Mental Health and Covid-19: Statements

I thank the Minister of State, Deputy Butler, for coming to the House again today. We could nearly make her an honorary Member as this stage. We are taking statements on mental health and Covid-19. I have a full list of Senators to speak on this important topic. I am glad the Minister of State is here to outline the issues and for Senators to be able to talk about the challenges they and their constituents are facing with this topic.

My understanding was that I would only have seven minutes at the end to wrap up and that I would not be making an opening statement. That was what my office was told.

If the Minister of State wants more time at the end, it can be facilitated.

That would be great.

I call Senator Clifford-Lee, who is sharing time with Senator Paul Daly.

I thank the Minister of State for attending. She has been here on a number of occasions. We all know that because of the pandemic, the issue of mental health is of vital importance to people. We are all experiencing shocking levels of mental health issues in our communities. With the stress of prolonged lockdowns, as well as the isolation and the hopelessness that many are feeling, people feel there is no light at the end of the tunnel or they cannot see it at least.

Many supports have been put in place such as the text back and other facilities. There are issues such as the bad housing situation facing some people, along with mothers with young children trying to work at home and home school. The mental health of the nation's children is severely affected by the lack of in-class time. The schools going back is a priority of the Government. It will be a key to alleviating some of the pressure under which people are finding themselves.

Young people are facing difficulties with the uncertainty around the leaving certificate. The Minister for Education, Deputy Foley, outlined several weeks ago that a two-pronged approach will be taken to the leaving certificate and that students will have a choice. This was the express wish of the students. I appeal to all parties involved with the leaving certificate to get back around the table and keep the mental health of young people in mind when they are discussing and moving forward with their work. It is important they are given certainty at this point. They are facing enormous stress and strain, being isolated from their friends, not having any sporting or cultural activities. Now the uncertainty around their future education and careers is hampering them. Will the Minister of State bring that message, namely, that young people are under strain, back to her colleagues in the Department of Health and around the Cabinet table?

I thank Senator Clifford-Lee for sharing time with me. I welcome the Minister of State and compliment her on the great work she has done since her appointment. Knowing her personally, I would have expected no less. Under such trying and testing times, she has proved herself to be a hands-on Minister of State. The progress she has made in such a short time is admirable.

I welcome all the money provided for schemes such as In This Together, Keep Well and the Community Call campaigns. Coming from a rural area, there are some points I wish to highlight when it comes to isolation, the trials and tribulations so many people and families have gone through over the past year and seems to be on the horizon for the foreseeable future. There are issues with bereavement, isolation and children home-schooling, missing their friends.

The biggest problem we all have had with mental health, along with the lack of treatment for it, is the inability of people to admit that they have an issue. In some conversations I have had with people, they tell me that they were lucky the virus did not cross the threshold or that they did not have a bereavement due to Covid. People are nearly ashamed to say that they are down, not handling this well, missing their friends or missing the night at the bingo, going to mass or trips to shop.

While they are not handling it well, they say they are lucky. It is going to be so important, as we come through this, to reach out to those people. In addition to using awareness campaigns and the media, the Minister of State should, through the various Departments, brief volunteers, as in the GAA. When people return to their training sessions, which I hope will be sooner rather than later, maybe a GAA club should be conscious of mental health issues and perhaps should have an officer to identify what is affecting those in whom they have seen a massive change since before the lockdown.

The same applies in education. Teachers, principals and school staff have a role. We often talk about the role of the teacher in identifying problems outside the classroom, but it is often the caretaker, secretary or special needs assistant who sees a change in a pupil's activity in the playground or on the sports pitch. They may even see a change in a pupil's appearance or punctuality. There are little things that the teacher or principal might not see. We need an awareness campaign because we will all need to look out for so much more than we used to. The biggest problem we will have is that people will suppress their feelings. People who are down now do not realise it and actually believe they are lucky because the disease has not come across their threshold.

A lot of debate will be required on the bereaved. There will have to be a collective national approach to the question of how we commemorate those we have lost and how we can do so in a way that goes some way towards meeting the needs of the bereaved. I do not want to sound flippant but Ireland does grieving better than anywhere in the world. That adds to our strong mental health after a family bereavement. The ability to grieve after a bereavement has been taken away. There are people wallowing in sorrow who cannot express it and who have not grieved properly. It is possible that this will be the biggest mental health issue after the pandemic or in living with the pandemic. It will have to be addressed nationally. The idea of a national commemoration day to commemorate and recognise those whom, sadly, we have lost is brilliant but I do not know whether it will go far enough to help affected families to get over the loss they have experienced and the fact they have not been able to grieve.

I thank the Minister of State. I thank my colleague for letting me in early. I do not like leaving before hearing the Minister of State summing up but unfortunately I cannot be here later.

I am sharing half my time with Senator Seery Kearney.

I welcome the Minister of State back to the House. I wish her well in what is an absolutely daunting challenge, particularly in the area of mental health. It is daunting because successive governments from all sides failed to invest incrementally over the years in mental health services. As such, the Minister of State has taken over an area that has seen significant underinvestment. I welcome the fact there is a significant commitment in the programme for Government to invest in mental health and mental health services. I also welcome the fact that, in last year's budget, which was the first of the current Government, there was a significant increase in the resources made available to mental health services.

We are all aware of the pandemic and the absolute challenges people have faced in respect of their mental health. They may not necessarily have had major issues with their mental health before the pandemic although I believe everybody does have such issues to some extent. People who did not have a significant challenge previously have found it difficult. For those who have had challenges, it has been incredibly difficult.

I very much feel for the 60,000 leaving certificate students who have not got a clue what is happening or what is going to happen and who are in limbo. This poses mental health challenges in the run-up to what will have been one of the most important events in their lives to that point, namely, the sitting of the leaving certificate examinations. I hope this matter is concluded with urgency.

The investment in mental health has to be multi-annual and it has to continue to grow because we are fixing a broken system. Too many people have lost their lives as a result of a lack of intervention at the right time. We all know stories of people who presented themselves to hospital seeking help, who reached out looking for help and were told they were okay and not ill enough or bad enough to be admitted to hospital and who then went and took their own life. I know one case in my county that happened in the last number of months. It is unacceptable and disgraceful.

There are many people out there whose hearts are in the right place and who want to do the right thing. When tragedies have happened in communities, people have set up different foundations, fundraising initiatives and so on. I have raised this at the Joint Sub-Committee on Mental Health, which our colleague, Senator Black, chairs, and with the Minister. There are many well-intentioned organisations out there duplicating each other - it could be in the region of nearly 1,000 - that offer various supports for mental health. My worry is that their good intentions are not being channelled in the right direction. We need to review the various organisations around the country in the area of mental health and see if we can bring them together under a united meitheal approach. We should look at great work being done by Pieta and others. We need to learn from experience and ensure all resources are being channelled in the right direction to have maximum impact.

I really appreciate the energy the Minister of State brings to her role and her office is fantastic to deal with. I thank her very much. There are many schemes and they are all to be truly welcomed throughout this. If there is any silver lining to this Covid situation, it is that mental health is being spoken about and there is a destigmatising of it. We see the supports across all Government Departments, especially the Department of Education. I appreciate all of that.

Mental health services in the community have been affected by redeployments. I ask that the Minister of State use her good office to influence that those staff be brought back as quickly as possible and that we get those services back. I understand why we need to redeploy people but if we were to have a list of who gets staff back first, we should ensure mental health services have priority.

This week we got a phone call from my dad's GP asking if he is going to take the vaccine because he is 87. Of course he is. He has his sleeve already rolled up ready to go. As a family, there is a great sense of relief that the worry is coming to an end as to whether he will survive this and whether we will still have him in a few months' time or even a few weeks' time. Over the coming weeks, we will have that sense among a lot of families. We are not unique in that. Many families will experience the sense of relief that their family member will be saved from this.

How we communicate the over-70s roll-out programme is really important. We are clear that it is starting from next Monday. Newspaper reports today are talking about it going on until mid-May. It is important we emphasise that it is the second dose that will be done by mid-May. It is not that people will have it for the first time, but that they will complete their second dose. It is really good news and we need to hear that.

I am chair of the Dublin 12 drugs task force. In the context of mental health, I want to honour the work done by those front-line staff over the last 12 months. They have been extraordinary but they are flagging seriously to us that, under the pressure of the current circumstances and all they are experiencing, people who have been successfully managing their addictions have made a step backwards or are relapsing. I have spoken extensively to the Minister of State, Deputy Feighan, about this but it should also be approached from a mental health point of view. I think the two dovetail. We need to be ready to provide and ramp up support services, because there is a hidden alcohol tsunami coming at us, according to practitioners on the front line.

I respect what they are flagging to us. They are seeing it and taking the calls. They have adapted incredibly well and they are amazing people working out there for us, so I thank them. We should listen to what they have said and start preparing for drugs task forces, addiction services and mental health resources all coming together in order that we will have a careful, ready-to-go solution at the end of this.

I am very glad to be a part of this discussion. I welcome the Minister of State to the House again. We chatted at a different session earlier today.

We are living through the most strange and difficult times. We are living with restrictions for fear of our health and that of our loved ones, with the sense that no matter how hard we try to do what is asked of us, the goalposts keep moving. It can be a daily struggle for us all. The past few weeks has been particularly tough for many of us, and I am not afraid to say I have struggled over that time and found it exceptionally difficult.

To anyone listening to this debate, reading about it tomorrow or perhaps watching online, I point out they are certainly not alone in feeling strain on their mental health. There is no shame in feeling tired and low during this time. We have been faced with an incredibly difficult task of isolating from loved ones and finding an inner reserve of patience and strength that can be difficult to find. There has never been a time when we have all been told we are in this together and that we are all in the same boat while feeling so isolated and on our own. There is no weakness or shame in reaching out for help, whether to a friend, a family member, a GP, a counsellor, a therapist or a support group such as the Samaritans. If someone needs to make that call, he or she should make it now, or if someone thinks that someone else needs to receive a call, he or she should make it now. It is very easy to stand in the Chamber and tell people to talk to someone but the resources and the supports are just not there.

I refer to Senator Black and the Joint Sub-Committee on Mental Health, which she set up and chaired. Before Christmas, we heard weekly from people working in primary care settings and all sorts of places who outlined the stark reality of the current circumstances and what is potentially coming down the line in terms of a mental health crisis post Covid. As I have stated previously in the House, I recommend everyone watch the footage from those meetings because being a member of the committee was the most illuminating and possibly the most useful experience that I have had since becoming a Senator.

When we speak about mental health in the context of Covid, I am acutely aware that the first perspective most of us speak from concerns the mental health crisis that many are living through and the negative impact that Covid has had on everyone's mental health, which is fair and understandable. I believe, however, and I hope others will agree, that Covid and the social restrictions it has resulted in has also given us an opportunity to examine how we were living our lives beforehand, and more specifically that there is a want for a greater balance between our working and family lives. For many people, the absence of a daily commute and the costs associated with - the literal, physical and mental costs - has been an improvement.

