Dáil Éireann díospóireacht -
Tuesday, 1 Feb 2022

Vol. 1017 No. 2

Child and Adolescent Mental Health Service: Motion [Private Members]

Deputy Mark Ward

I move:

That Dáil Éireann:

notes that:

— under the United Nations Convention on the Rights of the Child, every child has the right to the highest attainable standard of physical and mental health;

— there were 3,065 children on Child and Adolescent Mental Health Services (CAMHS) waiting lists as of October 2021, including 863 waiting greater than six months and 202 waiting greaqter than 12 months;

— there are particularly long CAMHS waiting lists in Community Healthcare Organisation (CHO) 4 (Kerry, North Cork, North Lee, South Lee, West Cork) and CHO 8 (Laois/Offaly, Longford/Westmeath, Louth/Meath), which accounted for 48 per cent of those waiting in Ireland in March 2021;

— in 2020, 4,905 children referred into CAMHS requiring specialist mental health care were turned away after consultation, with the referrals deemed inappropriate;

— one-in-five consultant psychiatrist posts are vacant or filled on a temporary basis, which results in a large gap in clinical oversight and quality control, with notable resignations over several years due to the unsafe conditions which understaffing has placed patients and staff in;

— there are 9,554 children on Primary Care Psychology waiting lists as of October 2021, including 6,029 waiting greater than six months and 4,272 waiting greater than 12 months;

— over 71,000 children are waiting for life changing treatment, including 19,000 waiting greater than 12 months, across occupational therapy, physiotherapy, ophthalmology, speech and language therapy, dietetics, psychology, and mental health services, which are all vital to the mental health and well-being of children; and

— the World Health Organization recommends that 12-14 per cent of health and social care expenditure is directed towards mental health services and that the agreed Sláintecare minimum target is 10 per cent, yet expenditure on mental health services remains lower than 6 per cent of the healthcare budget, with expenditure on children's mental health services as low as 1 per cent;

further notes:

— the shocking and highly troubling findings of the Maskey Look-back Review into the malpractice and substandard treatment of children under South Kerry CAMHS, which put more than 200 children at significant risk of harm and resulted in significant harm to at least 46 children who were prescribed inappropriate medications without proper follow-up and oversight;

— that the individual who uncovered this malpractice and ensured it was brought to light has since left the Health Service Executive (HSE) and claims to have been undermined and side-lined;

— the Government's commitment to an audit of prescription practices and adherence to clinical guidelines across CAMHS State-wide;

— that more than 50 children were inappropriately placed in adult psychiatric facilities over the last two years; and

— that the outgoing Children's Ombudsman regarded this practice as "lazy" further commenting that "we have let the idea that we do not have the resources in place rule the fact that the best interest of the child is being overrun"; and

calls on the Government to:

— protect our children's mental health and fix our children's mental health services;

— immediately put in place supports for the children and families affected by the malpractice in South Kerry CAMHS;

— broaden the CAMHS review to include capacity deficiencies and geographic inequalities, to examine whether persistent consultant vacancies have contributed to substandard care, and to review the excessive amount of referrals which are deemed inappropriate;

— immediately conduct a review, to be published, into the treatment of the South Kerry CAMHS whistleblower and the circumstances around their change in duties which led to their resignation from the service;

— tackle extreme waiting lists and clinical oversight deficiencies in children and adolescent health services by addressing the two-tier consultant contract issues which prevent the filling of consultant vacancies;

— put in place a proactive strategy for the recruitment and retention of psychologists across CAMHS;

— immediately re-appoint a National Director of Mental Health in the HSE;

— legislate to end the practice of placing children into adult psychiatric facilities;

— deliver 24/7 access to mental health services and a consistent 7-day week outpatient model for CAMHS; and

— set out a plan for achieving a minimum of 10 per cent of healthcare expenditure being directed to mental health services as agreed under Sláintecare.

We need to fix our children's mental health services to protect our children. The shocking report into malpractice and the substandard treatment of children in south Kerry's Child and Adolescent Mental Health Service, CAMHS, found that more than 200 children were put at significant risk of harm. At least 46 children were prescribed inappropriate medication without proper governance and suffered significant harm.

You only have to listen to the heartbreaking testimony of parents whose kids were wrongly medicated about how they lost their personalities and their smiles.

The first thing the Government must do is immediately put in place supports for children and families effected by the malpractice in south Kerry. It needs to put in place a comprehensive care plan so that these children can get back on the road to recovery and be given the chance to reach their full potential.

Public confidence in youth mental health is at an all-time low. The Government has announced an audit of all CAMHS services across the State. I called for that audit to be carried out last April but my call fell on deaf ears. The Government has wasted eight months. The national audit must have independent oversight and it needs to be broadened. It must look at how twin deficiencies in staffing and working conditions, especially the lack of supporting multidisciplinary teams and the two-tier consultant contract, have contributed to substandard care and to vacancies across CAMHS. The audit must also answer why over 3,000 children are on waiting lists for CAMHS services, including 200 children who have been waiting for more than a year. It must answer why the quality of treatment available to a child is based on where they live and why some CHO areas are performing better than others.

In 2020, almost 5,000 referrals to CAMHS by medical experts were deemed inappropriate. What happened to those 5,000 children? I have been inundated with messages from people across the State this week who have concerns about CAMHS and who feel they have been let down by the service. One young person contacted me to say that someone is finally doing something about it. They stated that they had waited three years to start their healing and then they was rejected by CAMHS because they was not taken seriously enough or believed. They said that they were not listened to and were pushed too far. They thought the only way out of was to take their life which they attempted. They wound up in hospital and only then were they diagnosed and put on another waiting list.

That is the real life experience of a young person who was deemed inappropriate for CAMHS. It is not just CAMHS that is failing children. The failure is right across children's healthcare. At the moment, more than 9,000 children are on primary care psychology lists, of whom 4,000 have been waiting more than a year. Early intervention is key. We all know that if some of these children had got the care they needed when they needed it, it would take the pressure off CAMHS for more acute cases. There are also 71,000 children waiting for life-changing treatment including 19,000 children who have been waiting for more than 12 months for services such as occupational therapy, physiotherapy and speech and language therapy. We can all get bogged down in statistics but behind each figure is a child with dreams and ambitions who has family and friends who are impacted by the lack of care being given to that child. It is a child who has a right to be given every chance in life to reach their full potential. Successive Governments have failed these children. I have no doubt that in her response, the Minister of State will mention the amount of money that has been spent on mental health but it is not enough. It is still way behind best international practice, which recommends that 12% to 14% of the overall health budget should be spent on mental health. Sláintecare recommends a minimum of 10%. Currently, the Government is spending less than 5.5%. The Ombudsman for Children told the joint sub-committee that children's mental health is 1%. That is nowhere near good enough.

There is very little accountability for governance at the top of the HSE. That is why Sinn Féin has consistently called for the reinstatement of the office of the national director for mental health. I welcome that the Minister of State has added her voice to this call but she needs to make sure that this happens. She should be running the show and calling the shots, not the HSE.

Deputy Pa Daly

Families affected by CAMHS catastrophic failure of children told me that they found the report soul-destroying, that they were sick to the stomach when they learned of the harm suffered by their vulnerable children and that worse, it could have been prevented had changes been made first, after the resignation of consultants in the south-eastern service or at least shortened had the issues been addressed when they were first raised by the whistleblower. There were children who asked to self-medicate and who were a year without follow-up appointments. Those with social anxiety and chronic fatigue dosed with antipsychotic medication.

The acknowledgment of the report and the apology is a start. The 35 recommendations must be implemented without further delay. Parents need care plans immediately. They need the scope of the review to be broadened to north Kerry and beyond. Parents who need anonymity need to have that guaranteed in any redress scheme. The HSE must pay for an independent consultant or consultants to review the files and advise the parents on treatment and the harm done to their children.

As noted, the WHO says that 12% of healthcare spending should be on mental health. Here it is less than 6%. Hence the waiting lists and short staffing. We need the right resources. We need key workers, social workers, proper oversight and the ending of pay disparities between the different systems and the improvement of working conditions, offices and support staff. The capacity deficiencies and geographic inequalities also need to be addressed. In my area, there is the longest waiting list in the State. It comprises 682 children, almost half of whom have been waiting to access CAMHS for more than a year.

The motion is not a request; it is a demand. Our children deserve what it seeks.

Deputy David Cullinane

Time and again we see scandal in our healthcare services and time and again we see no action, accountability, consequences or change. We saw it with the Grace case, the Brandon case, CervicalCheck and now CAMHS in Kerry and the appalling way those children were treated. We know there was poor clinical oversight, mismanagement and the appalling treatment of a whistleblower who came forward. The pattern is the same. The whistleblower was thrown under the bus and there was no change or consequences for those who failed.

Take the Grace case as an example. In 1995, a complaint of sexual abuse was made by a former resident of the foster home that Grace was in. In 1996, the health authorities decided that they would remove Grace from that home but that decision was reversed by the health authorities in the same year. It was reported that:

When removed in 2009 from the foster family, Grace 'cut a sad figure' in a 'wretched' state, frail, dirty and unkempt, with health problems due to a poor diet and psychosis. Her only possession was a child’s toy which she held onto 'for dear life' and to which she still clings.

Yet there was no accountability, no consequences and no change. We see it with the Brandon case. The report is unpublished but we know of horrific abuse of people in that setting. Now we see it again in CAMHS in Kerry where young people were treated so appallingly. The whistleblower was treated with disdain and was the person who paid the price. It is the same old story. No accountability at the heart of the HSE. There is no culture of accountability. We cannot continue to come into this Chamber and say we are shocked, outraged and disappointed and then there is no change and no one is held to account. The Oireachtas must decide if it is going to deal with the culture whereby there is no accountability or transparency and no one is held to account once and for all or if it is going to continue to keep coming back to all of these crises and scandals and simply say that we are shocked. We all know we are not shocked because it happens time and again. There is a real question for the political system. We must decide once and for all that we will embrace a new culture in the Department of Health and in the HSE and that we will do our very best for all those children in CAMHS and elsewhere who have been failed by the system.

