Joint Sub-Committee on Mental Health debate -
Thursday, 17 Jun 2021

Impacts of Covid-19 Lockdowns on Mental Health Services for Young People: Discussion

Chairman

I welcome our witnesses. They will be presenting virtually to our meeting which will focus on the impacts of Covid-19 lockdowns on mental health services for young people. I welcome from Jigsaw, the national centre for youth mental health, Dr. Joseph Duffy, CEO and Dr. Gillian O'Brien, clinical director and from the Soar foundation, Mr. Mark McDonnell, CEO, and Ms Megan Byrne, programme facilitator. Before we hear their opening statements, I need to point out to our witnesses there is uncertainty if parliamentary privilege will apply to their evidence from a location outside of the parliamentary precincts of Leinster House. Therefore, if the witnesses are directed by me to cease giving evidence in relation to a particular matter, they must respect that direction.

Apologies have been received from Deputy Mark Ward, Senator Annie Hoey and Deputy Neasa Hourigan. Deputy Gino Kenny is running late, as is Senator Martin Conway. They will be joining us soon. I call on Dr. Joseph Duffy to make his opening remarks.

Dr. Joseph Duffy

Jigsaw warmly welcomes the opportunity to contribute to the vital work of the Chair and committee members once again. As Ireland’s primary youth mental health charity, supported by the HSE and other funders, Jigsaw has, over the past 15 years, established a track record in achieving better mental health outcomes for young people by providing a range of primary care therapeutic services for young people aged 12 to 25 and creating supportive communities around them.

From the start of the Covid 19 pandemic, we were adamant this would not change. In the past 15 months, we have seen how Jigsaw has constantly evolved in response to an ever-evolving situation. From early on, we were acutely aware that Covid-19 and the measures taken to contain it had the potential to negatively impact on the mental health of young people. The restrictions, though necessary, took aim at our collective need for closeness in personal relationships with family and friends, autonomy, control, direction and a future to aim for, which are all key components of our mental health. Young people, in particular, have been disproportionately impacted over the course of this pandemic in terms of significant disruption to education; important milestones and transitions lost; opportunities for developmentally important social interactions removed and employment opportunities all but wiped out. Many see their future as being unrealised and a youth unspent.

In response, Jigsaw adapted by offering choice to young people about how they could access our services; in person, on phone or via video. In tandem with this, we developed a range of online supports and services aimed at marrying the opportunities technology affords with our expertise and experience. It is a union that has offered real and tangible supports to many young people, across a range of platforms and throughout the country.

How has Covid 19 impacted on our young people’s mental health? Research and reports carried out by NUI Galway, NUI Maynooth and the ESRI, more recently, and reports this week from BelongTo and the Ombudsman for Children paint a picture of increased isolation, rising anxiety, worry, stress and fear among many cohorts of young people. At Jigsaw, our data support and follow this.

Over the past 15 months, we have seen significant periodic variations in the referral levels to Jigsaw, in line with stricter public health guidelines. We saw 67% fewer referrals in the initial period from March to May last year, during the first lockdown. That was down a further 17% in the second lockdown in September. In the third lockdown, we saw referrals significantly down by approximately 35%, but we have also seen a periodic increase once it begins to open back up.

Looking at the characteristics of those young people who were coming to Jigsaw during that time, our data show that the levels of psychological distress of those we have supported have been relatively stable for the 17 to 25 year olds, but there has been a slight but significant increase in distress levels for younger people aged 12 to 16. In terms of the concerns identified by young people, most of the concerns would be similar to what we have seen before, except there are increased disturbances around anxiety and sleep. While anxiety has always been a top-presenting factor in Jigsaw, both pre-pandemic and post-pandemic, factors contributing to anxiety, the system around that and how it manifests are shaped differently. We may talk about that later.

There has also been an increase in the proportion of younger females, aged 12 to 16, coming to Jigsaw. This has changed from 35% in 2019, to 39% in 2020 and 44% in 2021. We have engaged extensively with schools and communities over the past 15 months, with more than 12,000 online teacher course registrations, close to 1 million page views on jigsaw.ie and more than 1,300 in attendance for our Jigsaw Connect webinar series; that is teachers, parents and young people participating in online training. What is hugely important is that behind each statistic is a young person, teacher or concerned parent.

Jigsaw has taken significant learnings from this time. We must look forward and use the opportunity presented to us to face some long-term challenges facing our young people and system of care. We are acutely aware Covid-19 has only exacerbated a worsening situation regarding our collective mental health. Long before Covid-19, mental health services across primary and secondary care were overstretched, disjointed and under-resourced; rates of self-harm were on the increase and young people throughout the country were experiencing significant levels of anxiety and stress. Suicide was and remains, the single biggest cause of death among young people.

Wait times for primary mental health services were excessively long; staff recruitment is a significant challenge; overall investment in mental health is well below international comparisons and the demand for services such as Jigsaw’s was growing year-on-year; in our case, at an increase of approximately 25%. Long before Covid-19, areas such as research, schools, third level and community supports remained chronically under-invested.

For us, Covid-19 has the additional challenges which have been presented but it has simply exacerbated an already dire situation in terms of youth mental health. We need to take action now. What is important is to think about the hope on the horizon. There is a good policy environment now in terms of tackling some of these fundamental issues. Given the increased political and public will around Sláintecare, Healthy Ireland, Sharing the Vision and the more urgent needs among young people, doing nothing is no longer an option.

We need to think about new and fresh perspectives and looking at spirit of flexibility, agility, openness and doing things differently to focus on the short years young people have in terms of their mental health and trying to support them. While we are aware there is no easy fix or miracle solution for mental health challenges, which can be complex and challenging, there is much the Government and policymakers can do to better support young people those who are experiencing mental health difficulties.

Increasing the funding for mental health is hugely important. That is something others would argue and support. It is important to look at not just dividing the budget but increasing the overall budget and looking at supporting upstream and early-intervention services in particular. It is important to look at how we enhance the workforce planning around mental health. Recruitment of sufficient numbers of appropriately qualified mental health professionals is a significant challenge to all agencies within the sector, Jigsaw included. What is clear is there is a limited number of mental health professionals graduating into and entering the system and many of them leave the country to avail of better opportunities overseas.

There is significant competition for posts between services. We are all struggling to resource teams and this is especially challenging in certain geographical areas. We end up competing against each other. With regard to some of the elements which will contribute to addressing this issue, we would be looking at increasing the numbers at the university courses, especially in relevant disciplines.

We would look at the allied health professional training courses to include a greater emphasis on youth mental health, thereby facilitating a smoother transition for graduates into mental health services. We also see increased family focused, more flexible, well-being focused employment in the field, along with the promotion of the mental health field as a progressive, recovery-focused place to work where you can make a real difference in the lives of others.

As well as the funding and recruitment, it is about the system integration. Members will be aware that the Pathfinder Project report on youth mental health in 2017 looked for a whole-of-government approach to address the challenges facing the current youth mental health system. Jigsaw believes that a director of youth mental health needs to be appointed without delay to drive this forward. It would look to bring together the recommendations of the task force in youth mental health and the mental health Pathfinder report and have a strong holistic and systemic focus. We believe that a truly co-ordinated, integrated mental health system across primary, secondary and tertiary services would ensure access to the right mental health care at the right time and in the right place, and that this would make sense. These are the principles enshrined in Sláintecare.

We call for increased funding for Jigsaw and, importantly, that this funding be multiannual. With more than 15 years’ experience of delivering and evaluating youth mental health services and supports, we are uniquely placed to provide some fresh perspectives. At Jigsaw, we are committed to exploring and demonstrating how new models of community-based, person-centred early intervention mental health care can be expanded in a sustainable manner that will deliver a demonstrable positive impact on the mental health of young people. Our aspirations in this area can only be accomplished with multiannual funding. We believe such increased investment would consolidate our work and create a new evolved and blended service offering across in-person, video, phone and online services and supports that would make a significant difference in creating a more responsive front-line mental health service for young people and would contribute to reducing wait times, alleviating pressures on specialist services and provide greater support for communities.

As an organisation fully committed to working with and supporting government agencies, we thank Senator Black and the committee members for this opportunity to meet with them today. Given the ever-growing demand for mental health services and supports in a world that has changed now more than ever, with the support that is there, real opportunities are at hand to address these challenges. While the current cost of the Covid-19 pandemic to individuals, families, schools, communities and society at large is uncertain, we are clear and certain that we all have a role to play in developing these new solutions. At Jigsaw, we are fully committed to playing our part, and I hope members will continue to support us in these ambitious plans. I thank the committee for their time.

