Mental Health and Older People: Statements

I thank Members for the opportunity to update them on developments in my area of responsibility, which covers mental health and services for older people.

The protection of the vulnerable continues to be a priority for the Government, especially in these challenging times. We recognise that those with mental health issues and older people are often among the most vulnerable in society.

While much has been achieved in mental health in recent years, largely due to a welcome and broad consensus both inside and outside of the Oireachtas, much remains to be done. We are fortunate in Ireland to have in place fundamentally robust legislation, policies and services that have been built up over time and which, overall, compare favourably internationally. More importantly, there are identified and widely agreed pathways to undertake further improvements on all these fronts, including improved residential and community-based care for children and adults and psychiatry of later life.

In terms of mental health, my objectives right now are to progress the commitments reflected in the Programme for Government: Our Shared Future, and also to maximise the response of the mental health system to the evolving issues posed by Covid 19. I am, for example, progressing the update of the Mental Health Act 2001. I am determined that the legislation required to open the new forensic mental health facility at Portrane to replace the Central Mental Hospital in Dundrum is completed as quickly as possible. This significant and modern facility is expected to open early next year.

The establishment of the monitoring and implementation committee to oversee the new policy, Sharing the Vision – A Mental Health Policy for Everyone, is well advanced. This will be key to building on the fundamentals of A Vision for Change, driving new service developments and instigating new approaches to delivering some existing services through, for example, the greater use of digital technologies. I intend to increase, as overall resources allow in future years, the €1 billion or thereabouts given to the HSE this year to maintain and develop its wide range of mental health and suicide prevention services. These span all specialties and ages, from mental health promotion and early intervention to acute inpatient care and clinical programmes such as self-harm or eating disorders. Improving access and reducing waiting lists, where possible, are key objectives for the Government, notwithstanding acknowledged difficulties and the greatly changed operational environment posed by Covid-19.

Hopefully, the opportunities posed by the new policy, new infrastructure, increased training places and new technologies will assist in improving recruitment and retention rates in geographic areas of the country where these have, for whatever reason, traditionally been below the national average.

Since becoming Minister of State, I have met various mental health groups and advocates and visited services on the ground. I intend to meet and visit many more, Covid restrictions allowing. While I accept the scope for improvement on many fronts, my experience so far has been that the passion of advocates is matched by the dedication and professionalism of our mental health and other care staff to deliver the best possible service, often in the face of increasing demand and unprecedented circumstances. Some of the negative stories I hear do not correlate with the positive reality on the ground.

As I have indicated, work continues on draft heads of a Bill to revise the Mental Health Act 2001. These relate, for example, to revised criteria for detention, new definitions of mental illness and treatment, improved safeguards for change of status from voluntary to involuntary patient and the treatment of children under the Act. This process takes into account Ireland's international obligations, such as the ratification of the Convention on the Rights of Persons with Disabilities, as well as recent legislative changes in Ireland, including the Assisted Decision-Making (Capacity) Act 2015, and proposed protection of liberty safeguards. These changes and others, when included in revised mental health legislation, will further improve the protections available to mental health service users.

The implementation and monitoring committee envisaged under Sharing the Vision – A National Mental Health Policy for Everyone will be representative of relevant stakeholders, including service users, which is extremely important. It will drive reconfiguration, monitor progress against outcomes and deliver on commitments made in the new policy.

I would like to highlight, in particular, the issues posed by Covid-19. The pandemic is understandably a source of significant stress, anxiety and fear for many people. This arises from the disease itself, as well as from impacts such as increased social isolation, disruption to daily life and uncertainty about employment and financial security. Just as effective physical measures can be taken to limit the impacts of Covid-19, there is simultaneously much that can be done to promote resilience, protect mental health and aid recovery, where this is necessary. It should be remembered that other serious diseases and illnesses can potentially lead to mental health pressures that are often also positively addressed.

All levels of the HSE mental health service, in conjunction with many State and other agencies, will continue to respond in the best possible way to Covid-19. We all want to ensure that services continue while at the same time introducing more tailored measures to deal with mental health needs during and following the pandemic. It is worth noting, in terms of the effects and challenges of Covid-19 on our mental health system, that approximately 90% of supports were continued during lockdown. In addition, a blended approach to service delivery was quickly adopted by many organisations and that will help inform greater clarity around the roles and responsibilities throughout the sector in the future. I thank the many organisations that have acted very quickly.

Approximately €1.1 million has been provided for a mental health promotion and well-being campaign, through enhanced online supports funded by the Sláintecare integration fund. This funding has been used by the HSE to further update the mental health signposting website The funding enhanced psychological oversight of the new free national crisis text line, provided free online counselling for those affected by Covid-19 through MyMind and peer group support for healthcare workers and medical staff. A further €1.1 million is supporting the HSE psychosocial strategy. This will enable the healthcare system to plan additional integrated solutions to augment existing interventions funded to date.

HSE mental health services have a proven response model in place for monitoring and safely delivering services to the maximum level possible in pandemic circumstances, for both community and residential services. The Mental Health Commission will continue to play an important role in helping to monitor and combat Covid-related issues in mental health centres under its ambit. The Department will continue to work with both the HSE and the Mental Health Commission to ensure the evolving situation is monitored and any required actions are taken as fast as possible.

We have been working with the Department of Education to provide a collaborative approach to assisting leaving certificate students and their families in dealing with the additional anxieties associated with cancelled examinations and the return to school or going to college. A guidance document and list of supports have been developed for parents and teachers. The website has been updated and provides a good starting point for any student, parent or teacher looking for information on what is available during this difficult time. I am conscious today of all the students waiting for their first round offers from the Central Applications Office on Friday.

The impact of Covid-19 on society in general, but on older people especially, has been considerable. Older people have made huge sacrifices to protect themselves and the rest of society. We, as a country, owe them a debt of gratitude for their selfless action. I am acutely conscious of the grief people have experienced over the past six months. I offer my deepest condolences to all those who have lost loved ones.

Maintaining our well-being and resilience in these challenging times has not been easy. Our lives have changed dramatically over the past six months. We have all had to adapt to a new normal that is different for every one of us. Perhaps the biggest changes have been experienced by those most at risk, namely, older people and those with underlying conditions. My Department and the National Public Health Emergency Team have, from the outset, focused on them, establishing a subgroup on vulnerable people as part of our early response to the pandemic. The subgroup has provided oversight and assurance with regard to the measures required to protect vulnerable groups from the virus to the greatest extent possible. Specific guidance for the over-70s and medically vulnerable has been provided by the Health Protection Surveillance Centre and is available on its website.

The Government's In This Together campaign has provided lots of tips and advice on looking after mental well-being, staying active, eating well and staying connected, drawing together a range of activities that can be pursued at home or locally, alone or with family members or friends online. The campaign has simple key messages on staying connected and creating a routine in addition to tips on stress reduction and links to services providing a valuable and vital resource of trusted information in one place. Through social media channels, the campaign called on those who were aware of vulnerable people in their locality to ensure they were checked on and looked after, either through helping with groceries and shopping or helping them to link in with relevant services.

The Community Call initiative has mobilised resources and community initiatives to support those who have been cocooning to help them to gain access to services. Community Call has been supported by local authorities, An Garda, the GAA, other sports organisations and community volunteers. As part of this, each local authority established a helpline that vulnerable people can phone if they are looking for basic services, such as the delivery of food or meals, or transport for essential trips.

Just 30 minutes of activity per day could have a great impact on one's health. Resources such as those provided through the In This Together campaign, Sport Ireland and other partners have been very valuable in promoting the need to remain sufficiently active even when restricting the number of contacts or cocooning. Our clear message is that whatever people are going through owing to reduced social contact or isolation, we should all stay as connected as possible, thus helping to strengthen community and individual resilience and restoring hope that we can and will recover. We will make it through this together.

Supporting older people to remain in their own homes and communities, live with dignity and independence and to be engaged in their communities is a key tenet of Government policy. We are committed to the development of improved committee and home-based services, shifting care to homes and offering greater choice for older people. This includes the development of the statutory home care support scheme, in addition to developing and enhancing services, such as reablement to support people to live at home for as long as possible and to reduce reliance on care in congregated settings.