During the week, I read the findings of the Macra na Feirme young farmer and rural youth survey, which I highly recommend doing because it includes very honest and insightful contributions highlighting a variety of experiences of young people living in rural communities. As someone from a farming background, I had to leave that community to achieve what I wanted for my education and career. I found myself connecting with many of the stories that Macra shared and I thank it for conducting the survey. Young people have been tremendously affected by this pandemic. It is fair to say those living in the more sparsely populated parts of rural Ireland are likely to be feeling very keenly the isolation in which we have been living for almost 12 months. In an average year, young people living in rural Ireland, with little in the way of local public transport and an unreliable Internet connection, could find themselves feeling isolated, and the survey showed that has been exacerbated over the past months.

There were some interesting and even positive findings in the survey results. A total of 53% of all the rural young people surveyed stated they would like to work from home or from a remote working hub in the future, 59% identified spending more time with their families as a positive of recent months, while 37% of those surveyed were happy with their current work-life balance. They are quite significant numbers. Notwithstanding the mental health issues we have talked about, lessons have been learned in recent months, particularly for young people in rural areas.

When we go back to normal, whatever that is, we will want to reflect on what learnings we can take from this that will be positive towards people’s well-being, growth and mental health. As I said, as we leave this pandemic and open our economy and our lives, we need to consider there are some elements of how we have been forced to live our lives in the past year that people will want to incorporate into their lives because they have been of benefit to them. Working from home allows workers to cut out commuting. It allows some people to fulfil better care obligations. For some, it simply means more time with their family and in their own locality. Workers who want to continue working from home post pandemic, even part-time, should be facilitated. As the survey showed, all this ties into mental health and well-being and how we will look at life post pandemic. I feel like my time is going on forever. The clock is ticking away.

To be of assistance to the Senator, I am afraid I started the clock a bit late. She should not worry. I know she has lots to say but she should not feel she is running out of words.

I can wrap up pretty quickly; I will not use the whole slot. I want to take a moment to reflect. Senator Seery Kearney spoke about her dad having his sleeve practically rolled up for the vaccine and the hope that is giving to him. On New Year’s Day, my dad was having a general new year's telephone call with his friend. They are both ever so slightly hard of hearing so we all heard the call. They were roaring down the telephone at each other about whether each was getting the vaccine and one would say he could not wait to get it. The hope that was giving them filled me with an enormous sense of joy. My dad practically has both sleeves rolled up and is waiting for the telephone call to get in and get the vaccine.

There is a flip side to that. I know of a young mother who had a heart transplant when she was quite young. She had a miracle baby; she is a single mother and she is very far down the list. If she gets Covid-19, it is very serious for her as a heart transplant recipient. She lives with this immense fear of what would happen to her child if she were to catch Covid-19. She has been cocooning since March, which is an extraordinarily long amount of time to not leave a house with a young child, because she is absolutely terrified of what could happen to her.

While the vaccines are giving hope to many people, there are those for whom the roll-out, through a series of issues, is causing distress and strain. I want to flag with the Minister of State that while it is bringing great hope, people are worried about how and when the vaccines will appear. GPs do not yet quite have the answer. I will wrap up with that.

The Minister is very welcome to the Chamber. Last March, we went through a period of uncertainty and upheaval never experienced before. We could no longer plan ahead or look forward with confidence. We lost the spontaneity of life. People’s livelihoods were put on hold and financial debts accumulated. All the simple things we took for granted evaporated as anxiety and fear gripped society. Families crammed around a single computer and stress levels increased and were sustained. Children stopped playing together. New school entrants were advised to keep a distance with no high-fives, play, sport or hugging. This is all against a natural path of development for children.

Musicians and performers lost their audiences. Stadia fell silent, weddings were postponed and graduation ceremonies never happened properly or at all. There were no leaving certificate goodbyes or no debs balls. Third level students remained in apartments gaping at computer monitors, with no exposure or participation in one of the most vital parts of third level life; savouring the university of life.

The world stands still. It is almost as if normal life has been brought to a halt, but at what price in terms of mental health illness? Some experts are predicting a tsunami of mental illness but, perhaps, that tsunami has already happened and has not been documented. Our health system has always been under-resourced and underfunded. Mental health has been the sad Cinderella; the poor relation when it comes to the overall health budget. Although some funding improvements in recent years have happened, it is not enough. What happens now? Are we analysing properly, or at all, the mental health price of Covid-19 and the hit people are taking?

Young people are being deprived of representing their clubs, counties and schools in everything from debating competitions, GAA and tennis to rugby and everything else in between. We must do so much more than focusing our attention, including media attention, on the tragic numbers of daily Covid deaths and cases.

All deaths and illnesses associated with this pandemic are heartbreaking but suicide has a shattering effect on families that never lifts or heals. I mention self-harm, anxiety disorder, obsessive compulsive disorder, post-traumatic stress disorder and depression. People need help now. Some need urgent intervention and more people will need help as this living nightmare throws its dark shadow over generations. Who is the advocate for mental health in NPHET's deliberations? People would like to be assured that such advocacy and such a voice will be heard, prioritised and placed front and centre. Can NPHET assure us of that? I know the Government respects NPHET. It is not a politician's electorate but the people of Ireland. Who is speaking up for mental wellness when NPHET compiles its recommendations?

As recently as this morning, it has been reported that psychiatrists in England are warning of a significant increase in pandemic eating disorders, with Covid-19 isolation blamed as the numbers of children with anorexia and bulimia soars, with fears for similar increases among adults. Eating disorders have thrived in this Covid environment as, for some, the focus on eating becomes a way of coping, coupled with the lack of physical activity, fear and uncertainty, and this fuels anxiety symptoms. Unfortunately, the evidence to date is incomplete and it will take considerable time to measure the true impact of Covid-19. What has been statistically proven among healthcare workers, however, according to the Irish Medical Journal and Trinity College's Professor Brendan Kelly, is that the rate of significant psychological stress among healthcare workers is approximately double that among the general population. They want more than a round of applause from people. To ameliorate this and if we want to help in a real way, healthcare staff require careful rostering, the ability to take leave, organisational support from employers, and, where necessary, psychological first aid.

Experts have expressed the opinion that the combined effect of the pandemic and associated restrictions and isolation is that approximately one person in every five in the general population in Ireland and elsewhere has suffered significantly increased psychological distress. Some 623 consultant psychiatrists registered with the College of Psychiatrists of Ireland completed an online questionnaire back in May and June. They are not very recent data but they are worrying. Their findings included proof of a running relapse of mental illness and an increase in the number of emergency referrals. Multiple factors of the lockdown were contributing to emergency presentations in hospitals. These presentations were believed to be primarily down to increased isolation, reduced access to face-to-face secondary mental health supports, reduced access to local counselling supports,reduced access to GPs, increased reliance on drugs and alcohol and domestic abuse in the home. Child and adolescent psychiatrists specifically highlighted school closures as contributing to stress and emergency presentations. I am not into the blame game but I urge everyone to remember that as we try to get our schools back to work and get everyone around the table as soon as possible.

I emphasise that the usage of mental health services is not a reliable indicator of need because the number of people who presented for self-harm was down 25%. One would think that is good but it is not because the number of people who presented for other causes is down 40%. It is just not documented. Are environmentalists are happy there is a reduction in carbon emissions this year in the incredible year we have had? They are not so we cannot rely on that data for presentations or take any succour at all from them. The effects of the pandemic on suicide are not yet clear because of this. Now is the time to act. We should act in anticipation of the worst-case scenario and not wait for statistical confirmation to warrant and vindicate an effective response.

It is the first time I have met the Minister of State, Deputy Butler, in the Chamber since her appointment. I wish her well and congratulate her. I will be critical of the Government but I do not doubt the Minister of State's personal commitment to this role. I would argue the Minister of State's job is certainly among the toughest of any Minister in the Government.

Where should one begin with this topic? Extensive research shows that there are massive challenges in this area. To cite some of the statistics, the HSE has stated that traffic to its mental health website was up by 490%, with more than 800,000 visits between March and July of last year. Jigsaw, which does such important work, has stated that demand for its services has increased by over 50% during the pandemic. The Samaritans have reported an increase in the frequency of conversations about callers' existing mental health difficulties being exacerbated and the lack of access. That is a point to which I will keep coming back, namely, the lack of access to mental health supports since the pandemic began. I am afraid I must tell the Minister of State that under this Government, we have gone from a mental health crisis to a mental health emergency.

The Mental Health Reform group, which is a national coalition on mental health in Ireland, has outlined two key areas for investment. We need staffing levels across the mental health system to be increased and people must get quick and easy access to mental health services when they need them. Just before the onset of the pandemic, I took part in a couple of meetings in Limerick and Clare with parents, in particular, of children who could not access services. There is no doubt but that we have lost lives due to access. This problem was not created yesterday or in the past six months. It has been ongoing, frankly, for decades. The challenges facing the Government are considerable but we need to see a change in gear in terms of the responses. I acknowledge that the previous speaker made the point well that while more funding has been allocated, much more needs to be done. It is good to hear that recognition from across the Chamber.

We must move towards parity of esteem for mental health provision, which places mental health on parity with physical health. Years of underinvestment have led to waiting lists with over 2,000 children on the waiting list for the child and adolescent mental health services, CAMHS, and more than 10,000 adults and children awaiting psychology appointments. No doubt all the Senators opposite know how bad this is because we all are contacted on a daily basis by parents and adults desperate to access the system. Unfortunately, the prospects are that in many cases, they will have to wait for years.

One of the major gaps in services commonly experienced by those in distress is the lack of care outside of 9 a.m. to 5 p.m. At present, there is no State-wide provision of 24-7 crisis services at a community level. People should have access to mental health treatment where and when they need it. Mental health issues do not only occur between the hours of 9 a.m. and 5 p.m. and nor do they take the weekend off. Mental health issues do not take a break during a pandemic. We can have no half measures when it comes to mental health.

The onset of the Covid-19 pandemic has only increased pressures on already under-resourced mental health services. GPs are overwhelmed. They have requested referrals to talk therapies and counselling but with people having no access to 24-7 services and accident and emergency departments not working, there is no follow-up with patients and consequently, people are simply falling through the cracks. The long waiting lists for child and adult psychology treatment are completely unacceptable. Early intervention is key to a child's development and children are missing out on lost opportunities because they cannot access the treatment that they need.

I want to speak briefly about Limerick. In the community healthcare organisation, CHO, 3, which covers counties Clare, Limerick, north Tipperary and east Limerick, the number of patients on the psychology waiting list for treatment was 505 up to October 2020. Of those aged between five and 17 years, 243 patients had been waiting more than a year in this area. This is costing us lives. I think we would agree it all comes down to funding. In the 1980s, mental health funding was 16% of the overall health budget but in 2020, it had fallen to 7%, and it is scheduled to be 6% in 2021. Sláintecare recommends 10% and the World Health Organization recommends 16%. Of the additional €4 billion provided in the Government's health budget for this year, mental health received €50 million, which equates to 1% of the overall additional health budget. That is what I mean by not enough.

The Sinn Féin spokesperson on mental health, Deputy Ward, is a man for whom I have great admiration -I say this not because he is a party colleague but because he is so passionate about this topic - and he introduced the Mental Health Parity of Esteem Bill 2020.