Chairman

I thank Dr. Duffy. I now call on Mr. Mark McDonnell to make his opening remarks, followed by Ms Megan Byrne.

Mr. Mark McDonnell

I thank the Chairman. On behalf of the Soar Foundation, and all the teenagers we represent, I would like to express my gratitude to the Chairman and the committee for the opportunity to speak on such an important topic today.

For the benefit of the members, the Soar Foundation is an independent organisation founded in 2012 to seek an alternative solution to the distress we were witnessing among our teenagers. Our approach was inspired by the Reach Foundation in Melbourne, which was founded by Jim Stynes, and has always focused on a preventative approach to well-being where all teenagers are developing the skills and character necessary to navigate everyday life. The purpose has always been a proactive approach to prevent significant mental health issues arising as teenagers approach early adulthood,and reduce the need for curative or acute services further down the line. Soar is a peer-to-peer model where we train young facilitators to deliver programmes primarily through the school system. To date, we have delivered our character building programmes to some 45,000 teenagers in 215 schools across 28 counties.

We are currently living through an environmental crisis, political instability internationally, social volatility, and technological advancements changing the world in a way that we cannot even assimilate. It is an anxious time and teenagers feel that deeply. Soar has been providing on-the-ground solutions for the previous nine years, but we knew we would need to continue to evolve and be agile in meeting their needs as a result of Covid-19. From our engagement over the past 15 months we are witnessing teenagers struggling with three key issues: isolation; a heightened sense of worry; and their confidence and self-belief is absolutely on the floor. We did three things initially. First, we listened to their concerns and gave them a platform to have their voices heard and normalise their experiences. This #GroundedForGreatness series covered topics such awareness, courage, and resilience, and received approximately 25,000 views and engagements across our media platforms. Second, we created a new online programme called Hustle where teenagers could explore the topics together over a four-week period from bedrooms, kitchens and sitting rooms all over the country. Third, we adapted our existing school based programmes to an online platform and provided sessions through Zoom in schools. We did everything we could to serve the needs of teenagers online until we had the opportunity to re-engage in person. Despite the logistical challenges, and with the support of some incredible schools and teachers, we have managed to serve nearly 4,500 teenagers face-to-face since March 2020.

We have been struck by the outpouring of emotion from teenagers all over the country in our workshops. This pent-up emotion needs a release where teenagers can express their experiences in safe environments. Initial findings from our research partners, the UNESCO Child and Family Research Centre at the National University of Ireland Galway, NUIG, indicate the positive impact of these essential environments, with increases in teenagers' emotional management, sense of belonging, empathy and maturity, social support, and inner confidence growing as a result of our programmes.

At this point I would like to heighten the awareness of the committee to the situation we are facing. We are witnessing teenagers emerging post lockdown with significant unprocessed distress. It will be essential to continue to provide safe, non-judgmental environments where teenagers can connect together as a group. These environments will help reduce that sense of being alone, validate their experiences, gain perspective together, grow compassion and empathy, and allow them to support each other, all with the intention of reducing the possibility of longer-term issues such as acute anxiety and depression presenting. It is essential at this stage to invest in preventative solutions to take increasing pressure off our already stretched acute services.

It is important to acknowledge the fatigue that may be present for teenagers post pandemic. Many have come through what is likely to be the most challenging period of their young lives. It would be a mistake to expect, or demand, that they immediately re-engage into high-functioning activity. It is important after any trauma or distress to recover. As we look to the longer-term future, it would be wrong to solely blame the pandemic for the struggles we are witnessing among our teenagers. The My World Survey 2 study published by our colleagues Jigsaw and UCD in 2019 indicated increases in anxiety, depression and self-harm increasing significantly over the previous ten years. The pandemic is the petrol being poured on what was a burning fire. We believe these patterns will persist as long as we continue to prepare our teenagers for a previous 20th century reality. We now inhabit a more volatile, uncertain, complex and ambiguous world. As a result, we need to create a model where teenagers develop the mental and emotional agility to thrive,and navigate challenges.

We welcome the progressive Wellbeing Policy Statement and Framework for Practice 2018–2023. We too recognise the interdependency of education and mental health. We recognise the underdevelopment of fundamental skills to cope with everyday life. We recognise the importance of developing a teenager’s inner character beyond their social media profile. We recognise the need for teenagers to become familiar with all of their emotions, and how one's mastery of these emotions can either block a person, or catapult the person towards what he or she is truly capable of. We recognise the unique strengths within every teenager, and often all they need to know is that they are not broken, they are not alone, and they have the capacity within them to chart their own future.

To conclude, we ask that the Government continues to invest in preventative interventions that focus on reducing risk factors associated with mental illness. While the well-being of our people is priority enough, we are fully cognisant of the economic and social impact it will have on the prosperity of the State. Young people avoiding mental ill-health through preventative measures are far more likely to complete their education, secure meaningful employment, contribute to their communities, live healthier lives, and reduce the strain on health services later in life. Soar's contribution to this national effort is evidenced in our five-year mission to reach every transition year student in Ireland with a preventative character building programme by 2025.

Ms Megan Byrne

I am from Blanchardstown, and I am 22 years old. I thank the committee for having my voice as part of today's conversation. In Soar, we ask teenagers every single day to step outside their comfort zones. I am very grateful to step outside of mine today.

I have been facilitating with Soar for four years, travelling around Ireland delivering workshops to teenagers.

My journey with Soar started seven years ago, when the team came to my school in St. Peter's College, Dunboyne and lit a light bulb in me that I could not switch off. I knew from the second the Soar team left the school that I needed to be a part of the difference Soar was making in the lives of teenagers like me. When Mr. McDonnell asked me to speak today I felt the excitement of the opportunity but with that came so much nervousness. That was calmed by remembering that although so many of us in this meeting are living many different realities, one thing we all have in common is that every single one of us has been a teenager. Before every workshop I step into, I ask myself who I was as a teenager and what I needed. I would love everyone present to think about what our answers to those questions might be.

As a teenager I tried on so many hats before I found the one that fit. So much fun comes with teenage years but I spent so much of that time lost and confused, although I would never have shown it. I had a short temper that quickly got me known in school as a young person one did not want sitting in one's class. People saw my bad attitude but rarely stopped to wonder what was causing it. I was not a bad kid, I just needed someone to see the good in me and for me to see it myself. Young people are made to believe that letting people see their vulnerability is a bad thing. For so long I spent so much time thinking I was the only one who had bad days, or who knew what foster care was, or who had a really sick mam. I thought I was the only person afraid of seeking help because so many of our experiences as teenagers are minimised by people saying it is just a phase. When I was in school a teacher asked my friend to describe the Soar workshop and he said it was like the Soar staff came in and had a magic wand and spread it over our class and made us all realise we are not actually as alone as we think. We spent four years thinking we knew everything about our class but we only really started getting to know each other when our classmates courageously started to reveal who they really were and share the lessons they had learned in life so far. While there is so much judgment filling up group chats and classrooms for teenagers, I remember so clearly the positive effect on our class when we were given the chance to tell each other how much we valued each other that day. One could feel the weight of having to pretend one had life figured out drop off. That is because someone stopped to be curious about what the reality of being a teenager is really like. They showed up, they listened and they cared, and that was enough.

I have worked with thousands of teenagers. As facilitators we are trained with the skills to build trust and be brave in how we connect with them. I often have moments that remind me why I do this job. In a workshop recently, one girl in particular stood out to me. She had the similar "bad attitude" my younger self had. Rather than ignoring it, I became curious about it, only to discover that behind the mask she was wearing was a person whose mam had passed away at the start of the year and who had been newly placed in foster care, which nobody knew about because nobody was asking what was actually going on for this person. The reality is that we see younger versions of ourselves at every single workshop we step into. The same things that held me and everyone in the meeting back are still holding back this generation. On top of that, they are facing additional issues such as stronger levels of peer pressure, social media and academic pressures.

Soar came into my life at a lonely point in my teens when I did not think I would see tomorrow. Over the last 15 months I have heard an endless number of teenagers experiencing this exact kind of loneliness. What they need now more than ever is a space helping them to connect together again after being isolated for so long. They need a reminder that someone cares for them and is rooting for them. The teenagers today have so much wisdom they should be sharing with each other but they are just not given enough opportunity to do so. Soar caters to every need I have just listed and that is why these workshops are important. We have to believe in our young people today if we want to have strong and confident role models, creators, carers and leaders in the future.

Chairman

Thank you so much, Ms Byrne. That was really powerful.

Senator Aisling Dolan

I thank the Chair. It is wonderful to have the opportunity to hear the presentations from our witnesses today and to thank Dr. Duffy from Jigsaw and Mr. McDonnell and Ms Byrne from Soar. Ms Byrne has given us such a fantastic insight. It is great to hear from someone who has experienced the programme and is now working as a facilitator within Soar, if I understood her correctly.

