I welcome the Minister of State, Deputy Jim Daly, back to the House. He is making a habit of it. The Minister of State is entitled to come in when he wishes. We usually have a few speakers and he can indicate to the Chair when he wishes to make his contribution. Some people wait for everyone to speak and others come in at the start but Senator Freeman and her seconder will be the first to bat off.
Mental Health (Amendment) Bill 2016: Second Stage
I move: "That the Bill be now read a Second Time."
I send my warmest congratulations to the Minister of State, Deputy Daly, on his promotion. I am absolutely delighted and I look forward to working with him in the future, as I have done in the past.
I am grateful for the opportunity to debate the Bill, which has been co-sponsored by Senators Craughwell and Marie-Louise O'Donnell. I propose to speak about the effect of the Bill, historical attempts to end the practice of admitting children to adult units, the United Nations Convention on the Rights of the Child and the potential implications of my amendment.
The Bill has a very straightforward purpose, namely, to prohibit the admission of children to adult psychiatric units save in exceptional circumstances and to encourage a policy whereby children are admitted to child-appropriate units. I propose to do this by amending section 14 of the principal Act, which deals with admissions, by inserting a new section into that Act, section 14A, which shall provide that “No admission order shall be made in respect of a child under the age of eighteen to an adult inpatient unit save in exceptional circumstances where it is in his or her best interests to do so". I also propose to insert a further subsection under section 14A, stating: "Where a child is admitted to an adult inpatient unit he or she shall be accommodated in an area separate from adults in an age-appropriate environment with age-appropriate facilities."
I acknowledge that this is not the first time this proposal has been made and I am indebted to the findings of numerous Government reports and recommendations to which I will refer during the debate. Despite the recommendations of these reports seeking to end the practice of admitting children to adult units, the reality is that legislation is needed to implement this policy when HSE commitments to end the practice of admitting children to adult units and seeking to phase out the practice have simply not succeeded.
It is very important not to underestimate the effect of these admissions on the recovery process for children with mental health issues. The practice of admitting children to adult units has long been condemned by the State.
The Inspector of Mental Health Services has aptly described the practice as "inexcusable, counter-therapeutic and almost purely custodial in that clinical supervision is provided by teams unqualified in child and adolescent psychiatry." The thing is, children sometimes suffer irreversible consequences by being exposed to adults who may suffer from enduring illnesses where at times it could occur that an adult may have to be restrained because of his or her potentially aggressive and violent behaviour.
A further impact on children is that these adult wards are often staffed by adult psychiatric teams whose members have not received child-specific training. The subconscious effect of children witnessing adults with enduring illnesses is that this can have a devastating impact on their future because they are likely to imagine a similar fate for themselves. I have sought to introduce legislation to end the practice of admitting children to adult units because of a consistent failure on the part of the HSE - despite its previous commitment, by way of protocol, to phase out the practice - to simply end these admissions. The HSE's historical attempts to end this practice illustrate that its laissez-faire approach is anti-therapeutic and abusive of our vulnerable and voiceless children.
The guiding policy document for mental health services in Ireland, A Vision for Change, was published in 2006. It sets out the direction for mental health services. It is an excellent document. It purports to describe a framework for building mental health services across the entire community and providing accessible, community-based, specialist services for people with mental illnesses. Eleven years have passed since the report recommended that the admission of children to adult units be scrapped in favour of admissions to child and adolescent appropriate units. A similar conclusion was drawn in a number of expert reports that reviewed the operation of the Mental Health Act 2001. Similarly, they recommended that the practice should cease. The 2001 Act was first reviewed by an expert reporting group in 2012 and, again, in 2014. Both reports recommended the use of legislation to implement the practices. The reports also questioned whether the Mental Health Act 2001 includes and complies with international human rights protections afforded to children under the UN Convention on the Rights of the Child. In 2014, the expert group's report was published by the then Minister of State at the Department of Health, Kathleen Lynch, as mental health services were part of her brief. It recommended the insertion into the 2001 Act of a stand-alone section dedicated to children and including a number of provisions, one of which would state, "Services should be provided in an age-appropriate environment wherever possible" for children.
Both reports found that while the admission of children to adult units has declined in recent years, the continued practice was still unacceptable. The 2014 report reads, "Progress needs to continue to drive down admissions of children to adult units and to drive down waiting lists and waiting times for certain child and adolescent mental health services." As Senators probably know, there has been a slew of reports published which recommended that the practice of admitting children to adult units should end. Those reports were followed by a number of failed attempts to implement their recommendations. In 2007, a year after the implementation of A Vision for Change, the then Ombudsman for Children, Emily Logan, criticised the practice. She called for the implementation of the recommendations contained in A Vision for Change to proceed without further delay. She explained, in her capacity as Ombudsman for Children, that these and other issues had been raised with her office by children across the country. Now, almost 12 years later, the current Ombudsman for Children has made the same complaint.
The proposal to phase out the practice has also been unsuccessful. In 2009, the Mental Health Commission introduced an addendum to its code of practice in respect of the admission of children under the Mental Health Act 2001. The code of practice directed that no child under the age of 16 should be admitted to an adult unit after 1 July 2009. Not only was that not complied with but 12 months later, as many as 12 children under the age of 16 had been admitted to adult units.
Can Senator Freeman move to her right as her microphone appears to have a fault?
I thank the Senator.
The Children's Mental Health Coalition comprises 50 member organisations from a range of backgrounds and sectors. The coalition has previously submitted to the Department of Health - in its review of the Mental Health Act 2001 - that legislation should be enacted to end the practice and that children should only be admitted to such units in exceptional circumstances. Even then, such units must have child appropriate facilities. That is not happening in Ireland as we speak.
The programme for Government introduced in 2011 - some six years ago - contained a commitment to end the practice. In December 2011, the official code of practice relating to admission of children came into effect. The Government has stated that, apart from in exceptional circumstances "no child is to be admitted to the adult unit of a psychiatric hospital". Once again, we have failed our children.
I hope I have clearly highlighted that the intention to end this practice is not recent. However, ending the practice is something we have not succeeded in doing. We have not merely failed to follow through on these promises domestically but we have also failed to fulfil our international obligations. Ireland ratified the United Nations Convention on the Rights of the Child without reservation on 21 September 1992. The convention aims to improve the lives of all children under the age of 18 through securing necessary changes in Ireland's laws to protect those rights. Article 37(c) of the convention provides that "every child deprived of liberty shall be separated from adults unless it is considered in the child's best interests not to do so". Ireland has repeatedly failed in its obligation to comply with these very basic and fundamental human rights by confining children to adult units. We have seen a fluctuating trend of admissions to adult units in the past ten years. In 2013, there were 91 admissions of children under 18 years of age to adult psychiatry units, comprising 22% of all child admissions. While this number fell marginally to 89 in 2014, it increased once again to 95 in 2015. Despite having ratified the convention, we are not complying with our obligations.