It aims to compel a change in attitudes towards mental health at the highest level of policy making in the Government. Surely, that is what we need. Sinn Féin also introduced the Health (Amendment) (Dual Diagnosis: No Wrong Door) Bill 2021. This important legislation aims to plug the gaps between mental health and addiction services. Despite considerable evidence of interaction between mental health issues and addiction and the possibility that one is a direct result of the other, they are treated almost exclusively as separate conditions. Ensuring access to appropriate treatment for people with dual diagnosis needs is a major policy concern. Sinn Féin recognises that those who are addicted to drugs and alcohol can have mental health disorders and vice versa.

Drug and alcohol misuse is primarily a public health issue. Harm reduction and prevention are guiding principles for Sinn Féin in the development of future drug and alcohol strategies. Treatment and rehabilitation strategies will go hand in hand with recovery initiatives that will help to support people in recovery. Sinn Féin supports an holistic approach to prevention, rehabilitation and recovery.

Unfortunately, a mental health issue is often hidden. It can be subtle in effect but devastating in results. Individuals and families are suffering as we speak - suffering the loss of a loved one due to mental health issues, experiencing issues themselves or looking on as family or friends suffer. Covid-19 has compounded feelings of isolation, loneliness or hopelessness in people who suffered mental health problems before the pandemic began. It has also created strains on people who never experienced mental health issues before and who, for the first time in their lives, are confronted with feelings they never had previously. In July 2020, Mental Health Reform published research that showed significant public demand for greater action from the Government and its agencies to respond to the mental health impact of the pandemic.

The Government needs to recognise the often unseen problem of mental health issues in society and help to prevent a greater problem coming down the line. The Government needs to realise that it has to invest in mental health so that people can get the help they urgently require. We need much more funding and support and urgent action.

I call Senator Black, who is the Chair of the Joint Sub-Committee on Mental Health.

I welcome the Minister of State. I agree with Senator Gavan that she has a tough job ahead of her. She is a compassionate person and I wish her well in her role.

As I am sure the Minister of State is aware, mental health activism is a passion of mine in my work as a therapist and a politician. I set up the RISE Foundation to work with and support family members of a loved one who has an alcohol, drug or gambling problem. Often, family members are significantly impacted by someone they love going down that self-destructive route in the form of depression, anxiety and stress. My passion for mental health has always carried through to my politics. As Senator Hoey mentioned, my ongoing efforts and work saw the cross-party Joint Sub-Committee on Mental Health set up last November. I am grateful and honoured to sit on that committee as its Chair.

Mental health is a topic that needs more attention and voices within the Government now more than ever. Since the committee's commencement, we have worked hard to create a schedule of items that it is paramount are accounted for and discussed. None is quite as important as the systemic impact of Covid-19 on the mental health of members of society. Now more than ever, people are feeling isolated, disconnected from their communities and frozen. They are struggling to engage with a future that seems unpromising. Financial burdens seem insurmountable and threatening. This is having terrifying impacts on our people. Everyone, including friends, colleagues and people close to my family, is being impacted. It is our duty to create a framework facilitated by open and in-depth discussions so that we can plan a brighter future.

There is a waiting list for primary mental health care of up to 11,000 people, 80% of whom are children, and the wait is up to two years per person. It is vital that we consider providing lower level preventative supports, promote and support voluntary services, and invest in primary care psychologists. It is also vital that we tackle inappropriate referrals at secondary level, given the issue of dual diagnosis, and support implementation of multidisciplinary teams so that people suffering with illnesses like eating disorders do not have to travel outside Ireland for adequate treatment.

We need to tackle the staff shortages in third level care. With the demand constantly rising, the limited number of staff is crippled. These issues are to name but a very few that we must tackle head on to correct each level of mental healthcare.

Only the tip of the iceberg is in view when it comes to seeing the effects of Covid-19 on mental health in Ireland. There are many reasons for this, such as the fear many individuals have of going to hospital during a pandemic, even in a mental health emergency, which forces them to struggle with it alone, and this is so true. Voluntary organisations are struggling to fundraise in these times and so cannot provide the necessary supports they once did.

The nightly announcement of the number of Covid-19 cases and deaths are a very public declaration of how the virus is affecting the population, but privately we know Covid is harming many more, with higher levels of anxiety and mental illness. Medics have reported that the first lockdown caused more people to feel loneliness, depression and anxiety. It sparked an increase in prescriptions for sleeping tablets, anxiety medicines and antidepressants. These figures are only increasing during this lockdown. The reality of the pandemic is that Covid-19 has not affected the population equally. Those with the fewest social and economic resources to alleviate the effects of social restrictions will be impacted the most, for example, those living in deprived areas with insecure and-or low income jobs, insecure housing, single parent households or abusive relationships. It also acutely affects those with existing mental health problems, whose mental health may worsen when access to their healthcare support is restricted. Others who are most at risk at present include those who have lost or are at risk of losing their jobs, those separated from loved ones, healthcare workers, people who face domestic abuse, the elderly, individuals who have pre-existing mental health difficulties, some Covid-19 survivors who are experiencing post-traumatic stress disorder, PTSD, and depression, and those with intellectual disabilities.

The priority for us right now is to plan and anticipate the huge escalation of mental health service requirements and secondary mental health services. It is now emerging that this will peak in the coming months and will last for many months or even years. We have a separate curve to flatten outside of the Covid-19 cases within secondary mental health services. Unless we anticipate, plan and invest in all of our secondary mental health care services as a priority, they will be overwhelmed, with terrible consequences for mental health and the economic recovery of our country. It is paramount that we start to strategise ways to implement greater Government action to respond to the impending mental health crisis and strategise a recovery plan for mental health during, and in the aftermath of, Covid-19.

There is no doubt there has been a huge surge in demand for mental health services which, prior to the pandemic, were already overstretched. The evidence for the impact of Covid-19 on the mental health of the people goes on and on. The reality is we are in a crisis far greater than any of us could ever have anticipated. Covid-19 is no longer our only battle. Our main point of action is to consider how we can provide lower level preventative support and promote and support the voluntary services. We must urgently invest in primary care psychologists and therapists across the board. We must urgently tackle the current issue of inappropriate referrals at secondary level. We need to tackle the staff shortages in third level care, as with the demand constantly rising the limited number of staff are crippled. These points are only a small number of the large tasks we must take on if we are to begin to correct each level of mental healthcare so we can save the lives that are at risk.

I thank Senator Black for her work on the mental health committee in the Oireachtas and for her work outside of Leinster House in the voluntary sector in the area of mental health.

I remind Members we are sticking to the rota and even if people come in out of sequence, unfortunately, we still have to stick to the rota. We are still going through the spokespersons in the debate. Before Senator Mullen speaks, I ask Senator Seery Kearney to take the Chair for the first time and thank her for taking up a role as an Acting Chairman.

Gabh mo leithscéal nach raibh mé ann ag an tús.

I welcome the Minister of State.

In five, ten or 20 years' time when we look back at the last 11 months, or the first 11 months of the Covid pandemic experience, three enormous failures will be recalled. The first obviously was that towards elderly people in nursing homes. We will have to continue to reflect on that and the death toll that resulted.

The second failure is the decision to cancel so many oncology consultations during 2020. There are already indications from Dr. Greg Korpanty, in University Hospital, Limerick, and others that people are now presenting with more advanced cancers. Sadly, in the years to come they will pay a price for the decision within the health system to cancel oncology appointments.

The third great failure will be around the general mental and well-being of the population that has taken such a hammering. That was driven by three factors, in particular: unemployment and the destruction of so many businesses; the suspension of normal social life and separation or people who have been separated from their families; and the impact of the virus itself on so many people who have recovered from it.

I want to say a word about media coverage. With the endless stream of doom and gloom on the airwaves, particularly on our national broadcaster, I worry that it is taking a serious toll on even the most firm minded people.

I give credit for the good programmes and the public service information. I get that RTÉ has a public service obligation and a duty to inform the public. I get that they cannot afford to ignore the gravity of the pandemic. Even so-called light entertainment is engulfed by the issue with large sections of "The Late Late Show" now devoted to discussing Covid each week. There was even an ill-judged attempt to rebrand "Operation Transformation" with a name that referred to Covid. This all pervasive doom and gloom is more than bordering on the irresponsible and we have to wonder indeed if the mental health of ordinary people has suffered as a result. It is no wonder that Lyric FM has seen a 10% increase in its listenership as people seek refuge from the 24-hour Covid news cycle. It sometimes strikes me that those who are most addicted to the news coverage around this issue are those who are most endangered by it.

This morning I listened to Claire Byrne on the radio. She talked to a student about the ongoing leaving certificate imbroglio and she said that this must be terribly stressful on students. If one tells people that things must be terribly stressful for them then it is more than just empathy. It is irresponsibility actually because what one is doing is perpetuating the experience of stress.

Can we get back to encouraging people to be resilient? To invite people to count their blessings, as we all should, is not to ignore the problems that we face because there are resources and there is support. Yes, there are things that are lacking and, yes, there are problems and we must be ceaselessly energetic about addressing them but there has to be a national consensus about the need to get positive in the face of the challenge. I would invite RTÉ and other media to get out of the one-track zone of seeing things through the lens of power and conflict, or panic and anxiety. We need something more and we need something better.

Specifically in terms of mental health, we started from a position pre-Covid where mental health spending comprised 6% of our health budget compared with 12% in the UK and across Europe. As I said during a Private Members' motion on direct provision centres, which I proposed in 2019 and which was adopted unanimously, the State still does not take mental health as seriously as it does physical health. Therefore, even after additional billions of euro being spent on health this year we begin dealing with the fallout from Covid from a poor starting position. That has to be said. The challenges faced by mental health services are, potentially, daunting. We urgently need to build capacity for increased services and increased need specifically to deal with the knock-on effects of lockdown such as loneliness, isolation and alcohol abuse. I note what has been said about the coincidence of addiction and mental health issues in the context of both drug and alcohol abuse, and I will come to gambling in a moment.

I will deal with the knock-on effects of the lockdown, the likely effects of a further economic slump that we may face post Covid - and I am probably starting to sound like the national broadcaster now - not helped by Brexit and, most important, the neuro-psychiatric complications of Covid itself. Before Christmas I read about a study conducted on the Continent. It found that of those who had been hospitalised with Covid 12% went on to have symptoms of post traumatic stress disorder, PTSD, 27% had anxiety and more than 50% reported severe or chronic fatigue.

We have heard anecdotal reports of the latter phenomenon. If this is indicative, we must plan seriously for the major problems that will be faced by people who have recovered from the virus, not to mention the wider population. Certain people with serious mental issues, such as schizophrenia, will undoubtedly have worst outcomes in the event of contracting Covid-19. We must consider whether these people should be vaccinated earlier in the schedule. Perhaps the Minister of State will tell us if that has been considered or if she will consider it.

We must be careful with regard to suicide. I recently spoke to a senior, eminent professional working in the area of psychiatry and the view is that while there is a great deal of anecdotal evidence that suicide rates have increased in the past year, there is no evidence in the official statistics of any increase in Ireland or the UK. While this may change, we need to be careful and not be alarmist. The best advice from doctors and mental health groups is that the discussion of suicide should never overstate its prevalence because this, in itself, has a triggering effect on vulnerable people.

