’s mental health is as important as their physical health. If a person is disabled in one aspect of their health, then it will have an impact on the other aspects unless the condition can be treated quickly. We all know that.

I am sure all Deputies will agree that, too often, there are significant delays in the treatment of mental health. This has been particularly true in recent years for young people who engage with the child and adolescent mental health services. Early diagnosis and treatment are crucial in assisting these children in managing their illnesses and recovery. Childhood is fleeting, and where help is needed, it should be offered as soon as possible. Children deserve better than to be waiting for treatment and to be subject to a postcode lottery, which happens quite often.

Under the previous Fianna Fáil-Fine Gael Government, waiting times for an appointment with CAMHS grew longer. Since 2020, the number of young people waiting more than a year increased by 145%, from 223 to 546. Behind these statistics are young people who need support. It will be a young person whose life is impacted because they are not receiving the support they need. Behind these statistics are parents desperate to do the best for their child. I welcome the reinstatement of the Mental Health Bill 2024, which the programme for Government notes is a priority. The programme for Government states that its passage “is essential to modernise our mental health services”. My party agrees that the passing of this legislation is very important. We also advocated for its implementation throughout the previous Dáil, but two and a half years later, we continue to talk about a Bill that has not passed. The Minister of State will be judged on her progress of this. We will hold her to account but we will also help her when we can.

The treatment of mental health in the State is challenging. Too many people do not get treated and too many face the challenge alone. In Limerick, we are fortunate in some of the fantastic volunteer support groups that operate in centres such as the Haven Hub where you can walk in and talk to somebody, our courageous suicide prevention teams who patrol the banks of the River Shannon to assist anybody who is in need, or the Bedford Row project. Without their efforts, many families in Limerick would be in a much more difficult position. They have provided coping skills to children and their parents. They are some of the unsung heroes of children’s mental health. However, these heroes can only do so much without State support, support that, without the enactment of the Mental Health Bill, remains lacking.

In the past couple of months, Limerick has seen the launch of the community access support team which is comprised of gardaí, medical professionals and paramedics who respond to out-of-hours mental health issues. I was delighted to attend the launch last year, which the Minister of State attended and I met her there. Again, that was a delayed launch. When I first raised this in the Chamber, I was advised it would be launched in the last quarter of 2022, but it was launched in 2024. While we wait for the Government to step up to the mark on mental health, waiting lists are growing. For instance, in my area covering Limerick, Clare and north Tipperary, at the start of the term of the previous Government, 196 people were waiting to be seen by CAMHS. The figures are indicative of the snail-like approach to mental health and this needs to change. While children await appointments, their childhood is being damaged.

Deputy Barry Heneghan

Go n-éirí leis an Aire Stáit. I want to highlight the vital role sports clubs play in supporting mental health in our communities. I have seen at first hand how young men and women of north Dublin can have a sense of camaraderie going to sports matches in Shelbourne FC. Shelbourne FC runs a football for all team, which provides a football service to include individuals with a range of disabilities, including autism, Down's syndrome and multiple intellectual disabilities. There are more than 70 players aged 20 to 50 years who train and play for the club. The focus is on a player’s ability rather than their disability. I have seen the impact it has had on players. It is a lot more than just sport for them. There are also the social connections and self-esteem for the players as they put on that jersey and are treated with the same respect as any senior team member of that club. In the words of Leanne Walsh, they love it and play for Shelbourne. That is their team The club has a business plan that is dedicated to supporting children and adults with disabilities which will help their mental health. There are already strong partnerships in place with Child Vision on the Gracepark Road, St. Michael’s House, the CRC and Prosper Fingal.

These connections show how sport is a powerful tool for inclusion and mental well-being. I am calling for investment in Tolka Park to make this vision a reality. None of this would be possible without Ann Murray, Finian McGrath and Leanne Walsh from St. Michael's House and I thank them for that.