The Senator has one minute remaining.
If we take a closer look at the reasons for these admissions, we can see that it is closely linked to two shortcomings relating to child and adolescent mental health services. First, there is a critical lack of inpatient beds in Ireland. Even more worrying is the chronic shortage of consultant child psychiatrists. Such psychiatrists are responsible for authorising these admissions. Theoretically, the number of inpatient beds in Ireland is 74. Two weeks ago, however, ten more beds in Dublin were closed and there cannot be an further admissions in respect of the 20 beds in Cork.
I shall speak briefly about the HSE, particularly as I have only one minute left.
The HSE has communicated a hesitancy with introducing legislation because it has suggested that, rather than addressing the problem, it may result in a situation where children have no inpatient service at all in circumstances where there are no available child inpatient beds. I make two responses to that argument. First, the purpose of any legislation is to introduce policy that changes an unacceptable practice to achieve a higher standard of care and improve an existing practice that has been deemed inappropriate. The HSE stance shows a reluctance to increase bed capacity or to drive forward the much-needed intensive recruitment of child psychologists in Ireland. I emphasise that the rights and welfare of the child are central to this Bill and that I will ensure the implementation of the Act is rolled out compassionately and that the appropriate safeguards are in place to ensure a seamless transition.
I call on the Members of the House present to support the amendment in its present form. I thank the Cathaoirleach and fellow Senators for granting me the opportunity to speak about this important issue.
I thank the Senator. I allowed her an extra minute because I interrupted her twice. Senator Boyhan is next to speak, followed by Senators Feighan, Swanick, Devine and Kelleher.
I formally second the Bill. I thank Senator Freeman and acknowledge input of the co-sponsors of the Bill, Senators Craughwell and Marie-Louise O'Donnell. I warmly welcome the new Minister of State, Deputy Jim Daly, and wish him well in his challenging post.
This issue has to be about the rights of children and putting children at the centre in terms of care. Ideally, no child should be in any form of residential psychiatric care. There is no question of children having to be in adult psychiatric services. Senator Freeman referred to the 2006 A Vision for Change document. That is now 11 years old and its executive summary set out that the Government would cease the practice of having children in adult psychiatric services. That was the policy back then. There is no doubt that current Ministers have consulted that document. Will the Minister of State say how many designated children's beds there are for psychiatric services? Will he explain why many of these beds are shut down during the summer months? Beds that had been up and running in approved centres for children with expert, specialist child care psychiatric services are going to be closed this summer on the Minister of State's watch unless he can do something tomorrow or the day after to stop them being decommissioned. Against what is meant to be Government policy or its objective is to keep children out of adult psychiatric services, but children will be forced into them unless something is done. We cannot have a situation where there are empty specialist beds for children in child psychiatric services but the excuse is that they are not available. They are available and must be funded and resourced. That is the job of the Minister of State or the Government and it is very important. Exceptional circumstances have been referenced. That can have many meanings. We cannot have a situation where there is bed capacity in the service but the Department of Health is going to close some of those beds for the summer. Is the Minister of State aware of that? He is new to his post but it is a very important issue. It is about prioritising things, allocating resources and putting facilities in place.
Senator Freeman has clearly set out the Bill. It is important. There may be other Stages on it. It might be helpful if the Minister of State could indicate if the Government will support this Bill. Clearly, it has made a decision. The Minister of State might be kind enough to share that decision with the House. Will the Government support this Bill or does it intend to oppose elements of it? It is an important Bill and we must always remember that it is about children and their safe and appropriate care leading to rehabilitation and ideally getting back to live with their families.
As Seanad spokesperson on mental health, I sincerely thank Senators Freeman, Craughwell and Marie-Louise O’Donnell for their work on this very important issue. I welcome the Minister of State and offer him congratulations on his appointment. I wish him well in his brief, which is very difficult but one which he is well capable of handling. I wish him every success.
No Member of this House would disagree with the broad thrust of this Bill which is aimed at protecting very vulnerable children and young people. An amendment is proposed to the Mental Health Act of 2001, which has been the subject of many comprehensive reviews by an expert group established by the previous Government. I was a Member of this House in 2002 and this issue was part of my brief from 2002 to 2007. Sometimes we find ourselves in situations and experience a sense of déjà vu. It is incredible that we are still discussing this very difficult, complex, delicate and emotive subject. The expert group was made up of a cross-section of mental health professionals and stakeholders, including the Mental Health Commission, the Irish Human Rights and Equality Commission, the Irish Mental Health Lawyers Association and a service user representative. The group's final report contained 165 recommendations. It made 13 recommendations as to how our mental health legislation could be improved in relation to children. It included a recommendation that every child should have access to health services with the aim of delivering the highest attainable standard of child mental health and that services should be provided in an age-appropriate environment wherever possible. That is a recommendation that all Members strongly endorse. I have been to various facilities in Roscommon and have seen that sometimes people should not be there and young people should not be there. We were quite slow, as were the services and the service providers. Sometimes Members, as politicians, do not have all the solutions, but we are not equipped to deal with these very difficult situations. People within the services sometimes do not go beyond what they should do in providing these services. I thank the Senators behind this Bill for bringing it to the House. Sometimes we rely on service providers or people in Departments to lead by example, and sometimes that has not happened. Perhaps legislators have not led by example either.
The Government has said a number of issues in this Bill need to be examined further. The Government is certainly not opposing the Bill and I believe this debate yet again raises the need for appropriate inpatient psychiatric units for children and adolescents. As Senator Freeman has pointed out before, there is protective legislation in England and Wales which provides that where a child is admitted or detained in hospital for treatment, the environment in the hospital must be suitable having regard to the child's age. This is very important. The Bill aims to address this situation in Ireland. Senator Freeman and her colleagues have rightly highlighted an issue which is repugnant to us all. The trauma to a child placed in an adult psychiatric ward must be truly horrific for both the child and his or her family.
While there are still challenges, it is good to see progress has been made. In 2008, there were 247 such child admissions to adult units but this decreased to 68 in 2016. However, all Members agree that one child admission to an adult unit is one too many. As I said, the Government has raised a number of issues with the Bill. Among them is the concern that the option to admit a child to an adult unit in exceptional circumstances should not be restricted by law. While best practice will always be to admit children to age-appropriate units, the Government's view is that the other option should not be restricted by legislation.
It must also be remembered that the Mental Health Commission has a code of practice that specifically covers the involuntary admission of children to adult units. All such admissions must be fully explained to the independent regulator.