Work is ongoing in the Department to determine the optimal approach to the development of the statutory scheme within the broader context of the ongoing reform in Ireland's health and social care system, as envisaged in the Sláintecare report. This work has been informed by stakeholder engagement, which will continue through the development of the scheme. The HSE continues to work closely with providers and community staff to identify where a service is most required and has been undertaking risk assessments of local services. This is to ensure, in so far as possible, that day care centres can resume in the context of Covid-19 and having regard for public health advice. Day care services will resume when safe and when all infection prevention and control measures and the requirements of physical distancing can be maintained so as to protect service users and staff and to prevent any further spread of the virus. Some centres may not be suitable owing to the constraints of the physical environment, and it will be necessary to continue or expand alternative service delivery models developed during recent months. I am deeply aware of the impact of the continued delay in the reopening of day centres on older people and the important role a day care service can play in their lives. I have asked the HSE to ensure that it will continue to assess the risks and benefits of reopening, in addition to continuing to expand and explore alternative ways of delivering services to this vulnerable group. I am continuing to meet the groups that work with and on behalf of older people to determine how older people can best be supported during these challenging times.

The Covid-19 nursing homes expert panel report was published on 19 August. The report contains 86 recommendations in total and over 15 thematic areas, with associated timelines for implementation over the short, medium and longer terms. We have established an oversight structure to ensure the implementation of the important recommendations contained in the report. This encompasses the establishment of both an implementation oversight team and a reference group.

I am acutely aware that Covid-19 and the resulting national and local lockdowns generated specific challenges for people with dementia and family carers. Day care and respite services have been suspended and the usual routines have been disrupted, creating additional pressures for service users and their families. The HSE has adapted its community services to provide a flexible response so the needs of people with dementia continue to be met during the Covid-19 crisis. Primary care team support is operating nationwide, with referrals being made to community supports, including the Alzheimer Society of Ireland's dementia advisory service and the local authority community response forums. The HSE's memory technology resource room network has been centralised, with advice and video assessments provided by telephone and online.

As this is my first time addressing Deputy Butler in her capacity as Minister of State responsible for mental health and older people, I congratulate her on her appointment. As Sinn Féin spokesperson on mental health, I look forward to working with her in a spirit of constructive, genuinely solution-focused, tangible opposition.

For too long, mental health has been the Cinderella of the health service. We need parity of esteem between mental health and physical health. In June of this year, the former Minister finally published Sharing the Vision - A Mental Health Policy for Everyone. There are 100 recommendations in the document, 41 of which are classed as short term and to be implemented within 18 months. These short-term recommendations comprise the foundations of the whole policy. They are the building blocks on which it is built. If these foundations are not secure, the policy itself will come tumbling down. It is almost three months since Sharing the Vision was published, yet there are still no costings or timescales for its implementation. As part of the Minister of State's discussions on the upcoming budget allocation for mental health services, she should ensure that the appropriate resources to implement the 41 short-term recommendations are made available if she is to give this policy document a fighting chance.

The first recommendation is for an independent national implementation and monitoring committee to oversee the process. With regard to the previous document, A Vision for Change, the Minister of State's predecessors chose the recommendations to examine without taking into account the overall vision of the document. This is not a game of Jenga whereby one can pick and pull the policies that look the most appealing but in which, ultimately, everything just collapses.

It is a shame that the Taoiseach did not believe mental health warranted a place at the Cabinet table. If he had, it would have given the Minister of State direct access to those who make the policies on housing, education, social protection and other matters right across the spectrum. The policy decisions made at that level have a direct impact on people's mental health.

As with the Minister of State, I have had several meetings right across the country with relevant stakeholders. One of their key asks - I am trying to help the Minister of State out on this - is the reappointment of the HSE director of mental health services, who would report directly to the Minister for Health.

The decision of the HSE to remove the post of national director sent out a clear message that mental health is not a priority for the executive.

There are huge concerns in respect of all areas of mental health service provision, but most notably in that of child mental health. More than 8,100 children and teenagers were awaiting psychology appointments at the end of June in 2020. This figure represents an increase on last year's and shows that systematic underinvestment in and mismanagement of mental health services are coming home to roost. What worries me most is that 3,359 of these children were waiting over a year. This is unacceptable. Early intervention is key to a child's development and any delay in treatment can have an untold detrimental impact on children's future well-being. Sometimes we get lost in figures. We hear figures all the time in the context of Covid-19 and get lost in them, but behind each of those figures that make up the number of 3,359 waiting for appointments is a child with an individual story and an individual need. It is a vulnerable child who deserves a service.

I challenge Deputy Butler, during her tenure as Minister of State with responsibility for mental health, to get rid of the draconian practice which leads to some of our vulnerable children with acute mental health needs being admitted into adult psychiatric hospitals. It is frightening for any child to be admitted to a hospital for mental health reasons but this is exacerbated for those children who are placed in adult units. In 2019, 54 children were admitted to adult units. Child or adolescent mental health care should not be dealt with through a service that is not specifically equipped to deal with their needs.

As the Minister of State will be aware, two weeks ago I received a petition from Stacey Quinn who collected 45,000 signatures calling for 24-7 access to emergency mental health services. I commend Stacey on her activism and passion and the Minister of State on acknowledging the petition to me yesterday. What Stacey and the 45,000 signatories are calling for is not rocket science. All they are seeking is something simple, that is, 24-7 access to emergency mental health care. If I bang my head on the outside, I will be treated by a medical professional. If I have an issue going on inside my head, however, I will not receive the same level of care. Mental health issues do not occur just between the hours of 9 a.m. and 5 p.m. and they do not take the weekend off. As the Minister of State mentioned, mental health issues have not taken a break during the pandemic. In fact, we have heard from numerous stakeholders that mental health problems have been exacerbated because of Covid-19.

We can have no half measures when it comes to mental health. The onset of the Covid-19 pandemic has only increased pressures on an already under-resourced mental health service. We heard from the Covid-19 committee that there will be a huge demand for mental health supports post pandemic and that this demand has already been seen during the pandemic, right across the spectrum. Our community-based mental health services that were already bursting at the seams prior to Covid are now seeing unprecedented demand for their services. Despite modest Government investment in mental health services in recent years, we have seen little improvement in waiting lists. The figure of €1 billion allocated for mental health in 2019 was much lauded by the Minister of State's predecessor and thrown out by him at every opportunity. However, I remind the Minister of State there was also budget of €1 billion back in 2009 and there has been no substantial increase in funding in over ten years despite a much higher level of demand.

Tomorrow is World Suicide Prevention Day. Last year, 421 people lost their lives through suicide. That is 421 too many. I wish to send my condolences and solidarity to everyone who has lost a loved one through suicide.

Increasing the priority and spending on mental health services is not a cost, it is an investment and one the Minister of State cannot afford not to make.

I congratulate the Minister of State and look forward working with her constructively.

Covid-19 has had a disproportionate effect on our older population, not just in the number of elderly people who died but in how the Government's response impacted on their daily lives. In the context of every roadmap and announcement, they were told to cocoon and stay hidden in their homes and that everything would be okay. We see now that everything was not okay.

The level of over-subscription to the Age Action and Irish Red Cross hardship fund shows that there is a huge need for the Government to set up a fund of its own. While I commend the work of Age Action, it, and groups like it, exist only because of the continued failure of successive Governments to provide proper funding and services for our older population. More than 21,000 applications were received for the Age Action fund. With €103,000 raised, only 453 applications out of 21,000 were granted. This was not Age Action's fault. It petitioned the Department of Employment Affairs and Social Protection to help in meeting this demand. It is a disgrace that calls were ignored and that many vulnerable elderly people were left with no additional financial support during this difficult time. I have spoken with representatives from Age Action who expressed their deep frustration at this. Many of these applications were from people who relied on external supports such as day care centres, which are still not open, while others require technology to assist in maintaining social and familial relationships.

