Joint Sub-Committee on Mental Health debate -
Wednesday, 20 Oct 2021

Impact of Covid-19 on Children: Discussion

Chairman

Apologies have been received from Senators Dolan and Hoey.

This morning we will meet representatives from the Irish Society for the Prevention of Cruelty to Children, ISPCC, and Barnardos to get an update on the impact of Covid-19 on the mental health of children. I welcome our witnesses this morning, who will be providing us with an update on the challenges faced by organisations working in the area of child welfare. From Barnardos, via Microsoft Teams, I welcome Ms Suzanne Connolly, CEO, and Ms Laura Keane, project leader of Barnardos in Limerick. I also welcome Mr. John Church, CEO of the ISPCC, who is appearing in the committee room.

Members and all in attendance are asked to exercise personal responsibility in protecting themselves and others from the risk of Covid-19. They are strongly advised to practise good hand hygiene and leave at least one vacant seat between themselves and others attending. They should also always maintain an appropriate level of social distancing during and after the meeting. Masks, preferably of a medical grade, should be worn at all times during the meeting except when speaking. I ask for everyone's full co-operation on this.

Members are reminded of the long-standing parliamentary practice to the effect that they should not comment on, criticise or make charges against either a person outside the Houses or an official either by name or in such a way as to make him or her identifiable. I remind members that they are only allowed to participate in this meeting if they are physically located in the Leinster House complex. I ask members to confirm prior to contributing to the meeting that they are on the grounds of the Leinster House campus.

I now call Ms Connolly from Barnardos to make her opening remarks.

Ms Suzanne Connolly

I thank the Chairman. Barnardos warmly welcomes the opportunity to speak to the committee on this important issue. I am appearing today alongside my colleague, Ms Laura Keane, who is a project leader working in one of our centres in Limerick.

Barnardos provides front-line services to vulnerable children and their families in our 45 centres throughout Ireland. We offer a range of early intervention targeted services in our centres, in family homes and in schools. Last year, Barnardos worked with almost 18,000 children and their families, helping them with their children's behavioural, emotional, educational, physical and social needs.

Since the onset of Covid-19, children and young people have had to stop doing all the vital things that had been part of their everyday life and crucial to their well-being. They were excluded from meeting with friends, going to school and taking part of activities, all of which impacted negatively on their social and emotional development, as well as their mental health.

The impact of Covid-19 is not equal across all children. Many of the children we work with experience a huge amount of adversity in their lives. They are living with domestic violence, parental addiction, poor parental mental health, acrimonious separation and poverty. Covid-19 and its impact was an additional burden on these children. We saw parents deal with worsening mental health, increased substance use and conflict within the home. This has inevitably led to some parents struggling to cope themselves. When parents cannot cope, it impacts on their children's well-being and mental health.

Our 2021 back to school survey, in which almost 1,500 parents participated, reinforces this. It found that 52% of parents had faced increased mental health difficulties, 50% experienced increased stress at home and 15% reported increased substance use. A substantial portion, 29% of parents, stated that they were concerned about the impact these issues were having on their children.

Additionally, our back to school survey found that 63% of parents said they were worried about their children's emotional development, coping skills and ability to talk about their emotions. Some 58% of parents were worried about their children's stress levels, while 57% of parents were worried about their children's anxiety. Furthermore, 49% of primary school and 46% of secondary school parents stated that they were concerned about their children's social skills, peer relationships and ability to interact with others, while 47% of primary school parents and 58% of secondary school parents were concerned about their children's loneliness and their children not having the level of social connections they needed.

The transition out of lockdown has continued to be difficult for children with whom Barnardos works and it affects their development. A significant proportion of children are struggling to engage with education, for example. They are struggling to adhere to routines, follow rules and even sit still in the classroom. For them, this is due to anxiety and being concerned that they are too far behind their peers to catch up. As a result, their learning has regressed and sometimes, they are finding real difficulties with self-esteem and anxiety.

A degree of anxiety is normal. All children and adults are anxious at times and most children and adults have the capacity and skills to manage this anxiety and not let it impact too much on their everyday lives. Some children have families and friends who will support them through periods of worry and stress. For many children, however, anxiety is immobilising. It prevents them from leaving their rooms or homes and stops them from making friends, going to clubs and schools and generally living their lives. We know and research demonstrates that enabling parents to support their children within the family is one of the most successful ways of addressing children's mental health needs.

One of the key things we do in Barnardos is support parents by working to improve their relationship with their child by introducing and maintaining routines in their homes and helping parents understand how to manage their children's behaviour. All this is done through our Partnership with Parents programme, which by strengthening parenting capacity improves children’s mental well-being.

As well as providing parental support, we also recognise the importance of providing direct support to children by helping them learn how to understand and manage their emotions. We do this through our This is Me programme, which works individually with children to support their social, emotional and cognitive development and integrate their hearts, bodies and minds.

During Covid-19, our family support services adapted to respond to the issues families were facing. This meant staff responded to parenting challenges, providing them with the flexible support they needed to make sure they could focus on parenting as effectively as possible. We believe that children and families can overcome the additional mental health issues and challenges that have resulted from the pandemic. To do this effectively, however, they will need appropriate support, which will require adequate provision of universal services, as well as specific targeted support.

Chairman

I thank Ms Connolly. I call Mr. Church from the ISPCC.

Mr. John Church

I thank the Chairman and members of the sub-committee for inviting the ISPCC to be here today to discuss the impact of Covid-19 on the mental health of children. I will be pleased to address any questions members might have as the session proceeds.

Through our Childline services, children tell us first-hand about the experiences of their daily lives. In our operational year of October 2019 to September 2020, our listening service answered more than 240,000 contacts from children and young people.

Our therapeutic support service, which works with children and families on a one-to-one basis for up to six months, worked with 458 children. The mental health impact of Covid-19 featured heavily across these services.

When restrictions were first introduced in Ireland, children were among the first to be impacted. Cut off from school and from extended members, friends and the sports and activities which can play a vital role in their lives, they reached out to Childline for support. In the first week of school closures, Childline experienced an instant increase in demand across its online, phone and text-based services. While demand for our phone and text services were sustained thereafter, children continued to seek support in increasing numbers online. It may have felt as though their conversation could be overheard at home.

In the initial period of the Covid-19 pandemic restrictions, our listening services saw an increase in contacts around mental and emotional well-being, suicide and self-harm. Many children told us how their feelings of anxiety stemmed from every aspect of their lives. They picked up on what their parents were going through and what was being reflected through the news and on social media. Tensions which had been simmering under the surface in homes arose and in some cases children experienced adverse childhood experiences for the first time.

Between the closure of schools in March 2020 and the usual end of the primary school term in late June of that year, the Childline website experienced an increase in users of over 100%. Between March 2020 and July 2020 our listening services answered over 2,500 contacts from children seeking support around their mental and emotional well-being and, in addition, we answered over 600 contacts from children who spoke with us about suicide. The impact of intense Covid-19 restrictions reintroduced in December 2020 was felt acutely by children around Christmas time. They spoke with us about issues including loss, anxiety and suicide ideation. One call was received from a young girl who was living in care but felt that nobody was thinking about her. While her challenges have begun long before the global pandemic struck, the sense of isolation, fear and anxiety which had stirred up inside her over the months of tight restrictions had brought her to a place where she felt she could not go on and that she urgently needed to talk.

Since October 2020 the Childline listening service has answered over 5,500 contacts in total from children seeking support around their mental and emotional well-being. They tell us how they feel anxious, unhappy, lonely and more.

The Childline therapeutic service, which offers more directed therapeutic support to children, young people and their families, is now seeing significant stress and anxiety around school and peer interactions. Children have become more withdrawn. They are out of the mode of socialising and perhaps they have changed too and they are not quite sure where they fit in any more. There are increased levels of anxiety, with more children feeling as though they cannot leave their bedroom or their house and as though they cannot go back to school or to the so-called normal.

Our E-therapeutic support model now allows us to support these children and young people online. The model of E-therapeutic support allows us to engage with young people online, offering the same levels of therapeutic interventions as our face-to-face sessions, with a focus on goal orientation to match the young person’s strengths and needs at the time of our work together.

We were fortunate during Covid-19 to have our E-therapeutic support programme evaluated through a pilot review and the results confirmed that where a young person wishes to engage therapeutically online, the impact of this work matches that of a face-to-face engagement. We are confident from the evaluation of the pilot that we have a robust proof of concept that highlights the potential in this service model and the role such a model can play in supporting children and young people post Covid-19.