I got to know about the Soar Foundation when I saw some updates about it online and I engaged at that stage with Mr. McDonnell. It was really great to hear about all the great work that has been done. I have a couple of questions for him about the foundation. He mentioned a mission statement to reach transition year students, which I like. We have nearly 300,000 students at second level so how many students are we talking about here? I know he mentioned reaching 45,000 students to date across 215 schools. I had a similar question about the FUSE programme at the education committee because that programme runs out of DCU and its staff hope to roll out training on tackling bullying to all the schools. It is wonderful but the challenge is how to do that in a way that it can be done within a few years. How are we going to reach all these students? That is the really hard part. There is also the question of how we set it up in order that it is done in a regional way.

I thank Dr. Duffy, who gave such an in-depth and detailed presentation as well. His work is so appreciated. Jigsaw is very well known for everything it has been doing over the last few years and particularly during Covid and the lockdowns. Dr. Duffy mentioned there are a few key areas he wants to see us progress. What things would he like us to take away from this committee? It would be good if he could give us maybe two practical things we could put into place in the next six months to a year and how we could approach that.

I thank Ms Byrne so much. She gave such a great insight there. It was well done. As she said, there are so many times when we do not know exactly what is going on in a young person's life. The real challenge in this is taking the time to listen. Sometimes there is not an awful lot of time because principals and teachers have such a workload and must try to deal with large classes. They have to ensure students know everything they need to know in preparation for exams and they have to prepare students for their future careers and career paths. How do we ensure there is more time for people who may need programmes like the workshop, which allows them time to explore, discuss, discover and understand a little more empathy, perhaps, for their fellow students? I hope the Chair does not mind my mentioning it but there is a bit of criss-crossing here with what we are doing in the education committee on supports being in place in schools for children who may be going through difficult times and how that is going to be achieved. If I have time I may come in again at the end.

Chairman

I am not sure who would like to respond first.

Mr. Mark McDonnell

I might give Ms Byrne a chance to think about that and I can jump in at this stage if that is alright. I thank Senator Dolan for her questions and interest in our work, which is very much appreciated. She asks a really good question and one we have grappled with for the last nine years. I am brought back to a comment a colleague of ours, Mr. Tom Harkin, made a long time ago. He was one of the senior facilitators in the Reach Foundation throughout all its work over the last 25 years. Mr. Harkin was so excited about Ireland. He said that no matter how much work the foundation did in Australia, it would never be able to achieve systemic change. When he came here he recognised two things, the first of which was the size of the country. Second, he was blown away by the openness of our young people to receive this work. He was so excited by the possibility around that. We have been inspired by that and it is why we have looked continuously to see where we can make our greatest impact.

I will describe to the Senator how we have approached this. Our 2025 mission is to reach every transition year student in Ireland with a character-building programme. From our research there are approximately 40,000 to 42,000 students in transition year in any given year, bearing in mind that 92% or 93% of schools actually have a transition year programme and about 75% of teenagers take up that option. For us therefore, that would represent real systemic change. We currently have a programme delivery team and a facilitator team of incredible people like Ms Byrne. There are around ten of them at the moment at different stages of their development.

We recognise we will need to get to a facilitator team of approximately 60 to be able to reach those numbers. With our advancements and our training and how we develop facilitators, we are confident we can do that part. That is the part we can control. The part that we will find harder to control is the funding to do that. We have broken down the costing on this and it will cost approximately €3.5 million over the next five years to deliver that mission.

To date, Soar has been 90% to 95% funded on private funding and we need to move into multi-annual funding from the Government so that we are able to start to deliver this mission. We recognise that is where we need to go if we are to scale this correctly. That is our mission and that is our way of doing it.

Once we start to get those increased resources, we can start to move into other areas of the secondary school system. We run some programmes for first years and second years because we have identified first and second year, and transition year, are those key transitional stages in a young person's life. We simply have not got the resources yet to really start to build out our first and second year programmes. That is why we are focusing on transition year initially and then we will move on further beyond that.

Senator Aisling Dolan

I thank Mr. McDonnell.

Ms Megan Byrne

Will I jump in now?

Chairman

Yes.

Ms Megan Byrne

On what Senator Dolan was saying, I was having a conversation yesterday with one of the girls in work who works with teachers the most and she was saying that they do come forward and say that it is hard to manage the behaviour of students as well as making sure the ball is kept going and they are learning. They have protocols that they have to keep in place and I guess that is where places like Soar and Jigsaw can come in. We can go in and just pause for three hours and ask what is actually going on there that day, and we get to be curious about the behaviour. I guess you put us in the middle of it. We do not have to give them detention for being late but we can be curious about what is the reason someone is late, whether it is because he or she hates school and why does he or she hate school, and whether it is because his or her home life is crazy, why is it crazy, and ask him or her to give us an insight into what is going on. Senator Dolan is correct. Especially now, times in school are crazy. Teachers are going all over the place because of the new protocols with Covid. When the Senator asked how we have the time to listen, I think one should just ask. If there is something going on, the best thing to do, in my opinion anyway, is ask why. If you are having a bad day and you are taking it out on people, I would ask you to pause for five minutes, what is happening and can you talk to me about it. If not, I would ask who have you got to talk to about it? Sometimes letting them know that you see that there is more going on than being late or having a bad mood in class, and letting them know that you see them, is enough to let them know they are not on their own in it. It does not have to be a massive intervention and go in and spend hours trying to figure out someone's life. It is about letting them know they are seen in their experience and they are not on their own.

Senator Aisling Dolan

That is perfect. That is really important. Sometimes it is about taking a pause. NUI Galway became the first mindfulness university in the country. About how important mindfulness is, sometimes just to take a break and a pause - we are rushing around so much every day - resets classes. It helps the students get a lot more focused. I suppose there are probably elements of that with the Soar programme where you are taking a break and asking people to evaluate how they are feeling and why they are feeling that way. That is really good. Thank you so much, Megan.

Chairman

Did Dr. Duffy or Dr. O'Brien want to respond to Senator Dolan?

Dr. Joseph Duffy

I thank Senator Dolan for her positive comments about Jigsaw. The Senator asked about two key areas. I will keep it brief. I think they were referred to already.

Over the next six to nine months, I would ask Senator Dolan and her colleagues to focus on the implementation of the Pathfinding recommendation. It is already in the programme for Government. This looks at the integration of youth mental health across the Departments of health, education and justice which have responsibility for children and young people. It would make a huge difference to really look at it. If we think about the presentations this morning, the good work that Soar is doing, the work that Jigsaw is doing and some of the other organisations the committee has already heard from, we connect with each other, with the HSE and with funders but there is no one office or person that directs that work. Some of the work that we can be doing will be complementary. Some of the work that we will be doing would be directly in competition and that is not the best use of resources. That would lead to much better integration and an understanding that the model of healthcare has moved away, through A Vision for Change, Sharing the Vision and, indeed, Sláintecare, from mental health being seen to be in an institution to it being in the community and in schools. That would really help in terms of change.

The second bit of it which has already been referred to is around the increase in funding. This is a perennial point that people make but it is important, as we move post-Covid into an environment where there will potentially be significant demands to pay back all the money that the Government has borrowed, to think about the future. I am particularly thinking about young people. This investment and the early intervention investment will really pay off in the future. The work that we are doing in Soar and the work that is being done in Jigsaw is enabling that smooth transition from adolescence into adulthood. That is what is important and this is where the early investment lies.

Senator Aisling Dolan

I thank Dr. Duffy.

Chairman

I now call Deputy Buckley.

Deputy Pat Buckley

I thank all the guests. Megan, you were a breath of fresh air. I spoke to Ms Byrne off-camera a while ago. There is certainly nothing wrong with your confidence, I can tell you.

Most of them tipped on the issues of funding. It always has been a massively underresourced system. The recruitment issue always has been a massive problem. Dr. Duffy is correct. A director of youth mental health services is still an ongoing problem. If we cannot fix those three issues straightaway, we are at the bottom of the barrel.

I was doing some research. I have done a lot of work looking backing on the Australian model, the Beat the Blues programmes and all these over the years. It is only a while ago I found out that between 2018 and 2019, the Australian Government spent €10.6 billion. They have put in thousands of centres. They have gone into the schools. They have alleviated it and thus brought down the issues of people being admitted to the equivalent of child and adolescent mental health services, CAMHS, or psychiatric wards. I have always said, even on recent committees, the key to this is getting the young people involved because they are the experts and, as Megan said, asking the right questions but also listening. I found, even years ago when I used to go into schools and talk, you would speak very little and let the children come back to you. The children will express themselves. They will blow you away with their ideas. Another thing we have lost sight of is that we are a peer-led society. Being the elders, we always assume that we know everything and we should be telling them what to do when we should be shutting our mouth and listening to what the guests are saying and how we can adjust the system.