Samaritans Ireland agreed a memorandum of understanding with ALONE, many of whose volunteers felt overwhelmed by the levels of emotional distress expressed by the callers. Between 9 March and 28 June, ALONE received more than 25,000 calls from older people and made almost 120,000 calls. We need day care services for older people to reopen. We need repair works on older people's services. I particularly want to see the long-awaited repairs to Monasterevin Day Care Centre prioritised and completed as soon as possible. This has been an ongoing saga for many years.

Finally, I would like to recommend that people watch the movie "I, Daniel Blake". I have a copy and it should be compulsory viewing for all politicians. While set in Newcastle in England, the story will be familiar to people who must apply for any State supports here in Ireland. We need to remove the huge amount of red tape to make it easier to apply for State benefits. For example, the form to apply for the carer's allowance is 40 pages long. Some State supports can only be applied for online. This disadvantages many of our citizens, particularly, the older people I deal with.

Will the Minister of State engage with the many groups that represent older people and listen to their views? Please give them the help they deserve because they are the backbone of our country.

I wish the Minister of State all the best. I only have a short amount of time. I could talk for hours but I presume Members are all glad that I am prevented from doing so.

My parents are in their 80s so I wish to concentrate on relaying the concerns of a son about having two parents in that age bracket. My mum is 80 and my father is 81. They are active and very much community people as everyone around us and throughout much of Tipperary knows. My mother would have been going on her 15th trip to Belarus this year only for Covid-19. I do not know if I would want her going there to work in the orphanages the way the situation is at the moment. My parents are active in the community but their lives have changed dramatically and so have the lives of many elderly individuals across Ireland. We need to concentrate and focus in on them because they have paid their taxes. They have worked, by God, have they worked. They have worked so hard and they have gotten us to where we are as a community, a society and a country and we cannot just let them rot. I often feel they are being forgotten so it is the Minister of State's job in government to make sure they are not.

I want to refer to a gentleman lives near me. I will not say his name, although if I asked him, he would not mind. However, I have not asked him yet. He basically said that he will not tolerate another cocooning lockdown situation and he will take his chances. He is 86 years old. He could not really go to the pub because the pub is closed, not that he drank much. He cannot go to see his grandchildren and great grandchildren play hurling, or his grand daughters and great granddaughters. He has no car so he walks around the road on the bit of land that he has, which is not much. He basically hopes a neighbour will drive by so he can have a chat. He goes to mass once a week for 20 minutes or 25 minutes.

We have all the statistics in the context of what Age Action Ireland and ALONE have said. We all know what we are dealing with here. What I am asking the Minister of State is simple. All the technology in the world is not going to work for many of our elderly. We need a plan for them.

This will be with us for a considerable period irrespective of whether we get a vaccine. They deserve to live within our society and have a good quality of life like the rest of us. I ask the Minister of State to ensure that next week's plan is elderly proofed. I am sorry for getting down into detail. We need to have a specific plan to ensure that all our elderly can get out and about, have stimulation, and go to social and sporting events in a controlled and safe way.

Someone in their 80s asked me a very simple question as to when they could go back to playing cards, just the six not a nine even. This person used to play three or four times a week and that was their social outlet. How can we organise our society to ensure that the elderly can get out to play bridge, other card games or whatever their activity is? As a society we need to ensure that happens.

I take this opportunity to compliment the HSE. In the mid-west, including in my constituency of Tipperary, through the national programme for older people the HSE has introduced a very good capital programme. It is in the process of building a new wing in the Community Hospital of the Assumption in Thurles. That unit will be interventionist. It will scan the elderly around that area of north Tipperary and assess those who need to be brought in so that they do not end up as bed-blockers in acute care. This was thought out by the HSE through the Covid emergency funding. This was never thought of before early this summer. The previous Minister for Health was not aware of it and the current Minister for Health asked me what it was. I think it is a very good thing to look after the elderly and prevent them ending up in acute care. Given what the HSE is doing in the mid-west, in Clare, Tipperary and Limerick - I understand it is going on in Waterford as well - it would be good if that model could be introduced nationally.

I call Deputy Ó Cuív, who is sharing his time.

I congratulate the Minister of State on her appointment. She will do a very good job. She is a very caring person.

On a point of order, we usually follow the Labour Party.

There was a mix-up last night.

I am following the schedule that is in front of me. Government speakers are next, followed Sinn Féin speakers and then Social Democrats. I ask Deputy Ó Cuív to continue.

That is not the order that was followed in the last statements session.

It is the order that I have in front of me and I can only go with the order that is in front of me.

Maybe we could have-----

In the last session, Deputy Shortall followed me.

The Cathaoirleach said a mistake was made and apologised for calling people in the wrong order.

I thank the Deputy. I say to Deputy Shortall that it will have to be taken up with others. I apologise.

Deputy Ó Cuív is in possession and he lost about a minute and a half. The clock might reflect that.

We will start the clock again?

As I was saying, I wish the Minister of State all the best. She has a significant challenge. Over the years, it has always been more difficult for mental health services to get the money than it has been for some of the more high-profile acute services. We will give her every support we can in trying to get this money. As we are coming up to the budget, it is important that we are discussing this today. We could say much more, but we do not have the time. We should keep in mind that more than twice as many people commit suicide in this country as die in road accidents. We know how we rightly invest in road safety. We need to realise that this problem is there. The numbers have reduced but there is a long way to go.

Approximately 70% or 80% of suicides are male, but more females self-harm than males. We need to look at the holistic side of society and ask if we are putting unnecessary pressure on people. Every year I am appalled at the amount of pressure on leaving certificate students. We need to find a better way. We are a "cure" society and we may not give the same attention to things needing long-term care where there is no magic fixed finite cure as the world would see it. We need to recognise that in some cases, people with mental health issues need ongoing support which needs to be funded. The issue of waiting lists for child and adolescent mental health services needs to be tackled urgently.

I will speak briefly about older people. We need to look at the hierarchy. People should be where they want to be. If they want to be at home, they should be supported at home. If they want to be in sheltered housing they should be in sheltered housing and unless they choose to go to a nursing home, the nursing home should be the least favoured option for the State for many reasons that have become apparent. I put one major challenge to the Minister of State, which is that she bring in statutory home care. I know they will tell her it will take forever drafting Bills and whatever. I would rather a flawed Bill than no Bill. We can always amend and improve Bills as time goes on. We need statutory home care. The Minister of State will find that the time will go very fast in the job she has and the process can be very slow. She should publish and be damned. We can improve it in the House, but we need to see it introduced in the term of this Minister of State.

There has been considerable talk of older people. People thought it was a rule - we found out in the end it was not - that the over 70s could not leave their homes. I think that was wrong on balance. We now know that going out in the fresh air was low risk. The mental health risks of staying home all the time, totally isolated, were considerably greater. There are plenty of safe places to exercise and walk. We need to listen to what older people say. As one who is more chronologically challenged than most in this House, I think we should stop being maternalistic or paternalistic towards older people. People who are chronologically advanced in years - Micheál Ó Muircheartaigh is the ultimate example - are well able to make their own decisions.

I wish the Minister of State well in her new role. For far too long mental health issues have been ignored, stigmatised and demonised. What the Minister of State said in her speech was absolutely correct. Many families contacted my office, concerned over the lack of mental health services during the Covid pandemic and asking when they would resume. It is important to have a roadmap for that and I know the Minister of State will do so, which I welcome.

We have half the European average of acute psychiatric beds available and funding for our mental health is half what it is in Europe. We are not investing where we need to. Twenty extra beds were promised to the psychiatric hospitals in the south east in 2018. That did not happen. In my area, eight beds should have been provided in St. Luke's Hospital in Kilkenny. I would really appreciate if the Minister of State could commit to addressing that.

I am glad that the most recent Mental Health Commission report showed that the Department's compliance level increased from 46% in 2017 to 73% in 2019. The Mental Health Commission visiting all these hospitals is very important and will have a significant effect on everybody. The report welcomed the appointment of a support service manager in 2018 to improve things such as hygiene and catering. It also found that everyone was willing to work to monitor and evaluate standards of care and make improvements where possible.