Mental well-being and anxiety continue to be among the topics spoken about most frequently by those who turn to our services for support. In the years since October 2020 we have answered around 26 contacts each week from children and young people who tell us they feel actively suicidal, have suicidal thoughts and feelings, or have previously attempted suicide. In that same period, we have answered 923 contacts from young people speaking about self-harm. We anticipate that children will continue to experience acute challenges related to the impact of Covid-19 on their mental health for some time to come. We must ensure that they have access to the supports they need, when they need them.

I thank the members for their attention and I look forward to engaging with them.

Chairman

I thank Mr Church, who has presented some shocking statistics there to our committee.

Deputy Gino Kenny

I thank the Chairman and all of our witnesses today. It is a sombre exercise listening to the facts relating to the impact of Covid-19 on children. Even though children were probably spared the worst ravages of the illness and this pandemic in respect of mortality and sickness, they were not spared the disruption of their lives as it had a very significant impact on children. I can only imagine what kind of fear there was with the onset of the pandemic. Most adults when they heard what was coming must have experienced a fear factor and that would have seeped down to many children and disrupted their lives incalculably in some ways.

There is a legacy from the pandemic in what it has done to children and it is important to address those issues as quickly as possible. In practical terms, what legacy issues can both agencies address in respect of the disruption that the pandemic has caused, in particular, for children?

Chairman

Would Mr. Church like to respond to that question?

Mr. John Church

I thank the Deputy. The short answer is that we do not really know but we are starting to see these. The basis of our intervention in Childline and the ISPCC is helping children to build resilience in order that they can cope with these adverse childhood events. There is much research to show that everyone will encounter adverse childhood events and this is certainly a significant event, as we can see. The data are there and the committee can see from our colleagues in Barnardos and within Childline that the anxiety levels and tensions were through the roof. The first indication we got was 27 March, which was when real lockdown happened, and from then on we a saw 30% increase in our calls to Childline. Much of what happened at that stage was about fear, the fear of not only getting the virus but for loved ones and of one's grandmother getting it, which were the initial calls we received in Childline.

As we went on people began to realise that this was not going to last just a few months or was just time off school - which is usually great - but was going to go on for much longer. With the announcements yesterday it looks like some of the restrictions are also going to go on for a little bit longer.

From our perspective, our hope is that it highlights the need to at least match mental health services with the investment that we have in the physical health services side. Those mental health services are significantly undervalued. If one looks at the WHO recommendations, it recommends that 12% to 14% should be invested in those services and we are currently at 5%. We are way off in the supports we provide to young children. If one looks at the waiting lists for child and adolescent mental health services, CAMHS, these are unacceptable. If anything, we need to act very quickly in starting to look after the children and young people because these adverse childhood events will impact society later in life.

Ms Suzanne Connolly

First, as adults, both as parents and as this committee of elected representatives here and all of the professions, we should do all we can to let children know that we are there for them, that we can support them in their anxiety and enable them to think positively about their future. The reopening of schools was crucial and key. We now need to ensure that children can thrive in schools, go to and stay in school and that they can develop to their potential. That is why I was so pleased that that happened. The closing of the schools had a very significant impact on their well-being, as well as on their other activities.

As Mr. Church has said, we need a variety of services. We need both the generic universal services which say that a degree of anxiety, worry and stress is normal. However, when that stress begins to interfere with one’s everyday life and capacity, that the services are then available. That needs to be across a continuum, from services such as Childline and the services that we provide in the communities and homes. These must also come, as Mr. Church has alluded to, from the more specialist CAMHS services, where children really need particular types of attention because of the level of this anxiety, because they have potential disorders such as obsessive-compulsive, or because there is suicide ideation. Perhaps Ms Keane would like to add to that.

Ms Laura Keane

Absolutely. I echo everything said by Ms Connolly. I will answer the Deputy's specific question on what we can do to counter the impacts or the legacy that will be there post-Covid for the children and families that Barnardos works with. One of the key ways we can support children into the future is by creating that sense of belonging and connectedness for them. We do that primarily in our work on the ground in Barnardos by supporting parents to have a better understanding of their child's needs; have a better insight into their emotional world and what is going on for them; build up their skills to be able to support their children in their overall development; and improve parent and child relationships and communication. In my work on the ground, a key way to support children post-Covid is by supporting their parents to better able to be that front line of support to them.

The other key piece of work we are doing at the moment is working with children one to one to build their resilience, as mentioned by Mr. Church, and to develop their capacity to cope with stress, to understand what stress does to their bodies, and to help them to calm themselves and to re-engage with those really critical opportunities of education, hobbies and social networks. From a practical perspective on the ground, our direct work with parents and children is helping them to develop those skills to mitigate the impact of what they have been through.

Deputy Gino Kenny

Mr. Church has alluded to services related to intervention, and particularly around the CAMHS. We are all aware of the very long waiting times for intervention, and we know that early intervention is crucial for children's well-being.

We spoke a few minutes ago about the first port of call for children being their parents, or whatever circumstances is their family model. What advice does Mr. Church have for children in that regard? Anxiety is a fact of life. It is how one deals with it. In the past 18 months, this has manifested in all sorts of ways for everybody but particularly for children. Some children may have inverted this and may have shown behaviour they have not shown before. With regard to parents, siblings and the child's family group, the pandemic did a number of things but it may also have brought people closer in communities and within families, which is very important. That went a number of ways also. When parents are speaking to their child, what is the best way to engage around certain types of anxieties that children may be having during the pandemic and post-pandemic?

Mr. John Church

First, it has to be acknowledged that the majority of children and young people have been amazing during this Covid period. They showed incredible resilience. They got back to school and they got back to sports. However, the numbers we have presented here today show that a worrying number of children are being left behind. The ISPCC's philosophy of resilience building does involve the parents. The nature of Childline is that it is a confidential service. The children contact us and they are the centre of our service. Very often the issue is how to communicate with the parent. The children may say, "My parents are not listening to me", or "I do not know how to talk to my siblings". The services we provide help children to do that. We have also introduced a parent hub, something that Barnardos has also done, in recognition that the parent is a significant part of this also. We are moving more of our services towards early intervention and prevention. The one bit of advice that we would give to parents is to continue to talk. Talking is very good. Talking makes you stronger. People are probably better at it now than when I was a young fella. That is a very good thing. It is not a sign of weakness. Parents should talk from a very early age with their children, and make that brave move to start very early. They should also talk to teachers and to coaches. Very often teachers are the ones who recognise signs, and will come to a parent on the sideline to perhaps say, "I have noticed something about Johnny and he has been a bit quieter". Talking is very important, as is listening.

Ms Suzanne Connolly

The children have told us they really want their parents to look after their own mental well-being and to be kind to themselves and manage their lives. If the parents are okay then children are able to feel they can be supported and they do not have to worry about their parents. I would like to put this into the mix, and perhaps Ms Keane would like to add to that.

Ms Laura Keane

I was going to make that exact point. In regard to how parents can best respond to their children's mental health needs and their children's anxiety, it is absolutely about minding their own first. It is the notion of the adult putting on his or her own oxygen mask before putting on anybody else's. In a sense, parents learning ways to manage their own stressors and anxieties, to remain calm and to focus themselves is the first step in responding adequately to their children's needs. Beyond that, it is absolutely as Mr. Church and Ms Connolly have said, it is about talking and open communication within the home. That starts from the very early years of a child's life, that sense of "you can come and talk to me about anything". It is not just about the talking and the open communication, it is also about shared joy and fun between parents and children. It is very important to have that sense of safety, nurture, fun and joy at home.

As Mr. Church has already mentioned, the third piece is talking about the child's experience extending out into the other spheres the child is part of, including school life, friendships and community involvement, and making sure there is a sense of how the child is doing in all of those areas. Those are the three layers, as I would see it, for how a parent can best support their child's mental health.

Deputy Gino Kenny

I thank both organisations for coming in. It is very insightful and informative with regard to the impacts on children. It has been a very difficult time for everybody. Hopefully we are coming to a conclusion, somewhat, of the terrible ravages of this pandemic. I thank the ISPCC and Barnardos for all of their work.

Deputy Pat Buckley

I thank Mr. Church, Ms Connolly and Ms Keane for coming before the committee this morning. The one beauty about these committees is that a lot more can be said and printed here than in any media or newspapers. It is a great opportunity to get the truth and the real stuff out there.