Megan, it is not a trick question, but I am curious, again, because it is coming from the younger side. With all the Covid restrictions over the past number of months and the fact that you have been very isolated - away from friends, school is not there and sporting clubs, your hang-outs, youth clubs and everything gone - the one chance you have to get out and try and express yourself you are portrayed in the media as being the baddies, the spreaders, etc. We always say that where there is an action, there is an instant reaction. Surely it must be very disheartening for you as young people that the system was beating you before it even gave you a chance to express or explain why. In every society and every faction, there will be a handful who will do wrong. I just want to see what Megan's feelings are on being tarred with the same brush.

I would say to all the guests that anyone who works in this sector does so for more than one reason. The first is obviously to do the right thing. Obviously, the second is that you have also had, or possibly had, experiences that brought you on this path. To make Mr. McDonnell laugh, Megan asked whether I could go back and remember what I was when I was a teenager, and I said I was trouble. That is about it. I would be curious to see how Megan feels about how the young people were portrayed over the Covid restrictions.

Chairman

Megan, do you want to come in? I see Mark has his hand up, as does Gillian.

Ms Megan Byrne

I am happy to come in. It is so interesting. When Deputy Buckley was saying that when he thought of his teenage self he thought he was trouble, I was thinking would the Deputy's teenage self ever imagine him here today.

Right now, what is going on is disheartening. Teenagers have so much to say but they are not being asked what their experience is like right now. Adults are speaking for them. They are also saying that teenagers are spreading the virus, causing trouble and are up to no good when there is so much more to them than that. Teenagers are like an iceberg. People see the tip of what is going on and make assumptions but there is so much more there. Nobody is giving teenagers the space to explore these issues. They can only be told they are doing the wrong thing so many times before they start believing it. We are saying that we want to give teenagers the space to believe they can be the next President of Ireland or the next astronaut but how can we expect them to believe in themselves when we do not believe there is any good in them now? We know that there is good in teenagers but if they are on social media every day, they will see that all of the headlines about teenagers are negative. When they are in class, they hear teachers saying things like "If it was not for you..." and putting teenagers down. In that context, how can we expect them to believe in themselves and in their ability to get to where we want them to be in the future?

I do not really know how to properly answer the question but agree that the situation is disheartening. We are saying that we want teenagers to believe in themselves but that has to start with us giving them a little credit and acknowledging that they are more than capable of more positive things than we give them credit for.

Mr. Mark McDonnell

Deputy Buckley said that Megan was a breath of fresh air but I think he sounded like a breath of fresh air there, to be honest. He said that teenagers and young people are the experts and I completely concur. We must have a discussion in this country about the over-protection of teenagers because they are so capable in the right environment. They are probably more capable than adults in terms of being able to speak about what is really going on for them and about their vulnerabilities, their inner character and their inner emotional dialogue. The feedback we get all of the time is the environment is not being provided for them to that but they are ready, willing and able.

A discussion must be had about the fact that a certain amount of stress and worry is normal for teenagers. As adults, what we need to get better at doing is facilitating discussions around that worry and stress by asking teenagers what is causing them stress and anxiety, where it is coming from and what they can do find solutions. We must give them the autonomy and the space to find their own solutions. That is the stuff that builds resilience and inner confidence whereas if we continue to protect our teenagers, to not hear from them and to be a little afraid of what they have to say, they are going to continue to be underdeveloped emotionally and mentally. We need to start being braver around giving young people space.

The other point I want to make is on the perception of teenagers at the moment. Again, the Deputy raised an important point. What teenagers have gone through in the past 15 months in this country has been unfair. We expected a 17-year-old to react in the same way as a 57-year-old but that is completely unrealistic, physiologically, biologically and mentally. Even in terms of the brain, there is so much going on for teenagers at that age and it is so different to what is going on for a 57, 47 or 37-year-old. As adults, we need to be more responsible in asking why a small number of young people are acting out. As Megan said earlier, the powerful thing to do is to ask why they are acting out rather than condemning, vilifying and shaming them. We need to move on from that and into a period of celebrating our teenagers on a national platform. I do not know how we do that but I am sure teenagers in Jigsaw and Soar would be happy to engage on it. That really needs to happen.

Deputy Pat Buckley

I thank the witnesses for their comments. They are right that this is my passion but the key point is that we are not the experts. The experts are not in the Royal College of Physicians, the College of Psychiatrists of Ireland or any other organisation we care to name. I do not want to offend anybody but it is the people who have lived through the hard knocks in this generation, the likes of Megan and her young friends, who are the experts. We need to set up a young citizen's forum or something similar because we need their expertise and information. They are the ones who can see the tsunamis that are coming down the road and who can predict the future. As adults, we should be the facilitators.

I thank everybody in attendance today. These meetings are always a pleasure but unfortunately, I will not be able to stay to the end today because I must go to the convention centre shortly. I thank the witnesses for their contributions and I thank the Chairman for her patience.

Chairman

Just before Deputy Buckley leaves, Dr. O'Brien wants to respond to his comments.

Dr. Gillian O'Brien

I agree with the Deputy on the issues of funding and staffing, which have been with us for a long time. I totally agree on the importance of young people's expertise. A lot of solutions have been put on the table that young people and their expertise have fed into. We have talked about the Pathfinder report from 2017, the youth mental health task force report and we now have Sláintecare. There are lots of great ideas out there for system reform and it is incumbent on us and the Government to respond to what young people are telling us and to make some clear and tangible changes.

As an example, Jigsaw was set up in 2006 to meet a need or fill a gap. Young people said that there was nowhere for them to walk into easily to get help and support. Certainly CAMHS and AMHS were there but they were specialist and people needed a GP referral. Young people said that they needed something that was free and that is the context in which Jigsaw was set up. Fast-forward 15 years and as we have become more established, there is a growing demand from young people for our services. This means that not everyone can access our service as quickly as we would like. Our data shows clearly that young people who access Jigsaw within a few weeks have much better outcomes. Their distress comes right down. The longer they have to wait to come in to Jigsaw, the harder it is to achieve that outcome. Demand is outstripping capacity and that is happening across all services, not just Jigsaw. What we are trying to do is look for more funding but also to pivot and see if we can do things differently. A good example of that is our live chat service. We set up an anonymous online service just last year and we are now hearing from young people who never accessed any kind of mental health service previously. These are young people who are hard to reach. A number of weeks ago a 16 year old came through who was very suicidal and who had made very definite and concrete plans to end their life. That was the first time that person had shared this with anyone, in an anonymous forum because they did not have the courage to go in to a regular service. We worked with that young person and were able to share that with their parents and get them the help they needed.

Jigsaw as an organisation takes responsibility for thinking about how to use our funding to best effect. We cannot sit back and keep doing the same thing over and over again because the demand is rising. We need the Government to work with us and all other agencies to do things differently and to reform our system of care. There are lots of great ideas in Sláintecare, Pathfinder and Sharing the Vision and now is the time to act on those.

Deputy Gino Kenny

I thank the witnesses for their statements. I apologise for being late but I had another speaker engagement.

We have all stated previously the obvious fact that the past 16 or 17 months have been hugely challenging for everybody. Young people have had their world turned upside down and things that they took for granted were not there anymore. They lost their sense of liberty, freedom and togetherness and that will take considerable time to reboot. There was a vacuum that still persists to some degree. Services such as those provided by Jigsaw continued and there was significant demand for same.

Early intervention is key in terms of both physical and mental health. Early intervention can be transformative and it can save lives.

That is why it is crucial to have these services in place so that people do not have to wait three months. There have been cases where people have had to wait two to three months to get intervention. That is unacceptable for somebody in a crisis situation. That is an ongoing part of it.

In regard to young people, we have to look at the world post-pandemic now. Prior to the pandemic, I always found young people were given a bad rap to some degree. I always had major issues with people who used the term “anti-social behaviour” very liberally in respect of young people. It was used as a tag, in some ways, or as a generalisation. That can become insidious in respect of young people. We were all young and did things 20 years ago that we might not do now. We have to look at this through the eyes of young people and find out where they are at rather than talk down to them. We have to talk to and listen to them. That is the most important thing in this context, that is, to listen to young people, to find out where they are at, what their vulnerabilities and anxieties are and what they think.