This report, however, also found that services were recorded as being over capacity on several occasions, which is a concern. Coupled with the fact that children are not getting access to age-appropriate services, this really highlights the urgency of the situation. Previous speakers have spoken about child and adolescent mental health services, CAMHS. There is a waiting list of two and a half years for CAMHS. I know the Minister of State is aware of this because I spoke to her about it. This is unacceptable. I know she is also aware of another issue because she is working on it. In 2019, in excess of 50 teenagers and adolescents were placed in adult wards in psychiatric units. That is unacceptable. These are the areas in which we need to deliver and this is what we have to do.

The number of admissions is rising, waiting lists are growing and nobody has the resources to deal with these issues. We have seen an enormous rise in mental health issues since this global pandemic first hit and we are going to see things descend into chaos if we do not look at our capacity now. If we are to increase the number of beds, we obviously must increase the number of appropriate staff. One of the biggest issues I see is that of staffing. People wish to use services but the staff are not there. Getting staff will be one of the Minister of State's greatest challenges. That is what we need to do. We need to keep our staff and to get staff into our psychiatric hospitals and services. That was one of the biggest issues I faced.

The final point I will raise with the Minister of State relates to older people. I know how important this issue is. All of us speaking will appreciate how important our elderly people are to us. My elderly mother is at home. She is 85. Covid has been very hard for the elderly. Testing in nursing homes is very important and I know the Minister of State has been working with the Minister, Deputy Stephen Donnelly, in that regard. I work with two section 39 care homes. One is in Carlow and the other is in Bagenalstown. These care homes are like a home from home. There have been significant cuts to funding for section 39 bodies. If we do not fund these homes, I fear that some will close. In fairness, I know the Minister of State is coming to visit one of these homes in Carlow this week but, across the country, keeping these care homes open will be one of our greatest challenges because there does not seem to be funding for them. I thank the Minister of State and wish her well.

The last few months have taken a toll on everyone, particularly those suffering with mental health issues. It has been an intense period and the stress and anxiety associated with the coronavirus has put a strain on many of us. Before the pandemic and the lockdown, mental health services across the State were bursting at the seams. They did not have the capacity to deal with the number of people presenting for services. It can be difficult to get people to engage with mental health services but, when they do engage, they can find themselves turned away because of a lack of capacity. This is a disgrace. It is a result of decades of underfunding. People presenting to mental health services are extremely vulnerable. It is simply not good enough for the door to be closed on them in their time of need. This is not the fault of the staff, who do great work, but rather a sign that the whole system is completely overwhelmed.

We have seen endless documents and reports outlining how poor our services actually are but Governments have continued to sit on their hands and hope that glossy documents will be seen as progress. A Vision For Change was produced in 2006 but everything still seems to be the same. It was a great document but its recommendations have barely seen the light of day. We now have Sharing The Vision. I hope the 41 recommendations identified for the short term are implemented within the 18 months.

It was reported in the Irish Examiner last week that 2,315 children are currently waiting to see a specialist in CAMHS. Some 224 of these have been waiting for more than a year. This is completely unacceptable. In my own constituency of Dublin Bay North, 152 children have been waiting more than three months just to be allocated an appointment. I believe the Minister of State will agree that is not right.

Last week, my colleague, Deputy Ward, and I had the pleasure of receiving a petition from Stacey Quinn, which the Minister of State has now received. Ms Quinn is a constituent of mine. She collected 45,000 signatures calling for a 24-7 mental health service. As the Minister of State knows, it is not only between 9 a.m. and 5 p.m. Monday to Friday that people need services. We need a publicly funded mental health service of which we can all avail and we needed it yesterday.

Consultations and reports are fine but, unfortunately, they do not improve even one person's situation. We need action and we need proper services. I wish the Minister of State the very best in her new role.

I believe everybody in this House is only too aware of the challenges in respect of mental health. We see people facing such challenges in our own families, in our communities and in our constituencies. People regularly come to the House to talk about the level of need, particularly unmet need, that exists. That has been going on for some time. The real test of people's commitment to prioritising this area comes at budget time. That is how we show how serious we are about mental health services. To be serious means providing the necessary funding at budget time. In addition, in the particular circumstances we are in at the moment and in light of the very significant additional need arising from the pressures, stresses and anxieties of Covid, the demand for additional funding and additional services will be all the greater. That has to be part of the medium-term plan to be published next week. It is just as valid a need to be met as any other need contained within that plan. I certainly hope that, in addition to a clear roadmap to restarting all of the other health services that have been put on hold, mental health services will be given priority within the plan.

In recent years, what we have seen with regard to funding and recruitment has largely been smoke and mirrors. For as long as I can remember, there has been wrangling in this House about whether money has been fully spent in a particular year. Looking back over recent years, approximately €50 million less than was committed to by successive Governments was delivered. Money was not ring-fenced. We are therefore starting from a position where there has been a shortfall of approximately €50 million. In addition to this are the additional pressures arising from Covid.

Earlier this week, the chief operations officer of the HSE, Ms Anne O'Connor, made a statement in which she made it very clear that there had been a significant increase in the number of referrals to mental health services, especially among older people and children. This is a massive concern because these services were very much overstretched before the pandemic. As others have said, at the beginning of the year 2,000 children were on the waiting list for CAMHS. We can quote figures. I have the figures for the psychological services here. As of last May, there were more than 10,000 children, adults and older people on waiting lists for psychology services. A waiting list of three months is the maximum one would see in most other countries. Let us even take out the impact of Covid and look at what is happening with regard to psychology services.

In children from zero to four years of age - cases of infant mental health problems - and taking out, as I said, the first three months, there are currently 798 infants waiting more than three months for psychological services. There has been much talk about what is happening at the moment in education with the leaving certificate and so on. We know children in particular are under huge pressure due to Covid. Before Covid even started however, the number of children and teenagers waiting for psychology services was 5,600. That is 5,600 teenagers and children waiting more than three months for psychology services. In the adult age group, 18 to 64 years of age, the figure is less startling; it is about 1,500. It then drops again for older people. However, it is indefensible that we have a situation like that where teenagers, children and infants - almost 7,000 people in total - are waiting for psychology services for more than three months, and that was before Covid. This is an absolute national crisis. We need the funding to be put in place urgently and we depend on the Minister of State to deliver that.

Returning to the Government side, Deputy Dillon is sharing with Deputy Cahill.

First, I wish the Minister of State the very best in her new portfolio.

I welcome the opportunity to highlight the incredible effort and sacrifice made by our older people in recent months as we navigated the Covid-19 era. I cannot overstate the significant changes Ireland's older people made to their daily lives in order to adhere to public health guidelines and those efforts must be commended. For the countless grandparents the length and breadth of Ireland who missed their grandchildren's birthdays and for those who remained cocooned at huge personal sacrifice and chose to act responsibly, the changes were significant.

I previously raised the issue of mental health being the next big challenge arising from Covid-19. Older people have played such an important role in containing the impact of this pandemic. We must recognise, however, that they need support to continue doing so. To give one example, I am aware of a Castlebar woman in her 80s who set foot outside the house only twice since March, despite being in reasonably good health. She did so once for a healthcare appointment and the second time to visit a supermarket. Some of our older people, who once yearned to remain living at home for as long as possible, are now suffering from chronic loneliness and a sense of withdrawal from society as a result of being voluntarily housebound. Thankfully, we have a programme for Government which takes account of Covid-19. However, we need to update existing policies and strategies, such as the national positive ageing strategy, the Irish national dementia strategy, the housing options for our ageing population statement and the national carers strategy to ensure they are fit for purpose in what is now a changed world.

I for one want to ensure that our older people feel their sacrifices over the past few months have been recognised and that they feel confident their Government and we, as a Parliament, have plans in place to bring some degree of normality back to their lives. It seems fitting to quote the phrase that a nation's greatness is measured by how it treats the weakest members. However, I do not think this fits what has been seen over the past few months by Ireland's older people. In the face of a pandemic the likes of which none of us has ever witnessed, they stood resilient and ever-willing to play their part for their communities and families by putting service above self. In the weeks and months ahead we need to ensure we do not neglect the incredible personal sacrifices witnessed throughout every community. We cannot take these sacrifices for granted and must ensure the mental health of our older people is protected.