I will turn first to Barnardos with a question for Ms Connolly and Ms Keane. The opening statement showed there was an 82% increase in stress, a 50% increase in stress at home, and a 15% increase in substance use. This was all during the lockdown. The witnesses spoke about all of the options and the additional challenges resulting from the pandemic, such as funding. The last budget provided for a measly €24 million. I do not believe the €24 million will keep the services in the ticking over position, as they stand now. Ms Connolly and Ms Keane spoke about helping parents to engage with their children and children to engage with their parents. There is an old cliche, a problem shared is a problem halved. When it comes to mental health or anxiety, however, or anything on that scale, it is very difficult for the child to go to a parent because we are naturally a reactive society, unfortunately, so the problem shared is not a problem halved, it is a problem doubled. The first thing the parent does is to react. The child sees that and there is another reaction and then it escalates. Mr. Church said, and he is right, that the schoolteacher or the sports coach is normally the one who first picks up on this. Are the organisations facing major challenges in trying to get parents and children engaged? Obviously, there are additional issues there.

On the second one, in his opening statement Mr. Church said in the space of 11 months the society's services had listened to calls from nearly 250,000 children. I am actually lost for words. Nearly 250,000 children in the space of 11 months. That is in only one service. We have been trying to get this through to Governments over the years. Again, we are a reactive society. We will wait until there has been a tsunami of suicides and then we will say, "God, how did that happen?" or ask why is this or that broken, when we are hearing from the witnesses coming into the committee telling us about the issues and trying to resolve them and they are not being listened to. I found the following line stark since we are talking about children. We know in adults and maybe young adults it could be prevalent but the ISPCC had: "... over 600 contacts from children who spoke with us about suicide." "Suicide" is the full-stop word. It is the last one. You have gone beyond anxiety, social exclusion and stuff. That is very worrying.

I am very interested in the society's e-therapeutic support programme because we have a different generation there now. However, again many of these people do not have broadband, the Internet or computers to be able to get that. The other line was, "... 26 contacts each week from children and young people who tell us they feel actively suicidal, have suicidal thoughts and feelings, or have previously attempted suicide." That is 26 per week. I am not going to do the maths now but we have been talking about mental health and mental health services for a very long time. What seems to be coming up all the time is the lack of services. Then when you go to whoever is in power, they tell us of the lack of resources and that they cannot get staff. We had it here two or maybe three years ago when 114 assistant psychiatrists were promised. They did step up to the mark and did hire them but they were not doing psychiatry, they were doing paperwork. There is a massive breakdown within the system.

I do not want to come across as always being negative because there are people in the front line here who are absolutely amazing but it is about how we pull together all the supports to support the likes of Barnardo's, the ISPCC or any of the other NGO groups. It is heartbreaking for us listening to this. You can imagine the stress on families. I have seen it in my own family and I even struggled with it during Covid. We are used to being out and about and meeting people but I was actually struggling from social anxiety and was trying to condition myself back into getting out and being confident around people. However, thinking of the present organisations and children who are most vulnerable, it really hurts me when I hear these statements.

I have two questions. Do the witnesses agree that between here and, say, next May we will see a tsunami of mental health issues coming to their services? It is a weird one. May is normally the highest factor month for suicides. It is not in the dark, grey days of December or January but the start of summer, which is crazy.

I asked my second question at the last meeting. There was €24 million and apparently a €10 million one-off payment to be invested in new mental health services this year. We in Sinn Féin put forward a package of more than €113 million, which would have been the largest in the history of the State. That shows who we are serious about and who listens to people. It is a difficult question the witnesses may not be able to answer on the budget for this. I think Mr. Church mentioned the WHO and investing 10% or 12%, whereas I would say we are investing less than 5% in mental health services. It is not always about money because throwing money at the problem will not fix it. We have to go back to the start and look at salaries, the training for psychiatrists, psychologists and so forth. That takes years and because the system is so toxic it is not being fully supported. Those who have the empathy to work in those services lose faith because they do not have their own supports and see children falling through the cracks. Is it therefore a matter of going back to the start and saying we need to streamlines services, we need to streamline training, we need supports to be put in place and we need proper budgets ringfenced every year? Also, as the Chair will be aware, we are talking about all the stress and anxiety of Covid and so on and we are talking about investing in mental health services, yet we have the Owenacurra Centre, in my own town of Midleton, that has never had Covid, has never had a suicide and because of lack of investment from the HSE in the maintenance of the building it is going to shut down that service in the middle of a pandemic. It is ludicrous.

Do the witnesses understand what I am saying when I refer to supports and trying to get people to work together? It is a lot to take in but I would love to hear the opinion of the the witnesses on it. It is not a quiz or a competition. I just need their honest opinions because we can take it back. When you are in committees like this, at least the public outside are hearing the truth and hearing it from the witnesses who are in here. I do not think many people would have been aware that the organisations' services have been under so much stress during Covid and how well they have coped with it. I do not see any of them throwing the rattle out of the pram, if they know what I mean. They have kept their decorum. However, we also need to know how well they are prepared going into the future with this trend, which I suspect will increase in the next couple of months, and how they will cope with it.

Mr. John Church

It is a huge issue. How do you eat an elephant? First, I will directly answer the Deputy's questions and then I will develop my answers. Will there be a tsunami of mental health issues? Yes, absolutely. The issues we have encountered during Covid were on the rise anyway. Suicide ideation and anxiety were on the rise anyway. Life is different. It seems to be more challenging for children nowadays. Maybe it is the way we parent; I do not know. However it is a very tough environment for children growing up now. I will get on to budgets in a minute. To our last point about parent-child interaction, Childline is a confidential service so sometimes the only person or service children have a relationship with, in terms of their issue, is Childline. They cannot talk to their parents. All I can say is, on 27 March thank God we got essential service status. It meant the 220 volunteers across six units in Ireland could travel in and out. I shudder to think about that not being available. At least we were there, because we were needed. We went 24-7 with not only our telephone but our web chat and text service, which was very positive.

The Deputy asked about our e-therapeutic services as well. Funny enough, it dealt us a positive hand in that we were forced into piloting video therapy. All our 21 therapeutic staff were taken off the road and we went straight into video. Then we took the chance to do a pilot. All 468 children were put through this pilot and the results were comparable with face-to-face. That is hugely encouraging. We have presented that to Tusla already and we will present it to whoever wants to see it. To the Deputy's point, we are not throwing the rattle out of the pram. We are coming up with solutions. Another solution we introduced during Covid was an external service called SilverCloud. Members may have heard of it. It is a cognitive behavioural therapy, CBT-based online intervention. We have already taken 70 children off the CAMHS waiting list. There were 2,700 on that list waiting 12 months. We are running the pilot. Not only are the children coming through very well, the parents are coming back to us - because they are involved - and to our point earlier about getting parents involved, they are saying they are noticing a difference. We are saying now to Government we have got solutions within our infrastructure and we have got the capacity to see four times the number of children per day than we would face-to-face, with similar outcomes. Members may ask how that is the case. We are operating in the environment children are used to. Children are living online. They are used to texting, chat and video. That is their environment. We are coming into their environment instead of forcing them into a face-to-face environment.

Suicide ideation was always on the increase. Self-harming is always an issue. We would often have instances of people self-harming on the call in the middle of the night with a volunteer. It is the only place in the country they can go.

There is nowhere else open except accident and emergency and hospital. At least we are open 24-7. We get only 30% of our funding from Government but to back up the Deputy's point, and I have said already, we are coming to the Government with solutions. We would like to come with solutions. We have an infrastructure that has taken 30 years to build up with Childline and we have committed volunteers. We are now going online and we can see four times the number of children with similar outcomes. That is a good starting point in eating the elephant.

Ms Suzanne Connolly

To give some context, my background is social work and I have spent the past 30 years involved in delivering services to children and families. Notwithstanding the fact that I think online services have a future and are meeting a need, as Mr. Church highlighted, I feel passionately about in-person services for vulnerable children and their parents and the importance of delivering those services where children and families can access them. It is important to see what is happening in the home and to have a warm, welcoming service in a centre. We need to be there for the long haul for children and families because some children have had multiple traumas in their early life and need intensive services and service provision. We also need to be very careful, particularly when talking about children, as we cannot separate their overall development from their mental health needs because if children have anxiety, it affects their education and their social abilities too. Whatever we are doing, we have to plan with a range of organisations working together to ensure the best outcome for a child. That is really important. We need to listen to children and parents and be clear about what works. We offered online services during Covid as well but what we found was that people really wanted our staff to be there, professionally, socially distanced, 6 m away, waving to them from the road to say, "We are here for you". We delivered hot meals to those parents and their children and the children could not wait to get back into centres.