Deputy Pearse Doherty

Last week, I said that there should be a step change in Government policy around how we deal with children and adolescents in the context of mental health.

This should be a watershed. It should be a moment in time when we say we can no longer allow our services to be so depleted and exhausted that so many people go without and those to whom services are provided receive, in some cases, services that are dangerous. However, I am not convinced that is going to be the case. I am not convinced that the Government is actually going to change direction in any way.

Deputy Cullinane rightly outlined all the other scandals, including the Grace scandal, by which we were appalled and which we thought should be watershed moments. He mentioned the Brandon report that the Minister of State, Deputy Rabbitte, wants to be published, but which she somehow cannot get the HSE to publish in order that the families can see what happened to the 18 individuals involved in that setting. If you go back years and years, you will see more and more of the same, yet we trundle on without accountability and without real change. All the people out there who depend on these services, namely, children and adolescents suffering with their mental health, are seeing that the State is letting them down in the main.

We do not provide enough money to support our services. We do not provide 24-7 services. We do not have clinical oversight at a national level of these services. My colleague, Deputy Ward, has been championing this since he was elected to this Chamber but yet again Government fails to act. I have spoken to many young people who have mental health difficulties. I have spoken to people who have been in facilities in this State due to eating disorders, anxiety and other issues. They see very clearly that more needs to be done for them and their cohort. This needs to be a time when we are not coming back here next year and saying only 1% of the health budget is provided for children's mental health or that we have 71,000 children on waiting lists for life-changing treatments, including mental health services, speech and language therapy and dietetics or that we have 3,000 children on CAMHS waiting lists. All of those are statistics of shame and there should be no more. If we are to really honour the people who surround us here tonight then we need to ensure we treat all the children of the nation equally. That means providing them with that helping hand. When they reach out for a helping hand from the State, there should be somebody or some service there to support and protect them. At this point, the service is not up to standard and in many places, it does not even exist.

Deputy Pauline Tully

The news about the treatment of children attending CAMHS in south Kerry was alarming but I firmly believe that the problems there are being replicated in many ways across the State, although hopefully not as seriously. The news of a nationwide audit is welcome but it needs to happen without delay. I hear from those involved with CAMHS there are issues around medication, poor management and nurse dominance and that there is a lack of training, of appropriate resources, career progression and there is a hierarchical status. I hear that there is more emphasis being put on ensuring they are covering themselves so as not to be sued than on real and necessary patient care. Children or their families are often blamed if suggested treatment does not work. Children with a diagnosis of autism will not be admitted to CAMHS yet children with autism are 28 times more likely to consider or attempt suicide. There are also simple things like notice for an appointment not being received by a parent until the day of the appointment or the day after. This is not an isolated incident. This has happened to families attending different CAMHS in different counties.

CAMHS and mental health services in general need to be completely overhauled. I am not saying there are not excellent people working in these services. Of course there are. They do very important work and help many children but it could be done so much better and include so many more children if properly staffed and managed. Over 2,000 children and young people are on waiting lists at any given time. At the end of November there were 3,357 children waiting to be seen. Of those, 221 had been waiting for more than a year. That is leading to heightened mental health issues and costing the State multiples to address further down the line. The funding announcement in budget 2022 of €24 million for mental health services is totally inadequate. Ireland only allocated 5.1% of its health budget to mental health services. The WHO advises that should be 12%. Sinn Féin committed to an additional €113 million of new funding in our alternative budget. Mental health services are starkly underfunded. This needs to be addressed if we are to ever resolve this emergency situation and not allow it to get even worse. The Assisted Decision-Making (Capacity) Act 2015 does not allow for decision supports for people aged under 18 years. That legislation needs to be amended immediately to prepare for the reform of the Mental Health Act, which sees those aged 16 and 17 years give or withdraw consent for mental health treatment.

Deputy Pat Buckley

We are back again. I am delighted to speak on this and thank Deputies Ward and Daly for bringing this motion forward. It was said already there are 71,000 children waiting for life-changing treatment, including 19,000 who are waiting for more than 12 months for occupational therapy, psychotherapy, speech and language therapy and many more mental health services. I do not know when the Government is actually going to get it into its head that everybody within the mental health services must be supported. That includes staff, not just patients. We must make a serious investment in this area.

The whistleblower was also mentioned. Consider the bravery of a whistleblower to come out and say things are not being done right and people are suffering. They should be commended, not punished. It is very important that is recognised. I also put a message into the Minister of State's mailbox today regarding another whistleblower within the mental health services. I look forward to her response to that. In addition, Deputy Mairéad Farrell and I have brought forward a Protected Disclosures (Amendment) Bill. We hope the Government will support it.

A few years ago, I think it was 2018, I was doing much research on how much Governments were spending on counselling, cognitive therapy and play therapy within the mental health service. It struck me that the budget at the time was approximately €10 million whereas the moneys spent on medicine - we will call it medicine - was more than €400 million. There is a massive disparity in that regard. We have all seen what has happened in the CAMHS in south Kerry. It must be noted that there are fabulous people within the system and that the services which are practically fully resourced do work. I will always give that commendation. The problem is, however, that if we do not start investing in this, we are going to be back here again with scandal after scandal. I call on the Minister of State and the Government to support this motion and do the right thing for the people of this country.

Deputy Imelda Munster

CAMHS and other mental health services in this State are so woefully underfunded that what happened in south Kerry should come as a shock to no-one. We spend 6% of our health budget on mental health. That is half the level recommended by the WHO. This needs to be increased as a matter of urgency. There are currently more than 3,000 young people awaiting appointments in a CAMHS psychiatry service. There are over 9,500 young people on a waiting list for child primary care psychology. Over 3,982 of these young people have been waiting for over a year.

In my area of Louth and Meath, the CAMHS struggles to adequately staff itself. It is difficult to recruit staff, like occupational therapists for example, because the terms offered in other areas like primary care are often better so people choose not to work in mental health services. In Louth and Meath the service only has access to inpatient beds and does not have access to day beds at all. Accessing the inpatient beds has proved increasingly difficult. We also need to provide more beds for young people with eating disorders. There has been a significant increase in cases since Covid with no plan or response to that to date.

The Government should listen to what we are calling for in the motion. It is practical measures to protect our children by fixing children's mental health services. We need to reappoint a national director of mental health in the HSE. We must scrap the appalling practice of placing children in adult facilities and ensure we have enough beds and enough resources to appropriately treat children. We also need to drastically increase mental health funding across the board by a minimum of at least 10%, as agreed under Sláintecare. We cannot have more cases of people becoming severely unwell and even dying because they cannot access services. Our children cannot continue to be treated like this. It is inhumane, unfair and it must stop. I could have told the Minister of State stories from my constituency of young children and young adults who were either turned away when they sought help or had no follow-up and no backup and sadly took their lives in the most horrific of circumstances. That has to stop. The Minister of State needs to get a grip because the HSE is such a mess. It is an absolute mess. It will never get its act together.

For the sake of our children, the Minister of State needs to get a handle on this and put whatever direction and insistence is needed in place. She needs to do it now to protect our children. This situation is not good enough.

Minister of State at the Department of Health (Deputy Mary Butler)

As Minister of State with responsibility for mental health, I hope I have the support of everyone in this House in working to address the challenges across our mental health system and, in particular, in child and adolescent mental health services. This was evident from the debate last Wednesday in this House when we discussed youth mental health. Of course, to the very front of our minds then, and this evening, are the disturbing and devastating revelations in the report on child and adolescent mental health services in south Kerry. The HSE has considered the report locally and nationally, acknowledged the systemic failures that occurred over a sustained period of time and accepted the recommendations.

Last Wednesday, I set out in detail the many contributory factors that led to this catalogue of failures, including an absence of clinical oversight, appropriate governance and management structures. Work is under way to implement the full suite of recommendations as a matter of priority. Of these, six have already been implemented with 13 having commenced implementation. The HSE has met with 198 of the 240 young people affected, and their families, to discuss the deficits they received in their care and to provide them with key information and referral to any necessary services and supports. This includes counselling supports and appropriate services from within child and adult mental health services. I am in close contact with the chief officer of the area to ensure that any additional supports that are required are provided. The HSE apologised to each individual at these meetings, and subsequently in writing, for any harm caused.

The report outlined the alarming effects of the prescribing of medications on the children and young people affected, including sedation, the production of breast milk and weight gain. I described these impacts in some detail last Wednesday. There are 35 recommendations in total in the report, including an assessment of a reconfiguration of the service. As I set out to the House previously, as part of the recommendations a full nationwide audit will be conducted of compliance with existing CAMHS operational guidelines by all CAMHS teams. I have also directed that there be an independently led prescribing audit in each of the CAMHS teams. This will cover community and inpatient teams. There will be a further independent-led audit of case files in north Kerry.

Alongside this, the HSE will commission qualitative research to identify the experiences of children, young people and their families using child and adolescent mental health services nationwide. I have directed that this three-stranded approach be subject to independent oversight. In addition, I am pleased to update the House that the Government has today committed to a non-adversarial scheme for compensation for those children, young people and families affected by the report. I will be working closely with my Department, the HSE and the Attorney General to ensure that the details of such a scheme are confirmed without delay. Many families have already been subjected to harm and considerable distress. I will do my utmost as Minister of State for mental health to reduce the potential for any further upset as this process continues.

The report is shocking and frightening and my thoughts are still very much with the children and young people affected. The systems we have in place must be fit for purpose to support the good work that we know is going on as much as to bring to light and address what harm is caused. Accountability in this context is vital. I understand that An Garda Síochána in Kerry is in receipt of the detailed and extensive final report, which will now be considered to see if there are grounds to commence a criminal investigation. While it is not appropriate to comment on HR or industrial relations matters relating to any individual, the CEO of the HSE has said that disciplinary action will be taken if appropriate.

Members will know that I have consistently sought the reinstatement of a national director for mental health post in the HSE. This is not solely a reaction to the publication of the report, but I take this opportunity to renew to the House my call seeking that this important post is reinstated to give vital strategic direction to the development and improvement of mental health services. Contrary to what Deputy Ward said about my being late to the call, he did not include a national director for mental health in his previous PMB.