On a point of information-----

I thank the Senator for yielding. On that point, some statistics are lagging way behind, such as coroners' reports, so we could be waiting a considerable time for them. I thank the Senator for taking that information.

I take that on board.

Finally, gambling is an issue that was raised by Senators Cassells and Joe O'Reilly on the Order of Business today. We must take on board the evidence we are hearing through our work of people who have relapsed into problem gambling due to anxiety, unemployment or sheer want of something to fill their time. One man spoke bravely on the radio last year about how he had developed an addiction to the national lottery, a problem that is often overlooked and dismissed even though it is a form of gambling, albeit in aid of good causes. The College of Psychiatrists of Ireland recently called the gambling problem over the past year "a hidden epidemic" and a "public health crisis". We must take heed of the advice it has published on how to tackle it. The pervasive advertising of gambling, particularly at weekends and during sports events, the sports events many of us love and to which we are perhaps potentially addicted, is grotesque. We must tackle the gambling epidemic head-on, as it preys on the well-being of vulnerable people across the country.

I welcome the Minister of State and commend her on her work. The welfare of people is important to us as a collective and also individually. The important point all Members can make today is that there is significant investment, but there is a need, as Senator Mullen correctly said, to teach people resilience. In that regard, I ask the Minister of State for her co-operation on the need for the Government to legislate for mental health training in the workplace. I am struck by the fact that we sometimes do not talk about mental health, so I commend Senator Black on her work and on bringing forward the conversation or comhrá on the need for mental health to be prioritised. There is a need for the Government, and I will work with the Minister of State on this, to bring forward legislation to bring mental health training for employees into the workplace. I believe it is essential for the well-being of the workplace. In the context of Maslow's hierarchy of needs and reaching self-actualisation, this would be a key component of our new workplace relations post pandemic.

We know anecdotally about the effects Covid-19 has had on people. The pandemic has highlighted more than ever that we must prioritise promoting and nurturing positive mental health in the workplace. We all have heard stories about what has been happening to people's mental health. I am struck by Glenn Close's great quote: "What mental health needs is more sunlight, more candor, more unashamed conversation". We put a value on health and safety in the workplace. I believe we can work to achieve mental health training and bring about better awareness, which will become the norm. We talk about resources. We are putting significant resources into mental health in a variety of ways. However, I ask the Minister of State to speak to the Minister of State, Deputy Chambers, and the sporting organisations across the country.

There is a group of young people aged 17 or 18 years and younger that could train in pods of 15, whether it is for soccer, hurling, football, rugby or whatever sport. We all know of sports complexes that have acres of ground where young people could train safely and kick a ball around to one another. There does not have to be organised matches. Young people are frustrated in this lockdown because they have lost that sense of hope. That vision of playing games in the summer has been taken away from them. Allowing that would not add to the Covid-19 statistics. It would bring about a surge in positive mental health. I see it in my own county and city. There are young people out on the greens where we live kicking a ball and training. They can do that safely in their GAA, soccer or rugby clubs and I ask that consideration be given to that.

This State has spent billions of euro on mental health. We must ensure now that the current challenges we face have a positive impact on people. Linda Poindexter stated: "One small crack does not mean that you are broken, it means that you were put to the test and you didn’t fall apart." As a nation we must learn that we can work together as a collective to help one another. I commend the work of Senator Black and her group. I also commend the work of the Minister of State, Deputy Butler. She has an enormous task ahead of her but her passion and personal sincerity will win through, as will that of the Minister of State, Deputy Feighan. I thank her for being here today.

I welcome the Minister of State to the House again. I am grateful to have the opportunity to address her and my colleagues on a matter of grave importance. There is surely not a family in this country that is not affected by the issues of mental health disorder, dementia or intellectual disability. Mental health is an often overlooked and neglected aspect of healthcare in this country. Our history is not an enviable one in that regard. To our shame, this failure is not merely a feature of our history. It continues right up to the present day.

Mental health continues to be the poor relation of in healthcare in terms of investment in services and treatment. The societal stigma associated with these issues, born out of ignorance, must be dispelled and consigned to history. To our shame, we still do not allocate adequate resources to provide much-needed mental health services. It is recommended internationally that approximately 16% or one sixth of health expenditure should be spent on mental health. Ireland spends less than 5% yet many studies show that we have a higher prevalence of mental health problems than other developed nations.

In 2018, the OECD Health at a Glance report showed Ireland having the third highest rates of mental health illness out of 36 countries surveyed. It estimates the cost of our mental health crisis at more than €8.2 billion annually. That is not just an economic abstraction. There is also a human cost. Behind the cost to the economy and the health system, is a story of personal pain, suffering, distress, anxiety, loneliness, addiction, homelessness, suicide, grief, death, tragedy, missed education and employment opportunities, unfulfilled potential and lives not lived. For anyone with any insight or an ounce of compassion it is truly an awful vista. The number of psychiatrists we have per capita is at the bottom of the international league table. If any of this is grossly inaccurate, I would be grateful to hear the Minister of State go on record to advise this House otherwise.

On a more personal note I ask her to examine the issue of funerals and bereavements and the effect the restrictions are having on the health of those left behind. Many of us have had people we know pass away from Covid-19. Many of the people who are passing away are in their 70s, 80s and 90s.

Religion and faith played a significant role in their daily lives. Many of these older people would have gone to mass daily and that communal worship was taken away from them. Country churches may only have had ten to 15 people congregating each morning for that most important aspect of people's lives.

Currently, ten people are allowed to attend a funeral. Many families of the generation that is passing now may have six or up to ten or 12 children, so how do they choose who goes to the funeral? People are getting left out, including sons-in-law, daughters-in-law, brothers and sisters and grandchildren, etc. This is the effect that the restrictions on funerals have on the people who are left behind, and that is cruel.

Churches are very suitable for social distancing. Taking away faith from older people, including taking away access to priests who can anoint them before death, is wrong. I have heard horror stories. I was very fortunate but many people were not. Sometimes the diseased bodies were not dressed but were put into a body bag with the hospital gowns. I have heard of families who had loved ones brought straight to a grave without having the funeral mass. How uncompassionate is that? Will the Minister of State consider how we are dealing with funerals and bereavement in this country? Ireland is better than anywhere else when somebody dies in the community but the Government has robbed families of support in a time of grief. It is inhumane to stop people showing solidarity with grieving families. Surely we can find a safer way to conduct funerals and continue to support grieving families.

I thank the Minister of State for making herself available at such short notice. It was just last Friday morning that I rose here to ask for such a debate. I am glad it is happening so soon. It is only right as it is a relevant topic that should have the attention of most of us.

There has been much good discussion today. I will first discuss our schools. The younger cohort in primary schools do not have the same access to social media etc. and they do not currently have a voice. Before making the rest of my comments, I appeal to the school unions to put their heads down and do their best to get the children back to school and sort out the questions around the leaving certificate.

The pandemic is causing mayhem. A recent medical journal article by Dr. Brendan Kelly of the department of psychiatry in Trinity College Dublin, entitled "Impact of Covid-19 on Mental Health in Ireland", outlines the widespread concern about the impact of Covid-19 and associated restrictions on mental health. He reports that evidence to date demonstrates that the combined effect of the Covid-19 pandemic and the associated restrictions is that approximately one person in every five in the general population in Ireland has significantly increased psychological distress, including anxiety and depression. Risk factors include being female and living alone. Rates of significant psychological distress among healthcare workers are approximately double those of the general population. To alleviate this, healthcare will require careful rostering, ability to take leave, organisational support from employers and, where necessary, psychological first aid. The Covid-19 infection affects mental health both immediately through depression and anxiety and, most likely, in the longer term, especially among those who are hospitalised, through traumatic stress and post-viral syndromes.

Last year, Maynooth University and Trinity College Dublin studied 1,000 people in March and April, during the initial restrictions, finding that 41% of respondents reported feeling lonely, with 23% reporting clinically meaningful depression, 20% reporting clinically meaningful anxiety and 18% reporting clinically meaningful post-traumatic stress.

A peer-reviewed study of 847 members of the public in Ireland between March and June 2020 also found significant increases in incidences of depression, anxiety and stress, compared to before the restrictions. A survey of 195 psychiatrists of the College of Psychiatrists of Ireland, conducted in May and June 2020, found that the majority reported increased referrals for generalised anxiety disorder, where there was a 79% increase; health anxiety, with a 72% increase; depression, with a 57% increase; and panic, with a 54% increase.

All these things culminate in the need for Government action. That is why we are having this debate and it is what we are calling for. While many propositions will be made in this debate today, we are going to have to adopt an approach to this issue that is new and different, and other to what has been done heretofore. I know that waiting lists have been addressed in the past, with the National Treatment Purchase Fund. Other countries are adopting initiatives such as giving vouchers to GPs. We may need to do something like that, and give vouchers to GPs for those who do not have access to or cannot afford to see psychiatrists or psychologists, etc. I know that across the Border people are given vouchers, even just to go to the gym. We must think outside of the box. I welcome the opportunity to address this issue today.

I want to acknowledge the amazing work of our front-line staff in our mental health services, and all the organisations supporting people at the moment. They are thinking outside of the box and pivoting in how they connect with groups, such as school classes and sports teams. In Dublin 15, we are blessed with a network of community centres. In places like Huntstown and Castleknock, when people could not go to the community, the community came to them and looked after our most vulnerable. I am very proud of the response that our local communities led through the lockdowns.

There is no doubt that there is much work to do when it comes to our mental health. I know that the Minister of State is committed to this work. We talk about how Covid has exacerbated vulnerabilities across sectors. It has also exacerbated problems for people. People are under acute pressure at the moment, but the effects of Covid on our society could last for years. I agree with Senator Black that mental health needs to play a key role in our Covid recovery.

I am concerned for older people who are locked away in their homes for months on end. People are bereaved and have been unable to attend funerals for their children. Parents of children with special needs have had their routines turned upside down. Children and young adults have missed social and developmental milestones. Business owners are under stress. Victims of domestic violence are affected, as are women who are bearing the brunt of pandemic parenting, homeschooling and domestic duties. Expectant and new parents are being left isolated at a vulnerable time. Covid sufferers and front-line workers are affected. The list goes on.

The Psychological Society of Ireland conducted research early in the pandemic which highlighted widespread distress among the general population in several counties, with specific reports of incidences of depression, anxiety, PTSD, reductions in life and personal relationship satisfaction and increased levels of loneliness. Interestingly, internationally and in Ireland, the age group that is impacted most by loneliness is that of those aged 18 to 34. While there are pockets of positivity, where there are acute problems, they are running very deeply.

Access to services in a community setting has never been more important. It is the foundation of mental health access, laddering up through primary, specialist and acute care. I fundamentally believe that we need more public access to talking therapies. The increase in online access to services and the introduction of the national crisis textline have been great, but the Minister of State and I both know that we need more, and we need more staff. The budget for mental health services is over €1 billion and promises an increase in mental health community teams, CAMHS, assistant psychologists and psychologists in primary care and in Jigsaw services. However, targets have been set before, and we are still behind on them.