It annoys me, from a funding point of view, that the services provided by the community and voluntary sector do not get sufficient recognition by the Department of Public Expenditure and Reform in the thinking about what is needed. We are constantly having to spend a lot of effort in explaining what we deliver, why it is important and why it meets a need. That is very effortful and sometimes it takes away from the effort we could be putting into developing more and more programmes that work for children and families. I also feel it is important that we do not talk about just the problems but about the solutions. With the right services provided by organisations like Barnardos, the ISPCC and others, as well as the State and different professions, we can meet children's needs and give them hope and possibilities for their future, and a sense of purpose and meaning. That is important.

Ms Laura Keane

I will answer the question about whether we as organisations on the ground feel we are facing a tsunami of mental health issues over the next number of months. We are seeing an increase in mental health difficulties for children and parents already so I would absolutely be concerned about that continuing. We see children who are finding it difficult to make and sustain friendships now that they have gone back to school because they have regressed in their social skills. They are struggling to play with friends in the schoolyard, they are lashing out more and getting into fights more. Children are more isolated and withdrawn. As Ms Connolly mentioned in her opening statement, some children are struggling to leave home at all, and sometimes struggling to leave their bedrooms, such is their level of anxiety and isolation. We are seeing children with increased regulation difficulties. They are struggling to sit still in class, they are more disruptive than they would have been and more aggressive in their behaviour. As Mr. Church mentioned, we are seeing a marked increase in children presenting with sometimes severe anxiety and indicators of depression as well. We are seeing increases in children self-harming and having suicidal ideation. We have seen already a significant increase in all of those things.

As regards parents' mental health, we are encountering parents with higher levels of stress who are struggling to cope with the daily challenges of parenting, bearing in mind they are supporting children who also have a higher level of need. Some parents are struggling to re-engage with society and supports themselves. We are absolutely seeing an increase in mental health challenges for children and parents and the concern is that is going to increase. One of the questions was how we are finding parents' engagement with the supports that a service like Barnardos can offer. We are actually seeing positive engagement from parents on the ground. As Ms Connolly said, what parents are telling us is that they want us to be there in the home, supporting them directly and supporting their children to get through these challenges and to help them develop their skills and insight to be able to mitigate the impact of Covid and support their children's development. Services like ours always have waiting lists. We could do much more than we are currently able to do if we were adequately resourced. That is what I am seeing on the ground.

Chairman

I have tonnes of questions. There is so much going on as I am listening to the witnesses speak. First, I thank them for the phenomenal work they are doing. I can safely say I speak on behalf of the members in that regard. Unfortunately we are low on members today due to the fact that Wednesday is a hectic day here in Leinster House. It is a small committee anyway. I want to ask about the process of the organisations. If a child rings the ISPCC or Barnardos or connects with them in some capacity, what happens? What is the process? Obviously there are different processes for the two organisations but I ask the witnesses to take me through the journey towards a positive outcome for that child. I am sure they do not always get positive outcomes but just give me an example.

Mr. John Church

Our greatest engagement with the greatest number of children would be through our traditional Childline phone line and online. We introduced the web chat service and kids love it and interact with it. We also do face-to-face services like Barnardos but through a different model. Those children come through referrals from GPs and Tusla, mainly. To take a typical phone call, I would first note that it is confidential. A child rings or contacts us through the web chat service and that child and our volunteer both have a pseudonym. Immediately he or she is told that this is non-judgmental and non-directive. We believe everything the child says and that is the process. The volunteers are very well-trained and are also supported through their own couselling intervention because it can be very difficult sometimes. The majority of our outcomes or interactions are very positive. We get repeat callers. We get children calling on Christmas Day, which is actually quite a popular day, sometimes just to say what they got for Christmas. Then in the afternoon they are worried about the alcohol level that has risen in the house. It ranges from children just being lonely with nobody to talk to, to having difficulty with their exams. They can call as often as they like but we are working towards empowering the volunteer to refer that individual to some of our other services. We have often directed other children and young people to services outside our own if we feel there is an issue of suicide, alcohol, drugs or whatever.

Chairman

To what service would you refer them?

Mr. John Church

Pieta House would be one. We have a good relationship with Pieta.

Chairman

Does that service see children under 18?

Mr. John Church

It does if they are touching 18. Sometimes we get children of 19 as well. These are issues that our volunteers are very well-trained on and we can deal with them for children under 18 but it is about building the resilience of the child. The conversation with the child is important. We do not provide solutions. We do not direct the child as to how to do things. We establish what their network is and what their supports are first and foremost and encourage them to come up with a solution. That may take a number of phone calls or online chats but we believe it is the way to do it, as opposed to prescribing for every child. Let them come up with the answer and they can ring any time. Some of our busiest times are online chats in the middle of the night when the house has gone very quiet and the parents are in bed.

At least they can now go online and have a chat with somebody, who could be in Limerick, Castlebar, Drogheda or elsewhere. We have a number of units around the country. Children get exactly the same welcome and go through the same process in each instance.

Ms Laura Keane

The typical journey for a parent or child who comes to Barnardos begins with referral, which can happen through a number of avenues. We take self-referrals from parents, referrals from schools, public health nurses, doctors and community projects, and we take a number of referrals from Tusla's child protection services and duty and intake social work services. There is a very broad range of services referring into Barnardos, including families themselves. The journey then proceeds to an assessment of the child's needs, taking into account his or her unique strengths and challenges, and the strengths and challenge within the family unit. The idea of the assessment is to determine what the parents are able to bring to the table, what other supports they have around them that can be drawn on, and what is available through school and other services. The purpose is to come up with a plan of support to target particular areas of need for that particular child. For each child, an individual, tailored plan is drawn up based on his or her unique circumstances and needs.

Many of the interventions we provide are for parents, as I mentioned, with a focus on developing their insight and skills in supporting their child's development. There is a focus on how to support their relationship and communication with their child, with an understanding that this is one of the best ways to support children's well-being. Other areas of support we offer to parents following the assessment include support in providing structure and positive routines at home in order that children have a predictable environment that supports their overall development. We also work with parents on understanding their children's social and emotional needs and identifying practical ways in which they can make sure their children are achieving in those areas. Parenting input is something we regularly offer families after we have completed an assessment.

The other key service we offer is one-to-one work with children. This is often focused on developing their emotional literacy, including understanding their feelings and how they can manage their behaviour more positively and make more positive choices. We work to help them to communicate and interact more positively with family members and peers. That is very broadly the journey on which a parent or child would embark when they come to Barnardos. The focus is on providing specific, tailored plans that respond to each family's unique circumstances in the context of the particular community in which they live.

The benefit of this very direct model of support is that it means we mostly work in family homes and are really tuned into the challenges and strengths going on around a child. It allows us to develop very connected relationships with parents and children because we are in their world and we know what that looks and feels like. Our model is very much strengths-based, with an emphasis on meeting parents and children where they are at and drawing on the positives that are already there in terms of making changes. That is a very broad run-through of the process. It is different for every parent and child who comes through the door. Ms Connolly may wish to pick up on anything I missed.

Chairman

No, that is fine. I am aware that Ms Keane has to leave soon but I have a couple more questions before she does. There has been concern during the Covid-19 pandemic that there was an increase in parental misuse of alcohol, prescription drugs and illegal drugs. Gambling has also come to the fore as an issue. Can Ms Keane say a little about the impact of that behaviour, particularly around alcohol misuse? I do not know whether anybody really understands the impact it can have on a family. Even the individual engaging in the behaviour may not understand its impact, particularly on children. Has Barnardos seen an increase in alcohol harm and drug misuse? What are its findings in that regard?

Ms Laura Keane

We certainly have seen an increase in problematic coping strategies among parents because of the stress they experienced during the pandemic. Many of the parents and children who come to Barnardos were experiencing multiple challenges in terms of their well-being before the Covid crisis and had a great deal of adversity to manage in their lives. A significant number of the parents we work with come from very difficult childhood experiences themselves. During the Covid period, we definitely saw an increase in drug and alcohol use, a rise in conflict and violence within family homes and an exacerbation of existing parental mental health difficulties. Obviously, all of that had a direct impact on children's well-being and mental health.

On the specific point about an increase in drug and alcohol use in homes, what we saw and heard from families was that their home life really became like a pressure cooker during the Covid lockdowns. Those issues may have been in the background already but, suddenly, everybody was at home together, all day and every day, and there was stress on top of stress and none of the normal outlets, releases or reliefs in terms of school routines, work or social connections within the community. We certainly saw an increase in that type of pressure. In terms of children's direct lived experience, they saw parents being less emotionally and physically available to them because they were more likely to be using substances. Routines fell away in family homes and there was a sense of unpredictable, chaotic home lives, without any of the buffers that were there before Covid such as community activities and hobbies and, critically, school routines. There was a sense of people being in a pressure cooker scenario without any of the usual outlets.