I would like to speak about adult admissions. In 2011, we had a very difficult situation in Roscommon. We had a €20 million development. We wanted to build an endoscopy unit at a cost of €8 million. A rehabilitation unit from Dún Laoghaire was going to be built as well. We were working in conjunction with the Mayo-Roscommon hospice to build a stand-alone hospice on the grounds of Roscommon hospital. As those who are familiar with the hospital will appreciate, we wanted to build all of these facilities together so that they could be accessed through the front door. The psychiatric services at the back operated virtually independently of the hospital. We said we wanted to build a brand-new facility out the back, where eight or nine acres were available. We understood that this would involve some inconvenience for a while. After six months, we could not get any agreement. There was no agreement. A brand-new facility would have been built on the right, but there was no agreement. We ended up having to build the endoscopy unit over the urgent care centre. We are now in planning to build the rehabilitation unit around the left side of the psychiatric services. We are building the palliative care unit around the other side. Five years later, people are now telling me that the psychiatric services are not fit for purpose. There is something fundamentally wrong. Nobody wanted to make a decision. We had to go ahead. This was a lost opportunity. Opportunities are being lost around the country. At the time, we could have gone straight out the back to build all the services. It would have cost much less and there would have been less hassle. That is the problem.
It is clear that there are many challenges. I would like to think that this Government will focus its efforts on ensuring enough mental health beds for children are available to meet the level of demand that exists. All of us have a duty and responsibility to safeguard our children and young people, especially our most vulnerable. As a public representative, I would like to send that message out again today. I would like us to do everything we can to ensure this happens. I thank Senators Freeman, Craughwell and Marie-Louise O'Donnell for their duty and vocation in bringing this Bill before the House.
I congratulate the Minister of State, Deputy Jim Daly, on his appointment and welcome him to the House. I thank Senator Freeman for introducing this important legislation, which Fianna Fáil is happy to support. This Bill, which proposes to end the practice of admitting children to adult psychiatric units, legislates for what is already the stated policy of the HSE and the Department of Health.
The admission of a child to an adult ward can make the inpatient experience far more distressing for the child. It does not place the child in an environment that supports his or her recovery. The inappropriate admission of children and adolescents to adult inpatient units is undoubtedly a matter of significant concern. Resources must be brought to bear as a matter of urgency to provide for the community-based service and the age-appropriate acute care that would reduce such admissions.
My party colleague, Deputy Browne, also has a mental health (amendment) Bill in process. Thankfully, it has been allowed to skip pre-legislative scrutiny and go to Committee Stage straightaway. This is in part as a result of a commitment to give mental health a level of priority which has usually been reserved for physical health. That mental health issues are featuring on the legislative agenda of both Houses with such support is a demonstration of increased awareness of mental health issues on all sides of the House.
Senator Freeman's Bill is to be highly commended. I say that as a doctor who has worked in the mental health service in Dublin, St. Ita's Hospital and the NHS system in Wales. If this Bill is passed, it will create a statutory basis for ensuring the practice of admitting children to adult psychiatric units can no longer occur. Generally speaking, admissions are covered by section 14 of the Mental Health Act 2001. The Bill before the House intends to amend the 2001 Act by inserting new provisions to the effect that, "No admission order shall be made in respect of a child under the age of eighteen to an adult inpatient unit save in exceptional circumstances where it is in his or her best interests to do so", and that, "Where a child is admitted to an adult inpatient unit he or she shall be accommodated in an area separate from adults in an age-appropriate environment with age-appropriate facilities." That is very important.
Mental health advocacy groups have expressed concern that this Bill, as drafted, could have unintended consequences. We would like these matters to be addressed as the legislation proceeds. There is a risk that the simple provision of a legislative lever that prohibits child admissions could have the effect of overbalancing resources towards the provision of more inpatient beds in a reactive manner. The provision of a better-resourced, community-based mental health service, in conjunction with some preventive measures, could be expected to have the effect of reducing the need for inpatient beds overall. It is expected that improvements in community-based services, including a seven-day service and a 24-7 community-based crisis intervention service, would lead to a significant reduction in the number of inappropriate child admissions to adult units.
It is critical to build the capacity of the primary care sector to provide comprehensive mental health services, with a particular emphasis on providing crisis out-of-hours mental health supports in every community. Similarly, we must develop local alternatives to inpatient services, such as assertive outreach, early intervention in psychosis and other community-based incentive supports, in addition to family-centred supports. It is vital that we increase accessibility to specialist child and adolescent mental health services, including both inpatient and outpatient services where necessary, to avoid inappropriate child admissions to adult units. There is also a concern that the effect of the establishment of a law that allows child admissions to adult units in exceptional circumstances, as set out in the Bill, could be the opposite of the intended aim. This could happen if a legal basis for inappropriate admissions that does not exist currently is created. We will tease this out at later Stages.
I am aware that many Members of this House want their local child and adolescent mental health services to receive better funding and resources. There is a need for a considerable increase in recruitment to community mental health teams. The HSE has admitted that it has just over half the staff it needs to operate such teams if it is to comply with A Vision for Change. One in four of the population of Ireland is under the age of 18. According to the HSE, there were 648 staff in the child and adolescent community teams at the end of 2016. This represents just over 54% of the staffing level of 1,195 that was recommended in the A Vision for Change policy document on the basis of 2016 population levels. Such insufficient staffing levels in our mental health services must be addressed with urgency. The inadequacy of current provision has the potential to pose serious knock-on effects.
While I understand that there are some problems with recruitment, I am sick and tired of hearing that the Government is doing everything possible in this respect, as I believe this is simply not true. According to the 2015 annual report of the Mental Health Commission, "there is still a most unsatisfactory situation whereby children are being admitted to adult units, there were 95 such admissions in 2015." It should be noted that the Mental Health Commission's code of practice, which has been accepted by the HSE, states that inappropriate admissions of children to adult units should not take place. Obviously, this has not translated into practice. There is a clear need for legislation to prevent such admissions. That is why I am supporting the Bill before the House.
I welcome the Minister of State, Deputy Jim Daly, to the House. I hope we can work collaboratively as we have done on the Joint Committee on Children and Youth Affairs. I congratulate Senator Freeman, who has vast experience and deep knowledge of the mental health landscape, and the two other Senators who are sponsoring this Bill. Pieta House's community hub approach is in line with what my Sinn Féin colleagues and I have been advocating for. Local communities need to own the topic of mental health so that local people can be served. Mental health services need to be run by, on behalf of and for local communities. In this House, we should work as a team in supporting the lead Senator who has proposed a Bill as an idea or a first draft in amending or refining that legislation so that the best Bill possible can be produced for the good of the people of this island and, in this case, for the good of our children.
This Bill is very well intentioned and highlights a serious problem which must be dealt with by the Government. No child should be placed inappropriately in an adult ward without additional supports.