It is difficult being young in the first place. Social media has played an amazing and a transformative role in all our lives and everybody has a mobile telephone. However, it can put a lot of pressure on people. When I was growing up, we did not have social media. It can have an effect on people’s mental health.

It is good we are talking more than ever about mental health. Talking about something can be extremely good for an individual. If an individual is in a crisis situation or feeling low, he or she can talk to his or her peer group or to professionals, which is very important.

It is important to consider the post-pandemic world because things will not be the same as they were 16 months ago. It is up to young people to be transformative. They are more politically engaged than they have ever been. They are asking questions of the previous generation. What the previous generation did is very different from what this generation is doing for all sorts of socio-economic reasons.

This is probably an obvious question about the last 16 months. What kind of observations has Ms Byrne’s peer group had in terms of what the pandemic has done and continues to do? This pandemic will end. How will young people blossom, become stronger as a peer group and, importantly, have political clout? Many young people can vote and they are engaged in a lot of issues in this House and outside it, which is important. If there is a good political aspect to your life, it is good. Young people are probably more engaged than they ever have been around a whole host of social issues, which is good because politicians and the political establishment can put people off.

How does Ms Byrne see the post-pandemic relationship in terms of young people and the social challenge faced as well as in relation to medical services? What challenges did the pandemic present and what challenges will it pose going forward? Funding is obviously a major issue. Is there one thing that has shown up in the last 16 months?

Sometimes humanity is at its best when it comes together. When we are apart and fragmented, it can leave scars in society which are difficult to heal. Coming together, interventions and public togetherness are hugely beneficial for people's physical and mental health, regardless of how old they are.

Ms Megan Byrne

Deputy Gino Kenny asked what was going on for teenagers during the pandemic. To be honest, the pandemic just magnified problems that have always been going on for teenagers. When I go into workshops with a team, it is rare teenagers talk about Covid. We might talk about it a tiny bit. What they want to talk about is how they are feeling, say, alone or restricted or not having enough people are on their side. The pandemic has magnified everything that they were already going through.

Deputy Gino Kenny asked how we can help them blossom going forward. The way we do that is by being human. The Deputy acknowledged that when we were teenagers, we did things we might not do today. What teenagers need now is for us to be human with them. To let them blossom, the first thing we need to do is to let them we know that we understand them as we have all gone through it together. We need to show our experience of the past few months and let them know how we are finding it difficult to come out of lockdown into real life. In that transition period when life goes back to whatever the new normal will be, we have to keep them in the loop as to how we are finding it and then see how they are finding it. We need to stay connected the whole time with them.

Dr. Gillian O'Brien

Ms Byrne made a lot of good points. In terms of observations from a service provider's perspective, it was helpful to hear a young person's perspective.

The pandemic has been an adverse event on a national scale. The trauma that people are experiencing is widespread. Like with any trauma, it will take time and space to process it. What is particularly challenging about this pandemic is that it came on top of an already bad situation in terms of youth mental health. It is not like we had good rates of youth mental health before this happened. What we are seeing in Jigsaw is actually not necessarily young people coming in with higher levels of distress. That has been borne out in our data. Young people are as distressed as they were before the pandemic. The factors contributing to their distress are different. We are seeing an awful lot of young women in particular who are anxious and their way of managing this is through disordered eating. We have seen a huge spike in eating distress. We have seen many young people experiencing loss and bereavement, particularly after a number of lockdowns. Many young people have lost family members and loved ones. There is a multitude of other losses, such as employment, education and all the opportunities for social interaction.

It is important to remember that the data is not telling us that we are seeing more distress but the distress is different in its nature. It is exacerbating an already pretty dire situation in terms of youth mental health. It reinforces again the need to take action and to implement the good ideas and policy already on the table.

Mr. Mark McDonnell

Ms Byrne and Dr. O'Brien have done a great job in responding to some of those parts so I will not reiterate what they have said. I agree that over the past ten years, it has definitely become more acceptable and easier for us and young people to speak about mental health, to come out and be open about it. However, that freedom is different from doing something practical with it. The statistics that have come through from Jigsaw's My World survey accentuate that fact. In the past ten years, anxiety, depression and self-harm are still rocketing. Life satisfaction, optimism, body confidence and things like that are plummeting. Even though we are able to talk about it more, still nothing is really changing. We need to be looking for more practical solutions on the ground, rather than just talking about it. That is where Soar comes in. The bottom element of the pyramid of the Wellbeing Policy Statement and Framework for Practice 2018-2023 refers to support for all. We need to start getting in at the preventative stage for young people. That is when we can roll up our sleeves and work with this stuff, have the conversations and hear from young people, allow them to feel heard and less alone. We can give them some tools to be able to go out into the world, navigate it and thrive. That will build confidence and resilience. Just talking about it will not be enough. Practical solutions are also needed.

Dr. Joseph Duffy

I thank the Deputy. I will build on what Ms Byrne, Dr. O'Brien and Mr. McDonnell said. We have come to a place where we are getting better and better at listening to young people but it is hugely important that we, as adults, do something with what they say. We must really listen to them. Dr. O'Brien referred earlier to one of the examples of that within Jigsaw. When we went to develop an online support service, one of the key elements of that for young people was that it would be anonymous. That was a real risk in terms of thinking about having a service with which young people could connect. It is important because we know that there are many young people out there, in particular many young men, who might have a worry or concern and want to talk about it in a confidential way. We are thinking about the experience of young people now and into the future. We must take the lessons and learnings from Covid-19. We must consider the impact of technology, which does not work for everybody but works for some young people. We must think about whether there are safe spaces to help young people.

We have been doing some work with international colleagues, representatives of headspace in Australia and Foundry in British Columbia, Canada. We have been thinking about using technology to support young people, connect and help them. The other part of this goes back to what Mr. McDonnell was saying earlier. It is about the message that young people can do a considerable amount for themselves. They do not always need support from Jigsaw or Soar. They need to be listened to and have support among each other. There is a huge amount that can be done on a broad, universal level. We must think about a system of mental health care and how we can change it to make it responsive and integrated.

Deputy Gino Kenny

I have a question about something Dr. O'Brien was talking about which has been mentioned a fair few times in the past year, that is, the manifestations of eating disorders, particularly for young women. Why do our guests think this is happening? Has there been a spike in eating disorders, particularly in the past 18 months? People's routines have been disturbed and they have spent more time at home and on social media, which can have an insidious effect on a person's self-image. What factors have played a role in the fact that eating disorders have manifested themselves more than they did prior to the pandemic? I do not know if I would call it a "spike".

Dr. Gillian O'Brien

There certainly has been an increase and the young people we have seen are pointing to a few different reasons for it. Disordered eating is largely about trying to integrate some sense of control when a person feels out of control or things are happening that make the person feel anxious. Many young people point to the fact that we are now living in a very uncertain time. There are a lot of genuinely anxiety-provoking things happening in the world, in terms of threats to our health from the pandemic, the climate crisis and other things. There is a lot of instability in the world. Some young people will point to that. On an individual level, young people are talking about the fact they are at home all day, not out and about as much, so there is a lot more self-focused attention and a lot more time to think inwards and reflect on things. Those people are also on social media an awful lot where, as we know, much comparing goes on. It is almost like a melting pot, a perfect storm of many different conditions. Anxiety has always been our top presenting issue and many young people are trying to manage that anxiety through restricting their food intake or perhaps binging and then feeling guilty and purging it afterwards. That is definitely something we have seen. We are meeting young people at that sub-threshold before a eating disorder has developed fully. We try to get in their early. I know from my colleagues who work in eating disorder specialist units that they have seen an increase in young people with well-developed anorexia and bulimia. There has been some challenges around the funding for those particular services. It is across the board.

The Deputy mentioned early intervention and with eating distress, it is particularly important to intervene early because once those patterns take hold, they are insidious and difficult to change. It is a real concern. There is so much of it that we are now looking at setting up an online group-based programme to look at eating distress and try to meet the needs of a large group of young people. It does not matter where they are in the country, they could log onto that programme. We are trying to be innovative and think differently about it.

Chairman

Does anybody else wish to come in to answer Deputy Gino Kenny's question? No. Is the Deputy happy enough to move on?

Deputy Gino Kenny

I am.

Chairman

I call Senator Conway. He is on mute. Can the Senator hear us? I will ask a couple of questions and then allow the Senator to come in.

I was blown away by our guests' presentations. I have learned a lot, mostly about listening to what young people have to say. That will be important, going forward. I agree with Deputy Buckley and others that we will learn more from young people than they can learn from us. There is no doubt about that.