We, as individuals, must continue to play our part and assist where possible. We must continue helping to ensure our older people have avenues to connection, be it through technology such as ipads and phone calls or through traditional communications such as letters or postcards. The Minister of State and her Department are facing an incredible situation of global significance where our incredible healthcare workers are working in extremely challenging circumstances. While they continue to do their work, we must look beyond the walls of our healthcare facilities to ensure the mental health of our older people is prioritised and measures must be put in place to address their concerns.

I thank the Minister of State for the manner in which she has settled into her new portfolio. She has really hit the ground running, particularly in the area of mental health. I would like to highlight the work she has put into ensuring Thurles will have a Jigsaw centre open by the end of the year. This facility will provide a face-to-face service in Thurles which will be accessible to all young people who live, work or attend school or college in County Tipperary. In addition to this there will be online support and services through a range of digital inventions such as phone and video support, a freephone support line, Jigsaw live chat, email supports and more. Young people are facing increased rates of anxiety as a result of school pressure, social and personal circumstances and now the added stress of the Covid pandemic. A facility such as this has long been needed for County Tipperary and I appreciate all the work the Minister of State has done on this with me.

I stress the need to extend the Jigsaw services to other areas of the county, particularly the population centres of Nenagh, Clonmel, Roscrea and Tipperary town. These areas have for a long time been in need of mental health supports and services for young people. As the Minister of State knows, our county has no psychiatric beds and we need them in both the north and south of the county. I am in constant contact with constituents about the need for psychiatric treatment in their home county. Families and loved ones of those living with mental illness are contacting me on a daily business about this. At present Tipperary people either have to travel to Ennis or Kilkenny for such facilities. These hospitals are already struggling with bed spaces and I call for psychiatric beds in County Tipperary as a matter of urgency.

There are some wonderful voluntary organisations and I will mention Carmha in Nenagh working with mental health issues. It provides counselling facilities for people in need in their communities. It is vital that groups such as Carmha are provided with secure funding on an ongoing basis. They need to be supported through the State and also to have the assurance that funding will be provided on a continuous basis and not just on a once-off basis.

I highlight two cases of people in my constituency and the difficulties they have had with the mental health services over the past couple of years. The Minister of State is aware of these cases but I would like to put them on the record. One is a young lady who I have been dealing with virtually since I was first elected in 2016. She is now 23 years of age. Her psychiatrist recommended that dialectical behaviour therapy, DBT, was the best course available to her to try to deal with her condition. This young lady has tried to commit suicide on two occasions. I have been trying to get her access to a DBT course for three and a half years. At first she was refused access because she had a County Tipperary address. The course was based in County Limerick and people from the mid-west region were denied access to it if they had a County Tipperary address. We finally overcame that hurdle and now Covid is the obstacle in her way. This young lady has been trying to access this course for three and a half years and it just not acceptable that a person with her mental health issues can be waiting such a long period of time for access to a course that her psychiatrist recommends as the best possible solution for her, the best possible hope of recovery for this young lady.

I also highlight the case of a man for whom we have been trying to get a bed in the Central Mental Hospital in Dundrum. This constituent has been suffering from mental health issues for years and is currently in prison on a minor charge. He has been in and out of Ennis on a number of occasions and each time he is released he is rearrested within a matter of hours for some minor offence. This man is unwell and desperately needs treatment. His family are worried sick for him in prison as his condition continues to deteriorate. He urgently needs to be assessed and needs a place in the Central Mental Hospital so that his condition can be treated.

I have spoken to a number of legal experts in the field who have all stated the same thing, which is that prison is not for this man and that he needs urgent help in an appropriate facility.

I understand the Covid pandemic has placed increased pressures on the Exchequer. I recognise the work the Minister of State has done in her brief and I thank her for what she has done for my county to date. We need resources and action at local level to deliver for voluntary groups. We need psychiatric beds in my county and appropriate treatment in suitable institutions for those suffering from mental health issues as a matter of urgency so the Covid pandemic does not turn into a mental health pandemic.

Lockdown, cocooning and self-isolation have disproportionately affected the elderly during the pandemic. This has given rise to serious concerns regarding their mental health. For many of the elderly, especially those who live alone, their only social contact takes place outside the home. As a consequence of the pandemic, they are effectively cut off from any interaction with others in the community. We cannot underestimate the importance and impact of community centres, bingo halls and churches on the mental health and well-being of the elderly. For example, in Finglas we have Odin's Wood Day Care Centre which provides a variety of services and activities for the elderly on a daily basis. The centre provides day care for those aged over 65 years. Individuals are collected from their homes and brought to the centre. They can avail of personal care in the form of a shower, a bath, hair dressing or chiropody. They can interact socially and can avail of the services of a community nurse, who visits the centre every day. They can also eat in a communal area with a four course meal provided daily for those who attend the centre. It was to open on Wednesday in a limited capacity but the centre received an email from NPHET stating it was not to open and it was not given a timescale as to when it can open. I am also aware of other day care centres in the same boat.

Many people are fortunate to have family and friends on whom they can rely for support in these trying times. Many who do not have such a support system must rely on social services or voluntary organisations. Such contacts can, unfortunately, put them at additional risk as they are in a vulnerable group. Cocooning and self-isolation help to reduce infection and the transmission of Covid-19, particularly for such a high-risk group with a decreased immune response. However, it has the inadvertent consequence of keeping them separated from everything that had previously kept them active and engaged. This has left many elderly people even more socially isolated and inactive than before. Additionally, the elderly are more likely to have many underlying conditions, resulting in increased hospitalisation, with the potential consequence of increasing the risk of contracting Covid-19. Cumulatively, these can all lead to chronic stress, anxiety, depression and increased loneliness. The lack of exercise can also lead to deconditioning, resulting in weakness, the loss of strength and potential falls. Lockdown and self-isolation can also lead to a reduction in the cognitive stimulation that comes with socialising and engaging with neighbours and the community at large, potentially leading to a rapid decline among those with medical or cognitive frailty.

Among the measures that could be put in place are, for example, the implementation of universal screening and treatment for mental health for the elderly. The Government could also look at extending the behavioural and mental health competency of primary care providers, who could help identify concerns and issues before they arise. For those in the community, a dedicated unit of trained professionals should be set up for the purpose of maintaining daily contact with the elderly, especially for those with little or no support. It is happening to a degree at the moment but is more or less on an ad hoc basis. The entire process needs to be better co-ordinated.

I wish the Minister of State well in her new job. As a result of Covid, the past six months have affected the well-being of everybody but old people have suffered disproportionately. A total of 56% of all deaths have been in nursing homes and the vast majority of deaths in the State have been of older people. There was, and still is, a sense of fear with regard to how old people interact. Even the word "cocooning" was almost derogatory and some older people took its use to task.

In all of the grimness there was a bit of light because sometimes in the darkness there has to be sunshine. There was an amazing film in the "Letters from Lockdown" short film series by RTÉ about Margaret Lynch who is 100 years old. It is absolutely fantastic and really encompasses the generational gap between older people and their grandchildren and how Covid affects them and their families. Every time I see the film I shed a tear - but I also smile - because of the effect the past six months have had on old people.

There has been a digital divide in the past six months, which has been compounded by the ageist society we have. There are many things the Minister of State cannot do but something practical she could do is what Age Action is calling for, which is to include in the budget for 2021 a digital allowance in the form of a €2.50 increase in the telephone support allowance because of the digital divide during the lockdown. This would be very welcome.

I noted the contribution of the Minister of State on day care centres and Deputy Ellis made a pertinent point on these services. My mother goes to a service in Clondalkin but she has not been there for the past six months. She was going every day to get her hair done, have her dinner and meet her friends but this has broken down. It is very important that these services resume very quickly. The lack of routine and social isolation that have happened are unquantifiable with regard to older people in the State.