Deputy Gillian Toole

I wish the Ministers of State the very best of luck. The greatest wealth is health and the greatest health is mental and emotional health. We can be a little flippant in this House with the use of the word "resilience". We use it in connection with things when it actually derives from the ability to successfully adapt to stressors, to maintain psychological well-being in the face of adversity and to bounce back from difficult experiences. To this end, investment in the support of children's mental health is of paramount importance. The educational objectives in the programme for Government can be implemented next month by experienced practitioners if the will exists. A working example is the success of St. Seachnall's and Rathbeggan national schools, both in County Meath, runners-up in the Mission Possible awards last year and last week. Their work has been enabled by Finding Your Wings, which is essentially a multi-sensory well-being experience that supports emotional and cognitive development. More information on this is available from me. These local initiatives support the entire school community and deserve departmental and our support. The focus on economic development and GDP must be expanded to included a well-being index. We are human beings, after all, not just human doings.

Deputy Mattie McGrath

I wish both Ministers of State well. There is a big job of work to be done here. Mental health is just the poor relation. There are so many problems. CAMHS services are non-existent in Clonmel. Where services exist, some consultants - not a lot - are exploiting the situation by not treating patients in the public service and instead forcing them into the private service. Much investigation needs to be done there. We had local heroes. Colm Ryan was a famous gentleman from Ballymacarbry in the county of the Minister of State, Deputy Butler. He was a wonderful man who helped in so many areas, raised funds for so many issues and supported so many people. There was devastation when he ended his own life. For his sake and the sake of dozens of people like Colm Ryan who have ended their own lives since - it is so sad - we need to be able to do something for people who are struggling. Going to an accident and emergency department, such as the mad accident and emergency unit in Clonmel, is not an option. We do not have a single long-stay bed in County Tipperary. People who have psychotic attacks have to go to the accident and emergency service. It is not acceptable.

Deputy Danny Healy-Rae

I wish both Ministers of State well in their new jobs. County Kerry has its fair share of mental health problems. We all know what happened with south Kerry CAMHS when 250 children were badly wronged, mistreated and badly let down. Not much has changed since then in south Kerry. Families are left to their own devices to try to mind their children around the clock. Some people cannot go to work because they have to stay with their children. There seems to be no way out. There is a waiting list of two years in some cases. That is not fair or adequate at all in this day and age, when a life could be depending on a bit of help. People need proper help and not just antidepressants. We are still waiting for the report on north Kerry CAMHS. A junior doctor was blamed in south Kerry. I wonder who will be blamed when the story comes out in north Kerry because it is up the line and we are not getting the proper services down to the patients.

Minister of State at the Department of Health (Deputy Jennifer Murnane O'Connor)

I thank the Members of the House for their contributions this afternoon. I will respond on behalf of myself and the Minister of State, Deputy Butler. While we all recognise that there are areas for service improvement, the passion with which we have discussed the issues is a clear testament to the fact that mental health is an important topic across all parties, and across all parts of government. Much has been said today about ensuring our mental health services are modern. It is important that our capital infrastructure, through which these services are delivered, keeps pace and provides modern, accessible and safe environments for service users. To this end, the HSE is developing a three-year prioritised capital plan to upgrade specific approved centres to meet evolving Mental Health Commission compliance requirements. The HSE is also developing a longer term ten-year capital plan for mental health, which will help to determine priorities for improving facilities nationally to underpin the implementation of our models of care and the type of infrastructure envisaged under the national mental health policy, Sharing the Vision. The new mental health ten-year capital development programme will focus on upgrading existing facilities, replacing inappropriate community facilities and continuing to expand services.

In the context of capital infrastructure development, the Minister of State, Deputy Butler, has secured an additional €2.1 million to facilitate the opening of 18 beds in the National Forensic Mental Health Service at the Central Mental Hospital in Portrane. The opening of these beds will increase capacity in the system for forensic mental health services, which is a priority for the Departments of Health and Justice. These beds will also allow patients to move through the various levels of support offered by the forensic care pathway in the hospital and, in turn, allow for further admissions across the Central Mental Hospital. I also look forward to the opening of an additional 20 CAMHS beds in the new children's hospital, which will support access to services in this state-of-the-art facility. It is meant to be a beautiful facility.

As I am sure you will all agree, CAMHS teams and those who work in our community and inpatient mental health services, along with the wide range of other mental health supports provided by or on behalf of the HSE, make a crucial and real difference to the lives of those who seek mental health supports each year. I wish to acknowledge, on my own behalf and that of the Minister of State with responsibility for mental health, the work of those who have an ongoing commitment to providing mental health interventions for the people of this country. The positive impact that increased investment, as detailed in today's opening statements, will bring to child and youth mental health services will be tangible, measurable and impactful. Improving access to modern mental health services requires that the waiting lists for CAMHS be addressed. In order to continue to meet demand over 2025 and future years, CAMHS teams need to be appropriately staffed. The investments I have announced for 2025 will go some way to meeting that staffing need. Budget 2025 provided 95 new posts for youth mental health, including CAMHS. I look forward to all posts being filled as a matter of urgency.