It is important to note recent trends in the admission of children to adult units because we all know it is a real issue. Between 2015 and 2016, the number of children placed in adult units decreased and this is to be welcomed. However, I believe this improvement will be short-lived and we cannot be fooled into thinking that the problem is beginning to go away. I fear we are actually beginning to see a rise in the figures again this year. In the first four months of this year alone, 38 children were admitted to adult units. If that trend continues it will mean that more than 100 children will be admitted to adult units in 2017, which is a big increase on the 2016 figure of 68. In light of this, the legislation before us is more timely than ever.
I refer to a response to a parliamentary question tabled by Deputy Buckley on the availability of child and adolescent inpatient beds in 2017. The HSE stated there has been a 50% reduction in the availability of such beds in the Dublin region due to staff difficulties. This obviously is the capacity issue. UNICEF published a report on Monday which showed that Ireland's 11 to 15 year olds are the second or third most likely out of the 37 countries surveyed to experience at least two traumatic mental health stresses every week. That is significant. What are we doing to our children? What are we doing to our society? Referrals to CAMHS have increased by 60% over the past six years. This is really heartbreaking stuff and we are cutting every service to the bone. It cannot go on.
It is unacceptable to put a child in a psychiatric unit with adults. I say this on the back of 30 years' experience as a psychiatric nurse. In those 30 years, I have seen children being what is called specialed, which means that a staff member is with them at all times and is never more than an arm's length away in order to protect them in an adult psychiatric hospital. It is frightening for children and is a dangerous environment. They witness horrific situations that children should never witness. Indeed, it is hard enough for adults to witness them. They are isolated and traumatised before they even begin to try to address the reasons for their admission in the first place.
I am extremely concerned and have been vocal about the closure of the youth mental health beds in Linn Dara in my home constituency of Dublin South-Central. I challenged the Minister about it in this House a few weeks ago. It cannot be all about beds and I understand that. We need a community-based approach and I am a long-term advocate of the community well-being approach and of community hubs. That said, beds are also important and I am devastated that the reality on the ground means that Senator Freeman's Bill, if and when it is passed, will not be able to function.
Deputy O'Reilly tabled a parliamentary question on my behalf on 19 June. The reply she received says that the recommendations of A Vision for Change were based on population figures from the 2002 census, which was 3.9 million. The total recommended number of staff then was 10,650. The 2016 population is at 4.7 million and the adjusted staffing requirement is almost 13,000. We have seen a significant increase in our population in the last decade and a significant increase in our birth rate. I believe we are considered to be the youngest country in Europe. Overall though, when one looks at the statistics for the entire country, only 52% of whole-time equivalent posts in CAMHS are filled. That leaves unfilled 48% of posts. Where are we going and what are we doing? There is a 48% deficit in caring for our children, which is gobsmacking.
Sinn Féin supports this Bill but may seek to work with Senator Freeman to amend it slightly to offer more detail in order that the core premise of the Bill can be realised. I would like to flag the fact that we will offer more detailed criteria and definitions under which it may be acceptable for someone under 18 to be placed in an adult unit. We may seek to do this as the Bill progresses. We would also like to set time limits for finding a place for a child in a more appropriate setting. These contributions are intended to strengthen the Bill.
We will also call for a more cohesive and strategic approach from the Government to child and youth mental health overall. We need investment in the community, community ownership in community hubs and 24-7 access to care for our children. We also need to ensure that no child is treated in an adult centre and we are very happy to support Senator Freeman to progress this aim.
I ask the Minister of State to be both passionate and compassionate in his new role and to re-open the beds in Linn Dara, regardless of the cost. We can work with the Minister of State on this and the unions will work with him too. They have solutions. That would be a great statement of the Minister of State's intent. I ask him to be proactive and to reopen the 11 beds and not to fall back on the old reliable response about conducting a review. We are sick of reviews. We have reviews coming out of our ears. They do nothing but kick everything to touch.
I would like to acknowledge the presence in the Chamber of Deputy Pat Buckley, who has some expertise in this area. He is most welcome. I always acknowledge Members from the Lower House who come in to listen to our debates and show respect for our Chamber.
I would like to congratulate Deputy Jim Daly on being made a Minister of State. Cork has had a good week. I wish him well and advise him that we will be critical friends to him in his role as Minister of State.
I support the Mental Health (Amendment) Bill and congratulate Senator Freeman on it. She is a woman who really knows what she is talking about in this area. In that regard, we would do well to listen to her and to take note of what she is proposing and advising. The co-signatories to this Bill, Senators Marie-Louise O'Donnell and Craughwell, also bring experience and knowledge to this area.
Children and young people being incarcerated in adult mental health settings is simply not acceptable. A change to this situation is urgent and overdue. Reputable bodies like the Mental Health Commission, the Children's Rights Alliance and the Ombudsman for Children support the call for the ending of the current unacceptable situation in which significant numbers of children and young people - a total of 95 in 2015 - with serious mental health issues are admitted to adult psychiatric inpatient units. These children and young people are being detained, sometimes voluntarily, with adults who also have significant mental health issues. One does not need to be a psychiatrist, psychologist or social worker to know this is not good enough for some of our most fragile, troubled and sensitive children. That is why I am supporting this Bill. While I am clear and unequivocal in my support for this Bill, I believe that Senator Freeman and others should, as the Bill progresses, look at some of the practical implementation issues raised by the Department of Health and by Lucena's CAMHS consultants in their submission to the Seanad's public consultation which is currently under way.
This evening I would like to briefly put this Bill, focusing on the mental health and support of our children, in context. Children in Ireland today face many challenges as they grow and develop. Approximately 130,000 children live in consistent poverty; 1,200 children live in direct provision; Traveller infant mortality is 3.6 times higher than for the rest of the population; 170 children have been waiting more than a year for mental health services; 56% of LGBTI children have self-harmed; and 2,500 children live in emergency accommodation. This Bill rightly focuses on the unacceptable practice, which is part of the current hugely inadequate mental health system for children and adults, of detaining and incarcerating children and young people in adult mental health units due to a lack of alternatives.
On 29 June next, the Seanad Public Consultation Committee, of which Senators Freeman and Devine and I are members, will begin to examine the Irish mental health service for children and young people in depth. The committee received a record number of submissions, including from children who were directly affected, their often distraught parents, as well as from key organisations and academics.
We look forward to hearing directly from people, especially those directly affected, namely, the children, the young people and their families. Tonight, however, Members should also consider the effects of wider public policy failures on children's lives and on their mental health, well-being and ability to flourish. There are many policy interdependencies that affect children adversely and I will focus on a few of them tonight.
On the issue of housing and its failures, 2,500 children are living in emergency accommodation at present. The former Minister for Housing, Planning, Community and Local Government, Deputy Coveney, set the target of 1 July as an end-date for children living in emergency accommodation. On listening to the new Minister, Deputy Eoghan Murphy, talking this week about managing expectations in reaching the Government's targets, it seems likely that this deadline will be missed. Let us just think about the anxiety levels among those children living in such conditions. They have nowhere to play, to do homework or to cook a family meal, as well as no permanence or certainty, no long-term school place or community and no chance to make the friends who support one for life, as we all did. These friendships, family and community are critical for positive child development. As part of the framework for mental health and children's well-being, we must address housing as a matter of urgency.