If there is one thing the Minister of State can do in practical terms it is to try to address the aftershock of Covid, what we are living with and what it has done to old people. This can be done through opening up day centres as soon as possible, when all of the guidelines have been adhered to, and giving more resources to the older generation in particular. They have paid their taxes and done everything but the pandemic has stopped them in their tracks. There is always hope and I have referred to the "Letters from Lockdown" short films. There is always hope. There is hope in adversity and there is hope in this pandemic.

I wish the Minister of State the very best of luck in her new role. She has massive determination and an overwhelming desire to make a real difference in this area. Having listened to how well she is briefed, I am setting great store and faith in her ability to deliver in this very challenged area. I also welcome the very measured and informed contribution from Deputy Ward and I assure him we have signed up to a programme for Government that pledges to work to end the admission of children to adult psychiatric units. We also aim to seek the expansion of Jigsaw services for young people throughout the country. I have already had a number of conversations with the Minister of State on the provision of a Jigsaw service for County Longford. I hope during our time together in the House we will also be able to implement a dedicated youth mental health service in County Longford.

We have heard much this evening about the impact of Covid and specifically its impact on mental health. In reality, we had a mental health crisis well before Covid and it has not gone away. Nor should we be allowed to forget the patients, and there are many patients who, along with their families, continue to suffer in abject darkness.

One of the most heartbreaking aspects of our work is when families, often in the depths of absolute despair, reach out to us because they fear and in many instances justifiably believe that the mental health service has failed them and their family members. That is an indictment of us as legislators and a damning indictment of our mental health service.

Over recent weeks I have brought two specific cases from my community to the Minister of State's attention. Both cases feature young people. Both feature heartbroken parents and grandparents and devastated siblings. In both instances we have parents battling and pleading to get the care and referrals their family members so desperately need. We had one young person who was suicidal and self-harming and who genuinely felt this world was not for them. The Minister of State has read the devastating account of this family's battle for the appropriate treatment. The patient's family pleaded for access to a range of holistic treatments that would, they hoped, dissuade suicidal emotions, including the dialectical behavioural therapy, DBT, so desperately needed to help regulate emotions. That family rightly believes that this patient was failed not only by the HSE but also by the Government over two and a half years. Sadly, there are very few happy endings in this sector. Families, to their credit, do not expect magic wands but they do want to see a fit-for-purpose service based on intervention, real and meaningful engagement with patients and recovery plans.

If the Minister of State can bear with me, I wish to raise the case of the second patient on whose behalf I have reached out to her and to the HSE on a number of occasions in recent days. He has now spent an agonising ten weeks in isolation at a mental health facility. That is not the health service we, as a modern progressive nation, want or deserve. Staff at the facility have themselves reached out to the patient's parents and pleaded with them to raise this case politically and appeal for his transfer to a forensic setting where he can come out of seclusion in a safe and secure environment. I am pleading with the Minister of State to follow through on this and we will, I hope, see that happen. I have known this young patient for many months. When he is in form he is a wonderfully engaging young person with loads of potential. When the darkness overwhelms, however, he is sadly a different person. He is a young person with enormous potential, and his family and the healthcare professionals who have worked with them are anxious for an intervention that will adequately address the necessary care needs.

Over many years our mental health service has failed thousands of people. The service has come through a significant journey, but there is much more to do, as the Minister of State and I both well know. The two cases I have discussed with the Minister of State are just a touchstone to 100 more such cases. Let us ensure we do not fail them and we impress upon the service providers the need to respond and intervene as appropriate.

This is my first opportunity to engage with the Minister of State in this brief. I believe her to be a decent person and I wish her the best of luck in what is a challenging brief. I hope she will use all her energy to try to change things. It will not be easy but it is vitally important she do so.

I wish to raise with the Minister of State two issues, the first of which I suppose has a crossover with the brief of the Minister of State, Deputy Rabbitte, but I think it is relevant to her own brief as well. I refer to the day centres. We are still getting an awful lot of contact from staff as well as the families affected. They are upset and concerned. Decisions were taken in March of this year that we can all understand because of the situation we faced. Since March, however, people with intellectual disabilities and families with people with intellectual disabilities in their care have been under incredible pressure. They have borne it with dignity and patience but also a great deal of frustration and, I think, sadness and a sense of isolation. At the very best of times this can be almost 24-7, fairly intense and very challenging and difficult, but at this moment in time it is far more than that. The lack of day services is affecting the people themselves who avail of the services. There is a lack of routine and a limitation on social connections. It is having an impact on their physical health, their morale, the deterioration of their mental health and their sense of independence. That has a huge impact on them, but then it consequently comes to the home and to the parent, the sibling, the son or daughter or whoever it may be who is looking after them, and it becomes even more difficult and unsustainable. We urgently need to address this. We are finding this to be an issue and, as I said, there are many families concerned about it right across South Lee, whether Turners Cross or Ballincollig, and places in North Lee such as Farranree, Blackpool and Mayfield. A lot of these centres still have not reopened, so that needs to happen as soon as possible, and I know that the staff are anxious to see that as well. If the Minister of State could give more detail on this in her summing up, I would appreciate it.

The second point I wish to raise with the Minister of State is community healthcare organisation 4, which is Cork and Kerry, particularly as it relates to South Lee, in my constituency, which is always the poor relation, particularly when it comes to CAMHS, and always has the longest waiting lists. There are currently 411 people on the CAMHS waiting list in Cork and Kerry; 103 of them have been on the list for over a year, which is by far the largest number waiting this long of any community healthcare organisation; and 1,292 children are waiting for psychology appointments. To have children and youth in such difficult situations - crisis situations - and for them to be told the appointment is four months, six months or a year away is just not good enough. This also means that when the appointment comes, because there is so much pressure, sometimes the appointment is not really what it should be because the professionals are under pressure, and I appreciate that.

I always try to be constructive. I will conclude with a point I raised with the Minister of State's predecessor, Jim Daly. This is not going to happen overnight, but it seems to me very obvious that we produce any number of psychology students each year but that they cannot afford to be clinical psychologists. They cannot afford to go into that line of work because they have to take all that time to gain experience, not be paid further, get a very limited amount towards their education and sustain themselves at the same time. It is just not sustainable unless one comes from a background where there is a bit of financial support. I know there is a limited number of bursaries, grants and so on but it is nowhere near enough. We need to crack that. There are many people who are passionate about this, who want to help and who want to be psychologists and they cannot afford it. We need to address that.

Although I have wished the Minister of State well personally with what is, as Deputy Ó Laoghaire said, an unenviable portfolio, I do so again now. There have, however, been years of underinvestment, and I use the word "underinvestment" because, after all, the outcomes of early intervention and successful mental health treatment are an investment as much as education is. Ireland's mental health system was already under immense pressure because of the lack of investment before this pandemic, and now services are stretched even more. Our communities are in dire need of funding or investment to support them through this tough time. I know the Government is putting together a budget and the Minister of State will influence that, not just because she is a Minister of State but also because she is a woman. I do not care who hears me saying this. I believe women work differently and know how to impress on people the real, serious issues. I want the Minister of State to remember, however, that for every number and statistic quoted in the House there is a person. It is a child, brother, sister, mother, father or grandparent, not just a number, and that is what worries me about the statistics. There may be 1,020 children on a waiting list, but they are all somebody's brother or sister. What the Minister of State does will affect all those people we know and love.

Mental Health Reform, the national coalition of 70-plus organisations, has launched its pre-budget submission and sent it to every Deputy. It states that there are fewer staff in the system now than there was in 2008, yet mental ill health is at epidemic level, and worse it will get because of the pandemic, although not just because of the pandemic alone. We need an out-of-hours service, and not just in Wexford because it appears from the contributions of Deputies that it is needed all over the country. We need a 24-hour crisis service to give people at risk a proper chance of survival.