I note, from the Delivering Specialist Mental Health Services report of 2019, that we went from 69% of new development posts being filled in 2017 to 17% in 2018 and 32% in 2019, while funding for specialist community teams dropped too. The Psychological Society of Ireland, PSI, also conducted a survey which showed 92% of health and social care professionals said the current agency panel system does not work well as a method of recruitment. Where is the Minister of State with that and is Covid affecting the roadmap?

I am on the board of the charity Social Anxiety Ireland. It is a fantastic organisation, which needs to be brought into primary care. Social anxiety is the biggest anxiety disorder in the world, yet most people have never really heard of it or understand it. As a charity, Social Anxiety Ireland exists hand to mouth. If the Minister of State could see the impact that its 12-week group therapy programme makes, she would be amazed. I will speak to the Minister of State about that separately as my time is up.

I welcome the Minister of State to the House. She is always very welcome. I thank the Leader for setting up this important debate. It is good to have the opportunity to speak on mental health and Covid. The number of speakers lined up this afternoon shows just how important it is and how seriously we all take it.

I join with my Labour colleague, Senator Hoey, in acknowledging the immense impact that Covid has had on everyone, as well as on mental health, feelings of isolation, loneliness, distress and stress. Others have eloquently spoken about the true impact upon mental health.

It is not particularly helpful to blame the media for reporting in a straightforward and a fair way on what is going on. I commend in particular some of the really striking and moving reports we have seen in the past week alone from RTÉ "Prime Time". One last week involved going out with an ambulance crew in Cork and another report this week came from Tallaght hospital. These bring home the reality of Covid for front-line workers. That is really important work the media are doing.

I would be critical, however, of the Government's lack of communication as to a plan for getting us through this. That matter in particular is why all Members are hearing that everyone is finding this lockdown the hardest. There is no light at the end of the tunnel when we are told of another six weeks or another 12 weeks of level 5 lockdown, of living under draconian restrictions without the prospect of a cohesive and clear plan for getting us through it.

This week, my party put forward in the Dáil a clear national aggressive suppression strategy, effectively a zero Covid approach, which would require us to adopt the sort of approach we have seen in New Zealand. We are adopting it anyway in terms of strict lockdown. Such an approach would give people hope. If we coupled it with mandatory hotel quarantining for all arrivals, we would then see a way forward to returning to some sort of normality, pending the full roll-out of the vaccines, and even beyond that, as we know with the new variants coming in that vaccination alone will not resolve the issue. Anyone watching events in New Zealand is struck by how much less stress and how much less impact on mental health the global pandemic is causing citizens and residents there.

It is not possible to debate Covid and mental health without acknowledging that people need to see hope for the future. What is causing the heaviest burden for so many is the lack of hope we are experiencing due to this ongoing feeling of rolling lockdowns and no prospect of getting through it or of what lies beyond. Will the Minister of State pass that on to her colleagues in the Government? We need clear communication of a clear strategy. Then people can live much more easily with the stress, distress and loneliness of lockdown, if they know that we are getting through it with a purpose.

I welcome the fact that front-line mental health staff will be included in the vaccination plan for front-line healthcare workers. That is important. All of us are conscious that those resident in institutions and in mental health centres have been badly hit by the direct effect of Covid. Some 29 persons who were resident in mental healthcare facilities died from Covid. One must think of them, as well as of their families and their friends so sadly bereaved by their loss.

I wish to emphasise the effect of Covid on the mental health of children. Earlier this week, along with Deputy Ó Ríordáin, I launched a proposal for a catch-up scheme for children. A sum of €100 million should be pledged by the Government to enable schools to apply for targeted funding to make up to children for the immense loss they have suffered as a result of prolonged school closures. This has been recognised in Britain for more than a year. Just last week, the Institute for Fiscal Studies in Britain published a paper stating the crisis in lost learning calls for a massive national policy response. It pointed out the potential devastating effect of the crisis on educational inequalities and the mental health of children. We need to see a similar acknowledgement here of the impact on children. We need to see resources targeted to address the impacts on children and the serious impact Covid and associated school closures have had on their mental health. I rely on the Minister of State to bring these messages back to the Government. I am very interested in hearing what she thinks of a catch-up fund for children. It is an important practical measure we could introduce.

The Minister of State is very welcome to the House. I acknowledge her hard work in this area and on older people. I commend her on it.

There is no doubt but that we are bombarded with news about Covid from early morning until we go to bed at night. There is a constant stream of information about death tolls, infection rates and the R number. We need to know what is happening so this is necessary, but in recent months it seems everybody has become an expert on public health. Covid is present in every conversation with others, even here in Leinster House, through our masks, as we keep 2 m apart.

The mental health of every group in society has been impacted. From babies born last year, who have been held only in their parents' arms, to the elderly population in our nursing homes, this virus has truly affected every part of society. We are affected both by the virus itself and the necessary restrictions that have been introduced to try to contain it. Therefore, there is a double whammy. The disease itself has caused significant stress and anxiety. It has increased social isolation. There has been major disruption in our daily lives, particularly in the education sphere. Those in employment face uncertainty and so many have concerns over financial security.

The sandwiched generation, as we call them and about whom I spoke earlier on the Order of Business, are exhausted. They are caring for their elderly parents while trying to work and home-school their children. There is a very real threat of burnout in this case. We have to put in place positive mental health strategies to help this cohort to get through.

Children are missing the structure of school, and children with no siblings, in particular, are very isolated and lonely. Teens have no social outlet whatsoever. Leaving certificate students, in particular, are reporting very high levels of stress and anxiety, particularly since the announcement by the ASTI yesterday. All this is to say nothing of our front-line workers, who have had the most difficult year of their working lives. Many are reporting symptoms of post-traumatic stress.

Grief in the pandemic has been a very lonely place to be, coupled with the absence of our usual rituals of mourning. Jennifer O'Connell had an excellent article last weekend about families morning in a vacuum. It was heartbreaking to read. Many of us identify with it.

The department of psychiatry in Trinity College Dublin points to evidence that the combined effects of the pandemic and restrictions have caused significant psychological distress in one in five people. The rate is double that among those who work in the healthcare sector. As we move through the Covid landscape and look ahead to when the population will have been vaccinated, we have to consider the possible long-term mental health effects of what we have experienced in the past year. I refer to everyone from those with a pre-existing mental illness to those who have been particularly impacted by Covid and the restrictions, including those at risk for the first time. These are the children, youths and adults, including older people, whose lives were disrupted by economic and social upheaval.

Interesting research done on the severe acute respiratory syndrome, SARS, epidemic is absolutely worth examining.

The final point I will make is on the need for services for our young people. I brought it up before in Commencement matters and I have spoken to the Minister of State about the need for a Jigsaw facility in Newbridge, County Kildare. We have the highest cohort of young people and it is vital. I believe we are high up on the list and I would appreciate it if she would take that from today.

I join my colleagues in welcoming the Minister of State to the House. It is always good to have a constituency colleague in the hot seat. She has a challenging role and I wish her the best with it.

There is no question that Covid-19 has had a devastating impact on individuals and families throughout our country. Attention has been paid to our elderly and our young people because they have been so visibly impacted by this disease. In the case of our elderly, obviously they are more vulnerable to Covid-19, though it can affect anyone at any time. In the case of our young people, they have been visibly impacted because of the lack of in-person education, the cancellation of major milestone events and the inability to socialise at a formative time in their lives.

I do not blame the media, the Government or anyone for focusing their attention on our elderly and young people because that is where the visible effects are most apparent. However, when it comes to looking at the impact Covid-19 is having on mental health, the problem is it is often invisible. As Senator O'Loughlin said, it is often the people in the middle who suffer in silence. We have seen that with increased prescriptions for drugs to tackle mental health. We know it anecdotally from talking to constituents, families and friends. If a person has a cast on the leg or a bandage on the arm, everyone will ask that person how he or she is or what happened, whereas very few of us ask people "How are you?" and mean it or expect to get a response back saying "I'm not okay". We have come a long way in recent years in terms of people being willing to say they are not okay and the saying, "It's okay not to be okay", is important in that context. We have opened up more about it but we are not where we need to be for whatever reason, whether it be that there is a perceived stigma or that it is seen as weak to have a mental health problem. The reality is far more different. Mental health can take a toll on anyone. Be it the strongest person or the perceived weakest person, it does not matter. It does not discriminate who it affects.

If Covid-19 has taught us anything, it is that mental health issues can have such an impact and a toll, and even the strongest people who perceive themselves as optimistic and having a positive outlook have started to become insular, to look at the non-light at the end of the tunnel, as it were, and to ask when in the name of God we will get out of the situation we are in. I consider myself lucky that I have a job and am able to travel to Dublin, but many people are stuck within their 5 km. They are in a house or sharing with flatmates in a small area. They have lost their jobs or they are working at home and have to deal with home schooling. So many issues have faced so many people. The effect it has had is huge.

I will finish on the point, which Senator Buttimer raised, about sport and the benefit it can have, not just for our young people but right across society. I say that as a former physical education teacher. That, above all else, is something we have to grasp and try to find a way to facilitate people to exercise and meet in small groups or pods to engage with others, because that has such a positive impact on our mental health.

Sitting suspended at 3 p.m. and resumed at 3.18 p.m.

I welcome the Minister of State and I welcome the opportunity to contribute to this debate. Mental health has always been the Cinderella of the health service in this country, or until recently anyway. It has been underfunded and under-provided for. I have great confidence that the Minister of State, with her knowledge and background and the experience she has brought to her role, will do everything in her power to address that. Mental health has never been more to the fore, because of the pandemic in which we find ourselves, with the enormous strain and pressure on vast stretches of society. It is not just about people who have lost their jobs, although that is a major mental burden for them in trying to make ends meet; there are also people who would never have experienced, nor have expected to experience, the kind of personal isolation that is now part of their everyday life. We need to be careful with the restrictions we have put in place and with how we manage them and reach out to people.

I am very conscious that the younger cohort of people have suffered more than any. Whether young adults, students or people who are in or out of college, they are under enormous pressure.

I appeal today to the Association of Secondary Teachers Ireland, ASTI, to go back into those talks and engage fully and appropriately. No dispute was ever solved by people walking away from each other. For sure, it will take compromise and people will have to take a leap of faith and move beyond their entrenched positions. Teachers, parents and students all want this process to happen and have a successful outcome. From discussions I have had with them, leaving certificate students want a twin-track approach. They want the predicted grades. I do not for a minute underestimate how difficult that will be on teachers. It will, however, be equally difficult for children to sit an exam when they have not had the appropriate face-to-face education time to do it. I appeal to all sides to make that happen.

I am also concerned about the cohort of students who did their leaving certificate last year and who are now in their first year of college. I am concerned with the anecdotal information coming to me through my constituency office about the level of dropouts. I ask the Minister of State to speak to the Minister with responsibility for higher education, Deputy Harris, and engage with colleges to try to understand if we will have a higher dropout rate this year. She might ask him to engage with the colleges to establish how many first-year students have disengaged from college courses between the first and second terms. That information must be available.

What level of outreach have colleges been doing with first-year students? Perhaps, the Minister of State is best placed to advance this case. I have heard crazy stories of young adults who have left the shelter and protection of home, and the controlled system of post-primary schools, and gone into what we all know to be the open environment of third level colleges. They have not had that experience, however. They do not have anybody to rely on or to support them. In many cases, they are sitting in college accommodation, isolated, with no interaction other than what is happening online.