Mental health supports come in a range of types of interventions. It is important to note the role of digital mental health services as we seek to ensure the services we provide are modern and make best use of innovation in our wider health service. A mental health literacy campaign was launched in October 2022. It is an ongoing and iterative campaign to create awareness and understanding of mental health. It enables people to recognise and manage their own mental health, support others when they identify a mental health need, and identify health difficulties at the earliest opportunity using self-help, social support and community services. YourMentalHealth.ie, which provides information and advice about mental health and well-being, had nearly 2.5 million views in 2024, with a 65% engagement rate. This is an important initial source of information for people who may be seeking supports and information. The .ie domain and the clear links to our national HSE show the public that they can trust the information here, and in doing so, can be signposted to a range of services.

More recently, the HSE developed and launched My Mental Health Plan, which has been in use since April 2024. This is an online and interactive tool designed to help individuals to reflect on their mental health needs and receive personalised advice. The plan matches user responses to questions to appropriate supports. This results in the user receiving tailored advice and resources. Between April and December 2024, some 13,600 individuals started their mental health plan through this website, with 13,100 of them completing their plan. This high completion rate speaks to people's satisfaction with the tool and provides important evidence that this is a trusted and reliable support for people. In addition, Text About It is a free, anonymous, 24-7 messaging service that provides immediate support for mental health and well-being. Text About It provides a safe space where people are listened to by a trained volunteer. In 2024, there were more than 48,000 conversations on the platform, representing more than 4,000 conversations a month.

Over the past year, the Department of Health, HSE and Spunout have been collaborating to commission the development of a dynamic web-based signposting tool, the Navigator app, for young people between the ages of 16 to 34 to support their mental health.

The aim of the project, which has been developed thanks to funding secured by the Minister of State, Deputy Butler, is to facilitate help-seeking behaviours and enhance access to support. The app aims to provide young people, parents, caregivers and those working with young people with reliable up-to-date information on where to access supports and services at both a local and national level for a variety of mental health issues. This tool is due to be launched before the summer. These examples show how over the last number of years Ireland has managed to develop and implement mental health policies that are very supportive of mental health promotion and recognise digital supports as an important medium for mental health promotion. I can confirm that officials in the Department of Health are currently working with their World Health Organization counterparts to develop the first digital mental health roadmap, which will draw on Ireland’s experience in developing mental health digital supports and provide examples of best practice alongside other European examples. I look forward to the roadmap being finalised and published by the end of the year.

It is clear from today’s statements that mental health services in this country provide a wide range of supports from mental health promotion, prevention and early intervention, right the way through to specialist inpatient services. The Department of Health continues to work with the HSE and partners in the sector to ensure that investment, innovation and improvements are made across the entire spectrum of services and in line with our national policies. It is important that everybody who needs help seeks help, and that we work hard to ensure mental health is a stigma-free issue. Anyone can experience mental health challenges at any time during their lives, and that is why I want to repeat a vital message that often goes unsaid, which is that recovery is possible. If any person is feeling pressure, I encourage them to reach out for help. There are a wide range of high-quality mental health supports available in Ireland through the HSE or the many agencies providing care on its behalf. The best way to find out what supports would best suit someone is through their GP, or via information signposting such as online at YourMentalHealth.ie, which provides information and signposting on all the mental health supports and services that are available nationally and locally, provided by the HSE and its funded partners. The freefone Your Mental Health information line is available 24-7 and provides supports and services at 1800 111888. People can text HELLO to 50808 to access a service that provides emotional support 24 hours a day to anyone experiencing a crisis through engagement in a text message conversation with a trained and supervised volunteer.

On behalf of myself and the Minister of State, Deputy Butler, I thank the Ceann Comhairle for the opportunity to discuss mental health in the Dáil today. We all understand the priority and urgency of this issue.

Dáil Éireann debate - Tuesday, 18 Feb 2025

Mental Health: Statements

Dáil Éireann debate -
Tuesday, 18 Feb 2025