Deputy Mark Ward

It is something I call for regularly.

Deputy Mary Butler

Focused mental health leadership in the HSE is needed at national director level reflecting the need to enhance and develop relevant mental health services in primary care, acute hospitals and specialist mental health services as envisaged in Sharing the Vision.

Members proposing the motion raised a range of other issues. I acknowledge that there are serious challenges to be addressed in our mental health services. However, I would like to reiterate that mental health is a priority for me and for this Government as a whole. An additional €47 million for mental health services was made available under budget 2022, bringing the total allocation to €1.149 billion and continuing the year-on-year increases in investment in mental health services since 2012. This investment is underpinned by Sharing the Vision. Members are right to say that the funding for HSE mental health services is approximately 5% to 5.5% of the budget for HSE health services. However, it must be acknowledged that this does not take into account mental health services and supports delivered or funded through other parts of the health service, or by other Departments or agencies, constituting a substantial sum of expenditure year on year.

I also noted that many of the Opposition Deputies mentioned that we should be at 12%. Yet, when they took the opportunity in their pre-budget submission the increase was €113 million, which will bring us nowhere near 12%.

Deputy Mark Ward

The commitment was over the lifetime of the Government.

Deputy Mary Butler

It would not even increase it by 1%.

Deputy Mark Ward

The Minister of State can quote semantics all she wants.

Deputy Mary Butler

There is no point in being disingenuous on this.

Deputy Mark Ward

Absolutely not.

Deputy Mary Butler

As I outlined last Wednesday, youth mental health, including child and adolescent mental health, is of critical importance. In relation to CAMHS, budget 2022 will provide for the establishment of two new CAMHS tele hubs and a dedicated €6 million is available to expand the capacity of community mental health teams nationally, with a particular emphasis on CAMHS. This includes 45 CAMHS staff, building on funding for 29 additional CAMHS staff provided in 2021 on top of a total of more than 400 new posts between 2012 and 2019. I am pleased to say the HSE completed recruitment of 53 clinical positions within CAMHS in 2021. Some 93% of consultant psychiatrists within CAMHS are filled. We have 80 whole-time equivalents in place and there is an outstanding deficit of five whole-time equivalents, including the post in Kerry.

One of my particular priorities as Minister of State has been to deal with the issue of eating disorders. Contrary to what has been said about nothing being done, a lot is being done. A total investment of €6.85 million to progress the national clinical programme on eating disorders has been made, including €3.94 million in 2021 to complete the three existing teams and three new teams, which are nearing completion. One of these is a CAMHS team. Funding allocated in 2022 will provide an additional four specialist eating disorder teams, with one of these again being dedicated for CAMHS. This will bring the total number of specialist eating disorder teams to ten and I am firmly committed to continuing to develop these services further beyond 2022.

An additional €10 million will be provided this year for initiatives aimed at increasing mental health supports in response to the Covid-19 pandemic, in particular, for children, young people and students. A further once-off €10 million for mental health will be invested to improve the experiences of individuals, including children and young people accessing specialist mental health services, in addition to community and voluntary mental supports. As part of this fund, Mental Health Ireland will distribute a total of €1 million among smaller local groups providing vital mental health supports in communities nationwide. This grant scheme was launched yesterday and I encourage any organisation with a project or proposal that meets the criteria to submit an application. The €10 million allocation has also provided for the launch today of talking therapy sessions on a no-cost basis to individuals impacted by the pandemic.

NGO partner MyMind will provide up to 16,500 counselling and psychotherapy sessions, in more than 15 languages, through a €1 million dedicated fund. The delivery of these supports is a continuation of an initiative that commenced in 2020 and was funded from the Sláintecare integration fund. As part of this project, MyMind delivered approximately 22,000 hours of counselling and psychotherapy sessions to date.

We have also expanded our digital mental health services for children and young people through the 50808 crisis text service, SpunOut, SilverCloud, Turn2Me and the national roll-out of digital cognitive behavioural therapy. There are now 14 Jigsaw sites nationally that complement its digital services.

I acknowledge that we have significant challenges in our mental health services. The south Kerry CAMHS report is unflinching in setting out those challenges. While we have made much progress, I am fully committed to continuing to drive the necessary reforms across our mental health system in line with Sharing the Vision. This will be complemented by the significant work under way to overhaul our mental health legislation, which ultimately will enhance the rights and protections of people using our specialist services, including children and young people.

An Ceann Comhairle

The next slot is being shared by Deputies Ó Laoghaire, Carthy, Quinlivan and Mythen.

Deputy Donnchadh Ó Laoghaire

I commend the motion and the work of Deputy Ward, who has been an excellent advocate in terms of the issues around mental health. I echo his point that a 12% increase over the lifetime of the Government is quite ambitious. Sinn Féin's policies and this motion in terms of tackling some of these issues are also ambitious.

The report in regard to what was happening in south Kerry is deeply alarming. It is very worrying. It is the stuff of nightmares for parents. The testimonies given by some of the parents were shocking. Much of this is focused on a particular individual, but other individuals may be culpable, depending on the findings. This is a systems issue. There is no way a junior doctor should be responsible for that level of work or have that level of responsibility without adequate oversight. That is simply not good enough. This was allowed to drag on for years. The whistleblower was not treated properly and was not listened to adequately at the point of which the concerns were raised.

It is important the CAMHS review happens swiftly, that it happens across the country and that it takes a very broad view. We all wonder whether there could be similar issues in other parts of the country. In general, there is a feeling out there that our mental health services are inadequate. In my own constituency, there are 258 people waiting for CAMHS appointments, 104 of whom have been waiting more than six months, with 14 young people waiting over a year. That is the situation without even addressing whether the care they are getting is adequate. There could be issues around postponed appointments, whether people are getting adequate attention and whether they are getting adequate support from in terms of psychology and psychiatry because both are needed. Very often that is not the case. Sometimes, this is not the fault of individual consultants, therapists or whatever; it because the system is completely overstretched. These issues are growing and there is increasing concern in regard to this area. There is an urgent need to completely transform how we deal with mental health services in this State.

Deputy Matt Carthy

Our health services are an embarrassment and within that our mental health services are a humiliation. I say that not as a criticism of those on the front line but to recognise that systemic failures have happened too often and are too prevalent.

In this Chamber and in this debate, we hear all of the correct things being said by Government representatives. It has ever been so. On delivery, the proof is in the experiences of children and adults. For many, the experiences are positive once they enter the system, but for far too many the experiences are marred by delays in entering the system or being denied access to that system. For others, the experience of the system has been a bad one.

The reports from Kerry CAMHS are scandalous, but they are not new. This specific incident might be new, but the story is all too familiar. There is a failure in our health services. It is brought to the attention of HSE management but nothing is done other than the ostracisation of those who brought the issue to the attention of the management. Eventually, the reports are made public and that is followed very quickly by an apology and the rhetoric "we have learned the lesson." Nobody in the HSE management is held to account. That is the most predictable trajectory of any of these scandals. Those who failed to monitor the care being provided to children and those who failed to heed the warnings are either moved sideways or left in place, their salaries and pensions secure.

Unless and until individuals within management are held to account for their failures nothing will change. Three Government leaders came together and agreed, without any process, rationale or justification, a pay rise of more than €81,000 per annum for the Secretary General of the Department of Health. If the same leaders decided that the Government would prioritise mental health services, as Deputy Ward's motion calls on them to do, and they were determined that there would be accountability within the HSE, then it would happen, but nothing in the Government's remarks tonight suggest that it is up to delivering that necessary change. We are.

Deputy Maurice Quinlivan

There can be no denying that there are significant problems with the CAMHS system and that these need to be fixed. The recent review of south Kerry CAMHS uncovered widespread failings in the service. While the effects on some of these children were horrific, the fact that there were failings is no surprise to anybody. If we really want to cherish all the children of the nation equally, we can start by ensuring that children and adolescents have access to the vital services they need around mental health. This is not being delivered when one considers that there are thousands of children waiting for treatments of various types.

I welcome the Taoiseach's recent confirmation that there will be a full audit nationwide of compliance with CAMHS operation guidelines. However, this audit should be extended to include geographic inequalities and capacity deficiencies. The geographic inequalities are clear for all to see. As of October 2021, in CHO 3, which is in the constituency of Limerick that I represent, the number of patients aged under 18 waiting for psychology treatment for in excess of one year was 36% of the total. In CHO 6, it was 3%. The people of the mid-west deserve better. One third of children in need of psychology treatment are waiting more than one year. Let that sink in. It is shocking. These are young people in their formative years. Without early intervention, issues will escalate. One year is a very long time to go without necessary treatment. We should all be cognisant that, globally, suicide is the fourth leading cause of death among children between the ages of 14 to 19. We have had too little investment in mental health services. CAMHS does not have the resources to deal with the numbers of young people who are desperately seeking help and support. The vacancies, particularly in the field of psychology, must be filled. In other countries, psychology is considered a basic service.

The time for apologies is over. It is high time to tackle the extreme waiting lists and take meaningful steps to address children's mental health services. In its two budgets, this Government could have increased the amount of the health budget assigned to mental health, but it did not do nearly enough. As stated by colleagues, Sinn Féin's alternative budget called for an investment of €113 million in CAMHS. We need, at least, 10% of the health budget assigned to mental health services, as recommended in Sláintecare.

Sinn Féin has called for 24-7 access to mental health services. One such de-escalation unit will be trialled in Limerick. I cannot wait for that service to start in the second half of this year. It will provide for the triaging of mental health contacts by a team of paramedics, gardaí and a mental health expert. A similar scheme in Belfast, introduced by my party colleague, Órlaithí Flynn, MLA, has proven to be successful. If the Limerick trial proves to be successful, and I am confident it will, such a de-escalation model should be made available as a priority to all CHO areas across the state.

I cannot speak for other areas, but I can say that in Limerick the volunteer mental health organisations do a phenomenal job. Too often, they are the ones dealing with out-of-hours crises. It should not have to be this way. It is high time for the Government to step up and commit to mental health services for children and adolescents and to increase capacity and ensure sufficient expert staff are available so children no longer have to wait one year for vital apportionments.