I have heard of cases where certain lecturers are putting the course online, effectively giving students the book and telling them to go and learn it and do the exams. I am sure they are isolated cases. However, I want the Minister, Deputy Harris, to engage fully with the third level sector and come forward to us, insofar as he can, with information about the important matter of dropouts and the mental health issues that have been felt by those in first year, and try to understand what that engagement has been, or in many cases, has not been, with first year students.

There are obviously huge implications for this year’s CAO. I heard the Minister on the radio today regarding a welcome announcement that there will be 2,000 extra places. Are those 2,000 places on top of the extra places that were provided for last year? Are they in addition to the 8,000 or 9,000 additional places? What impact will that have on addressing the significant burden that is coming on the CAO? The students who drop out this year and do not complete courses will no doubt be back on the CAO again. There is, therefore, a real pressure point. It is adding significantly to the mental pressure and torture on the minds of our youngest in society. I appeal to the Minister of State to engage with the Minister with responsibility for higher education on the basis of the mental health impact on those students.

I welcome the Minister of State to the Seanad. I congratulate her on the work she has done since she became Minister of State with responsibility for mental health issues. She has taken a lead on an awful lot of projects. It is an extremely difficult time for people but she has an extremely important role at the moment.

On a personal level, I thank her for the commitment she has shown to County Tipperary. I do not think we have ever had a Minister who has come to Tipperary and Clonmel and has taken such an interest and active role in trying to solve issues related to mental health in the region. She is only over the border and always available for a call. I am grateful for that.

As others have said, Covid-19 has many factors that have impacted on life and people in this country.

The biggest scar we will have from Covid-19, when we have people vaccinated and when we have control of the disease, will be the long-term mental impact for people. That impact will be felt by everyone, regardless of what age group they are in. I mention young children who cannot go to school and those doing their leaving certificate, who Senator Dooley mentioned and who are suffering uncertainty and stress with that. College students will have lost almost a year and a half of a four-year course. For anyone who has experienced college life; it is probably the best time of their lives but these students are not having that experience. People who are older and feel isolated are not able to meet up with friends and family and that is extremely difficult. As a Government, we need to be prepared for that and we need to be able to ring-fence funding for the impact that will be felt post-Covid-19.

I was speaking to Councillor Richie Molloy who is very involved with carers. Research shows the impact of Covid-19 on young carers, in particular. I know the Minister of State has a role in that as well and that is important too. Beyond 2021 - everyone is hoping we get back to normal in 2022 - the role we have in helping our communities get over the scars of the last year and a half will be hugely important.

We are quite fortunate in Tipperary in the last year or two with the announcement of Jigsaw. I know the Minister of State has been proactive in getting it up and running. Most people within the county accept that because of Covid, things have been delayed in having a building. It is important to stress Jigsaw has an online service which is available to people in Tipperary and across the country. If the Minister of State has any update on that, I would be grateful if she could send it on because it is important and it has been committed to by the Government and by her. I know a building has been sourced, interviews have been carried out and positions have been filled. Everything is ready to go and it is only being held up - like everything else in the country - by Covid. If the Minister of State has any update on that, the people of Tipperary and of Clonmel, where there will be a hub with the main centre in Thurles and a second hub in Nenagh, would be interested in it.

I refer to the Minister of State's other brief outside of mental health. I had a meeting last week with a group in Clonmel, headed by Noel Morrissey, about palliative care. There is a new building which the Minister of State will be aware of as she and the HSE are proactive on it, namely, St. Anthony's unit in Clonmel. It is a new top-class facility that is being built. Could the Minister of State send on some information on that? Where is it at and what is the long-term view? We had a constructive meeting. The Mayor of Clonmel, Siobhán Ambrose, was there as were my colleagues, Michael Murphy and John Fitzgerald. It is something that is needed in the town and in the region of Clonmel and Carrick-on-Suir. If the Minister of State has an update on that, I would be grateful to receive it.

I thank the Minister of State for being here and for being a mental health champion. It is clear since the Minister of State has gone into the Department that she has a personal interest in this. I know it is an issue of concern to everybody in this House and right around the country and that the Minister of State is interested in solving the problems. I know her legacy will be to resolve many of the challenges we have been talking about.

I particularly commend the Minister of State on some of the work she has been doing in the area of CAMHS. I know she recognises that it is not a 9 a.m. to 5 p.m. service. She knows about the particular challenges we have had in the south east and she has been active in engaging with Raymond Shannon and others from Talk To Tom and with voluntary groups. If we can move to a position where we have support, particularly for children and adolescents, throughout the week, that would be a noble legacy on the Minister of State's part.

I want to talk about two groups and the mental health impact they have suffered. One sector of society that has been very much affected by the pandemic is that of artists, musicians and those in the creative industry. We know they have been affected economically but for an artist or a musician, what they do is not just a job but it is part of their identities. I know many of those in that sector are suffering because they are not able to perform.

We need to look at specific measures. Artists and musicians have helped us through this period. We need to look at specific measures, as we are coming back as a community, to ensure that mental health supports are there for the creative sector.

The other group many have referred to is young people. When I was 18, 19 or 20, the last thing I wanted to do over a weekend was be stuck at home with my parents watching "The Late Late Show", particularly given that the starts of many of those shows are depressing. We have got to look at a new deal for young people coming out of this who have missed their 18th and 21st birthday parties. They have missed all of the opportunities that we had as young people.

I would share the concerns around the pressures that are being faced by those who are in first year in college and by those who are doing their leaving certificate. Whatever the resolution on the leaving certificate issue - I support giving leaving certificate students the choice - what is most important in this debate is those students' mental health and well-being and helping them to fulfil their dreams. I ask that when we come out of this, we look at a deal for young people to ensure they have the opportunity to have as full a life as possible having missed all of those important rites of passage.

It is fair to say that like nearly everybody else, I am fed up. I am tired of the restrictions. I want to go out and meet friends for coffee. At this stage, everyone is just waiting until we get the vaccines so that some level of normality can resume. It means that tempers are frayed. What we, including the Minister of State, have got to do is talk about positive mental health. We have got to start to talk about how folks might realise that everyone is going through a difficult period, be kind and be a little gentler. I wish the Minister of State a happy Valentine's Day. When we are in the series of love, love is an important thing. It is about stressing those important messages as well. We have to have hope. We have to have love. Those are the qualities that will bring us through this pandemic but that will bring us back together again as society.

I encourage the Minister of State to continue to be a champion. There are specific areas to address that we have talked about in looking at trying to provide mental health supports to people but we have also got to stress that there will be hope and that there is positivity.

That is possibly a first - to be wished that - in the Seanad.

To lead off on the final few points that Senator Byrne made, my sister, Ruth, is 20 years of age. She is in her second year in UCD and she has spent her whole second year on Zoom lectures at home. She does not know it, but I feel so sorry for people of her generation who are missing out on what are the best years of their lives. I look back on my three years in UCD as the happiest times of my life. They really were superb. Young people in this country have been scapegoated for some of the bad behaviour that we see sometimes by the curtain twitchers - the people on Twitter. These young people have been literally locked up and cooped up for the past year and a half. They have borne the brunt of this harder than anybody else. I am certainly in a much luckier position going through this than I would have been at the age of 20 or 21. We need to acknowledge the sacrifices that young people - teenagers and those in their early 20s - have made over the past 12 months.

That leads me on to the second point I want to make in relation to students. I would appreciate the Leas-Chathaoirleach giving me a little latitude on this. Speaking of the mental health struggles for students, I have been doing a lot of work with the students at Dundalk Institute of Technology, DkIT, in my town of Dundalk in the past week. They have, unfortunately, got caught in the crossfire of an industrial dispute between the Teachers' Union of Ireland, TUI, and the president of DkIT, and their examination results are being withheld from them. They are now eight days without having their examination results. Hopefully, the matter will be resolved over the weekend but we do not know yet whether that will happen. The president of the Dundalk Institute of Technology Students' Union, Mr. Taidgh Kavanagh, is an impressive young man who is doing quite a lot of work for the students there. We support the principle of the TUI and the work relations committee which they are engaged with. Unfortunately, the other side walked away from the table. The DkIT management side has walked away from negotiations.

As a result, students have been caught in the crossfire and their exam results are being withheld. I will take this opportunity to urge the DkIT management to walk back to the negotiating table, come to a compromise and ensure that students' results are released to them. That is the fairest approach to take. In this debate on mental health, imagine the difficult year that those students have had. They need to know their results, especially if they are in their final year and want to know whether they will get a 1.1, 2.1 or 2.2, which affects where they will go to college. That they do not have their results yet is a disgrace, so I hope that the situation is resolved as soon as possible.

I will turn to my final couple of points on mental health. RTÉ's "Claire Byrne Live" and other television shows are like the fifth horseman of the Apocalypse at times. I have never seen more doom and gloom. I have stopped watching them. The point is always made that they have to present the other view, but just because it is the other view does not necessarily mean it is right. Zero Covid is a fallacy. I say that because I am from a Border region. I live 15 minutes from the Northern Irish Border and know how bloody hard it would be to secure it. This talk is nuts. Besides trying to achieve zero Covid that way, we have three major ports in Ireland - Dublin Port, Rosslare Europort and the Port of Cork. Freight gets into New Zealand via containers, with one massive ship bringing in 1,000 containers. In Ireland, we have what is called ro-ro, which involves approximately 1,000 individual trucks and drivers coming in and out. How would zero Covid work in that light? How would it work if someone from Belfast or Newry travelled down to Dundalk to do some shopping? It is a fallacy. I understand that people are desperate and are trying to cling on to something, but zero Covid is not the way to go about this. It is like throwing a lifeline to a drowning guy who is looking for a bit of hope in the depths of January when we are all sick of restrictions, lockdown and everything else. We will be proven right on that in a couple of months or a year when all of this is ended around the world, the nightmare is over and we can look back at what worked and what did not.

I welcome the Minister of State and thank her for presenting to us. I acknowledge and pay tribute to the 29 people who lost their lives in mental health residential units and to their families. I welcome the start of the vaccination programme's roll-out to the over-65s in more than 46 mental health facilities.

We have heard the statistics and everyone has mentioned the increase in mental health issues. According to Trinity College Dublin's studies, one in five people is suffering. There has been a significant impact, especially on children. Special schools are reopening, which is giving parents hope and respite. Other schools will be reopening. College students have lost their college experience, which is a major issue. The 50808 text line is crucial, as it allows students at home to ask for help and talk if they are feeling down. Most shocking is that domestic violence is on the rise. It is significant in regional areas. There have been reports in The Connacht Tribune about the increase in domestic violence. That is scary. What is happening behind closed doors as opposed to outside is shocking.

I am a member of the Joint Sub-Committee on Mental Health, which is chaired by Senator Black. We all speak of mental health and wellness, but sometimes we must ask what well-being is and what it feels like. When we speak of mental health, it is as if well-being is up there somewhere, but well-being is about feeling well in oneself. Sometimes, it is not about the individual but a collective experience. It is about the community a person lives in and how he or she contributes. I suppose I am representing the Roscommon-Galway constituency, but the sense of community in small towns and villages in regional areas is strong. Before we had to deal with Covid, we had to deal with young people leaving our areas, but it is that sense of community that keeps many of those towns and villages going. There is an education for us all about what well-being is.