My first question is not around mental health services. I will ask our guests the question because of their expertise with young people and the fact they are in constant contact with young people. How do we make sure that young people can get heard in general? I am not even talking about it from a mental health point of view; I mean it in a general way. I am naive in this area. Do we need a young people's forum for us to learn and be able to hear what their needs are in general? I agree with Deputies Gino Kenny and Buckley about the way young people get a bad rap. There has been much talk about anti-social behaviour and the media can come down heavily on young people. They are well capable of asking and talking. They are very conscious of general issues around climate change and everything else. How can young people be heard in general? Have our guests any advice in that regard?

Ms Megan Byrne

When the Chairman speaking, I was thinking about our workshops in the Soar Foundation. I said they are three hours long, but in the first hour we are not jumping straight in and asking the young people to tell us about the stuff in life that is tough, but asking them to tell us about the things that they celebrate in themselves. We are building trust and rapport and just being curious about the lives they live. What we want to give them is space just to talk in general. If we go in and say we are talking about mental health for three hours, they would leave the classroom. If we want to give them a space to feel safe enough to come forward, it starts off with just giving them a space, full stop.

If there is going to be a panel to bring in young people's voices, what comes to mind is that there is such a wide range of young people. Somebody mentioned earlier those who take part in anti-social behaviour. If there is going to be some type of committee, I would want them to be on it. They are the ones who have the real stuff going on and who will be really honest about saying: "If you want to know what is going on in my life, let me trust you first, let me know I can trust you and let me know you care". They are not just going to open up and say what needs to be fixed. They are going to sniff people out and make sure that they can trust them and that they want to listen. The way to listen more is by showing that we want to listen and to hear what they have to say. That is important. I am not a teenager anymore but if I was sitting in front of somebody and that person was asking me to open up, if I got a sense that the person did not care and was just asking because he or she had to, I would not do it. I see that in teenagers in workshops every time we go into a school. Once they know that somebody wants to hear what is going on for them, they will tell the person anything. Then, most of the time, one cannot stop them talking.

I do not know if it answers the question, but it starts off with tuning into ourselves. Why do we want their voices? Why do we want to know the good stuff they are doing and the tough stuff they are going through? It starts with us questioning that in ourselves and opening up a little space in our minds for what is going on for them and then taking it from there.

Dr. Joseph Duffy

It is a good question. It allows us to stand back and think. One of the things that struck me last year was when we appeared before the Special Committee on Covid-19 Response. We had a young person with us and her view on the messaging on Covid-19 was that the messages and methods that were used were very much for adults. They were traditional media methods. In terms of thinking about listening to young people, it is important to think about their means of communication and their structures. When we talk to young people in Jigsaw, they will say there is no one thing. It might be anonymous, it might be a special group and it might be different ways. However, one of the keys Ms Byrne has put forward is about building relationships and that sense of trust. If the State, the Government or an organisation wants to listen to young people, it involves building up that dialogue.

The other part that is important is the work that Soar Foundation does, some of the work we do ourselves and particularly the work we do in schools. It is about building the competence for young people to be able to have that conversation. Sometimes if we just say that we want to hear from them, they will ask: "What do you really want to hear about? Can you tell me about that?" What we have learned is that if we have focused questions, young people appreciate that. They take a couple of things from it. They take it that we have given it some thought, that we have been clear and that there would be a feedback mechanism. One of the big things is about building and thinking. One of the things that internationally people look at is, and the name escapes me, the people's or citizens' forum in terms of having that together and having a representative group. Models like that need to be explored. There is Comhairle na nÓg and many other structures, but it is about giving a broader message about how we are listening to young people and what we are going to do with that information.

Mr. Mark McDonnell

It is an interesting question. To mirror what Dr. Duffy said, perhaps, even in the questions we ask ourselves on this, we are probably still looking at it from an adult perspective. Some of the greatest movements that have occurred in the world have happened from the ground up. They have come from young people. As adults, we cannot be afraid of that. I would look at it in two strands. We need to create more environments like what we provide in the Soar Foundation and which Jigsaw does as well, and just create space where teenagers can authentically connect together. The environments for authentic connection, where they can start to figure life out, are scarce. We just need to create the environments and leave them to it. That is probably the most important part. If we are looking at just the well-being of our young people, that is good enough. If we want to start to shape policy as we are doing today, it is as simple as having more Megan Byrnes in the room, inviting people to speak and to listen and respect what they have to say. Young people are no different from us. They want to be heard and respected. More young people such as Megan Byrne and her peers at tables like this is exactly what we need.

Chairman

I agree 100%. We need to be educated. The older generation certainly needs to be educated by the younger generation. That is my feeling at present.

I call Deputy Lahart.

Deputy John Lahart

First, I wish to apologise. I was in the convention centre.

Chairman

That is no problem.

Deputy John Lahart

Bilocation is not possible and there was no disrespect intended. I read the submissions last night. I am interested that the contacts to Jigsaw reduced during the lockdowns and then increased during the relaxation. Intuitively, one would have thought that the telephone calls would have increased during lockdown and relaxed afterwards. Has Jigsaw extrapolated anything from that?

The other thing I have been conscious of, and in speaking about the younger generation I am referring to 15- to 30-year-olds and even 15- to 25-year-olds, is that they are incredibly resilient, as I have mentioned at this committee previously. I used to be a psychotherapist, although that does not give me any expertise. I am still a psychotherapist, but am not practising. I am aware of the resilience of young people and their ability to bounce back. What struck me with the vaccine roll-out is that, unlike the older cohorts, there has been no whining, screaming or tantrums at missed deadlines and perceived failings in the system. The Minister asked a reasonable question two months ago and had what seemed like the entire nation jump down his throat. It was reported that he had asked his officials to look into the possibility, advisability and practicality of vaccinating 18- to 30-year-olds earlier. I heard a number of parents in the over 50 age group say: "I would welcome that because they are worried about bringing the virus home and I am worried about them bringing the virus home because they were socialising a lot more than I am". However, it was shut down as a conversation in less than 24 hours. As time has gone by, I believe flexibility and agility on that might have been advisable.

My point is that their lack of vociferousness about the vaccine could be misinterpreted. There is a view among the public that they are the strongest cohort, the most resistant to it and they have the least to fear, yet we spent all of last year panicking the bejaysus out of everybody about this, regardless of their age group. I would hate to think that there is a group of young people who are afraid to shout: "What about me?", to ask why they are last and to ask people to look at the sacrifices they have made developmentally due to chronological reasons only. In my view, they are the biggest sacrifices any age cohort has made. I mean that. The adults have gone through their developmental stages and, by and large, we can relive the experiences we have today and tomorrow, unless we experience the death of a loved one. I am referring to the vital transformational developmental phases of an adolescent into the early to mid-twenties. Adolescence is stretching for longer and I suspect that Covid will have extended it further. As we know, and this is the lecturer in me, adolescence did not exist 100 years ago. It is extending.

Do the witnesses have any evidence that there is a fear that people do not want to shout for the vaccine? They are as fucking entitled to the vaccine as anybody else and they have said nothing. Have the witnesses picked anything up about that? I am quite exercised about it. Their silence troubles me. I do not think it is that they are all okay and are the least resistant. I know quite a number of them. Some are teachers, and God, it is kind of freaky and scary to go into a classroom of 30 kids - I know that cohort is a little older - and doing it day in, day out. That is just one example. Others work with groups of people or stack shelves in shops, or they are students or whatever else. I would not like us to misinterpret their silence as meaning they are happy with being last in the queue.

Chairman

I thank Deputy Lahart. Dr. O'Brien has her hand raised and then Ms Byrne will come in.

Dr. Gillian O'Brien

I will speak to the first point of the Deputy's question about referrals to Jigsaw and I will leave the other piece. That correlation between referral rate and the level of restriction is really interesting. We have looked into this and hypothesised and there have been some anecdotal reports.

One thing we know is that while self-referrals are accepted in Jigsaw - a person does not need a GP referral - many young people are signposted. A teacher, sports coach or someone in the community might comment that they do not seem themselves, ask if everything is okay and ask why they do not get in touch with Jigsaw. That person will then make contact or their parent does. One of our hypotheses, therefore, is around people circulating in those places where someone would comment that a person is not in school or at college or going to the GAA. These are all places where people would have been signposted to Jigsaw. Some young people and parents also told us there was an assumption that everything was shut down.

Deputy John Lahart

Okay.

Dr. Gillian O'Brien

There were a lot of assumptions out there. That was a lesson for us about learning and communicating. We are still open for business but in a different way; we are online. That was, therefore, a really good learning experience about getting that message out there if we ever move back to greater restrictions again, although hopefully we will not. That piece, however, definitely reinforced with us how important all those other people in the community are who support young people, identify when they are struggling and suggest places like Jigsaw to them.