Deputy Johnny Mythen

The fall-out of what happened recently in our CAMHS service cannot be understated. It was the worst nightmare one could imagine. My thoughts are with the children and families directly affected. It is difficult enough to reach out for help. People now have to deal with the mistrust caused by what has happened. This will have long-term implications. The State must provide a rounded and thorough response and wraparound care packages for the young people involved and their families. We need to be mindful too of those who are watching this unfold. Young people and their families may now be very wary about seeking help. We need to restore confidence so that they will know they will get the professional support to meet their mental health needs.

It is important to recognise that we have many good people working in our mental health services who, despite the inadequate resources and dysfunctional system, provide a very caring service for our young people. The manner in which CAMHS is currently operating means its work is largely unsustainable. We have heard here about the frequency of professional burnout, as happened in my own county of Wexford in 2018 when Dr. Kieran Moore, a specialist consultant paediatric psychiatrist stated: "What the team is being asked to do is absolutely unsafe and unfair for children."

It is clear these conditions relate to the staffing recruitment and retention issues. We need more resourcing. We also need to change the national structure of our child and adolescent mental health services, CAMHS, to confront these issues. The State-wide CAMHS review needs to include capacity deficiencies, geographical inequalities and whether persistent consultant vacancies have contributed to inadequate care and the excessive amount of referrals. For example, 4,905 children in 2020 were deemed inappropriate. The significant workforce challenges in psychology with insufficient graduates to fill posts need to be addressed. We need to plan to achieve a minimum of 10% of healthcare budget being directed to mental health services, as agreed under Sláintecare. That level at present is less than 6%. In my own county of Wexford, that would help to fund an out-of-hours CAMHS service. The last time I asked about plans for that, the HSE said there were no immediate plans for a seven-day service in Wexford. Is that still the case? If it is, the Minister of State needs to intervene and direct the HSE to plan for an out-of-hours service in the county.

Many of the cases of mental distress in the young people with whom I deal happen in the evening, after dark, or at the weekend. They need to have somewhere to go rather than the emergency department. They need to have access to care after 5 o'clock. Let the Kerry CAMHS tragedy be a catalyst for real change in the national structure of CAMHS, which is failing our most vulnerable citizens. I thank Deputy Ward for leading on this matter and I urge every Deputy in the House to support the motion.

Deputy Duncan Smith

I commend the motion. I also commend Deputy Ward, in particular, for his ongoing work in this area. He certainly does not just pop up when issues hit the news. He consistently raises the need for improvements to mental health services. Fair play to him.

Referrals to child and adolescent mental health services in Ireland increased by more than 40%, from approximately 12,800 in 2011 to 18,100 in 2019. Unfortunately, our services have not increased to match that. At any time, more than 3,000 children and young people are on waiting lists for CAMHS. The Minister of State with responsibility for mental health and older people confirmed that of the 18,000 children expected to be referred to CAMHS in 2020, only 11,000 were expected to be seen. That means we were unable to reach 7,000 people who were referred in 2020, a time when the pandemic hit and we all knew and could see the impact on young people and their mental health was becoming more severe and profound.

In replies I and my colleagues have received to parliamentary questions, the HSE has stated that waiting lists are due to a lack of availability of specialist CAMHS clinicians. Current vacancies and difficulties in recruiting in an international context can impact on waiting times in various areas. This is the root of it and we cannot get proper answers to the issue. Why are we unable to hire and retain clinicians at all levels in our psychiatric services to ensure we have a functioning service? Why are vacancies unfilled not only for months but sometimes for years? As I have asked in other parliamentary questions, why do we have competitions and interview panels for roles for which no one is successful, which means the HSE has to re-advertise the role? This is the fundamental question that needs to be answered and addressed. We all know many people who entered third level to study nursing, medicine or some sort of care degree. We have a vibrant third level sector in this area. Where are our graduates going? Are they staying in the service or are they leaving? If they are leaving, why are they leaving? Is it down to the cost of housing, the cost of living or the wages and salaries in our health service? Is it down to the work practices in our health service or a lack of confidence in our CAMHS? Do people who qualify and desperately want to work in mental health decide they will not work in CAMHS because they know what it is like? Perhaps those people think that some CAMHS are working and others are not but they are not going to be able to practise the type of clinical mental health service they want to practise in an Irish context. These are the fundamental questions. The answers can be painful for the institutions of our country, the Government, the HSE and our third level institutions but those questions need to be answered.

Having all these vacancies, year after year, is leading to these waiting lists. It means that children and young adolescents are left bereft of the support they need. We really need to get serious about recruitment and retention. We cannot just throw it out there. We need to get to the root of the problem. We need real answers to parliamentary questions. We need honesty from the Government and once we have that, we can look at the reasons. We feel we know the reasons but where are the numbers? Where are our graduates going? How many people are leaving midstream? How many are leaving because they are not getting the promotions they need? How many are leaving because they are whistleblowers? They may not have come to the Government, Opposition Deputies or their local politicians but may have gone to managers and been told to go away, that there is nothing to see here. We need the answers to these questions.

Most CAMHS still operate Monday to Friday, 9 a.m. to 5 p.m. or 5.30 p.m. That is outdated and must end. The only people who receive 24-7 mental healthcare in this country are the most profound, severe cases of young people who are being treated in the few inpatient residential beds we have. We do not want to see our young people having to be treated in long-stay inpatient residential care but some are there because they have to be. Some are there because they did not have early intervention care. They have been on waiting lists too long and their mental health has deteriorated because they have not received the care to which they are entitled, need and have asked for. We touched on this issue when we heard statements on young people's mental health in the Chamber last week. Part of the reason we have more presentations is not because people's mental health is worse now than it was ten or 20 years ago. It is because people are talking about it more and have the confidence to say to their parents, peer group or whoever it may be that they are struggling and need help. That is to be commended. However, if we keep going the way we are, with waiting lists like this and situations like the one that happened in south Kerry CAMHS, people will be less inclined to come forward. They will keep their problems to themselves because they cannot face being left outside and not getting the care they require or, worst of all, they cannot face opening themselves up, exposing their vulnerability and asking to be cared for only to get poor care that is ultimately going to damage them. That is why this is such a chronic failure. These young people got into the system. They were supposed to be cared for and were not. They were supposed to get the treatment they deserved and was their right but they did not.

Parents and carers were, and are, second guessing whether they can engage with the services now, debating whether they have the trust in the services. They must have that trust. We need to make it clear that advocacy on behalf of young people with mental health issues is more important than ever. Parents and carers need to have confidence. They must know that if they get their children into the service, they can ask every question under the sun of the person who is giving that care. It does not matter how senior the consultant or doctor. They must ask questions about medication and get second opinions. No question is too stupid; every one is vitally important. We need now, unfortunately, to hold to account all our professionals in this area. The days of blind trust in our medical professionals are gone because of cases such as the one in south Kerry CAMHS. It should not have to be that way but it is.

The Minister of State last week voiced her support for a national director of mental health. I would like to know if any progress has been made. What has the Minister said, if the Minister of State has had any conversations with him? Is he back from his trip and has the Minister of State put this issue to him? If we had a national director of mental health, it would not help every person going through the system or trying to get into the system at the moment but it would be a statement of intent from this Government as to how important are our mental health services. I believe the Minister of State in that regard. She speaks with real integrity and passion on the issue and I believe her when she says she wants such a role. She is the Minister of State with responsibility for mental health.

If this does not happen, we need to know why. If we get this role in place, we will have a figurehead and we can drive on and deliver the cultural and systemic change we need in our child and adult mental health services. I commend the motion again and thank Deputy Ward.

Deputy Róisín Shortall

I commend Deputy Ward on bringing this motion to the House. It is comprehensive, detailed and timely and I urge the Government to support it if it has not already indicated its position.

Having listened to the Minister of State's contribution a short while ago, a couple of issues arise. I will pick up on the final point made by Deputy Duncan Smith about the Minister of State's call for a national director for mental health. It is scandalous that there is not a national director for mental health. The Minister of State said she made that call several times. She is the Minister with responsibility for this issue. Is the senior Minister not listening to that call? Is that role not valued by the Government? It should not be the case that the Minister of State is making the call. Given that she has political responsibility for this area, she should be insisting on it happening now rather than it being a call in the wilderness. People in positions like that in the Department need to stand up because this matter is too serious. The Minister of State needs to ensure that what she is demanding is responded to. That needs to happen.

I will pick up on a few other points the Minister of State made. She noted that this report being referred to the Garda. My heart sinks when I hear that because it happens all the time. Major reports about various scandals come out and are referred to the Garda. We heard yesterday about the report into the Grace case, which was referred to the Garda. That involved an appalling litany of failure and no action is being taken by the Garda, so it has come to a dead end. We also have the Brandon report and without impacting on that too much, the same thing has happened. It has been referred to the Garda, so we await what will happen with it. We do not hold our breath when these reports are sent to the Garda.

A step that comes long before matters are referred to the Garda is the proper management of people who work in senior positions in the health service and ensuring those who are paid to manage do so and are accountable for their work. There is a big distinction between management and administration. Sometimes, when we have large numbers of managers in different organisations, especially State organisations, they are engaged in administration rather than management. Management is about accountability at the end of the day. We organise our health services in such a way that there is not accountability. That is what we do, as has been recognised for some time.

A very important element of the Sláintecare work involved looking at those elements of our health service and the HSE that are dysfunctional and result in people who depend on the State to provide good quality health services being let down. A basic requirement in any developed country is to have in place a properly functioning public health service. Why is it that our health service does not work well?

There are approximately 113,000 staff in the HSE, including a considerable number of managers. Managers are important and I am not disrespecting them but they have to manage and be held to account for their roles. Another feature of the HSE, one which has been identified and talked about for a long time, is the way in which it is structured. An organisation with 130,000 staff and a budget of €20 billion, which is bigger than those of several Government Departments combined, will not be responsive and agile unless it is properly structured.