I am conscious of the particular challenges in regional areas - older populations, particularly in Roscommon and east Galway, and more isolated areas, which we saw from the previous census. Many people live on their own, for example, older people who have lost their loved ones and whose children are living abroad or in cities. It is difficult to find hope.

Hope is a very simple thing but that is what we have to give. We have to give hope. We have to understand what well-being is and we have to have something to look forward to, in a nutshell.

I want to speak about the importance of certain activities such as walking and cycling. We know this and that they are wonderful and we need to do them but it is so important to put funding into active travel to get footpaths so people can go out and walk in rural areas because, unfortunately, we cannot do it safely. Some of my colleagues have mentioned the importance of arts, culture, music and heritage. We have our amateur theatre groups, community town hall theatres and rural pubs that sometimes double as community centres and put on plays. They are all run by dedicated volunteers. They are highlights of our communities and they are so well supported but we need investment to support these groups. I am speaking about how mental health is connected with so many areas.

Local and national newspapers and regional stations are very important to me. Print and radio media are crucial to our well-being, particularly for those living in a town or village whose only connection to the outside world is listening to their favourite talk show host on Galway Bay FM or Shannonside Northern Sound. They are who get people up in the morning and who they listen to between 9 a.m. and 12 p.m. or whenever. People know what is happening in the world. With regard to newspapers, we have had many representations this week about the huge drop in advertising for print. There has been a 20% drop. We see support for broadcast. We need to look at support for our regional newspapers also.

The journalists have also been on the front line and we should not forget this. The journalists have been out there, getting the news and putting it into the newspapers at regional, local and national level. They are among the front-line workers who are supporting well-being and making sure there are stories that have some levity as well as the seriousness of everything we are dealing with. My job at home is to collect the newspapers to deliver them to some of my family and they really look forward to that. Once a week, the newspaper comes through the door.

We need to integrate across Departments with regard to education, farming and local government where we see mental health coming in. The Irish Farmers' Journal is doing a campaign to phone a friend. There is also the European innovation programme on farm safety, which includes mental health and well-being. We see this happening in many Departments and I encourage it.

I thank the Minister of State for being here and listening to so many contributions and for leading the charge in this area under her portfolio. Over the past three hours, plenty of people have come in here to tell her what to do. I want to thank her for what she and her team have done. I also thank all of the agencies throughout Ireland with which she interacts for what they do on a daily basis. As this debate is going on they are going about their work.

It is not as if people are not aware that we are facing a massive attack on our mental health and mental well-being but the response has been substantial from a range of groups. This morning, on my way here, I do not know how many times I heard the advertisement from the HSE for yourmentalhealth.ie, making sure the message is getting out continuously and telling people there is practical advice for them. This is happening on a daily basis and I acknowledge this and the work being done by the Minister of State.

Awareness is the major issue and it should be the key aspect of this debate. I know it is the key aspect of the work of the Minister of State. Many of our community groups have played a leading charge in this respect because they cannot fulfil their normal role, be it as a sport club, a church group or a school. All of these groups, instead of doing their normal work, are remembering they are made up of members and individuals and they are reaching out to them on a continuous basis. Senator Buttimer was right in what he said earlier, that when people return to the fold of these groups they should be asked whether they are okay and that this becomes part of the norm. I acknowledge this is already being done.

Over recent years, we have become more open about protecting mental health and promoting positive mental health because it is a shared experience. This pandemic is testing us all in a way we have not been tested previously. Even those of us who might feel we are strong and resilient are feeling challenged and we do feel low. We wonder whether we should even be talking about it because other have suffered more because they have suffered a bereavement. People have lost in different ways. They have possibly lost their jobs or interaction through work or school, as Senator Byrne mentioned, sport, going to mass and the simple act of meeting people.

In an earlier debate, Senator Mullen called for resilience and said we needed to encourage people to be more resilient in the face of the onslaught of negative news. I believe we need to be more compassionate. Nothing can be better than showing compassion.

I want to finish with some words by a fellow countyman, a man from Ashbourne called Rory O'Connor. He is a decent club footballer for Donaghmore but he is more famously known across Ireland for his videos and social media site called Rory's Stories that has 600,000 followers. Daily he uploads funny videos that have been a source of great fun for thousands of people and gives people a light-hearted moment. Lifting the mood is exactly what this man is about because he has had his own personal battle with mental health. Last Christmas, he launched his book that detailed his battle and journey to the good place that he enjoys now. His book and videos have been a source of hope for so many people who have and do suffer from mental health problems. I pay tribute to him, and wish to put that on record, because he has done more for people than he knows.

I will end by citing a couple of the words that he posted on his site to give people encouragement. He said:

Just remember to look after our own self thoughts. No doubt it's hard to remain positive, considering this has been going on for so long now. But remember you are not alone, so many others are struggling, struggling more than we have before. Let your family and friends know if things are very bad in your head. It might not change the world, but it will help you manage things a bit better by talking. We can all relate to somedays going OK and you're upbeat about things and other days it feels like the weight of the world is on your shoulders and its difficult to see any positives. Enjoy the good days and battle through the bad days. Stay safe and head up, ... [we will] enjoy normal times together when they come back and they will come back.

Never were truer words spoken. I say well done to the Minister of State for all that she is doing.

In the temporary absence of our good friend, Senator Norris, the father of the House, I call Senator Paddy Burke.

I welcome the opportunity to say a few words on this very important topic. I welcome the Minister of State to the House and wish her well with her endeavours in terms of this topic that affects nearly every household in the country at some stage or another. I compliment her on the great work that she is doing in this regard.

A lot has been said about the activities that should take place to help the mental health of people, and I fully agree. There is more that the Government could do to open up areas that are locked down at the moment due to Covid. In the middle of last year or whatever, the Government locked down certain counties or municipal districts. If that were done it would allow people more freedom to walk in their own counties. There are many areas, including in my own county of Mayo where we have magnificent hillside and mountain walks. These places are not being utilised at the moment. I do not think that there would be an overflow of people in those areas, so allowing people to explore these walks would greatly help the mental health of an awful lot of people. At the moment people walk in built-up areas like Castlebar, where we have a magnificent walk around the lake that is availed of by many people. If other areas were opened, it would give people a greater opportunity to go mountaineering and so forth. I believe that golf courses could and should be opened up because there are more people walking around the golf course at the moment than there would be if they played golf. I do not see what the difference is between people walking around a course and holding a stick in their hands to hit a ball. This is an area that the Government should consider in terms of 5 March.

One of the big areas that concerns mental health is drugs. I compliment the Garda on taking the step to perform drug tests at work. The Government should consider introducing drug testing in the workforce. There are countries that have drug testing in the workforce, particularly in the construction sector and in many other areas. It is very prevalent in Australia, for instance, particularly if people are working on high-rise buildings or driving machines. It is only fair for the safety of others that drug testing would take place. I ask the Minister of State to take a serious look at this.

We are now approaching a phase in which people will be working from home. People who are on drugs will not be noticed, whereas if they have to go to the workplace somebody might notice they are on drugs. The issue is not to find out that they are on drugs but that the mental health of those people can deteriorate if they do not get help, and they may not get the required help if they are working from home. It is an area we should examine.

I saw a statistic more than two years ago, that 50% of people in the country are taking drugs. That is a massive statistic. I do not know whether it is true, but if it is, it is shocking. We have seen the number of fines from the Garda Síochána. It is doing great work in detecting drugs. Even today, €7 million worth of drugs were found in Kildare. Imagine €7 million worth of drugs. In the little village of Balla in my home area, the Garda found €73,000 worth of drugs. This is a small, rural village. I believe it is an epidemic in the country. It is something that is greatly affecting the mental health of many people, more than anything else in my view. There certainly must be a demand when so many drugs are coming into the country. I hope these are matters the Minister of State will examine.

I congratulate her again and wish her well in the great work she is doing in this area, because it involves a lot of misery for a large number of people. It brings great misery to many families. It is not a stigma, in my view. We all should reach out to people who need help, and I compliment the Minister of State in this regard.

There is another Member on the list of speakers, but the Member is not present. I call the Minister of State.

I thank the Members for their time today. It was a very good debate. The standard of the contributions was excellent. They were well thought out. Obviously, there were criticisms but they were constructive. I take on board everything that has been said in the debate, and I welcome it.

I will try to respond as far as possible to the questions that were raised. How much time do I have?

We have some time on hand. If you can hold everybody's attention, you can keep going.

I will try my best.

I welcome the opportunity to restate my and the Government's commitment to the continued development of mental health services and supports during and beyond Covid-19. The pandemic has been very challenging and, in response, a range of mental health supports has been established. At the outset, we put in place proactive measures to provide for any increase in service need. That is the most important point I can convey today. Supports were retained from last March when we had the initial wave of Covid-19. Some 85% to 90% of acute supports were retained. That message must be conveyed to the public because there is a very negative narrative circulating that nothing is being done with regard to mental health. A massive amount of work is being done. I commend every person involved in the care of people with ill mental health, be it in the acute setting or the community setting. Wherever it occurs, people are working their fingers to the bone each day to help people with ill mental health. They must be acknowledged.

Residential services were quickly identified as the highest risk areas for staff and service users. With this in mind, the Department asked the Mental Health Commission to develop a risk control and monitoring framework for these facilities to identify and address infection risks. As we know, infection prevention and control are the key issues in a mental health or healthcare setting. Facilities were reconfigured to reduce the risk of cross-infection. In addition, staff training, personal protective equipment, PPE, provision and testing were implemented to recommended levels.

As a result, HSE residential mental health services have continued throughout the pandemic. To ensure safety there has been reduced capacity in some settings, especially in respect of face-to-face meetings. There had to be a blended approach to that. Much of it had to be done by telephone or Zoom but it did continue. There have been some outbreaks but the procedures in place have reduced the impact of that as much as possible.

At this point I would like to remember the 29 people who died due to Covid-19 while resident in a mental health centre. I believe that without the work on outbreak control the situation could have been much worse. I commend all those involved who worked tirelessly to keep people as safe as possible.

I will pick up on a few points made by Senators. Senators Paul Daly and Keogan raised the issue of bereavement and the many challenges posed in that regard. I want to put on record that I have allocated money this year for more bereavement counsellors to be hired but counselling hours for bereavement and for bereavement crisis have been available during the entire time of this pandemic. There is a lot of support available of which people might not be aware.

There was much talk about bereavements and funerals in the debate. I would say to Senator Keogan that the Government is not stopping people attending funerals. Covid is stopping them attending because we have the evidence to prove that there were significant outbreaks associated with funerals. My 89-year-old aunt passed away on 1 April last year. She was one of a family of ten and none of her siblings - my own mother included - could go to the funeral. Twenty people were allowed to attend it, so our generation went instead. My mother still cannot believe to this day that her sister died and she could not go to the funeral and grieve. We were lucky to be able to record the service on an iPad and they were able to watch it. I understand at first hand how difficult it is but the challenges around funerals do not arise when one is inside the church. The churches have been fantastic at keeping people socially distanced. The distances are marked out as they are in this Chamber. However, the gatherings before and after the funerals is where the challenges arise. I am a weekly mass-goer and I would love to be able to go back to mass. I know such attendance is a comfort for many people, regardless of their religious ethos. I hope we will be able to go back there as soon as possible, having started the vaccination process.