Deputy John Lahart

That is fascinating. If Dr. O'Brien produces a paper with the fruits of her hypotheses it would be an interesting document to share.

Dr. Gillian O'Brien

Sure, I will do that.

Chairman

Does Ms Byrne wish to come in?

Ms Megan Byrne

Since the pandemic began, I have not heard anyone bring up a conversation like Deputy Lahart has. I think that is the problem. There is a saying that children should be seen and not heard. Now, expand the age of the children to 30 years old in terms of what Deputy Lahart said. It is as if people are saying they know young people are there but they are not going to talk about it or listen to them yet. They do not want to hear what we are going through.

I feel that young people now are being made to feel selfish for wanting the vaccine. I have not talked about it much with teenagers, as such. Even within my friend groups, however, many of us are afraid of getting the virus. Many of us ask "Okay, what does it mean?" And maybe it is for lesser reasons such as that we cannot travel. If we get it, what happens?

Some of my friends maybe have asthma or have a little bit more weight. They are seeing things that say if they get the virus, it is dangerous. If we talk about it, the response is that we are not 80 years of age. if an 80-year-old gets it, he or she could die. If we get it, we could probably die as well but there is no space to talk about it because it is as if we are selfish.

When Deputy Lahart spoke, I reflected on the guilt around that. If I were to say to a group of adults that actually, I want the vaccine as well, the response would be that I will be fine until I get it. They would tell me to just shut up for now - that I will get it get it and I am somewhere on the list. We are just not given enough space to look at the fears we have with this. I do not know if that makes sense. There is, however, a lot of guilt and shame around saying we want the vaccine because we know there are people who have it worse off. No one is really given space to be curious about how we are feeling about it or if we want it. We are just told we should not want it until we are asked or until we get the text on our phones to go and get it. I do not know if that answers the Deputy's question but that is something my friends and I have talked about a good bit.

Deputy John Lahart

May I follow up, Chairman?

Chairman

Yes, of course.

Deputy John Lahart

That comes from Ms Byrne's own cohorts. Her response is really interesting and that idea that children should be seen and not heard, if that is even a small part of it, is awful. They have been frightened. The level of responsibility they have exercised has just absolutely wowed me. There has been a lack of kickback and of vocalising any kind of concerns. They have not, therefore, been heard and they have been silent. Does Ms Byrne sense a strong desire for the vaccine? We are not even asking them.

Ms Megan Byrne

Yes, definitely. Every single person asks about getting the vaccine and the answer is obviously, "Get it in my arm now". We want it but we do not really have the conversation because we know the answer is that other people need it more. That applies to every person I have asked, however, friend or not.

Even sometimes after workshops, we stay behind and have conversations with teenagers. They talk a lot about wanting to travel and fulfil their dreams if they ever get the vaccine. It is as if it is this far-off thing that we all want it but we all just have to wait our turn to get it. I do not know. The want and desire for it is there. I think we are just afraid to make any noise in case someone turns around and says that we are spreading the virus or fights us back with the negative attention young people are getting in that regard.

Deputy John Lahart

Has it surfaced as a mental health issue?

Ms Megan Byrne

What do you mean?

Deputy John Lahart

Are young people stressed because of the wait for the virus? I know that every other age cohort is stressed. Even those who have received the first jab are stressed because of the length of time some have to wait for the second jab.

Ms Megan Byrne

I cannot really say. I do not know. I think the stress and the worry is there big time, however. Bars are starting to open up now. The want is now to go out and start seeing people and seeing our friends. But I think the worry is definitely there between my-----

Deputy John Lahart

There is another thing. I am sorry for cutting across Ms Byrne but I am just exercised about this. Mr. Tony Holohan said yesterday that from 19 July, everybody who has been fully vaccinated can travel without a PCR test. Nobody in Ms Byrne's age cohort will have had the first vaccination and that first travel piece is such a big aspect of the student experience.

I think the witnesses have opened up something. I came in really late and may have missed some jewels. What are the witnesses' asks of us as a committee around this? They have touched on something really rich here. What does the Chairman think?

Chairman

Before I comment, I would like to bring in Mr. McDonnell. He had his hand raised.

Mr. Mark McDonnell

I thank the Chairman. I will refer back to the first part of Deputy Lahart's question and follow up on Dr. O'Brien's great point. From our experience on the ground with teenagers, when we are delivering face-to-face sessions and walk into a workshop of 30 teenagers, there will always be five to ten of them with hoods up, looking out the window. They do not want to be there. They think it is a waste of time and the attitude is "Get me out of here". After ten, 15 or 20 minutes, when we start to build that connection, trust and rapport, that is when they start to come in. Beforehand, however, they are on the margins and the fringes and they do not want to be there.

When we started running our programmes online, even some of our board members asked why we do not continue to run them online because we are reaching more young people. That is our greatest concern, however. It is too easy for the young people on the fringes and on the margins to choose not to come to something online. They can just put it on in the background but they are not listening. When one is there in person, however, that is when one can welcome them in.

I refer to Dr. O'Brien's point that when some of our great youth leaders in the community and some of our great teachers are there, that is when they can see stuff. They are clocking that stuff all the time. That is potentially a reason for the drop-off. We have certainly seen that occur on our online workshops. It is something we want to go back to and we have gone back to face-to-face as quick as we can. I wanted to jump in and give our perspective on that.

Chairman

I thank Mr. McDonnell. To answer Deputy Lahart's question on how I see this going forward, I believe it is something we should bring up at the Joint Committee on Health and perhaps bring in a group of young people to talk about exactly what Ms Byrne spoke about. It is slightly separate from mental health but it would still cross over because it touches on all of it.

I have learned so much today. I cannot believe how much I learned from all the witnesses. It has been absolutely phenomenal and not only around mental health. I must say, the witnesses provide unbelievably brilliant services, which I am hungry to know more about. That is what they are leaving me with. I want to know more and hear more voices from young people.

This is vital. Young people need to appear before all our committees. We need to hear from them regardless of whether we are talking about climate or other issues. We need to hear the voice of young people in all policy. I am talking about 16-year-olds up to those aged 25 to 30. Does Deputy Lahart wish to add anything before we move on?

Deputy John Lahart

The Chairman has just opened up something for me. I am a Fianna Fáil politician and we have weekly parliamentary meetings. I am also party spokesperson on youth and equality. My party is having a meeting this evening. We are putting together a document on it. It will certainly be at the front of my mind next Wednesday. We may have missed something quite significant here. A big piece that is worth exploring is what we might perceive as the reluctance of younger people to express their need for and entitlement to the vaccine. I find it deeply touching that society may have missed that in all the drama of the past year. I find it really moving that all the adults may have missed something really significant. That is one of the big things I am taking away.

Chairman

We spoke earlier about young people not being treated with the respect they deserve, how capable they are and their ability to speak about many different areas, particularly policy. They are able to verbalise about their mental health. Unfortunately, young people get a bad rap along the lines of if young people go out, they cause trouble. Instead of that, we should look to learn from young people. We really need to learn more from them. That is what I learned today. We need to hear what they have to say and their thoughts and opinions. We can learn more from them than they can from us. That was very powerful for me. Senator Dolan wants to come in.

Senator Aisling Dolan

Only if there is time.

Chairman

Yes, there is.

Senator Aisling Dolan

This has been so enlightening. We should always keep the voice of that young person in our head. It is really important that we also have that voice of advocacy in many of our fora. Dr. Duffy mentioned the citizens' assembly. It looks at having representation of the group it selects across all different age profiles.

In his submission, Dr. Duffy spoke about self-harm. My question relates to boys and girls. I have been hearing a bit more about it from girls' schools. Could Dr. Duffy add anything on that? Deputy Gino Kenny spoke about eating disorders. I know that there are eating disorder teams within the HSE community mental health teams. It is a question of how one links in there. Do referrals to Jigsaw come from GPs or schools? This is something I am not 100% clear about.

I thank Mr. McDonnell, who I met along the way with regard to what was happening with mental health for young people. He knows Ballinasloe very well. I am a great advocate and champion for our town, particularly youth mental health, and will continue to be one. It is fantastic to see what the Soar foundation is doing, and to develop this association. I am very proud that Mr. McDonnell is from Ballinasloe from east Galway. My question concerns the urban and regional divide when it comes to mental health. Mr. McDonnell would have grown in a small town as well but for people in many small towns across Ireland, it can sometimes be very difficult to access some of these supports so this points to the importance of it being online. What has the Soar foundation done online to make sure it is more accessible is really important. Could Mr. McDonnell discuss that? I thank the Chairman and our team for organising this and the witnesses for their contributions.