This would give their close family and loved ones with no expertise in coping with these situations assurances that there is help at hand and a service that lets them know that we, as politicians, have their back. We, as politicians, understand that the risk of suicide in mental health patients is grave and we need a 24-hour service that can distinguish care differentials between adults and children. As it stands, many communities depend greatly on voluntary organisational services. One such service of which I cannot speak highly enough in County Wexford is MarineWatch, which patrols Wexford Bridge on a nightly basis to prevent the loss of life. No amount of gratitude from me or the public would suffice to express the value of what these people do. I hope the support and services of voluntary sector organisations like this will not go unnoticed when it comes to the Department and the Government putting a budget together for 2021.

Mental Health Commission says we need at least an additional €80 million put into mental health services. I call that an investment. Some €80 million is needed as an immediate measure to provide for an increase in the number of mental health patients and issues that have arisen during Covid. If there is any doubt about funding these services, let me tell the Minister of State what can be achieved and provide the good news story she is looking for. It is not all doom and gloom. I have had numerous phone calls from parents whose children got through the leaving certificate, but only because they were lucky enough to access services at a time when their children needed intervention to deal with mental health issues. If they were left untreated, they might not have been able to complete the leaving certificate. As it stands, they got that treatment and are now applying for college places. There are those who are applying to join organisations and start careers they never thought they would have because of their poor mental health.

The point is that the mental health services work, but only when they can be accessed. There are good news stories of achievement and survival but the problem is accessibility and availability. I do not accept it is just a financial deficit. I recently wrote to the Minister of State about a vacant position for a child psychologist for the CAMHS unit in Wexford. I thank her for a prompt response but I do not under any circumstances accept the reason is a HR issue. I will not quote the circumstances because they are in themselves devastating but if it was the private sector, I imagine it would be a legal matter. I will have to take this up again. In term of the impediment to the appointment of a child psychologist being a HR issue, Wexford CAMHS unit being without a child psychologist and there being no other applicant, it is fundamental to the success of CAMHS in Wexford that a child psychologist is appointed and we get over the HR issue in order to save lives. We will take that up again. The system is archaic in taking that approach. We have to restore the faith of the people in Wexford in the Government and have the staff requirements filled in the CAMHS unit in Wexford because the issue is ongoing for years. If we have one applicant who wants to take up the position of child psychologist and if we are told it is not a funding issue, how can we say "No" to this qualified person who has held the position before?

The Minister of State is from the neighbouring county of Waterford and I want her to visit the unit in Wexford, which would be a trip on the Passage East car ferry. The least the staff, who are under severe pressure, deserve is a visit from the Minister of State and they can inform her first hand. I do not expect it to be next week or the week after but she needs to visit that unit. I thank the Minister of State for listening to me. It is devastating to hear that what we are hearing tonight from every Deputy appears to be rhetoric. It is not rhetoric. Mental health and the elderly people in our society are as close as it comes to the education of society.

I am glad to get the opportunity to talk on this important matter this evening. Elderly people have been massively impacted by this virus. All those months they had to isolate or, to use the new word, "cocoon" at home have changed their lives utterly and many will not be the same again. I was hurt recently when the Government suggested elderly people needed to be careful. One was not sure whether it was because they were going to give the virus or get it. I resented and rejected that comment by Government.

The people at home are one thing but the worst thing that happened regarding the virus was that elderly people died in nursing homes and hospitals on their own. That was the very worst part of the whole pandemic that hit this country. Elderly people like to have their families with them as they approach their last days, as has been traditional. This did not happen and I am very sorry about that. We saw on the television the other night cases of where elderly people died, were thrown into a body bag and put into a coffin while family members had to stand outside the graveyard. It was terrible.

On the first day the Taoiseach, Deputy Martin, took Leaders' Questions, I had the opportunity to ask the Taoiseach to ensure families could visit their elderly relatives in nursing homes and hospitals. I am sorry to say it is not happening and if it happens on a very rare occasion, someone is wheeled out to an emergency exit door or a hallway. The elderly person who is visiting has to stay outside, whatever the elements. That is not satisfactory and we need to develop some way that either the families are tested coming in or the person in the home or hospital is tested. We have to ensure that family members visit.

I have one question. Is a member of the National Public Health Emergency Team involved in producing test kits? We need to know that because the kits are a savage price and they are costing people undue-----

I call Deputy Collins.

I congratulate the Minister of State on her appointment and I agree with my colleague, Deputy Danny Healy-Rae, who said last night that there is no better person in terms of her care for the unborn in our campaign some time back. She gave great support to that and if she gives the same support in the job she is in, we are in safe hands.

The mental health system is preparing for a tsunami of cases from young people. Staff working in the sector are worried. The sector cannot cope. Ireland's mental health services have a litany of shortcomings, such as a lack of funding, long waiting lists and a disjointed system without an adequate joined-up approach to caring for the individual. The mental health system in Ireland is especially poor at serving young people. Now, with demand expected to increase due to the Covid-19 pandemic, there are worries over whether the system can cope. The big question many constituents have is whether the system can sustain an anticipated spike in cases and referrals.

One major issue in the third level sector is that the €2 million announced last October by Mary Mitchell O'Connor, the then Minister of State at the Department of Education and Skills, for student mental health and well-being initiatives has not materialised. This was announced nearly 12 months ago. What happened to that funding? I have been contacted by many families across west Cork who cannot access mental health services. One such family had a daughter who needed urgent care from professionals and was on the verge of suicide. All of us have been touched by family or friends who have committed suicide and the devastation and trauma it leaves behind is undescribable.

The Government appears to love talking about mental health but that is not followed up by action, given the lack of resources in the health service. It is so wrong on so many fronts that people are being left in acute mental health units who simply do not need to be there.

I am calling for an urgent review of the availability of mental health services in every county by the Minister of State with responsibility for mental health and older people. This review should be swift and comprehensive and it should be done in a timely manner. The findings of this review should then be debated in Dáil Éireann within four weeks of this day. We simply cannot allow more people to take their lives due to mental health illness while this Government fails to implement the required policy interventions.

As the Minister of State has responsibility for older people, I must take the time to ask her about the cross-Border directive. Thousands of people in the South of Ireland requiring knee, hip and in particular, cataract surgery, are going to the North for surgery. Due to Brexit, I asked the then Tánaiste last year if the cross-Border directive would continue and the answer I got was that legislation had been put in place to make sure it would. Is this the case? Myself, Deputy Danny Healy-Rae, Councillors Ben Dalton O'Sullivan and Danny Collins and others have taken thousands of people to the North for eye surgery. Can the Minister of State tell me if this cross-Border directive will continue after Brexit? People cannot be left to go blind on the Government's watch.

I call Deputies Pringle and Connolly, who are sharing time.

I was caught on the hop there.

That does not happen too often.

There has been a lot of talk tonight about wishing the Minister of State well and we have spoken a couple of times at this stage already but I wish her well in her role as Minister of State with responsibility for mental health, in particular, because it is a vitally important service. While the Minister of State's intentions might be well and good and she will do her best in this role, unfortunately the Government will not give mental health services the attention they need to ensure they are developed. That will be a problem, it has been a problem for many years and it is not something the Minister of State will be able to solve as it stands. The Covid-19 crisis has put a focus on mental health services and it has shown that they are badly wanting, as if we did not know that already. We knew that before this crisis began and before January of this year because mental health services have always been given the least thought among our health service system as a whole.

I want to focus on the mental health reform pre-budget submission, which is vitally important, and which other Members have mentioned tonight. It calls for €80 million to be invested this year in the budget, which is not much in terms of a €16 billion to €17 billion overall health budget. I would like to see it being delivered but we will have to wait and see whether that will happen or not. That will be telling.

I thank Deputy Pringle for leaving me lots of time. I have already wished the Minister of State the best and I look forward to working with her. I am going to make use of the few minutes I have to zone in on a number of matters.

If the Minister of State wants to leave a mark, she might set up the independent monitoring panel as a matter of urgency. This was a recommendation from many groups. We had A Vision for Change and to me that was perfect. I am on record as saying it was the most wonderful vision in theory but it was never implemented. The independent monitoring body sat for two three-year periods and it did an excellent job. It was so good that it was abolished. I ask the Minister of State to reinstate it as a matter of urgency. I am a tiny bit disappointed that the Minister of State said in her speech that it was well advanced. Let me take that as a positive message and I ask the Minister of State to give me a date when it will be reinstated in order to assure me. The Minister of State mentioned representation across all of the therapies, not dominated by psychiatry. There is a role for psychiatry but there is also a role for clinical psychology and the various therapies. The Minister of State mentioned the users as well. That is one issue and I would appreciate if the Minister of State could give a date for it.