We are also aware of the sky-high rates of mental ill-health among Traveller children and young people. The Traveller suicide rate is six times higher than that of the general population and according to Pavee Point, it accounts for 11% of all Traveller deaths. Suicide for Traveller men is seven times higher and most common in Traveller boys and men aged 15 to 25. We need to know when their housing crisis, which predates the one engulfing us all, will be addressed and their housing needs met to address the off-the-scale mental ill-health in that community.
We need to address the needs of the 1,200 children living in direct provision and the impact of such a life on their mental health. We need to consider the policy failure in this regard and the impact on children. We also need to consider policy failures for children and young people with disabilities, who experience very high rates of mental ill-health. The fact is that such children often fall between the silos of disability on the one hand and mental ill-health on the other, often getting support from neither system.
We need to consider the policy failures of our children leaving care and the impact that has on their mental ill-health. While some positive announcements have been made on after-care, which I hope are realised, too many children at risk await the allocation of a social worker and there is still no 24 hour, seven days a week cover.
Let us consider our failure to progress the public alcohol Bill strongly advocated by my Civil Engagement colleague, Senator Black. This was shamefully held up in this House, despite knowing as Members do how alcohol abuse by parents and carers causes such harm to children and to their mental health and well-being. The Government failed to act on the evidence put forward by its own Department of Health and lacked the courage to stand up to the powerful alcohol industry, again to the detriment of our children's safety and mental health.
Our levels of child poverty and our failure to act are shameful. I hope that the new Minister with responsibility for employment and social protection will act on the report that was published last week on helping lone parents return to work in order that they can support their children. Members should consider how educational policy failures have an impact on children in general, and on LGBTI children in particular. According to the former Minister's report last year, twice as many children in this population self-harmed, three times as many attempted suicide and four times as many experienced extremely severe stress, anxiety or depression.
I have a clear vision of what an Ireland that cherishes her children would look like. Each child would be a wanted child, with those of childbearing age having access to timely sex education and accessible and free contraception. We would have a family support programme like the Sure Start programme in the UK, with universal supports and early intervention easily available on each child and parent's doorstep, especially supports that focus on children's early days, weeks and years, when so much happens developmentally. We would have a network of publicly-funded early education and child care and flexible working as a right for the parents of young children. We would have playgrounds and child-friendly places in every community, safe roads in the community in order that children can play outside and walk to school, schools open all year around with breakfast clubs so that no child need face the school day on an empty stomach, free school meals, after-school clubs, holiday play schemes and a welfare programme in every school, primary and secondary. There also would be accessible and free counselling, not just career guidance, as part of every secondary school, as well as counselling and welfare supports as part of every third level institution, particularly targeting young people in transition as they enter and leave. These are not pipe dreams. Such supports are commonplace in other countries across Europe and in places poorer than Ireland. I fought for this in the UK. My family had these supports available to us when I raised my children in a poor north London borough. I imagine that they have now, sadly, been dismantled by Tory cuts.
I too fully support the proposal in Sláintecare to ensure that mental health services in general and for children and young people in particular need to be adequate to the task and that the Children and Adolescent Mental Health Services, CAMHS, and others have the resources and the means to support children's mental health and well-being. Moreover, by also considering wider public policy on housing, Traveller accommodation, direct provision, disability, social welfare and other issues, we can prevent children getting ill in the first place. Our CAMH service should be a preventative and generalist one with greater focus on talking therapies including free and accredited psychotherapy, cognitive behavioural therapy, family therapy and art therapy, as well as community supports. I question whether it is necessary for it to be psychiatry-led. Medication and incarceration should be the very last resort and we should instead be understanding, cherishing, supporting and loving these, our most troubled and fragile children. The last place they should be is in an adult unit. We should do much more to make sure that they never get there in the first place, by doing all of the things specific to mental health but also generally in the community.
I thank Senator Freeman for bringing forward this measure and I heartily support it.
I join in the general congratulations of Deputy Jim Daly on his appointment as Minister of State. I suggest that it is a description he will never tire of hearing. It is well deserved and I wish him every success. I know he will deliver in this role and if I have any word of advice for him it is that he not lose his humanity, his compassion and his hunger to deliver and that he not be afraid to make decisions, decisions I know he will stand over-----
And, most importantly, not to lose his seat.
Absolutely. Do not remind me, a Chathaoirligh. I do not need to be reminded of that.
It happened to myself so I know what it is like.
This is very progressive legislation and I hope it passes through all Stages in these Houses very quickly. It is the type of legislation behind which this House can unite and I hope that all shades of political opinion can assemble behind it. It really is critical. Senator Freeman herself deserves great credit for advancing this legislation. It is essentially about human rights. The Senator of course brings a huge amount of professional experience to this debate and to forming this important legislation, as do many Members of this House. I often do not feel qualified to discuss issues like this, on a professional level at least. All of us who are public representatives, however - I have been a public representative of one description or another for 18 years now - have experienced where the gaps in services are in constituencies nationwide. Valiant efforts have been made, often in very difficult funding circumstances, to try to build up the architecture of services in recent years. The voluntary sector deserves great credit for spearheading some of the campaigns and some of the advances we have had in the provision of services to people with mental health conditions.
I also congratulate Senators Marie-Louise O'Donnell and Craughwell for co-sponsoring the Bill. It is really important that this House is spearheading an initiative to explore and examine CAMH services across the country and I know that this has been led by Senator Freeman with the support of everybody in this House. I cannot think of a better and more appropriate use of the time and energy of this House and its Members than doing a comprehensive analysis and talking to people affected by mental health conditions. These are the children and adolescents, their representatives and indeed their families, the people bearing the caring responsibility and the responsibility to support those in what are often very difficult circumstances indeed. It is important that we reach out to those who experiencing mental health conditions and have these conversations in our national Parliament. The symbolism of that is really important. We have started to talk much more openly about mental health conditions in this country, conditions that we would just not touch even a short number of years ago. That is something of which we can be proud. That does not mean that the job is done, however.
A good place to start when we are talking about the provision of services for children and adolescents is the Bill. A lot begins from this kind of perspective. It is, frankly, disgraceful that young people experiencing mental health issues are often confined to adult mental health units which are entirely inappropriate for them in terms of their age and the conditions they may be experiencing. It often serves to traumatise further young people who are in very difficult circumstances.
I was a member of the Government which in 2015, to the credit of the then Minister, Senator James Reilly and other colleagues, ended the practice of detaining young offenders in adult prisons, something that was entirely unconscionable, . It is extraordinary and, frankly, unconscionable that in the Ireland of 2017, young people with health problems too often have to face the prospect of entering adult units and all that involves. One of the most vulnerable cohorts of our society is being exposed to experiences that society should not expose them to. This has to stop, and it can stop if the House and Government accept the Bill.