Constantly now, when there is a crisis, we have Mr. Paul Reid coming on the airwaves to address and apologise for it and talk about a systems' failure. That is just not good enough. This has been identified very clearly in the work done in the Sláintecare committee. It made a clear recommendation on the need to restructure the HSE on a regional basis in order that we end this ridiculous scenario of community organisations doing one thing and acute hospitals doing another. They have their own budgets and there is no co-ordination or proper management of that. That is why a recommendation was made to establish six regional bodies within the HSE to combine the work of the acute hospitals and community sector under one management structure with a single budget. That is how we drive a system that ensures money is spent in the right place and gets the right results. Unfortunately, that restructuring has been resisted by senior people in the HSE and the Department of Health. That has to be addressed and must happen. It is the reason we are dealing with many of these problems.

This is not just about structures. It is about ensuring that when we have a regionally based management structure within the HSE, senior managers are legally accountable for their jobs. It is all very well to say matters will be referred to the Garda or the CEO will take disciplinary action if required - "if appropriate" was, I believe, the term he used. There is no provision for that in contracts at the moment. That is why we do not get the kind of accountability that is required for senior people to do their jobs properly.

Part and parcel of that recommendation from the Sláintecare committee on having a regional structure is having legal accountability built into the system so that either at senior administrative management level or senior clinical management level, there is statutory accountability for the provision of services and spending of budgets. That must happen. If there is a serious problem in the north west, senior management in the north west must respond to and account for it and there must be consequences for them if things go wrong and they do not do their job properly.

Another essential part of this is that resources must be allocated on the basis of need. We talk about the postcode lottery. It is just crazy at the moment. Three of the community healthcare organisations account for much more than 50% - the figure is something like 80% - of the waiting lists for child and adult services. The way funding and resources are provided is entirely ad hoc. I queried this with senior management because there is a very long waiting list for a particular service in the area I represent on the north side of Dublin. I compared it with Dún Laoghaire, for example, where the waiting list was a fraction of what it was in CHO 9. I was told that Dún Laoghaire had a much smaller population. That does not make any sense. Resources have to be allocated on the basis of need, that is, population need, socioeconomic profiling, age profiling and rurality, for example. We must allocate resources on the basis of need. Unless we do that, the system is run on the basis of chance.

Unfortunately, in spite of everybody talking about being shocked at what the Maskey report revealed, the reality is that we could have a similar shocking report about any of our health services in any part of the country. We do not know what is going on because the HSE is a big, amorphous body and we cannot identify what is happening. Are resources adequate to meet existing needs?

Is there an issue with management or human resources in those areas? Why is it not functioning? We cannot answer those questions at the moment.

We should, of course, allocating adequate resources to mental health services. Contrary to what the Taoiseach said, we do not allocate adequate resources. It should be at least 10% of the health budget. We have clearly failed children in south Kerry in this matter. However, the reality is that we are failing children and others in disability services and failing older people in services because there is not adequate management or adequate targeted resources.

Acting Chairman (Deputy Marc Ó Cathasaigh)

We now have People Before Profit. Deputy Gino Kenny is sharing with Deputy Boyd Barrett. Deputy Barry is not joining us.

Deputy Gino Kenny

I move amendment No. 1:

A. To insert the following after "attainable standard of physical and mental health":

"by ensuring that they are not being overmedicated due to shortages in staff across CAMHS, Primary Care and Early Intervention teams"

B. To delete the words "broaden the CAMHS review to include" and substitute the following:

"ensure the CAMHS review is independent and is broadened to include"

C. To delete the words "immediately conduct a review” up to and including “resignation from the service;" and substitute the following:

"— immediately conduct an independent review, to be published, into the treatment of the South Kerry CAMHS whistleblower and the circumstances around their change in duties which led to their resignation from the service and also into any other whistleblowers in CAMHS;"

D. To delete the words "across CAMHS" after "put in place a proactive strategy for the recruitment and retention of psychologists" and substitute the following:

", speech and language therapists and occupational therapists across CAMHS, Early Intervention teams and Primary Care"

E. To insert the following after "mental health services as agreed under Sláintecare":

"— invest in the National Educational Psychological Service to ensure every school has a psychology team; and

— support those studying psychology, speech and language therapy and occupational therapy by removing fees for their primary degrees and post graduate studies and paying for their placements".

I commend Deputy Ward on his continuing work on mental health care. While we support the motion, we have also tabled an amendment and it is my understanding that Sinn Féin will accept it.

We have spoken about mental health care numerous times. It is extremely important regardless of age, particularly given what has happened in the past two years which have been a challenging time for everybody. Trust is the primary concern of people who use CAMHS services. It is the most important issue when a young person uses the CAMHS services. Intervention and advice are key at this time because the young person has to seek advice and intervention. Trust is the central axis of a relationship between a medical professional and a child or a person in any age group.

The situation in Kerry crossed the Rubicon because it was probably the most serious of breach of trust that can happen. Inappropriate prescribing of medications to children is as serious as it gets. Many people will be asking questions, for example, whether this practice is taking place in other CAMHS services. I hope it is not but obviously the review will look at that.

The review has to be completely independent of the HSE. I see the Minister of State, Deputy Butler, is nodding, which is good. It must be completely independent of the HSE because for too long in this State the HSE and other civic bodies have investigated themselves. That is not good. Whistleblowers in other areas of the health service, particularly CAMHS, should be protected. They have done a public service in relation to misdemeanours that occur in all spheres of life. It is important that people can come forward, highlight what is going on in a service and express concerns about it.

Last week, I raised with the Minister for State a point related to the Joint Committee on the Future of Mental Health Care, which produced a report in 2018. One of its main recommendations was on the overmedication of children. This is a serious situation in the State. If we drill down through that, we find this was done to compensate for the lack of professional services for the children in question. That cannot continue because it undermines the services that children are trying to find. These are important policies that need to be addressed. We all want the best for our children, particularly at vulnerable times in their lives when early professional intervention is key. The policy of overmedicating children is extremely detrimental, not only to the child but also to their families.

Deputy Richard Boyd Barrett

I thank Deputies Ward and Daly for their timely and good motion to address the scandal that arose from, but is in no way limited to, what happened in CAMHS in Kerry. As Deputy Gino Kenny said, we have tabled an amendment that does not take anything from the motion but adds a few additional refinements. Specifically, it sets out that the review of CAMHS has to be independent, as Deputy Kenny said; that the cases of other whistleblowers and instances of whistleblowers being sidelined, victimised and witch-hunted, including cases that I am aware of, are investigated; that in having a proactive recruitment and retention strategy for psychologists, which is critical, we also have speech and language and occupational therapists across CAMHS, as well as early intervention teams and primary care services which either do not exist or are massively understaffed; that we set up a psychology team in every school as there are currently few if any psychology services; that we remove all fees and financial obstacles to the qualification of people who are studying for degrees, master's degrees or doctorates in areas such as psychology, speech and language therapy and occupational therapy; and that there is proper funding for psychiatry, higher degrees and so on, which is an issue I have raised on multiple occasions. We have a chronic shortage of these staff across early intervention teams, primary care and the CAMHS teams. That is at the root of this scandal. Yet, we are doing the insane thing of making it as difficult as possible for people who want to become qualified in psychology, with doctorates or master's degrees, or in occupational therapy, speech and language therapy or psychiatry. We are making it as difficult as we possibly can for them to get qualified. What sort of insanity is that? We have said again and again that those fees, financial obstacles and the necessary funding for those courses need to be put in place.

Forty-six children have had their mental health and well-being badly damaged by the very services that were supposed to protect, help and support them. That is a scandal but what is shocking, as everybody knows, is that this is not limited to north Kerry. This is a particularly horrendous incident which has had terrible consequences for families and children. Yet, the problem was well known by the Government, the HSE and Oireachtas committees. Indeed, it was flagged in 2006 in the brilliant A Vision for Change document. Its proposals were brought forward 16 years ago and never implemented. In fact, they were effectively watered down with the Sharing the Vision document because we could not implement the state-of-the-art strategy set out in 2006. If we had implemented it, we would not have had the problem we had in north Kerry and the problem we are seeing right across the services.

In April 2021, and I am sure I was not alone in doing so, I asked the following parliamentary question to the Minister for Health, Deputy Stephen Donnelly. It says a lot. I asked the Minister "if he will order a general review of the use and overuse of psychiatric medication in children across all CAMHS and primary care health services and in particular to review the way a lack of resources for alternative approaches is driving the overuse of medication given the concern in relation to the rapid rise in the use of psychiatric drugs in children". I asked that question in April 2021. The Minister did not answer the question but bounced it. He said that it was essentially not for him to answer. When I asked him to conduct a general review, he bounced it on to the HSE so that they could look at itself.

I got an answer at the end of June, two months later, in which the HSE ignored the request for a general review across all of CAMHS and muttered at the end that it would discuss the issue of overmedication with the CAMHS team in the College of Psychiatrists of Ireland. Did they discuss it? I bet they did not. I bet that was absolute horse crap. The HSE also said it would make efforts on the clinical governance issues. I want to know exactly what efforts it made after it answered that question because I bet the answer is "none". The HSE did not want to admit what was going on, as also happened in the case of Dr. Singh and many others. It was covering up for the fact that the service was massively under-resourced and managers were trying to deny the reality. The reality is that it compensated for the lack of resources for the CAMHS teams, the primary care teams, the early interventions and the lack of psychology services in schools colleges and so on with the overmedication of children. That is happening on a widespread basis and anyone who said anything was told to shut up or get out. That is what was going on. We have to get to the bottom of this very fast or more children will be damaged.

Deputy Verona Murphy

I thank Sinn Féin for bringing forward this motion. This is an opportune time to review the entire CAMHS system from top to bottom. I first note that our CAMHS team in Wexford does a remarkable job. It has no control over the deficits in staffing levels and what I am going to say is by no means a criticism of it. In fact, we have excellent staff; we simply do not have enough of them. We are understaffed, under-resourced and under pressure. County Wexford is still without a paediatric dietician, which I have brought up numerous times on the floor of this House. The incidence of anorexia in our children and adolescents is growing. It is a dreadful scenario for families to endure and watch their children deplete their bodies of food. They watch their children die of starvation, in effect, unable to access the care that is required to cure them of anorexia. It is curable but it needs intervention. The system simply does not work if the required staff are not available. A dietician is the support that is required for CAMHS in Wexford - not 0.5 of one but a full whole-time equivalent dietician.