I refer to the Assisted Decision-Making (Capacity) Act 2015. This Act became law in 2015 after a long campaign well before my time. I hope it does not go on well after my time because the Act was enacted and everything was good about it but the decision support service is not functioning, even though it has been established. What are the consequences of that? We have people being made wards of court on a weekly basis when there is absolutely no need for it and they are functioning at 100%. That Act abolished that whole concept and said we should assist people to make decisions. That is the second matter I ask the Minister of State to zone in on because that will make a huge difference to people's lives.

The third matter I want to zone in on is what we call our elderly. I do not like to distinguish in terms of age. The worst thing about the Covid-19 crisis was that we told people over 70 to stay at home. It was a dreadful message and I foolishly went along with it. At some stage, I realised this was totally unacceptable and the former Minister for Health, Deputy Harris, said he realised it was a wrong use of language and he would not do it again. We have spent years trying to bring equality into our language and we got rid of it in one go in a pandemic by talking about cocooning, which really meant locking up. We did it in such a deceptive way. We did not tell people they had a choice, even though they did have a choice. We should drop that.

We do not need to keep making statements about suicide. It was all there in A Vision for Change, which became Sharing the Vision and prior to that it was called Planning for the Future. We know what is happening and what is required. It is all set out in A Vision for Change. It has been updated and we have changed the title but it is all there. Anecdotally, we can stand here and tell the Minister of State about the suicide rates. It is not acceptable and I do not want to talk in an anecdotal manner. I want to ensure that the services are there on the ground.

The Covid-19 pandemic has brought into acute focus our lack of services. Day centres have been mentioned and I do not have time to go into them. There are a whole load of emails from people who are at the end of their tether because the day centres have not opened. The Government has to tell us what the plan is and when they will be opened in order to give hope.

I invite the Minister of State to respond to the debate.

I thank the Dáil again for the opportunity to conclude these statements and I thank everybody for their time and patience tonight. A huge amount of contributions have been made and they were all made in a positive vein, which I welcome. I will do my best to try to answer as many statements as possible if I can do so in the time allowed.

I thank Deputy Ward for his constructive approach and I look forward to working with him. We met yesterday and I would like to continue in that vein. He raised the matter of children in adult services and as I have said to him, that was one of the first matters I raised when I came into the Department. A reduction in the number of children admitted to adult psychiatric units is a priority for the HSE and it is a priority for me and for every Deputy in the House. It is fully accepted that admission to an age appropriate facility is in the best interests of the child. The HSE admitted 50 children into adult services last year. I have found out since that in a lot of those cases, they might have been males aged 16 or 17, whereas the CAMHS unit may not have been suitable for them at that particular time and they had to be housed in an adult facility for a while. On a couple of occasions, some of them might have entered such a facility on more than one occasion in the same year. I accept that a lot of good work has been done and the numbers have reduced but we have more work to do and I will continue to make sure that number comes down steadily. One child in an adult psychiatric ward is one too many for me.

Deputy Patricia Ryan mentioned Age Action, ALONE and the Community Call initiative and everyone here will compliment Age Action and ALONE and the fantastic work that was done.

I also wanted to mention Sharing the Vision and in that regard Deputy Connolly mentioned the national implementation monitoring committee. That is something that has been continuously worked on since I came into the Department. I will be different to other politicians and I am hoping to move this in the first week of October. It will be national mental health month in October and my aim is for us to put that committee in place. There will be an independent chair and there will be lots of sub-committees that encompass everything. It will not be top heavy at one end. The one aspect of Sharing the Vision that I love is that for the first time ever it is patient-focused and patient-centred and it is all about care in the community. The national implementation monitoring committee is hugely important. It will hold me, the Department, the HSE and everyone to account and will let us know very quickly whether we are doing the right thing or not. My aim is for the first week in October. That is my plan and that is what we are working towards at the moment. I am hoping nothing will change that.

I also wish to talk about the CAMHS waiting list, a subject which was raised frequently tonight. The waiting list stands at 2,366, which is a huge number of children waiting for supports. Deputy Ó Laoghaire mentioned that the numbers in the Cork and Kerry area are very high, which they are, at over 400. The numbers in Galway, however, are extremely good. I will start visiting all the CAMHS units and meeting the different teams across the country, but I accept that the numbers are too high. I have been working with the HSE to see how we can reduce them.

Not everybody likes the National Treatment Purchase Fund, NTPF, but for the first time ever we are going to look at using it for diagnostics. Legislation will be needed for this to happen because the current NTPF only deals with situations where people go into hospital to have hip or cataract operations, for example. We will need legislation to see how we can move forward with using the NTPF in the area of diagnostics and how we can buy diagnostics. We also want to ensure that there are no unintended consequences. When children come under the care of a CAMHS unit, they are being cared for in the community, and the most important thing is that that level of care in the community carries on. I am conscious of that, and I hope to move on that initiative soon as well.

Many Deputies mentioned day care centres. This matter is close to my heart. I am a strong advocate of day care centres. I met the relevant team in the Department of Health this afternoon to discuss this issue. I am very concerned about the effect that the continuing delay is having on older people. One Deputy, I think it was Deputy Gino Kenny, mentioned that his mother attends day care services. My mother is 83 years old - she is watching in tonight - and she also attends day care services. I know everybody is missing those centres. The HSE is continuing to assess the risks and benefits of reopening the day care centres. One of the main issues is that some day care centres have more space and capacity. Grants have been put in place, for example, in some situations, such as for community halls where people meet at different times. The grants are to support those initiatives by assisting with the installation of hot water in bathrooms, hand sanitisers and all the different supports needed. The problem, however, is transporting the patients, residents and service users to these facilities and that is where we are seeing the issue. I am strongly in favour of day care centres, however, and I want to see them reopen as soon as possible. Each CHO, therefore, is carrying out a risk assessment of every day care centre in its area. I cannot give a timeframe. We were hoping to open the centres in September, but then the numbers rose again. The situation is fluid, but I will keep the Deputies updated.

I met many active retirement groups, which are also anxious to get back into the community halls. People want to get back to playing bridge, and there are also knitting clubs and many others such groups. The whole thread running through the debate was that we have to compliment our older people. They did what was asked of them. It was very difficult cocooning for that length of time, but they did everything asked of them and they have been very stoic during Covid-19. Now, however, they want to get on with their lives and get back into the community. We will work very closely with the active retirement groups to ensure that happens.

I also met several Deputies regarding Jigsaw. New Jigsaw services will be rolled out in Bray and Thurles before Christmas. Jigsaw services now have 66% coverage throughout the country, but it will be great to see more such services available. Many people also spoke about suicide and tomorrow is international suicide prevention day. Last Friday, I was involved with the launch of the suicide statistics for last year. Unfortunately, as somebody said earlier, we lost 431 people to suicide last year, that is twice as many as were killed in road traffic accidents. I am not for one minute trying to lessen the tragedy of road traffic fatalities by making that comparison. Some 431 families were devastated by the loss a loved one to suicide last year. Connecting for Life is Ireland's national strategy to reduce suicide and that was developed between 2015 and 2019. I will not say it has gone out of date, but I will renew it so that process continues to 2024. That is very important.

The final matter to which I will refer relates to the Central Mental Hospital, which is currently located in Dundrum but which is no longer fit for purpose. It will be moving to the new National Forensic Mental Health Service facility at Portrane very soon. I will come before the House again soon with legislation to change the currently specified location for the Central Mental Hospital in Dundrum to the new facility in Portrane. I hope it will be possible to get support from across the House for that Bill. I have ensured that it will be simple, stand-alone legislation.

I thank so many people for coming in tonight and sharing their perspectives. If I have missed anything, we will pick up on the relevant questions and come back on the issues to which they relate.