I am sure Senator Freeman and the other sponsors of the Bill will be happy to work with the Minister of State and his officials to finesse and nuance the Bill. I am sure that offer will be made and the opportunity will arise. We can all get onto the same page on this issue. It is of critical importance. We can seek to address the resource issues we all know exist.
Notwithstanding all that, it is important we accept that, albeit incremental, services have improved in recent years. In my constituency we have a large new mental health facility in Drogheda which my former colleague, the former Minister of State, Kathleen Lynch, was instrumental in delivering for the area. It moves people from what are often Dickensian conditions in outdated facilities into new facilities. There are more outreach workers to deliver the community-based response we need.
Of course, prevention is key. Ensuring those who need acute services are accommodated in appropriate facilities with the range of different services they need is essential. I have already seen better outcomes from the types of services that have been delivered in my area in recent times. I appeal to the Minister of State to keep an open mind and ear in respect of the Bill and to work with Senator Freeman and the co-sponsors of the Bill to improve it if necessary.
I congratulate the Minister of State. He is coming down with congratulations today, but I genuinely mean it because I worked with him on the Joint Committee on Education and Skills for a number of years. He is a very able, informed and definite personality. He knows where he wants to go. I do not think he will be put off course very quickly. I wish him all that is best in this Ministry. There is much he can do. This is a significant area for children and the elderly. Everyone is talking about Brexit, but no one wants to attempt to talk about how we age in Ireland, even though our population is getting older and over the next 25 years, 25% of us will be aged over 65. That is a debate for another day.
I congratulate Senator Freeman. The Bill is her gift and we are just co-signatories. She did the work and had the idea. She came from a professional, brilliant workaday background. She brought all that into the Seanad and onto paper in the Bill. I want to wish her much luck. The work was brilliantly done and comes from a central place in her. She knows what she is talking about and how things could be changed. It was her gift which we had the privilege of signing. It is very much her Bill.
The Bill states that to put young people in a mental health service for adults is inexcusable, counter-therapeutic and purely custodial. I wish to make a philosophical point. Many Senators have spoken to the Bill very well. As a society, we have forgotten the distinction between an adult and a child, and those stages have become amalgamated and enmeshed. There is what one would call a disappearance of childhood within society which we, as a society, have tolerated. There is very little difference in our music industry, humour, clothes and food. The language used in front of children or that which children use is not different. In terms of expectations, attitudes and reactions, there is an absence of boundaries between the adult and child which is part of the reason we do not stop and think about what we are doing to a young fractured child when he or she is put into adult environments.
Sometimes we ask who is the mother and who is the child, and tell people that mummy looks as young as a child. A woman who is aged 47 may look 18. A child who is aged 13 may look 23. The media industry, including film, video and television, has created a sense of knowledge and way of knowing around that.
There are adult themes for children. This is a completely different viewpoint, but it is not really because it feeds into our lack of distinction. I remember railing against the sale of the national lottery to build the children's hospital, but understanding why it was necessary in order to find €400 million. We have only now turned the sod on it and are still rowing about the project.
Members should look at television, film, books and fashion. Adults are now selling sweets in advertisements, using the voices of children. There is a constant absence of boundaries between the child and the adult, which is a way of advertising, selling and marketing. A child will now advertise a car or food. There is no differentiation. In looking philosophically at the arts and the use of media, what keeps coming back to me is the disappearance of childhood and the amalgamation of adults and children, creating mini-adults. That came into my mind because many Senators spoke to the Bill. Sometimes we forget that there is a major difference between a young child, a young adolescent, an adult and a young adult.
I gracefully and gratefully commend the Bill and Senator Freeman, because she brought it to the House. We had the privilege of being co-signatories. I wish her luck and will support the Bill. I would take the advice of colleagues that there is always something to be added and some space to be filled in. We have an open ear, given the appointment of a new Minister of State who certainly has an open and good mind. He is an educationalist as well as a wonderful foster father. There are three or four people on his team.
I welcome the new bright and shiny Minister of State. I will leave it at that. He has the wind in his back in regard to one thing. The following statement was made by the Taoiseach when he announced his Cabinet last Wednesday: "As a Government, we are renewing our commitment to ratify the UN Convention on the Rights of Persons with Disabilities this year and to improving services available to people with disabilities". We are dealing with one critical element of that.
I thank Senator Freeman and her co-sponsors, Senators Craughwell and Marie-Louise O'Donnell, who has just spoken. As someone in the other House said a number of years ago, I feel like my clothes have been stolen because I will not be as eloquent as Senator O'Donnell.
I want to start by saying a child is not a small adult.
I was speaking to a paediatrician a few years about medication and I asked whether one simply halved the dose if the patient was a child. I was told that was not the case because the metabolism is different. Senator Marie-Louise O'Donnell was spot on. We should bring ourselves back 20, 30, 40 or 50 years and recall how we saw the world as children. How a child or a young adult sees the world is very different and that space is being shrunk now. It is meshing, as has been said. That is a core thing to recall in this discussion.
Senator Devine was very pointed when she talked about the things, without being too overt about it, that happen and can be seen in an adult psychiatric facility. One would not bring a child to see an over-18s movie. How does one then have them in a place where adults may be quite disturbed? We should be able to strip back the layers and say this is unconscionable.
Senator Kelleher has been very strong on community supports and I will not say too much more about it. Having good community infrastructure and supports both within the health sphere and beyond in education, etc., is critical. One wants to have the appropriate facilities for children and young people in terms of admission, but one does not want to need a lot of it. We want to head off as much as we can. It needs to be planned and appropriate.
In thinking about this since coming into the Chamber, I have been trying to imagine what it is like. I was thinking of being hospitalised due to polio when I was 11. I went to a hospital with a children's ward in it. The only thing I did not like was that there was also a school in it. The Minister of State, as a teacher, will forgive me for saying that. In a sense, that was a normalisation of it. All the staff and the things I saw around me were child and young-person specific. The orthopaedic surgeons may have also worked on the adult side, but they behaved in a way that was appropriate for children when they walked into that space. The man who delivered newspapers and comics, the porters and others did the same. The space will create or encourage the appropriate behaviour. Children can also help each other in their own ways. There is a sadness in it, but we also accept the importance of hospice care for children. We must likewise accept that there must be appropriate spaces and relationships for children and young people.