Chairman

Mr. Church referred to telephone calls in the middle of the night. Does he believe there is a connection there with the pressure on families during the Covid period?

Mr. John Church

Due to the nature of our service, we often have engagements with children during a violence event. We are almost like the emergency department of child services in the middle of the night. For all the reasons Ms Keane outlined, Covid led to a pressure cooker situation in which not only were children unable to leave the home but the alcoholic or perpetrator also could not leave. There was a major issue in that regard. As to how it manifested in terms of children contacting us, there was a fear before and after incidents of violence as well as anxiety at certain times of the day because they knew their father or mother was going to start consuming alcohol, get violent and abusive and take it out on them. A lot of support, including supports for our volunteers, was needed to deal with those issues.

I referred in my opening address to our online services. The 24-hour web chat facility and visits to our website saw a really significant increase because children did not want to be overheard. That is our hypothesis anyway. It makes perfect sense that if the perpetrator heard the child making a telephone call, he or she would be subject to the sort of abuse that was the reason for making contact.

Chairman

Is most of the contact done by way of text?

Mr. John Church

It is all done quietly from the child's bedroom. It is a very professional web chat service, which was implemented with funding from Vodafone. It is a godsend.

Chairman

I thank Mr. Church. Two more members have joined the meeting. I invite Deputy Lahart to make his contribution.

Deputy John Lahart

I apologise for my lateness, which was due to business going on in the House. I thank the witnesses for their presentations. The witness reports are very interesting and I want to drill down into some aspects of them. Picking up on the previous point, Mr. Church mentioned that children continue to seek support in increasing numbers online because they may be concerned that a telephone conversation could be overheard at home. Can he substantiate that hypothesis, because it is an important point?

If a child makes the switch from a telephone call to online, Mr. Church is hypothesising as to the reason for it. Does he have anything to back that up?

Mr. John Church

It was a hypothesis. In our engagement with the children, they said it to us. We do not have actual numbers; we are only lucky that we have a service there for it. Another hypothesis might be that children are moving away from the telephone anyway. We have seen a slow decrease in telephone contact to online, but as that trend went way up, it was very clear that it was correlated with the lockdown. I am quite happy to stand over that hypothesis. If we did some research, I think it would show that. It makes perfect sense that some of the children who are contacting us, normally by telephone, would switch to online because they do not want to be overheard.

Deputy John Lahart

I am not challenging the hypothesis; I am looking for it to be substantiated. The point was made that the listening services saw an increase in contacts around mental and emotional well-being, suicide and self-harm. I would welcome a little more detail on that.

Mr. John Church

Is the Deputy seeking detail in regard to what the children were reporting to us?

Deputy John Lahart

Yes.

Mr. John Church

Suicide ideation is very common among children. They would talk about having thoughts of committing suicide because nobody listens to them or understands them. It might be related to some sort of adverse childhood event that has happened. We deal with a lot of abuse cases as well. I am referring to children who have been sexually abused and emotionally and physically abused. That can often result in a child feeling that the only way out is suicide. On self-harm, I have grown to understand it more during my time in the ISPCC and from listening to the psychologists about it. It is seen as a way of relieving anxiety and tension. Young girls in particular will self-harm during the telephone or online engagement in order to relieve that stress, tension and anxiety. It is something I could never have imagined was possible, but it happens regularly enough for us to be concerned about it.

Deputy John Lahart

Mr. Church spoke of the increasing contacts in respect of mental and emotional well-being. He has mentioned suicide and self-harm but can he give us some examples of the issues that arise with children around emotional well-being and mental well-being?

Mr. John Church

We have gone into great detail about the stress, anxiety and fears.

Deputy John Lahart

Can Mr. Church flesh out the cause of the stress, anxiety and fear?

Mr. John Church

Specifically Covid, but these were issues before Covid as well. During the Covid period, which is the period under review today, the fear was around getting the virus and in regard to parents dying. Every day, as we all know, there were reports of numbers and deaths. This was being recounted to us. This information was all over social media and traditional media. That played havoc with children's emotions. It was the fear of getting the disease, that their loved ones would get it, including their grandmothers, and the isolation from their grandparents etc.

Deputy John Lahart

Can Mr. Church give us something more granular or an example of the narratives of that? I am trying to get to the heart of what it is like to be a child throughout this period.

Mr. John Church

The Deputy asked for something more granular. Does he want some transcripts of what children are saying?

Deputy John Lahart

The question is not a hostile question. I am interested in hearing what children were saying. I apologise for having missed the first 30 minutes of the meeting but the accounts being given are generalised. I am interested in hearing what is was like for children. I am trying to dig down into the examples.

Mr. John Church

We saw an increase in issues around anxiety, stress and tension such as we would normally see, but it was definitely more pronounced during Covid. The issues were particularly around violence in the home and domestic abuse. We were in close contact with Women's Aid over that period as well. What Women's Aid was listening to by way of its services on the adult side was being mirrored on our side for children. Covid played havoc with children's emotions. They were missing their friends. There was significant isolation and feelings of isolation and anxiety about being repeatedly being taken away from their day-to-day model of life and routine. The disruption in routine and the affects of that became a huge part of our conversations with children by way of the telephone in particular.

Many of the children who contacted us, in particular during Covid, did not do so to get a diagnosis and nor do we seek to diagnose. They are only children. At the end of the day, they were telling us how they felt. Our job is to listen and try to help them cope. Our epicentre is somewhere between 11 and 15 or perhaps 13 and 16 years of age. At that stage of life, many children do not know what is going on in their lives. All they can do is talk about how they feel, which is very good.

Deputy John Lahart

How would an 11-year-old source the contact number and how might a conversation begin?

Mr. John Church

The contact number is sourced, in the main, online. We are in schools as well. We are on social media too. We advertise our number on social media. Every call is a self-referral. We often get what is known as a "silent call", which is when an individual who has taken some time to get up the courage to call Childline does so but remains silent. We engage with that person for up to two minutes maximum. We seek to reassure the child that he or she can be heard and that we are there to help and we are not judgmental. It is about building up that confidence with the child. Very often, the child calls back and starts to talk.

In regard to the question regarding the 11-year-old, one of my first calls when I joined the ISPCC was from a ten-year-old. It is a typical ten-year-old testing the water. We ask the child for a name that is not their real name, the child gives a false name and the volunteer introduces himself or herself and tries to build up a relationship with the child. The average call is just over 60 seconds, but the range could be from ten seconds to 35 to 40 minutes. The latter would tend to be the older teenagers who are probably more confident to call. It is quite distressing. We get six and seven-year-olds calling Childline. They may have come across the number or, maybe, their friend has talked about it. You have to try to get into the mindset of a seven-year-old, using very basic language, to tease out what the issue is.

Deputy John Lahart

For those children who do speak, what might be an opening narrative?

Mr. John Church

It would be "Hi, I'm worried; I'm afraid." It is literally just one or two words sometimes. Thankfully, our volunteers are trained. We have a very young volunteer base as well. They are great at listening and asking the right questions to try to tease out the issues. Very often, the caller would utter only one or two words.

Chairman

Would Ms Keane or Ms Connolly like to comment?

Ms Suzanne Connolly

For Barnardos, it is really important that in our work, we recognise that every child is an individual. Children will express their feelings through their behaviour because they are not necessarily that articulate. It is our role as adults to think about what the child needs and what will support him or her. Earlier, Ms Keane talked about an assessment of need. That is really important. You need to think about the best way you can help that child and that family. We are aware that some of the children will have externalising behaviours.

You know they are unhappy because they let you know. Whether they are shouting, kicking or being very disruptive, you will know they are unhappy. Other children will go back into themselves. They will be quiet and may not come out of their rooms. They may eat less. To meet their needs, it is important that the adults around them notice that and do something about it. Within Barnardos, we have a range of services. Ms Keane is representing one service but we have 45 centres throughout the country and we provide a range of things. Across those services, we really try to think about what a particular child needs and to address those needs. We have early years services and, as we know, children at this age make their distress very clear through their behaviour. Older children may show it differently. If a child is not settling back into school and connecting with their friends and if they are no longer doing the things they did before, you will know that child is unhappy. It is our job to see what we can do to help such children get back on track.