The Luas, Dublin Bus or Irish Rail would be in chaos every morning if we did not have enough drivers. A schoolroom would struggle to function if it did not have enough teachers and our ambulance service would fail if we did not have enough crew members. Yet when we do not have the right staffing levels in CAMHS it does not hit the headlines like it would for these services. My discussions with GPs indicate that they are referring children to CAMHS and some are not deemed in need of urgent attention. That means that children and adolescents are going untreated, often resulting in them ending up in accident and emergency after attempting to take their own lives. Surely if a GP refers a child or adolescent they deem in urgent need of mental health care, they should receive that attention.

As has been noted many times tonight, in 2019 the staffing levels in the mental health services showed a deficit of 2,600 staff. That was 2,600 fewer staff than recommended in A Vision for Change. We need to deliver a service that is fit for purpose and at the moment we just do not have that. There are too many anomalies, too many people missing off the team and a lack of consultants. There is no dietician or in-house bed unit in Wexford, no beds in Waterford for minors and no 24-hour service in Wexford. It took a long time to recruit a badly-needed child psychologist for the service in Wexford and children and their families were exposed for years because of that.

What I had hoped to hear is that there is a willingness to examine, from top to bottom, all relevant issues surrounding the services and how they can be improved. The Minister of State has said that. I know that she, like me, is passionate about delivering mental health services that improve our children's lives and give them a future. I feel sorry for her this evening because her line Minister is in Dubai with the Secretary General of the Department of Health, both of whom should be here responding to what has gone wrong. The head of the HSE is making excuses on radio and excuses is what they are. There has to be accountability. We have reports from stakeholders who know about these things, such as Mental Health Reform, but the recommendations that have been made over the years have never been implemented because the HSE knows best. We now see the result of that and it most certainly is not what I would call best practice.

It is also not good enough that the Minister of State, as a new Minister who has no real fault in this, is taking the fall. I ask that she assert herself and not allow that to happen. There has to be accountability for those who are paid to take it. Being in Dubai when we are in the throes of a very serious mental health crisis is not what I would call either accountability or responsibility. I am very disappointed that that is the level of seriousness shown by our senior Minister in the Department of Health and his Secretary General. It is very disappointing.

Given the day that is in it, I want to mention the leaving certificate. The decision by Cabinet today has brought to bear very serious mental health pressures on at least 70,000 students. We will debate that further during the week.

Deputy Peadar Tóibín

Aontú is supporting this motion. The only problem I have is that if the motion is passed but the necessary investment is not put into services, there will be no beds for children within the system in this State. We need to have enough child psychiatric beds to admit children into. Otherwise it is not going to work for the children on the ground. We need to ensure that all children under the age of 18 have access to urgent emergency mental health services and that they are given access to an age-appropriate specialist, 24-7. At present they do not have that and many children are going into adult emergency departments where there is usually only a consultant in adult care to provide the service to them.

We also need to talk very seriously about funding. The World Health Organization advises that a state put 12% of its overall health budget into mental health. We are not even achieving half of that currently. Even in the middle of a pandemic when such pressures were being put on people's mental health, we only invested 5.1% of our health budget in mental health. Today in The Irish Times, a consultant child psychiatrist, Dr. Ian Kelleher, warned how dire the situation is. He stated:

There should be 100 specialist Camhs teams in Ireland. [Right now] There are only 73. Looking within the individual teams, many are grossly understaffed, some working with just one-quarter of the recommended level of staffing. Clinicians are stretched to the limit trying to keep up with urgent referrals and provide quality care.

This is somebody from the front line. With such a shockingly low level of funding, it is only a matter of time before a disaster happens. We are creating the recipes for crises such as the one that happened in Kerry. Unless the Government gets real with regard to the shortfall in investment, we are not going to see any change.

I was also told today that 16 and 17 year-old patients are ending up in adult emergency departments and there are no specific services for them. That needs to be looked at because there is a world of difference between the services needed by 16 and 17 year-olds and adults. The environments in which they are treated need to be different as well and must be suited to their needs.

This situation has been made worse by the pandemic. It is incredible that it is two years since the start of the Covid crisis and we still do not have official, trustworthy statistics on the rates of suicide and self-harm in this State. I understand that the suicide rates are collected from coroner court decisions on what happened in certain cases but surely the Government itself has carried out research into what is happening with regard to suicide rates across the country. Is the Government carrying out specific research into the levels of suicidality and suicide in this State as a result of the pandemic?

If it is not, is there a plan to do so? Is there a plan to understand the exact cost to the lives of young people, in particular, in terms of what happened in the past while?

A survey was carried out on 195 psychiatrists of the College of Psychiatrists in Ireland in May and June 2020 which found there was a 64% reported increase in referrals for self-harm and suicidal ideation. There was evidence of increased lethality of self-harm in at least one hospital. The Government needs to provide an update. This goes back to the request our party has made to it numerous times for a full investigation of what happened during the crisis and its effects on society. We need a start date for that investigation about which the Government is giving a nebulous promise.

Funding shortfalls are a political choice. They do not happen by accident. One will never see more investment in mental health on the front page of a Fine Gael election manifesto, but might see tax cuts for upper-income earners. Until mental health becomes a political priority for all the Government parties, we will not see change. I urge the Government to get real on political priorities.

Deputy Richard O'Donoghue

I will start by thanking the Minister of State, Deputy Butler, for coming to the Dromcollogher respite centre in County Limerick and taking the time to speak to the management, staff and volunteers who make the centre such a brilliant place. Some 51 people contributed to this debate last week. It was one of the most heartbreaking debates we have seen.

It was very sad to see the defeat on so many politicians as they made their contributions on yet another HSE inadequacy. Will we see more of this behaviour and practice by professionals? Where are the safeguards and the governance for the practices? Where does the buck stop? The indignity suffered by the young adolescents must be the last.

The Taoiseach said that it was not a staffing issue during the debate last week. In any sector one works, including mental health or hospital sectors, management is responsible for the care given out. Management is responsible for staff morale and the due care of people under its control. I have asked for help from the Minister and Ministers of State on more than one occasion to help me sort out the problems that management has not addressed in University Hospital Limerick, UHL, pre-Covid, during Covid and since Covid has been dropped.

The management is not able to control the consultants. People take up beds in the hospital for four or five days while waiting for a scan. We see the stuff being done on a day-care basis in the private hospital system in which people are in and out in one day. The problem is the consultants do not meet the patients for four or five days and hold up the valuable beds for people who are sick, but it comes back to management. Management has no control. I ask the Minister of State to help me sort out UHL.

Deputy Danny Healy-Rae

I am glad to get the opportunity to speak and I thank Sinn Féin. I will start by apologising to the parents and those lovely boys and girls who were harmed and not treated properly by the HSE. Those youngsters and parents did nothing wrong. I have to reiterate that they did absolutely nothing wrong. They sought help and did not get it. Some 1,332 children were not dealt with properly. Were it not for locum doctor consultant psychologist, Dr. Ankur Sharma, who raised the alarm about multiple medications to young mental health patients, how much longer would this have gone on?

One would think that when there was only a locum and not a senior consultant in place, management would have been more hands-on and managed what was going on. Paul Reid, who suggested there would be criminal investigations, should include himself. He gets approximately €420,000 and all he does is read out figures on the television every night. Any public relations person could do that. His job should be to monitor every last thing going on in the HSE on the ground.

The Irish Medical Council will draw up a report. Will it be influenced by the HSE? I have heard too often from hardworking nurses and carers who are afraid to open their mouths about any inadequacies in the HSE in the hospitals or any of the care facilities. Why are they afraid? They would be ostracised or maybe lose their jobs and they still work hard. That is very wrong and that culture must be rooted out and stopped, because that is what is going on. Even GPs are afraid to speak out. The HSE stumbles from one fiasco to another.

Deputy Michael Healy-Rae

I thank Deputy Ward and Sinn Féin for their work on this matter which is, of course, excellent. I ask the Minister of State to ensure that the vacancy for the lead child consultant psychiatrist is put in place. Surely be to God, we can get someone to fill that very important role. We have to ensure proper oversight, governance and clarity in dealing with these matters to ensure the likes of the situation we had in CAMHS in County Kerry will never happen again.

I gave Friday, Saturday and Sunday to meet with parents, not just of the 46 children, but other parents who were in the initial trawl and are still not happy with the investigation to date, nor with the way the situations of their children have been handled. I deal with those cases, case by case, as they have come to me in the past and as they still come to me. My office and I hear harrowing stories from people who have sought access to mental health services but have been unable to do so. Then we have the situation of the people who did reach out, got the service and then the service we provided harmed their beautiful and vulnerable children. It is an outrage of enormous proportions.

The problem we have going forward is around how we will, first, put right the wrong done to those children who in the HSE's words have been damaged. How will we restore confidence to other parents that in the future their beautiful children will not be afraid to access mental health services through CAMHS throughout the country? What will we do to make sure the parents not just in County Kerry, but throughout Ireland, will have confidence restored in the service? If one was the parent of a child who had troubles, how could one feel confident going to the HSE to ask for help?

When it comes to dealing with mental health, it is so important we make the services available. In County Kerry, on a continuous basis, we try to ensure we have proper services available. There is a lack, in particular, of a co-ordinated national system to resolve the crisis situations when they arise.

Deputy Michael Collins

Mental health must become a national priority, as our country must face up to a crisis beyond any other we have ever had. The Rural Independent Group's pre-budget submission sought increased funding of at least €85 million for mental health services this year to deal with the emerging mental health crisis. The increased allocation by this Government is only half that of our proposals. It is no wonder we have a crisis in mental health in this country.

Throughout the country, many individuals have severely struggled to access basic support even before the pandemic, but we have no doubt Covid-19 has adversely affected the physical and mental well-being of many more people.

Both my staff and I hear many harrowing stories daily from those who sought to access mental health services but, shockingly, had been unable to do so. I may ask why but the answer is simple. In 2021, only 5.1% of the total health budget went towards mental health in Ireland. By way of comparison, 13% of the health budget in the UK went to mental health. The Government is great at launching glossy action plans and strategies but this is less than 5% of the work. Ninety-five per cent is getting the job done by funding the services and providing the resources.