Young people, particularly teenagers, are not keen to be routinely in the company of their parents, even though they bankroll them and do a great deal else for them. How, then, should they be placed in an adult space in which people are going through very difficult times? If this was easy to solve, it would have been solved. However, it needs to come to an end. If we are to have anything left there for a while, it should only be exceptions. It is not acceptable and that has to be hammered home. It is what the Bill is about and we take it from there. I am hopeful about the new spirit the Taoiseach has brought to this issue and his support for ratifying the UN convention. This is one lovely piece of it. We are talking about people who have a lifetime ahead of them. Is that a lifetime where they can look back well on a place or situation which was difficult for them or will it be haunted by what happened?
I will call the Minister of State to speak next. First, however, I acknowledge the presence of Deputy James Browne in the Chamber who is holding a watching brief on proceedings.
I thank all of those Senators who have contributed to the debate. I thank them in particular for their very generous, effusive and kind welcome and words. I am not sure if I am worthy of all of what Senator O'Donnell said.
For how long it lasts.
Only time will tell. I will enjoy the day that is in it because as time goes on the welcome may be somewhat lessened. We may get more adversarial but hopefully we will not. On a more serious note, I commend Senators on the quality of the debate I have listened to. It is no wonder the House is referred to as the Upper House because there was a very high standard of debate here today. I have been genuinely very moved and impressed by the quality and calibre of the speakers and the sincerity, collaboration and genuineness of their approach. I say "Well done" to each and every one of the speakers.
I congratulate Senator Freeman for taking on an issue as real and urgent as this one. It is something that means a great deal to many people. These are our most vulnerable citizens and we owe it to them to discuss in the Houses of the Oireachtas the issues that affect them and to be their voice. I say "Well done" to her for bringing this to the floor of the House. It is a very good day when we have conversations like this in both Houses and when we have discussed so freely and openly mental health and the challenges associated with it.
As the newly-appointed Minister of State with responsibility for mental health and older people, I am delighted to have the opportunity to respond on behalf of the Government to Senator Freeman's Bill. It is important to begin my remarks by saying that I fully accept that we must continue to do all that we can to reduce to the greatest degree possible the number of child admissions to adult psychiatric units. I do not doubt for a second that all Members of the House agree on that and on the proposals contained in the Bill. The debate on the Bill is not about whether we agree that we need to reduce these admissions, which is a given. What we need to consider this evening is whether the Bill can actually achieve the aim of reducing such admissions. Equally, we need to be mindful of any unintended consequences of the Bill. We must not allow our shared desire to reduce such admissions to reduce in any way the scrutiny to which we subject this Bill.
The Government is committed to reducing the number of child admissions to adult units further and, in that regard, significant progress has already been made. Such admissions were reduced from 247 in 2008 to 68 at the end of 2016. Of course, that does not mean the job is done. Again, I do not need convincing that we need to continue to do more to bring this figure down further. It is still 68 too many if they are inappropriately placed in care. My Department and the HSE are working hard on a continuous basis to improve the delivery of mental health services for children. These services have benefitted from the significant additional investment in mental health in recent years. The HSE's service plan for 2017 will further develop CAMHS as a priority, including better out-of-hours liaison and seven-day response services. Since 2012, around €140 million has been added to the HSE's mental health budget, which is an increase of around 20% between 2012 and 2017. The Programme for a Partnership Government also gives a clear commitment to increase our mental health budget annually, as resources allow, to expand existing services.
It is no secret that demand for services continues to exceed availability as evidenced through waiting lists for CAMHS. CAMHS is identified as a key service improvement project for the HSE and work has been ongoing to reduce waiting lists with a particular focus on those who have been waiting for more than 12 months. Some of the main contributing factors that are impacting on waiting times for CAMHS services are vacancies within teams as well as cases that are more appropriate to primary care and disabilities. There are well-publicised difficulties in recruiting certain categories of staff, including consultants and nursing staff. The HSE continues to make strenuous efforts to recruit such staff, including greater support for specialist training of consultants and the development of a nursing postgraduate training programme. The recruitment of 114 assistant psychologists has recently been approved by the Department of Public Expenditure and Reform, which is a significant step in reducing waiting lists for CAMHS. Introducing mental health expertise in primary care also has the potential to provide quicker access to mental health supports for families and children where difficulties have arisen and to prevent the development of more serious difficulties.
The question that must be asked is how the specific legislative changes proposed in Senator Freeman's Bill this will improve services for children. As I have already said, we are all on the same side in wanting to reduce such admissions and the motives behind Senator Freeman's Bill are well intentioned. On the face of it, the Bill seems reasoned and proportionate but my Department has some concerns over the possible unintended consequences of the Bill and it would be remiss of me not to mention these. I believe these concerns need to be considered in more detail with Senator Freeman and other interested parties before the Bill advances to Committee Stage and I know the Senator agrees with me on this.
In light of this I welcome that Senator Freeman has agreed that the Bill not progress to Committee Stage before 31 October to allow time for my Department to continue to work with her on the Bill. As I am new on the job, I will take that opportunity to work with the Senator to add some finesse. We need to address the concerns, as none of us wants unintended consequences. We can debate those rationally but that does not take from the spirit of the Senator's Bill in any way.
The aim of this Bill, which is to allow for the admission of children to adult units in exceptional circumstances only, is already existing practice. The Mental Health Commission has a code of practice for the involuntary admission of children and section 2.5 of that document sets out the procedures that should apply in circumstances where it is deemed necessary that a child be admitted to an adult unit, including the need for the approved centre to have appropriate policies and protocols in place and age-appropriate facilities.
The code also puts an onus on the commission to review the number of admissions of children to approved centres for adults from time to time. The commission comments on this in each of its annual reports, as well as providing specific commentary in relevant approved centre inspection reports. These requirements are in place specifically to reflect the importance attached to monitoring such admissions where they are deemed necessary.
The commission also requires consultant psychiatrists to explain exactly why they have admitted a child to an adult unit. For example, in addition to setting out the reasons for the proposed admission, the consultant must outline the efforts made to admit the child to an age-appropriate approved centre and he or she is required to confirm that no bed is available in an age-appropriate centre. He or she must also explain what alternatives were considered to admitting the child to an adult unit and why these alternatives were not deemed possible. Furthermore, information must be given on the length of time the child is expected to remain in the adult unit and on the plans to place the child in an age-appropriate approved centre. Finally, the commission must be notified of all such admissions.
There is no doubt, therefore, that existing admissions must only occur in exceptional circumstances and all such admissions must be fully explained to the independent regulator. Putting existing practice on a statutory footing, however, presents a number of problems. For example, there are concerns over the requirement to put the term "emergency circumstances" in primary legislation. This phrase would have to be clearly defined, yet the word "emergency" by its very nature is difficult to capture in all circumstances. On the one hand if the definition is too literal, there is a risk that some children may lose out while if it is too general, there is a risk that any circumstances can be considered emergency circumstances.
Previous experience would suggest that referrals to the courts could increase and that they could be left to make judgments in cases which are not easily defined. While no one would deny that people have an absolute right to go to court, there is an onus on the Legislature to ensure to the greatest degree possible that the law is based on sound principles and is not easily open to differing interpretations. This concern is real and needs to be considered further.