Recently, Barnardos arranged another service. At an event last Friday, a parent and a young woman of 17 or 18 spoke about their experiences of the service over several years. They talked about how the service enabled them to get help when they needed it. There was a time when the young person did not want to talk to her mum and dad. Even though they wanted to be there for her, she did not want to talk to them. She wanted to talk to somebody else outside the family. The parents said they wanted a professional to help her. They were at the end of their tether. They were able to say that the service they had got from Barnardos, which provided a project worker, had made a real difference to their lives and to the life of their child in particular because she was struggling with her mental health. I hope that is helpful. I do not know whether Ms Keane wants to add anything.

Ms Laura Keane

No, I was also going to make the point that it is more typical for children to show us what they are feeling rather than articulating it. The children Barnardos works with are predominantly in middle childhood and children do struggle to articulate what is going on with them and how they are feeling. They need support to learn those words and those skills. A lot of the time, it is about looking at what their behaviour is telling us. A significant piece we can support parents with through our work is trying to see behaviour as their children's way of communicating with them. The children may not be able to say they are feeling worried or scared or that they miss their friends. They are more likely to show that by acting out, withdrawing or whatever it might be. One of the most important parts of our work is helping parents to understand what their children are showing them as a means of communication. I wanted to reiterate that very important point on what behaviour shows us.

Deputy John Lahart

Even as constituency politicians, I am sure my colleagues and I are aware of the impact of Covid on families and particularly on parents of children with special needs, whose environments were severely restricted in comparison with what they had been familiar with. The Barnardos representatives have said that we know children are among the groups most adversely impacted. How do they know that?

Ms Suzanne Connolly

Parents have told us through the back to school survey. Almost 1,500 parents have told us that their children have been impacted. We also know through our services. We have always seen it, even before Covid. When you go into a family home, you can quickly know what is there for a child and what is not. You sense the atmosphere. Sometimes you are dealing with families who are living in poverty. That gives you strong evidence. There may not be enough food around, the house may be cold or, although this is a bit unkind, the parents may not really be there because you can see they have taken a substance. You know the children's needs are not being met. During the Covid pandemic, we were involved in supporting families where domestic violence or acrimonious separation are features. We were out talking about this. Children have told us in Barnardos about the impact of living with parents who cannot talk to each other civilly. I am not even talking about the horrific cases where actual physical abuse is going on. Children tell us. They actually use the line that it gives them a sick feeling in their tummies. I could give the Deputy numerous examples of the impact on children.

Deputy John Lahart

What I am trying to drill down into is that it may be too early to tell. I am trying to drive at the point that we just know this intuitively. Have we done any studies that demonstrate-----

Ms Suzanne Connolly

Yes. There are.

Deputy John Lahart

-----that children have been more adversely affected by the Covid pandemic than other age cohorts? The reason I am asking these questions is that this has consequences for Government policy and, if it has consequences for Government policy, it informs the decisions we have to make as policymakers. That is why I ask that.

Ms Suzanne Connolly

It is a very good question. The Deputy is absolutely right; it needs to be asked and there needs to be evidence to support what we are saying. One of the things Barnardos has said is that we really want to understand the impact of what has been a very disruptive school year on children's education. The Economic and Social Research Institute, ESRI, and the Government itself have carried out research on this and we understand that some children who were lucky enough to be well-resourced at home, which is to say they were not worried about money, had access to digital facilities and their parents supported them, may not have suffered that much educationally. However, we are really worried that children who did not have that support at home, did not have access to broadband and who struggled to motivate themselves or be motivated to do well in school will suffer. Interestingly enough, Ms Keane has to leave in approximately four minutes because she is going to meet a family and Tusla to talk about a particular situation in which a child has not gone back to school. I will not ask her to talk about that particular case but there are probably other things going on in the family outside of the child not doing well educationally. I imagine there are struggles with parenting and so on. We know from our targeted family support work that children have really been impacted where they did not have the support at home that other children have. That is the reality. The other thing-----

Deputy John Lahart

I am aware from my own constituency that the school meals programme plays a role. I know there were unsung and very busy deputy principals and other staff members ferrying those meals around during school days. To cut it short, I would be interested in seeing any of the reports that back those statements up, including that from the ESRI, which Ms Connolly mentioned.

Chairman

A UNICEF report was released today that says Ireland has the third highest estimated percentage of adolescents aged between ten and 19 who have mental disorders. I can forward that on to Deputy Lahart. I only just saw it. I have not read it myself but the Deputy might have an interest in it.

Deputy John Lahart

I have a question for the ISPCC. It relates to e-therapeutic support. Will the witnesses elaborate a bit on that? How does a child access that? How do I, as a legislator, or any adult know that people cannot masquerade as an e-therapeutic support provider and that children will not find themselves straying into difficulty unknowingly? What safeguards are in place?

Mr. John Church

Traditionally, Childline has been known for its phone line, before our online services began. Over the years, as children changed, Childline introduced new online services as well. Like Barnardos, we have traditionally done face-to-face interventions as well. These are predominantly funded by, and individuals are predominantly referred through, Tusla. Two years ago, we undertook a strategic review. We wanted to bring our resilience-based service to more children. We asked ourselves how we should do that and what was the best way to ensure increased reach as we scaled up our services. We came to the conclusion that scaling up our face-to-face business or supports would result in a significant expense relative to what we could achieve through online or e-therapeutic supports.

We wanted to look at what type of typical interventions that would mean. As a lot of work is being done in the UK, Scandinavia and Australia on this, we looked at what others are doing. Then suddenly Covid hit and we were forced into a live pilot, which was a blessing in disguise, in that the 450 children who we would normally see face to face were forced to go through the same programme online through a video call. At present, we do a video call but we also have a service called SilverCloud, which is a cognitive behaviour therapy, CBT, based online intervention. That is a pilot and is being funded by the HSE. The HSE is looking at this as an intervention for children. It is already there for adults. Some 70 children have been referred off the CAMHS waiting list, and we intervene. It is a self-assessed six-week programme but we know when a child has dropped off so we intervene. We talk to the child and ask if there is any way we can help the child to keep on the programme. Then we talk-----

Deputy John Lahart

Briefly, how does that programme work? How regular are the interventions? Is it weekly or daily?

Mr. John Church

It is weekly, and over six weeks.

Deputy John Lahart

Is it an hour or two hours?

Mr. John Church

It is just over an hour for each module. We know when the child has completed the module. If there is a long intervention between modules, we also know we need to contact the child and see if there is any support. Some children fall off the programme, but at least we intervene.

Deputy John Lahart

How do they access it? Is it on their telephone or is it-----

Mr. John Church

It is online. It can be the child's tablet, telephone or the desktop.

Deputy John Lahart

At home?

Mr. John Church

Yes, at home in a safe place. These are referrals from the CAMHS in the HSE. It is working extremely well. The feedback-----

Deputy John Lahart

On that piece, how does the ISPCC-----

Chairman

Perhaps Mr. Church could send the committee that information, so we can move on from this specific point.

Mr. John Church

Absolutely.

Deputy John Lahart

I am just wondering how a child finds a safe space for that or who finds the safe space for the child to engage.

Mr. John Church

There is adult consent to that because it is through the HSE. However, over time, if we can get the funding to scale up on this, and that is what we plan to do, there might be some self-referrals or referrals within the Childline service. There could be a referral from the telephone into the e-therapy service. The Deputy asked how somebody can know that a therapist is not masquerading. Was that his question?

Deputy John Lahart

Yes.

Mr. John Church

It is based on trust. Organisations such as Barnardos and the ISPCC have to conform.

Deputy John Lahart

Mr. Church has answered the question anyway because of the route to it.

Mr. John Church

I see where the Deputy is coming from.

Deputy John Lahart

It is not like Childline. I thought this was a service a child can log onto anonymously, but Mr. Church is saying the child is channelled to it either via Tusla, CAMHS or the HSE.

Mr. John Church

Yes, that is the way we see it for the time being. We certainly see it as a credible intervention for the 2,700 children who are on the CAMHS waiting list at present.

Senator Martin Conway

I listened earlier in my office to the opening statements and the engagements. I thank the witnesses as they were quite informative. I am particularly interested in Deputy Lahart's engagement on Childline and the operational element of it. Are there many repeat calls? Does the ISPCC profile the callers to try to establish if there are repeat callers? What does the ISPCC do to support the repeat callers in terms of referral to other agencies? Is Childline just a specific listening service or does the ISPCC intervene through referrals if it believes that is necessary? I am trying to get a handle on that. Mr. Church said there were 240,000 calls in the first nine months of 2020. That is remarkable and I would like to know how much of that is repeat business, as such.