Mr. Mark McDonnell

In respect of the urban-regional divide, my mind goes immediately goes to what we are hearing in workshops. Quite often, what we hear in workshops is universal and where someone is from does not really come into it. We are still seeing the same things present. We are still seeing significant isolation and loneliness. Urban-rural divides do not really impact on this because so many people are spending time online, including on social media, and we might be fooled into thinking this is connection but it is not. A person could be living in the middle of Dublin city and be surrounded by thousands of young people within a kilometre of where he or she lives and still feel unbelievably lonely because he or she is on his or her phone on social media. It needs to be acknowledged that this is not the same type of authentic connection we get from spending time with people. That same level of loneliness can occur if someone is living in east Galway or in the middle of Dublin. Regionally, we do not see that many issues when it comes to what is presenting in our workshops. They are all the same patterns and themes regardless of where one goes in the country so I do not see the divide as much. It is something that needs to be addressed all over the country.

Senator Aisling Dolan

It is good to hear that there is that much engagement. My question was really about engagement with schools. Mr. McDonnell mentioned 28 counties. It is crucial that engagement happens in smaller areas as well in large areas.

Mr. Mark McDonnell

That is exactly where we want to go. Believe it or not, we have worked with 45,000 teenagers and we have not gone to one school looking to do a workshop. Every single one of those has come to us. It happens organically through word of mouth. Teachers, transition year co-ordinators and guidance counsellors are speaking to each other and then coming to us. That can be anywhere from east Cork to the middle of Dublin. What we want to do next is become a bit more strategic and proactive around where we go into the big hubs - the large towns where we could have a far greater return through meeting more young people. Again, we will need support and resources to be able to have that proactive way of engaging with teenagers in schools.

Chairman

Does Dr. O'Brien wish to address Senator Dolan's question about eating disorders?

Dr. Gillian O'Brien

With regard to eating disorders, because we are a primary care service, we would refer into those specialist community health mental teams if young people exceed our threshold and have a more complex or long-standing issue with their eating behaviours. We would support referrals in that direction.

In terms of self-harm, from what we see and from the report from the National Suicide Research Foundation, young females continue to engage in self-harming behaviour more frequently than young males. The peak ages for self-harm in females are 15 to 19 whereas for young males, they are 20 to 24. Females aged 15 to 19 far outstrip males in those age groups in terms of the rates of self-harm but that gap really narrows for those aged 20 to 24 so it is certainly an issue for young people in general. There is just a slightly different emphasis with regard to older young males and younger young females. About 50% to 60% of young people who come to Jigsaw have engaged in self-harm either in the past or currently. It is very common.

Senator Aisling Dolan

It is so tough to hear this.

Chairman

Was there anything else Deputy Lahart wished to say before we finish?

Deputy John Lahart

I am good.

Chairman

I have one question.

It is about something Mr. McDonnell mentioned earlier around mental health. He said something about how environments are not being provided for teenagers. I am sure that all witnesses can answer this question. Could he say a bit more about that? Obviously, the Saor foundation is a brilliant mental health service. There do not seem to be proper environments for young people to be able to speak out. Coming back to what Deputy Lahart said earlier, they do not seem to have a voice. Is that because the environment is not being provided for young people to have a voice? I am talking about all issues for them, be it mental health or otherwise. It could be around looking for the vaccine. Can the witnesses say a little bit more about that? Can they suggest ways of providing an environment for young people, to give them that voice, so that we, as policymakers, can learn from them? Would Mr. McDonnell like to start?

Mr. Mark McDonnell

It is an important topic to address. The greatest piece of feedback I can give is what we received from teenagers after a Soar workshop. They said: “That was different, because usually adults come in and tell us what to do”. Teenagers are kind of done with listening to adults. Teenagers are incredibly smart and intuitive. They clock everything that occurs. They know that we, as adults, do not have it all figured out. They can see that very clearly. If we go into environments and tell them that we have it all figured out and here is what they need to do, they will not take it seriously. They will say, “No, you are not giving me the truth, so I will not give you my truth”.

That is the point of difference in the environments that we create. We train young adults to do this, including incredible young people like Ms Byrne. Immediately, they are directly relatable. They are culturally relevant to the young people to whom they speak. They know that Ms Byrne is on their side. They know that she is also trying to figure out life and that she will be honest with them. Teenagers will respond to that. The more environments we create like that, where we trust young people to deliver these workshops in these environments and spaces and where we genuinely want to hear what teenagers have to say the better.

Ms Byrne made a point earlier that one should engage with teenagers so that they feel heard and respected. A key thing for us is that we remove judgment. If young people feel judged they will clam up. They will say: “You are not ready for their truth and do not deserve it”, and they are right. That is our point of difference. We remove judgment to give them space to talk openly and honestly. Then, we see them start coming alive. The most fundamental thing we can do for young people is to remove judgment.

On the latter part of the Chair's point and on what Deputy Lahart’s raised earlier, we see a worrying acceptance of a fundamental power structure. It is adults first; young people second. They almost accept that they will come second anyway, so why should they kick up a fuss and they will wait their turn. They have already accepted that the adults will get served first and they will get served second. As Deputy Lahart said, this is worrying because the acceptance is so ingrained in our young people. They do not even make a fuss about that. I agree that is a cause for further examination on the committee’s part.

Chairman

I thank Mr. McDonnell. Would anybody else like to come in on that?

Deputy John Lahart

There are a couple of things that strike me about what was said. It is a much bigger subject. Society is moving on; relaxations are increasing; lockdown is decreasing; and liberties are returning. We have forgotten about all the dead. I find that remarkable. Dr. Íde Milne wrote a fantastic book about the Spanish flu in Ireland called Stacking the Coffins: Influenza, war and revolution in Ireland 1918-1919.

My late mother was born in 1925 or 1926. I grew up on stories she had inherited about the Black and Tans calling to their house in Kerry and searching it, on stories of the Irish Civil War, and on stories about 1916, even though she had not yet been born. I never heard a story about the Spanish flu. One of the interesting points Dr. Milne makes is that our failure to memorialise the Spanish flu led to a significant level of unpreparedness in Ireland for what we have had to go through now. Maybe it was because there were so many other things going on; it was a revolutionary period and it was a post-Great War period. This leaves us in the shadow of the countries which experienced more recent pandemics but seemed to have been culturally and societally better prepared. I make this point because we have not memorialised those who died. I connect this to what was said. We have not recognised or acknowledged it as a society. Maybe the time is not right and maybe the State is planning a grand memorial at some stage. However, I am a politician in one of the governing parties and I not have not heard a whisper of this. It has often exercised my thoughts. We simply have not acknowledged it. We have acknowledged the front-line workers and others. I am not saying this because the witnesses are here at the Sub-Committee on Mental Health, and it is about young people. We have not even approached acknowledging the gargantuan sacrifices developmentally not mention anything else that young people have made to protect their parents and grandparents. This silent piece is one of the things I take away.

I have 17 nieces and nephews. If you said to me that “little children should be seen and heard”, even though they are all 25 to 35 years of age now, that is not the way they were brought up. Curiously, though, they have taken all of this on the chin. It is kind of mad. Is that overstating it or misinterpreting it, or are we missing something? It struck me like a freight train today. I thought that they were happy out, that they are fit and young, and that they feel young and fit. I thought that they do not feel scared by the virus, but they do.

Chairman

Of course, they do. I hear what the Deputy is saying. It comes back young people not being heard and not having a voice. It is like what Ms Byrne said earlier. If they ask, “What about us?” or “What about me?”, then they feel bad for saying that. If they say it, then it looks like they are being selfish. From our perspective, Soar and Jigsaw are doing phenomenal work on this. I cannot thank them enough for the amazing work that they do. They give young people that voice. Young people are able to talk to them. We need to do more of that in general. That is why young people do not ask, “What about us?” They do not feel heard. We do not provide an environment for them, apart from Soar, Jigsaw and other organisations. We do not provide in society an environment where they can speak up. That needs to change.

I thank the witnesses again for coming in today. We would love to see the Jigsaw My World Survey, if possible. If Soar has any other surveys it might have done, please do not hesitate to tell us. Would Dr. Duffy like to come in?

Dr. Joseph Duffy

We can certainly send a link to the My World Survey.

There is a website that provides much information about that. It provides a comparison between the data gathered in 2019 and the data gathered in 2012, in joint collaboration with University College Dublin, UCD. We will follow up and send it on to the secretariat afterwards.

Chairman

I thank Dr. Duffy, Mr. McDonnell, Dr. O’Brien and Ms Byrne for coming in. I have learned so much today from listening to them. I thank them for the phenomenal work they do.

The joint sub-committee adjourned at 2.20 p.m. sine die.