Arising from the possibility that putting the term "emergency circumstances" in primary legislation may add greater uncertainty to the admissions process, another concern is that consultant psychiatrists may reconsider referring a child for inpatient treatment if an adult unit is all that is available at the time. This potentially leaves a patient with a high clinical need open to the risk of delayed treatment or possibly no admission at all. As legislators, we should not be tying the hands of the medical profession and interfering with the clinical process.
While the rationale behind the Bill, as stated by Senator Freeman, is clearly to end child admissions to adult units, paradoxically the Bill as currently worded would for the first time actually legalise the practice of admitting children to adult units albeit in emergency circumstances only. The question must therefore be asked if this will be seen as a sign that such admissions, now being formally provided for under primary legislation, will in some minds standardise this process. This is the opposite of what the Bill intends to achieve.
A comprehensive expert group review of the Mental Health Act 2001 was published in 2015. The group made 13 specific recommendations as to how our mental health legislation relating to children could be improved, including, for example, the recommendation that a stand-alone section of the Act should deal with children. In addition, the group recommended including in the legislation a list of child-appropriate guiding principles which would include, for example, that every child should have access to health services which aim to deliver the highest attainable standard of child mental health and that services should be provided in an age-appropriate environment wherever possible.
The group suggested that the latter recommendation be included in guiding principles that are intended to guide the interpretation of the Act rather than recommending that any specific reference to adult units be included in a section of the Act listing it as an absolute requirement. This is a key distinction for Senators to consider and I believe that proceeding on this basis offers a measured and considered approach to the issue of child admissions to adult units without tying the hands of the medical profession in clinical circumstances. I also think this suggests a way forward that Senators could see as a useful compromise.
It is also important to understand some of the reasons a child might be admitted to an adult unit. For example, such admissions may be deemed safer than referral to an adolescent unit located a considerable distance away, especially if drug or substance abuse is involved. In a small number of cases young people have been admitted to an adult unit due to their challenging behaviour and the impact that this may have on other young people in an adolescent unit. In other cases, the parents of the young person sought to have the admission to the local adult unit instead of a placement in an adolescent unit due to the distances that can be involved.
Quite a few issues relating to the text included in the Bill require clarification or amendment. Most significantly, it proposes amendments to section 14 of the Mental Health Act 2001. However, this section only deals with adults, not children. Section 25 sets out the procedures to be followed for the involuntary admission of children. These issues can be addressed prior to Committee Stage taking place.
In concluding my remarks this evening I ask Senators to bear the following in mind. We want children to receive treatment in age-appropriate units but we do not want to legally restrict the right of the medical profession in this regard. We all know that due to staff shortages, the Linn Dara facility was recently left with just half of its 22-bed complement operational. The core issue facing the Linn Dara facility, as we know, relates specifically to difficulties with recruitment and retention of mental health professionals. This, unfortunately, reflects wider health system issues. The problem in this case does not relate to funding availability and the HSE is intensifying its efforts on recruitment. In circumstances where staffing difficulties across the health services is an ongoing challenge, there are concerns that restricting the admission of children to adult units in exceptional circumstances on a formal statutory basis will reduce the services' capacity to meet the real inpatient needs of our children. That is why I wish to further discuss the details of this Bill with a view to incorporating the views of the expert group review of the Mental Health Act 2001. On the basis of these further discussions to take place, the Government will not oppose Senator Freeman's Bill.
That is the Department's view on the issues involved. It is its right, role and responsibility to do that. As Minister of State, I very much welcome the spirit of the Bill Senator Freeman has introduced. She and her colleagues have done considerable background work on it. I am very enthusiastic about working with her. We will take on board the Department's concerns. That is my role and responsibility. Through reasonable dialogue and compromise we can come up with a successful Bill from which future generations can benefit.
I thank the Minister of State and all those Senators who took part in today's debate. I again thank those who co-sponsored the Bill, Senators Craughwell and Marie-Louise O'Donnell, as well as Senator Boyhan who seconded the Bill today.
I have five minutes, but there is so much I want to say. There are a few really important things we need to understand. In 2012 we had an historic referendum when for the first time our children, who had endured a legacy of mistreatment and neglect, witnessed a change in the Constitution to protect them and recognise their voices. I hope the House will indulge me for a moment while I briefly read the first line from Article 42A, which states: "The State recognises and affirms the natural and imprescriptible rights of all children and shall, as far as practicable, by its laws protect and vindicate those rights."
We must continually ask our representatives whether the services the Government provides protect and vindicate the rights of our children. We must always ask if we are doing everything in our power to provide adequate services. Most of all, we must never look back if an emergency situation develops and wonder what we could have done better.
Most of all, we must never look back. What if an emergency situation develops and we wonder what we could have done better? I have asked those questions of CAMHS and the HSE and I feel that we have not yet done all that is practicable to offer the highest standard of mental health treatment for our children. I hope that, in introducing this amendment, we can look downstream at the reasons these children end up in adult units. It is the "Why" that is most important in recognising the shortcomings and creating safeguards to stop these admissions.
I remind the House of some of the stark realities of our existing services. Ireland has the fourth highest suicide rate among our adolescents. Does the House know that 16 to 18 year olds do not exist in Ireland? The services for 16 to 18 year olds do not exist. There are 55 whole-time consultant child psychiatrists in this country. We have a population of well over 1.2 million children and we have 55 consultant child psychiatrists. What if they are out sick, on maternity leave or on holidays? Nobody sees those children. We have four inpatient units in Ireland for a population of 1.2 million children, and most of them are not working. Today only 44 beds are available. There are no out-of-hours emergency services which is why children end up in adult accident and emergency services.
I am looking forward to working with the Minister of State and I will work tirelessly. I will work all through the summer to help get to the Third Stage of this Bill. If we can work with the HSE to address these shortcomings, the necessity for the Bill will be rendered void. I hope that the Bill will focus all our minds on the needs of the child and his or her parents from the very first moment that they look to the State for assistance.
It has been said that Ireland is a good place to grow old in. Some have said that Ireland is a good place to grow up in. Sadly, for those vulnerable children who struggle with mental health issues it is not. However, today this is a small step and I hope it is the beginning of a process which will ensure that Ireland is a place where children can grow, develop and deliver on their full potential. An old Irish saying sprung to mind earlier today. Nourish the young and they will prosper; neglect them and they will fall. I hope that this Government and the Minister of State will begin to nourish.
When is it proposed to take Committee Stage?
Is that agreed? Agreed.
Tuesday never happens.
I also welcome to the Gallery Councillor Reape from County Mayo, her husband and some friends. They are very welcome. Deputy Dara Calleary is here as well. There is a lot of interest from the Lower House in these proceedings today.