Mr. John Church

We get a lot of repeat callers. On the nature of the service, it is a listening service. It is not like a triage to refer somebody on, because it is confidential. It is one service in a list of services. The child could very well be seeing a psychotherapist and could be within the system already. It is another option for a child to ring and have a confidential chat because the child knows he or she will not be judged, will not be told what to do and will not be chastised. We get a number of children calling repeatedly. We are looking at this as well, with a view to seeing whether there is anything we can do for the child if he or she rings ten times in a short period.

Senator Martin Conway

That is my point. Does the ISPCC feel a certain responsibility if a particular child is ringing consistently with a particular issue whereby the child could be in imminent danger or there is a serious problem? When does the ISPCC decide to escalate it to a different level and bring in the services that would support that child? I realise it is a delicate matter, but I am interested to know.

Mr. John Church

The answer to that is that it is when the child decides, because it is confidential. The volunteers are trained to know what the child is saying. If the child is in imminent danger, the volunteer would tell the child what rights the child has and what services are available, but ultimately the child has to say, "Yes, I need help". Then, under the Children First legislation, if there is any identifying or identifiable information we are then obliged to act. We refer children to the Garda and to Tusla depending on the time of the day if there are issues with abuse in the home.

Senator Martin Conway

However, the ISPCC would not initiate the contact with the Garda on behalf of the child.

Mr. John Church

If we have identifying or identifiable information, we are obliged to do that. If somebody mentions a name or says he or she is being abused by a parent and says he or she is sitting in the Phoenix Park, that is identifiable information and we are obliged to pass it on to the Garda.

Senator Martin Conway

Mr. Church mentioned in his answers to Deputy Lahart that many of the volunteers are young. Could he tell us a little more about the profile of the volunteers?

Mr. John Church

They are volunteers. Most of them work during the day and commit to one four-hour shift a week. Many do other shifts. On the age ranges, if the Senator walked into our shift today on Baggot Street or in Limerick, he would see many students, so they are young adults. They are probably doing some form of psychology programme in college. We have a number in our Dublin unit up the road who are retired. They have time on their hands and they want to give back.

Senator Martin Conway

I thank Mr. Church. Turning to Barnardos, I thank the representative for the presentation. Is there any international best practice that Barnardos has seen that we could learn from or on which we could piggyback in terms of policymaking in the future? Is there any example that stands out and which the witness would like to share with the committee?

Ms Suzanne Connolly

Is that policymaking in respect of mental health in particular?

Senator Martin Conway

Yes.

Ms Suzanne Connolly

Some of the members who are particularly interested in mental health may be aware that there is a big movement now around what is called trauma-informed care and attention. That is recognising that children and young people, and indeed their parents, would often have had adverse childhood experiences that will stay with them throughout their lives unless they get the appropriate type of service. That service needs to recognise that it is necessary to have quite well-researched, informed, professional support for people who have been through the trauma that is adverse childhood experiences. As Barnardos goes forward we want to bring that understanding into all the services that we provide for children and families.

Sometimes people are not able to move on in their lives because they are still carrying the hurts of things that happened to them in the past. One needs to think of ways of working with them that enable them to express those hurts and then move on. The way that will work for people will depend on what they are like, but sometimes it is really about connecting into their bodies, what their body is telling them and then what that will mean about how they can manage their emotions and make different choices.

Something we must be aware of is that knowing what to do does not mean someone will actually do it, as the pain and hurt might be too much. I encourage the committee to examine the evidence on understanding the impact of trauma. Children can sometimes misbehave, particularly in schools, and adults can believe that is deliberate, but the children are just expressing the difficulties in their lives and emotions they do not know how to process. When encountering children who are challenging, adults must ask themselves what is happening to them that has led to them behaving in that way and how can the adults help them. To a certain extent, this is also true of adults. People often engage in addiction and behaviours that are damaging to themselves because they cannot deal with trauma in their lives and the pain of living.

Senator Martin Conway

I thank Ms Connolly.

Deputy Mark Ward

I am delighted I made it to the meeting. I did not believe I would. I had a dental appointment this morning, so I listened to the opening statements in the car on the way here.

I welcome the witnesses from the ISPCC and Barnardos. We have heard a great deal about how children's lives have been adversely affected through their schools being closed and their clubs and sports not being available to them. We all saw how young people were criticised for hanging out in groups during the lockdown when no one was meant to be in a group of more than two people. I have spoken to community gardaí in my area and others who are involved in meeting children. It is easy to tell children to disperse and go home, but that is not an easy thing for them to do when home is not a safe space. That is a major factor we saw.

I will touch on a matter that was not covered in the opening statements but about which I spoke in the Dáil last night, and I wonder whether the witnesses have had experience of it. We are seeing people as young as ten years of age being groomed by older criminals into criminality in terms of drug use, drug crime and transporting money. There has been a visible increase in the number of young people experimenting with drug use. For example, one can see discarded nitrous oxide or laughing gas canisters, which are known as silver bullets, when walking around my area. Their increase during the pandemic was noticeable to everyone. Have the two organisations experience of young people being groomed into criminality and experimenting with drug use and how do they deal with these issues when presented to them?

Mr. John Church

The only matter that I can speak to is drug use, and since it represents only a very small part of our referrals in the Wicklow area, I am not sure whether I can provide anything that would be of great help. Ms Connolly's organisation probably deals with it more than we do.

Ms Suzanne Connolly

Grooming is something we are aware of in some of the communities in which we work. I will not mention which communities due to confidentiality, but we are concerned about the issue. With the Garda and other partner agencies in those areas, we are considering what alternative choices can be made available to children. Keeping them in school is important, or if not school, then school-type alternatives that can track these vulnerable children. Being involved in activities, be they boxing, football or something else, can keep children off the streets. We also want to consider how to support parents in this regard, but as the Deputy mentioned, that is difficult if the home environment is such that the children do not want to be at home. They are vulnerable to what the positive attention they get might afford them. We know of young children who are being given pizza to do something for people. As they get older, that becomes runners and other things.

This is something that Barnardos cannot address on its own. There would have to be an interagency approach. We have to give children alternatives. We all have to work hard towards this. Ms Kellie Harrington is an amazing role model because she talks about some of the challenges she has had in her life and what boxing has done for her, but also about how important her current job is and how she wants to keep it. The more we can get role models out there, the more children, who are being exposed to adults who want to groom them, can listen to them. They do not necessarily want to listen to a Barnardos worker, but they might listen to a local football hero or the Kellie Harringtons of this world in their communities. That is what I hope we can achieve through working together. It is heartbreaking to see innocent children being brought in and groomed and, before they know it, being caught up in criminality, and then so are their families.

Deputy Mark Ward

It is difficult. I have been dealing with families who are doing their best to mind their children, but when their children are outside, it is difficult to mind them all the time. I agree with Ms Connolly. There is a cohort of good young people who are not sporty, in youth clubs or interested in school. When there are gaps in services, young people tend to fall through them, and that is when the dangers show themselves.

I agree that there needs to be alternatives. There needs to be a cross-departmental and multi-agency approach, not only to mental health, but also to the matters we are discussing. One hat does not fit everything. As legislators, we need to start cross-departmental approaches. The budget was just passed and each Department is mindful of using its own budget, but if there was a cross-departmental budget from which two Departments could pull funding, it could work. Getting one Department to fund something under another Department is difficult because people are mindful of their budgets. That is my tuppence worth.

I wish to pick up on a point, although I do not want to sound like I am lecturing because that is not my style, and if I did not say that now, I would be kicking myself later. I come from north Clondalkin in Dublin Mid-West. It had one of the highest rates of youth and adult suicide in the State at one stage. Many of them were people whom I went to school with and grew up with. It is no coincidence that the very first Jigsaw and Pieta House projects were in my area. The community demanded something because they - or, rather, we, as I am part of that community - were very worried. As I was entering the room, I heard the term "committed suicide", so I wish to raise the matter with the witnesses. That term adds to the stigma. I do not want to lecture people on this, but "committed" views something of a crime. What we have learned in our community down the years is that changing the language helps young people and others to speak about suicide. "Died by suicide" is the term we use.

According to Mr. Church, over the past year, the ISPCC has received 26 contacts per week from children who are suicidal or having suicidal thoughts and 923 young people who have spoken about self-harming. What is the ISPCC's referral pathway for children who are feeling suicidal or actively self-harming?

Mr. John Church

This relates to Senator Conway's point. Until such time as we can identify the child, we cannot refer him or her. We can only support the child and help him or her in building resilience. As soon as we get any sort of information, we can refer a child. This is sometimes a source of frustration within the service, and definitely a frustration for some of the volunteers. We are looking at whether we can do something more.