One of the most harrowing scenes in life is attending the funeral of someone who commits suicide. The upset it causes the family, friends and community takes a considerable time to recover from and in some cases, they may never recover. I sincerely wish I had the formula to end this crisis, which is growing in my community at an alarming rate. I plead with people to show love, care and compassion to one another, talk to people who may be struggling as it may be them today and could well be oneself tomorrow, and extend the hand of friendship to try and ease the burden of pain so many carry at this time.

Mental health issues have no age boundaries. No matter what your age, it strikes and can bring anyone to his or her knees quickly. During the latter part of 2021, we heard from hospital consultants about the emerging tsunami of distressed young people presenting in crisis to the paediatric hospitals and the paediatric emergency departments due to mental health-related illnesses. However, hospital consultants also warned it was not possible to provide appropriate urgent in-patient care to children and adolescents due to the severe lack of beds for this group of patients. The Irish Hospital Consultants Association also stated that the number of adult psychiatry beds available for acute admissions had been reduced to the point where there were frequently no beds available at night in many of the community healthcare organisations. The association said this is causing an ongoing patient safety issue.

Deputy Catherine Connolly

The Acting Chairman might clarify the position regarding my amendment. I tabled it today.

Acting Chairman (Deputy Marc Ó Cathasaigh)

After we dispose of amendment No. 1, we will be in a position to deal with your amendment.

Deputy Catherine Connolly

The Minister of State, Deputy Butler, might indicate if she is intends to accept that amendment. It is a request from the Mental Health Commission to give it supervision and regulatory powers in relation to community facilities, which is one of the problems here. I went straight to the Mental Health Commission website to see what it had been saying about the issue. Of course, it could not say anything about it because it does not have regulatory authority.

Deputy Mary Butler

I will be accepting it and it will be included in the legislation that is coming this year. It is an important part of it. I thank Deputy Connolly for raising that.

Deputy Catherine Connolly

I thank the Minister of State, who is accepting that. I will not waste my time praising the Minister of State, Deputy Butler, but it is beyond endurance that the senior Minister is not here.

I thank Sinn Féin for using its Private Members' time but I asked the Government to put it on the agenda. This report has implications for all of the CAMHS throughout the country and if we cannot see fit to discuss that, of itself, as a subject, and to look at the findings of this report and see what we are learning from it, as I stated on the previous occasion, we might as well resign.

I have only been here since 2016 and I have been given to serious moments of despair, not at the problems we face but at our failure to take action, and report after report. I am old enough to know about Planning for the Future, which was in the 1980s. Then we had A Vision for Change and then Sharing the Vision. Of course, we had the update on the legislation. All of the time, we have the most serious difficulties on the ground.

The Minister of State might update us tonight on the monitoring because I never had any faith, even in myself not to mention all other politicians, in the implementation of reports. That is why we need an independent outside organisation to monitor and tell us about Sharing the Vision. I am still stuck with A Vision for Change because to me it was a perfect document. Where the imperfection came was in the failure to implement it. As I said, the implementation body sat for two to three years and then was disbanded; it did such a good job. Hopefully, this implementation body will do the same.

I looked to the Mental Health Commission to see what it said. In 2017, it expressed concerns about CAMHS in inpatient units. The commission has regulatory power over that. It also pointed out that CAMHS has had to provide services for mild and moderate mental distress due to the lack of primary care psychology facilities. Of course, a primary care strategy was rolled out 20 years ago but never implemented. It would have taken some of the pressure off. Children are inappropriately being referred to the CAMHS units and then, when they are there, amongst many other things, they are being inappropriately treated.

While I have a few minutes, I will go back to the report's findings. I have difficulty with the words "essentially independent", but the effects were so bad that they transcend my problems with "essentially independent". I have no idea why the following statement of finding is included, "No extreme or catastrophic harm had occurred in the 1,332 cases considered between July ... and April". This is catastrophic harm, as set out at findings 2, 3 and 4, but yet we are being told that. To me, that is Health Service Executive speak. I have never seen it in it. The Health Service Executive was instrumental in producing this report, notwithstanding the sterling work of the independent chair.

The report goes on to tell us that:

227 children managed by ... [a non-consultant doctor] where the diagnosis and/or treatment exposed them to the risk of significant harm by way of one or more of the following: sedation, emotional and cognitive blunting, growth disturbance and serious weight changes, metabolic and endocrine disturbance, and psychological distress. ...

3. 13 other children were found to have been unnecessarily exposed to a risk of harm under the care of other doctors in the service.

4. There was clear evidence of significant harm [but they feel obliged to tell us it was not catastrophic] ... to 46 children in the files that were reviewed.

They gave out a list of them and various things have been said.

That is a review following an internal audit. I am not sure why the triggers did not take off at that point to do an audit of all the CAMHS throughout the country, both community and inpatient services. Surely that would have been an obvious thing to do.

If we look at that report - I will work backwards in the time I have - we see three consultants left in the past year. This independent review tells us, "It is of concern that we have learnt that three consultants in the County MHS Area A have tended their resignation in the last year."

I had so many points marked out to go through methodically but I will not get the chance to do that. A governance group was set up in 2019. They raised concerns. Concerns were raised as long ago as 2016. There was diagnostic concerns and treatment concerns. There was the role of the private agencies in providing temporary doctors. There were family queries. The very concerned families did their best to raise their concerns, and were ignored. Phone calls were ignored etc. All that is set out. The maximum risk was set out, when they did a risk assessment, in relation to the vacancy. The risk was 25 out of 25.

What jumps out at me here is that there were good staff on the ground, who tried to bring concerns to the attention of management and nothing was acted on. We have one specific whistleblower and I would like the Minister of State to tell me tonight what review has been done in relation to how he was treated. If we are utterly reliant on a whistleblower, be it he or she, and we treat him or her so badly, it is impossible to have faith in the system.

I have to say publicly I am not one bit impressed with the comments from the CEO of the Health Service Executive in relation to this matter. National managers were aware that there were problems in south Kerry. That means the CEO, Mr. Reid, had to be aware as well. If he was not, then he should be asking how he is not being alerted to it. Then we have a Minister of State being repeatedly sent in here to face all of this. It is totally unacceptable to deal with us like that.

In relation to the language being used, there is a particular method that they use - I forget the four letters of it. The independent chairperson finds useful the analogy of traffic congestion and cars being backed up on a road and on a motorway in relation to the analysis of clinical cases and a backlog with clinical cases. I picked that out specifically because, to me, that is what has happened with language. Language, when I look at this and all of the governance documents, means nothing.

When a courageous person comes forward, his or her life is made a misery. I had the privilege in a previous life of working as a psychologist for the health board, and I must say, the service even in the bad times was 40 times better because at least language used to mean something.

Let us turn to the Mental Health Commission and the themed reports produced by Dr. Finnerty. I understand she is now undertaking an examination of south Kerry as well. She has repeatedly highlighted for all Deputies to see the difficulties in respect of mental health generally, and specifically in regard to Covid, the badly designed buildings about which we need to take action as a Dáil. In regard to mental health and the drugs that are prescribed, the physical health of the person suffering from mental health issues is utterly neglected. She has highlighted year after year in themed reports that physical health is utterly neglected and that people suffering from mental health problems die 15 to 20 years before their time. Year after year, this has been pointed out to us. I do not blame the Ministers of State. My point is we know all this information, so my sense of frustration is intensified with each session of statements in the House. I thank Sinn Féin for tabling this debate but it should be the Ministers of State, or the Minister for Health, laying out this report before us and inviting us to examine what will happen as a result of it, as opposed to us being grateful to Sinn Féin for using its Private Members' time for it.

How many draft reports are sitting in the various offices of Tusla and the Health Service Executive throughout the country as we speak, where whistleblowers have bravely come forward, a report has been produced and the word "draft" remains on it ad nauseam? Are the Ministers of State aware of how many there are? If they could check, that would be helpful. I refer to brave and courageous people coming forward, some of them managers and others doctors and nurses. They go to all this trouble and then the draft report remains with Tusla at its board or somewhere within the HSE, and Ministers of State have to come to the House and face the fire, as opposed to there being a proactive system that highlights problems and learns from them, not in a punitive fashion but before we get to the punitive stage. Someone should be held responsible for this.

Minister of State at the Department of Health (Deputy Frankie Feighan)

I thank the Deputies for their contributions on this very important issue, and Deputy Ward in particular, who tabled the motion, which the Government will not oppose.

We all have children and young people in our lives, whether as part of our family, among our friends or in our community. Along with our relatives, friends and community, we take special care of them and attend to their needs. We want to protect and guide our children and equip them for the challenges of life ahead. As parents, we want the best for them, and when we look for help, we put our trust in those who help us. Unfortunately, in the case of the children and adolescent mental health services in south Kerry, that trust was broken. The report identified failings at multiple levels, in regard to how medications were prescribed but also to how the service was managed. It is important that there be accountability at individual and systemic level. Individual accountability is subject to due process and I cannot comment on individual cases, but systemic responsibility is something that can and will be addressed. My colleague the Minister of State, Deputy Butler, is working closely with the HSE to ensure all 35 recommendations of the Maskey report will be implemented as soon as possible. Six are already complete and 13 have commenced implementation. Fortnightly updates on progress have also been sought. As the Minister of State noted, in addition to a national audit of compliance with existing operational guidelines among all CAMHS teams, an independent-led audit of prescribing practices among all teams, community and acute, will be carried out. I hope that in doing so, we can give some assurances to families that their children are safe and are receiving the appropriate care.

The issue of recruitment and the filling of posts is a perennial concern. It has to be acknowledged this is an international issue, common to many other health services and not specific to the HSE. However, we can do better. A total of 93% of consultant psychiatrist posts in CAMHS are filled, but the Maskey report has illustrated how unfilled posts can lead to serious systemic issues that can directly affect children and young people in contact with services. We have collectively to find ways to ensure our services are managed and delivered in line with high standards, issues with recruitment notwithstanding.