That leads me nicely to vaccinations, which is also linked to mental health. As Members are aware, we started by vaccinating the most vulnerable who were in the nursing home settings. The figures I have this week indicate that to date, unfortunately, we have lost 1,739 people in the nursing home settings. I commend again the work that has been done by public, private and voluntary nursing homes. They have been at the forefront of this pandemic for the past ten or 11 months. It has been very difficult. Unfortunately, people in nursing homes are very vulnerable. They have underlying conditions and when Covid-19 gets into a facility it spreads like wildfire. That has been very challenging. Obviously, they were prioritised first along with front-line workers but next Monday we will start the roll-out of the vaccination process for those over 70. We will start with those over 85, the majority of whom have been contacted by their GPs to arrange that. It will start with 12,000 doses of the vaccine vials being distributed to GPs next week.

This is a huge logistical challenge and there have been criticisms of the amount of time the vaccinations are taking but there are 490,000 people aged over 70 in this country. Many of them live in rural areas. Many of them might not be able to travel from their homes so the logistics around all of that are being put in place. The roll-out of the vaccine has to be safe and effective. We have also committed to giving two vaccines within 28 days. That makes it a challenge logistically but it is starting. The only limit to people getting the vaccine is supply and to date, the supply has been difficult. I was doing an interview earlier and before it I looked for the figures. We have received 273,000 doses of the vaccine and 250,000 doses have been put in people's arms. We have to keep a buffer for anyone who got their first dose of the Pfizer-BioNTech vaccine because there is a guarantee that they will get the second dose within 28 days.

There has been much criticism that the vaccine is not being rolled out fast enough. Nobody is sitting on a vaccine and no vaccines are in cold storage. I would love to say there is one for everybody in the audience; there will be but it will take time. I hope the number of vaccines coming into the country will ramp up significantly in April. This has affected older people's mental health but nobody will be left behind with this vaccination process. If somebody cannot leave his or her house, plans will be made to ensure the vaccine gets to them.

There are some older people not registered with a GP in this country for some reason. They may have come into the country or perhaps they chose not to have a GP. They need to contact the HSE as a matter of priority on 1850 241850. They will be facilitated through their nearest GP and I would appreciate it if everybody could get that message out there.

I compliment Senator Black, who is a passionate advocate for mental health. She spoke about setting up the RISE Foundation and she is the Chairman of Oireachtas Sub-Committee on Mental Health. I would like to work closely with her and look forward to a meeting we will arrange in the next couple of weeks. It has been said by many today that this is not just about the Department of Health, and that is why the new Sharing the Vision policy is cross-departmental. It goes across the Departments dealing with social protection, housing and business. People's mental health can be affected for myriad reasons and having everybody working together is very important.

Community mental health teams continue to provide services, with adaptations in place to protect service users and staff. Online psychosocial supports are now embedded in service provision. As Senator Black mentioned, there are many people with acute mental health conditions and I am thankful they are being looked after. A position has arisen in the past 12 months where people's well-being is being affected, leading to changes in mood, anxiety and depression. There are challenges with work and having enough money to pay the mortgage. They are trying to homeschool or there may be college students who cannot go to college. These people may be trying to care for others. There are many challenges but there are supports, and I will touch on that.

There are telehealth services, some of which operate seven days per week, including YourMentalHealth.ie, the information line 1800 111 888 and the crisis text line 50808. Non-governmental partner online supports include MyMind, Turn2Me, SilverCloud and Jigsaw. MyMind alone delivered nearly 10,000 free online appointments in 2020 and provides counselling in 15 different languages. We are now a country of many different races and languages, and we do not all just speak English and Irish. I was questioned in the Dáil last week about what we are doing for people in direct provision, for example, with ill mental health and those supports are there in up to 15 different languages. We are trying to ensure they are accessible to everybody. There is still some unused capacity in this area and the Department and HSE continue to plan for any surge in demand as it arises.

We do not yet fully understand the impact of Covid-19 on mental health but it is acknowledged that there have been increased presentations in certain areas. I am especially concerned about the rise in eating disorders among girls and young women. The 2021 budget allocation will enable continued development of the national model of care in eating disorders through the establishment of three new specialist eating disorder teams. I am fully committed to ensuring that the total funding of €3.94 million allocated to this important programme will be spent in full this year.

Currently, data indicate no evidence of a significant increase in self-harm presentations to accident and emergency departments, as was mentioned a lot today.

The significant increase in those presenting to accident and emergency departments with self-harm has been much referred to today. It is too early to speculate on the reasons for this increase. Many of the causes might be hidden at home and may not be brought out into the open. It is also too early to speculate on suicide figures, which the Central Statistics Office reports each June, following the coroners' verdicts. However, early international evidence has indicated no increase in suicide, and a decrease in self-harm suicide attempts, early in the pandemic. These findings should be interpreted very cautiously as we await more up-to-date analysis.

Of course, a negative mental health outcome for our population following this pandemic is not inevitable, if we set about responding to the challenge in a cohesive manner. In line with the WHO guidance, the HSE has published a psychosocial framework. It builds on a range of supports that were introduced early last year in response to Covid, including self-harm and psychological first aid supports for staff. The framework acknowledges the impact of the pandemic on mental health in all areas of society, and identifies priority groups, including healthcare workers and people bereaved due to Covid. The framework provides a cohesive, co-ordinated, consistent and collaborative approach to the provision of mental health services and supports across five key levels, from mental health promotion to specialist supports.

It was stated earlier that good mental health programmes have been in place before. Senators have asked if such programmes will be implemented and how it can be ensured that the money in the budget will be spent. I am trying to think which Senator raised that issue. The implementation of the Sharing the Vision policy is proceeding. The difference between this programme and others is that the independent national implementation and monitoring committee is in place. It was established last year and meets monthly. In fact, it held its third meeting this morning. It will hold me, the Department of Health, the HSE and the Minister for Health to account. I have no doubt that it will be quick to come forward if it feels that we are not doing what we should be doing. I am positive that Sharing the Vision is proceeding and is proceeding well.

Many Senators have raised the issue of budgets. I know that Mental Health Reform will have written to all Deputies and Senators in the past few weeks regarding the budget. It is fair to say that we have the largest budget in the history of the State for mental health. It totals €1.76 billion, which is a huge amount of money. The most important thing is that the money is spent well, and there is oversight of where it is being spent.

Of the additional €50 million which was secured, €23 million is allocated to commencing the implementation of the short-term recommendations of the Sharing the Vision policy. This includes funding to recruit 153 new mental health workers. There was much talk about CAMHS here today. To be honest, I was appalled to learn that the waiting list for CAMHS has got to the level that it has. Some 29 new staff will be recruited for CAMHS, which is hugely important. It will have a significant impact. I met with the HSE last week to discuss the recruitment of these members of staff. Obviously, Covid will be with us for a long time to come, and we need to have that recruitment process up and running in parallel with what we are doing on Covid. With panels and other aspects, it takes three to four months to recruit people. With recruitment for CAMHS in particular, staff will need specific training on dealing with children. For example, a staff member could be a psychiatric nurse who has only done adult psychiatry. Sometimes staff need to upskill and complete training. It is important from that perspective. We are focusing on this recruitment. I will be meeting the HSE every two months regarding how the recruitment process is going and where we are with it. There is no point in asking the HSE for an update on the process in October or November 2021. It is most important that those members of staff are recruited.

Many Senators have raised the issue of primary care psychology for children. I believe it was raised by Senator Gavan. It is a worrying issue. When one comes into this job, it is necessary to pick and choose what can be done in a very short space of time. Psychological care for children was an area that I was particularly bothered about. I am currently working with the HSE on a proposal to fully develop, at a cost of €5.5 million, a means of targeting the waiting list.

There are 4,800 clients under 18 years of age, many with quite complex needs, who have not been seen by a psychologist and are waiting over 12 months. An initiative is being planned which will supplement the enhanced community care programme to recruit staff on a one-year basis. It will be a targeted approach to get these almost 5,000 children seen this year. That will be a job well done if we can target the CAMHS and psychology waiting lists.

There are many people in posts who will be able to look after their routine lists. However, when a waiting list builds up to that extent, it is hard to target it. I want to put in a targeted one-off approach for one year only to get down the 5,000 children with complex needs who need to be seen quickly. I am hoping to have news on that soon. We are at an advanced stage on this. I have spoken to the Minister, Deputy Stephen Donnelly, and he is supportive of providing the money for it. We are just trying to finalise the details.

When issues come up with the provision of psychologists and psychiatrists, the problem is not money but getting the consultants and dedicated qualified staff to carry out this work because very few of them are unemployed. It is a question of trying to get that over the line but we are working hard on it.

Up to €15 million will provide additional capacity in private sector approved centres, more step-down beds and extra resources for community mental health teams, as well as reconfiguration of facilities.

With regard to other developments, the National Forensic Mental Health Service will be relocated this year from Dundrum to a purpose-built facility in Portrane. I thank Members of both the Upper and Lower Houses for supporting the legislation in December to facilitate this move. I am hopeful the relocation will happen in the second quarter of this year.

The review of the Mental Health Act 2001 is concluding and the heads of the new Bill will be published soon. A significant amount of work is involved in it but we want to get it right. Connecting for Life, the suicide reduction strategy, has been extended to 2024. When I came into office, it had expired, running from 2015 to 2019. I compliment the work of the National Office of Suicide Prevention, which is doing a huge amount of work in this area.

I thank all those working across the mental health sector who continue to provide services and supports during these difficult times. I am fully committed to continuing to develop and enhance our mental health system for all individuals during and beyond this pandemic. Senator Cummins referred to the stigma around mental health and its challenges. We have come a long way since last March. People are now standing up and they are not afraid to talk. It has been difficult for children, parents, students, those working from home and those who have lost their jobs. It has been the most challenging time but people are resilient and upbeat as well. The vaccines have given people much hope. It is slow at the moment as we are limited to supply. However, as soon as we have it, we will get it into the arms of every single person. I thank the vaccination teams which are doing phenomenal work in parallel to their normal work. It is absolutely fantastic that this work is being done.

Senator Cassells made an upbeat contribution. The response has been substantial from all those working in mental health supports. We need to move away from the negative narrative. A significant amount of work is being done, for example through the In This Together campaign. Up to €7 million was allocated to the Keep Well campaign. We must encourage people to keep well, to stay connected, to get out for that walk if they can and to do the very best they can to support each other. It is difficult but, by everybody pulling together, we can get through this. The light is at the end of the tunnel with the vaccine. Many people will be affected for a long time but I will not be found wanting as Minister of State to get the supports into the community that are needed.

I thank the Minister of State and colleagues for the sensitive and serious approach to this real issue. When is it proposed to sit again?

Next Monday, 15 February at 10.30 a.m. in the Dáil Chamber.

The Seanad adjourned at 4.15 p.m. until 10.30 a.m. on Monday, 15 February 2021.