Deputy Mark Ward

I might cut across Mr. Church to ask a question. Without identifying the child, are there pathways of referral? Does the ISPCC ask the child to speak to the one good adult or a sports coach? That is what I was asking about. Is there that pathway?

Mr. John Church

Absolutely. I am glad the Deputy asked me to clarify. All of our volunteers know every single service available and we constantly encourage the child to seek those services' support. It is proof of how many contacts we get every day that children find the Childline service of use and importance to them. Children want to be listened to. Some children want it to be confidential. It is one part of a support mechanism for a child. If we can identify the individual at any stage or promote the services that are available, we do that.

Deputy Mark Ward

I have a final question. I always like finishing on a message of hope. Ms Connolly of Barnardos stated, "We believe that children and families can overcome the additional mental health issues".

I believe that as well. Ms Connolly mentioned the challenges from the pandemic but also that, in order to do this effectively, Barnardos will need the appropriate support, which will require adequate provision of universal services, as well as specific targeted supports. I agree with that wholeheartedly. Is Barnardos running into barriers to finding that specific support for young people who are adversely affected by mental health issues and their families, not just during Covid but at any time? How would Ms Connolly see us, as legislators, breaking down those barriers for Barnardos?

Ms Suzanne Connolly

What I would say to legislators is that it is very important they ensure the community and voluntary sector and the services they provide get the money they need to be run effectively. It is not just Barnardos. We work with children and families on the edge. On the Deputy’s point about children who die by suicide, we have situations where parents have died by suicide and children are left without their parents. Along with others, we provide crucial services yet we have not had any increase in the basic budget we get from Tusla for ten to 12 years. That is not right. It is not right for the children, young people and parents we work with in the heart of local communities.

We have waiting lists. When children, young people and their parents need a service, they should be able to get that service. They need it when they need it. It is tragic. I have heard over the past couple of months of at least three parents who have died by suicide, including one situation where a young boy found his dad. That dad was trying really hard to stay off drugs but he was at that crucial time where he was detoxing and he accidentally slipped up, or we think that is what happened. I do not want to be talking to the Deputy in a year’s time with those things happening again. We can do something with the right resourcing and, as we said, with really good interdepartmental ownership of the issues.

Deputy Mark Ward

I agree 100%. Sometimes we have only a very short window of opportunity to be able to assist people in whatever way they are trying to progress their lives and to make life better. It is incumbent on us to ensure that when they seek a service, there is a service there for them so they can get the care they need when they need it and where they need it. I thank both witnesses.

Chairman

Thank you. I have a couple of questions that follow on from Deputy Ward’s questions. The first is a question around what supports Barnardos and the ISPCC could use if they had a magic wand. Today, what would they say the ideal is? What would be their ask?

Mr. John Church

On the question of why we are here and what the committee can do, I mentioned earlier that we need to move towards parity with the budget that is there for the physical health side of things. It is easy to talk about a broken leg but, if anything comes out of Covid and this committee eventually, it is that mental health is a significant issue, particularly for children, which is our area. We need to move towards increasing the allocation for mental health.

We would absolutely support the recommendation by the Mental Health Commission to recruit 138 additional child psychologists. I mentioned earlier the pilot we are running with SilverCloud. For us, it is a no-brainer. The children are benefiting from it and we can see four times more children through this than face-to-face, although I am not saying we will stop face-to-face and we are looking at hybrid models. Some children need a bit of face-to-face and a bit of online, and some need full-time face-to-face. It is about increasing that budget and listening to those like ourselves and Barnardos with regard to the solutions. We are almost like a subcontracted service in that the Government is subcontracting to all of our agencies. We are highly trained and highly professional and we have the capacity and infrastructure to do it. We just need more funding and we can clear that waiting list. For me, personally, seeing 2,700 children on the CAMHS waiting list is totally unacceptable and it can be fixed.

Ms Suzanne Connolly

I would agree with Mr. Church about increasing the allocated budget. I would also say the services we provide should be about the needs of the child, the parents and the family, and that we have wraparound and that we are all accountable for working together in that context. For me, the magic wand would be that any child and any parent in need of a service receives warm, welcoming, responsive, evidence-based approaches that want to help them and want to make a difference. It is also very important that we are a society where we recognise that to seek help is a strength and to be able to receive help is a strength, and that we are all in this together. That is something I wanted to say, namely, we are all in life together. As a country, if we chose to use our resources effectively, we could do fabulous things in terms of meeting the needs of children and their parents across a range of issues, but in particular in the context of their mental health and well-being.

Chairman

Thank you. I have one final question and I will let the witnesses go because I know they have had a long day. Both organisations work with crisis and it is a kind of crisis management to deal with trauma, and people are in a bad way when they contact their services. What recommendations would they have in this regard? Is it within their capacity to run a service that could provide intervention and prevention skills before it gets to that point where children and young people are suicidal? I hope I am making myself clear. Is there some organisation that does that already or would Barnardos and the ISPCC have the capacity to do that? If so, how would they go about it?

Ms Suzanne Connolly

The best example of that is two things Barnardos provides, one of which is support for young mums and young dads, as soon as the mum is pregnant, to ensure they can be the best parents they can be. A particular point is to ensure the mother stays in school or stays in education and continues to do well because we know that makes a big difference to outcomes for children, and that is research-based and evidence-based. The other thing we have in Barnardos is our early years family support service, which is providing that holistic approach to young children who really need it, and then we support their parents as well. We need to intervene early and we then need to ensure that children transition well to school and stay in school, or that they have alternative choices. They are the sort of things that are really important.

School is a very important context, or like-minded education supports for children who are not “good” academically but who might have a trade. It is that children are supported to have their needs met and have their developmental potential achieved. That is what I would like to see. Barnardos, alongside other organisations, is part of that trajectory for children. It comes back to the point I made that we need a mixture of the universal and the targeted, and that there is a range of professionals and volunteers who can meet that need.

Mr. John Church

What we are trying to do is to get into schools and clubs earlier. If we look at mini-rugby or mini-GAA, it is about having a presence there. We use some of the ambassadors and we will be using them a lot more, so there would be those like Kellie Harrington, if we can get our hands on her, and we would have them on social media, giving messages to children that it is okay to talk. One of the programmes we introduced during Covid, thankfully, is one that addresses the transition from primary school to secondary school, which we know, from talking to children and from Childline data, is a particularly traumatic time. It runs from ages 11 to 12, 12 or 13 and 13 to 14. We have introduced a programme called Smart Moves and 50 schools have taken us up on that. The Minister for Education is very keen on that so once we have done an academic term on that, we would be hopeful of engaging with all schools at that level. We have identified in our strategic review that the 11 to 13 age range is a key intervention time to build resilience for children.

Chairman

I have one further question. In my role as Chair of the Joint Sub-Committee on Mental Health, I am getting a lot of inquiries from family members of young girls in particular, for some reason, aged maybe 13, 14 or 15, who are self-harming and have suicidal ideation. We can recommend therapists or CAMHS but the waiting lists are off the Richter scale, even for private therapists.

Will the witnesses advise whether I should refer any of those young girls to either of their organisations? To give an example, one of them is only 14 years of age, has suicidal ideation and is self-harming. Her family members are out of their minds with worry and do not know what is to be done. Where should I go to seek help with her case?

Mr. John Church

Ms Connolly might like to respond to that question.

Ms Suzanne Connolly

Mr. Church spoke earlier about the role of child psychologists. I would say that, rather than focusing on a particular profession, we need CAMHS to address the situation of children who are at serious risk to themselves because they are engaging in self-harming behaviours. If there is a Barnardos centre close to the family's location, I certainly would advise the Chairman to refer them to that centre to see whether we can offer a response. Whether we can do so depends on the degree of self-harming. We certainly can support the parents and talk to the young person. However, if there is a serious level of self-harming, what is needed is the help of a psychiatrist. The danger, ultimately, is that the young person may seriously harm herself. We can offer certain things but not to the degree to which specialist psychiatric intervention may be needed. Having said that, I am aware anecdotally from my own work that it is not unusual, as Mr. Church mentioned, for self-harming sometimes to be happening to a smaller degree. It all depends on the intensity of it.

Chairman

I thank Ms Connolly for her answer. The sub-committee really appreciates the witnesses coming in at such short notice. My personal view is that we are facing into a tsunami of mental health issues for every age group at this time. I thank the witnesses for the phenomenal work they do and their helpful contributions today.

The joint sub-committee adjourned at 11.22 a.m. sine die.