The report was stark in its findings and comprehensive in its recommendations. It did not shy away from difficult matters. The HSE has acknowledged its culpability in this regard and is committed to implementing the recommendations of this report. The Minister of State, Deputy Butler, has met many of the committed staff in mental health services throughout the country. I am sure they share our concerns for the families affected and want to deliver the best for children and young people in their care. An apology has been given to all the children and young people involved and representatives of the HSE have met 198 of the families. Although it is no consolation, it is a start to the process of making amends to right the wrongs that have so carelessly been allowed to happen for such a sustained period. In this context, as the Minister of State highlighted, the Government has committed to a non-adversarial scheme of compensation for those affected, with details to be confirmed.

The Minister of State acknowledged we face serious challenges in developing our mental health services, and part of that development will involve looking back, identifying failures and learning from them. We must also look forward, however, identify what works well, build on progress and expand services. We have a robust national mental health policy in place through Sharing the Vision, with the national implementation monitoring committee at its heart. As the Minister of State mentioned, we therefore have a strong policy framework that is fit for the future, to develop and deliver a modern and human rights-based mental health system. This will be complemented by Connecting for Life, the strategy for suicide prevention. We have established a trend of increasing budgets, with significant funding available for new developments year on year. This is not just a sign of the priority the Government places on mental health but is a recognition of the value placed on mental health by our society, something that is especially true as we find ourselves in the tail end of a pandemic that has put us all under unprecedented pressure.

I acknowledge also the significant progress being made on the legislative front in regard to updating and amending the Mental Health Act 2001. This will bring a rights-based approach to our mental health law and enhance the protections and safeguards for children and young people accessing specialist mental health services. With a modern legislative framework, a ten-year strategy and a record of investment, we have a good basis for progress in the years ahead to develop mental health services. In the context of mental health, the pandemic accelerated other modernisations such as telehealth, including text message lines and online and remote counselling and services, innovations that can undoubtedly benefit our young people. While social media can be misused for nefarious purposes, as a colleague said last week, our pandemic might have been much worse in terms of our isolation from one another without social media and the connections it brought. That is why it is important our mental health services can develop, in line with a blended-care approach, quality-assured online options for a tech-savvy, young population.

In wrapping up this evening’s debate on the motion, I want to once again acknowledge the impact of the Maskey report. Not one word of the report has been changed or redacted and it is exactly as Dr. Maskey reported. I urge that use be made of the information line 1800 742 800, which is open from 8 a.m. to 8 p.m., seven days a week, for anyone affected by the report. Any young person who has concerns, or their family, should seek help without delay. The wide range of care services available provide real help that makes a real difference to many young people on a daily basis.

I know the Minister of State, Deputy Butler, has heard, as I have, what fellow Deputies have said this evening. The challenges in the delivery of mental health services are well acknowledged. Importantly, progress has been made and these developments will be built upon to ensure that the fundamental improvements that are needed across our mental health system are achieved.

Deputy Brian Stanley

The motion calls on the Government and the HSE to address the crisis in mental health and disability services for young people and children. We know this is a growing problem, unfortunately. The services have been at breaking point for too long and patients simply are not getting the timely and quality care and intervention that they need and deserve.

Last week, the issues in south Kerry child and adolescent mental health services, CAMHS, dominated the news, with more than 240 children found to be exposed to a risk of significant harm due to poor monitoring and insufficient funding. There is also a lack of accountability in various parts of the HSE senior management. I want to say to the two Ministers of State present that this needs to change. There has to be a system of accountability.

We have seen similar problems across the State in regard to child services. I received figures from the Department of Health which outline totally unacceptable child waiting times for child disability and mental health services in County Laois. Some children are waiting over five years for occupational therapy, or five years and three months to be exact. Imagine that. The boat is missed at that stage. A total of 1,158 children are on the occupational therapy waiting list and 51 children are waiting for physiotherapy, which has an average 32-week waiting list, with some waiting over three years. Speech and language has 237 on the waiting list, with the longest waiting list there being over six months, when we know how important this is to mental health. The worst is that there are 85 children waiting for psychological services, with some waiting up to 48 weeks. The Minister of State and I both know the importance of early intervention with regard to psychology. Families are experiencing huge delays in trying to get psychological assessments before they can even get their children into the system and then onto a waiting list. If we do not have timely, early intervention, it will lead to serious delays and developmental problems that continue into later life, as has been well established.

We continue to see a failure by the Government and the HSE to build front-line services. This is what matters to people, in particular families and children. There needs to be an immediate focus on filling those gaps in front-line services. I know we cannot flick a light switch but we can start planning. If we are not recruiting people into those disciplines, we need to start that recruitment. For God’s sake, in the Minister of State's term in office, will she try to get some level of accountability in the HSE in regard to matters like this? The situation with child and adolescent mental health services needs to be addressed urgently.

Deputy Martin Browne

What we have seen in south Kerry recently indicated the challenges facing young people in securing the appropriate mental health services in a system that has not been designed around their needs. The lack of resources and the poor roll-out of mental health supports in general, but particularly for young people, has been well known for some time. It has been made worse by a lack of urgency on the part of the Government, which says it is difficult to find the psychologists, occupational therapists, speech and language therapists and so on that the HSE South East told me last week are being sought in my constituency. This is what happens when, for decades, understaffing and under-resourcing have made it an unattractive prospect. It is a problem of the Government’s own making.

We see the State relying on the community and voluntary sector to make up for the shortfall in counselling and therapy services by expecting them to be able to provide their wonderful services for either no funding or for low level, short-term funding at best. We saw astonishing mixed messages about the Jigsaw service in Thurles. We saw how the thousands of people who turned out on the streets of Clonmel to demand that St. Michael’s be retained were ignored. Yet, the Government says it is taken aback by recent events. Give me a break. It is blinkers and ear plugs they have had for the last couple of years.

Last week, I spoke in the House about a 16-year-old girl who is looking for the opportunity to feed into improving mental health services because she was left feeling abandoned. Another person, a mother from Tipperary, told my office that, in her view, her local CAMHS service had an over-reliance on the prescribing of medication to her daughter. There was no referral to counselling, just medication. When they tried to get back in contact with CAMHS about easing the medication for a number of reasons, their calls were not returned for two months. If immediate medication is seen as the stopgap measure that they must revert to until counselling and psychology services are available, then children are continuing to be failed.

In the same health area at end of last year, of the 414 waiting for child psychology services, 32% were waiting more than a year, so there is a clear capacity issue. However, in CHO 5, which includes south Tipperary, the number waiting a year or more, while still too high, is far lower than in the north of the county, so the availability of services is a postcode lottery. This is no way to be treating our children.

All of this has been watched over by this Government and previous ones with the familiar faces that we see on the benches opposite. That is why we are calling for the broadening of the CAMHS review to include capacity deficiencies and geographic inequalities, and to look at whether persistent consultant vacancies have contributed to substandard care. We are also calling for a proactive strategy for the recruitment and retention of psychologists across CAMHS and for the immediate appointment of a national director of mental health in the HSE. The current situation is failing thousands of children and thousands of adults who simply cannot get the support and treatment they need.

I commend Deputy Mark Ward on bringing forward the motion.

Deputy Mark Ward

I thank all the Members who have contributed to this lively and emotive debate tonight. I also want to acknowledge both Ministers of State for staying for the whole of the debate because that does not happen all of the time. I thank Deputy Daly and Daniel Curtin from Deputy Cullinane's office for helping to draft the motion this week. We will be accepting the amendments that have been put down by other Deputies because they add to the motion rather than detracting from it.

It is all well and good that the Government is not opposing the motion but it needs to support it and it needs to put in place all of the measures that Sinn Féin is calling for. It has been a Government tactic over the last while to not oppose motions and to let them go through, which means the Government does not have to vote against them. In particular, it is a tactic the Government has been using on recent Sinn Féin motions or Bills. However, this is on children's mental health. The people will see through this if everything in the Sinn Féin motion is not implemented. If things do not start moving in the right direction, they will see this as gamesmanship and brinkmanship, and just allowing something to go through. They need to see the Government committing to what we have put into this motion because, if it does not, the public will not be forgiving.

The first thing we need to do, and the Government has committed to this, is to get things in place for those children who were affected in south Kerry. We need to put a comprehensive care plan in place, whatever it takes, in order that these children get the services they need immediately and they can start getting themselves and their families back on the road to recovery.

One of the things I did not get a chance to touch on in my earlier contribution relates to the draconian practice of putting children into adult mental health facilities, although I spoke about this in the debate with the Minister of State last week. On the back of this motion, the Government is saying it will support legislation to stop that. I am letting the Minister of State know that at the Joint Sub-Committee on Mental Health, on the mental health legislation, I will be tabling amendments and seeking the support of the Minister of State on that. I will work with the Minister of State and I will offer to put safeguards in place to stop this happening. There is a way around this. I am not saying it is the fault of the Minister of State. My understanding is that the reason this is not being legislated for is because it protects the Government and the State from any recourse people have if children end up going into adult facilities. Plain and simple, this loophole must be closed.

I also acknowledge the non-adversarial scheme for compensation, which is welcome. We need to learn from the mistakes of the past, such as CervicalCheck. It did not work out as everybody thought it would work out. This non-adversarial scheme became very adversarial. We need to learn from its mistakes and make sure that this is a comprehensive, easy-to-access scheme for all the families involved.

The Minister of State made a point about Private Members' business in the past and said that we did not include the national clinical director. I did a Google search. It was definitely in our Private Members' business on emergency response with regard to Covid. It was also in our pre-budget submission. It is something that we have been calling for for a long time. There are other matters in the motion that we need to look at, which were mentioned by other Members. We have to look at how whistle-blowers are treated. We need to encourage them to come forward if there is a problem. We hope to get to a stage where there are no problems, but, in the meantime, we need to put in place something in order that whistle-blowers feel comfortable about coming forward and they are not pushed to the side or out of the service. These are a couple of things that we will look to do.

Amendment agreed to.

Acting Chairman (Deputy Marc Ó Cathasaigh)

There is nobody from the Independent Group to move amendment No. 2, so I cannot deal with that. I will move to the question regarding the motion.

Amendment No. 2 not moved.

Motion, as amended, agreed to.