Dáil Éireann díospóireacht -
Tuesday, 27 Feb 2024

Vol. 1050 No. 3

Mental Health (Amendment) Bill 2023: Second Stage [Private Members]

Deputy Mark Ward

I move: "That the Bill be now read a Second Time."

I want to start by recognising the hard work by dedicated staff in the child and adolescent mental health services, CAMHS, in trying to meet the needs of children with mental health difficulties. Any criticism I have is aimed directly at the Government and the systemic failures within the HSE.

I listened to the response of the Government to Deputy Mary Lou McDonald on Leaders' Questions today and was disappointed, but not surprised, by the decision of the Government to kick this important Bill down the road for nine months.

This will, effectively, mean the legislation will not be passed during the lifetime of the Government. I am not surprised because there has been no urgency on the part of the Government to tackle the crisis in children’s mental health. This crisis has escalated to a full-blown emergency on the Government's watch.

When I was named Sinn Féin's spokesperson for mental health, I said I would work in opposition in a tangible and solution-focused way, but my commitment has not been reciprocated. Time and again, the Government has either voted down, amended or, like today, kicked the can down the road when it comes to the solutions that have been put forward. I would love to take credit for having come up with the idea for this legislation to regulate CAMHS, but the fact is it reflects the very first recommendation of the Mental Health Commission in its report on CAMHS. It was the primary recommendation among 49 in the report. The Government's response that this legislation will be dealt with during the reform of the Mental Health Act simply does not wash. There has been zero urgency to reform the Mental Health Act. We first got the heads of this Bill more than three years ago. I took part in the pre-legislative scrutiny at the Sub-Committee on Mental Health that produced the report two years ago and despite calls from me and stakeholders to prioritise the Bill's publication, the Government has failed to do so.

The Minister of State, Deputy Butler, does not have to believe me when I say there is a crisis in mental health, but she should believe the Maskey and the Mental Health Commission reports. She should believe the Ombudsman for Children, who has said CAMHS is unsafe. She should believe the Children's Rights Alliance, which gave children's mental health care another fail in its annual scorecard. She should believe the hundreds of emails I have received, and that she has no doubt received too, from concerned citizens in support of regulating CAMHS.

Even if she does not believe all that, the least she can do is believe parents. As I said, I am disappointed by the Government's decision to kick this legislation down the road, but my disappointment pales into insignificance when it comes to the disappointment parents are feeling. I welcome the representatives of Families for Reform of CAMHS to the Public Gallery. I, along with Deputy McDonald and our party's spokesperson for health, Deputy Cullinane, met them just last night. We heard personal heartbreaking stories from parents about how their children have been failed by CAMHS. One distraught mother told me about her ten-year-old daughter, Maggie. She has already endured cancer and now suffers from depression, anxiety and self-harming behaviour. Maggie was on the urgent list for a year before she was seen by CAMHS. She received assessment for an intellectual disability, but she was not accepted into the services because there was no CAMHS-ID in her area. Maggie is in a mental health crisis. She is receiving no care outside of her family’s support. She is in distress and will not leave her house except to go to school. Maggie's experience is not unique; it is becoming the norm under the Government.

The Mental Health Commission's report into CAMHS highlighted several issues with the service, including children lost to follow-up, a lack of monitoring of psychiatric medications, unacceptable waiting times for high-risk referrals and many more operational issues. Waiting lists have doubled under the Government, with the number of first-time appointments for CAMHS having exceeded 4,400 in 2023. This cannot be allowed to continue. The unacceptable postcode lottery for care continues to exist, with certain counties receiving lower quality care. Children with a dual diagnosis of ill mental health and an intellectual disability have fallen through the cracks, as have neurodiverse children. Parents, children and stakeholders have been highlighting the crisis in children's mental health, which has got worse under the Government. Sinn Féin has engaged with these families and stakeholders. We have listened to their experiences and are taking them seriously.

The legislation is not a panacea, but it is the first step in tackling the crisis in children’s mental health care and will lay the foundation to reduce waiting lists. The Government has dragged its feet on this matter and now it is time to support the legislation. It should not be kicked down the road. Our children cannot wait any longer.

Deputy David Cullinane

Last week, we had a debate in this Chamber on the need for improved services for children with scoliosis and spina bifida. During the course of that debate and in the lead-up to it, I met many of their parents and the children themselves and heard many heartbreaking stories. Today, we are talking about young children and young adults who have mental health difficulties and challenges and whose parents are telling us of their experiences. They are, again, experiences of a lack of services, a lack of opportunities, long wait times and an overdependency on medication, with parents and children not being taken seriously, children with autism not getting the services they need, and their mental health difficulties not being taken seriously by healthcare professionals. We have had many crises in CAMHS, as the Ministers of State know, and we have many capacity problems. That is not, by the way, on the staff, who throughout the State, in my view, are giving an excellent service. We simply do not have the capacity, the referral pathways or the options for young people when they need them.

Far too many parents ring me about this at all hours of the night. I could give the Minister of State, Deputy Butler, examples from our constituency, and I am sure she has had similar calls, of young children who have ended up in emergency departments because there was nowhere else for them to go, or who have presented to CAMHS and been told to go home. This is happening time and again. There is a need for reform. The Mental Health Commission made 49 recommendations and, as my party colleague said, the very first recommendation was to regulate CAMHS. I cannot see how any Government can be opposed to regulating CAMHS or how it can kick the can down the road. The Minister of State is shaking her head and saying it is not, but it has not done it. It has been in power for nearly four years and is coming to the tail end of its term. It promised lots of things but this was one promise in respect of the reform of mental health services and it has not happened. The Mental Health Commission report sets out a crystal-clear recommendation and we are proposing legislation to make that happen.

I have met many of these young people and their parents over the days leading up to this debate. As Deputy Ward said, we met representatives of Families for Reform of CAMHS, ordinary parents who have come together to advocate for not just their children but all children and young adults, and what they are asking for is what we need to deliver. As in the case of the debate last week relating to scoliosis and spina bifida, I cannot understand why we are not listening to the very people who need reform and services. When parents are telling us that their children deserve better and that they are not getting access to the services they need, we are clearly failing them. Our track record when it comes to children's healthcare over recent years, under this Government, is not good. We are seeing that throughout children's health services.

We have published comprehensive reforms, not just in the context of this legislation, regarding how we want youth mental health care to work better. There are lots of solutions in all that and lots of areas that need improvement. We are not saying this legislation is in any way a panacea for all the challenges in CAMHS or in mental health care for adults either, right across the services, but it is a small and important step. When all the experts, the Mental Health Commission, advocacy groups and parents are telling us we need to do this, and a Bill that will actually do it is before the Government, that the response from the Government would be to kick the can down the road for nine months is absolutely unacceptable. It should have accepted the Bill, allowed it to go to Committee Stage and dealt with any concerns it might have about it, but actually deliver for those parents and children.

The Minister of State should look at the scorecard the Government got recently in regard to children's mental health services. It was an E, a fail, on her watch and on the Government's watch, and that is not something to be proud of. They need to do better, as we all do, and children certainly deserve better.

Deputy Pauline Tully

I commend my party colleague Deputy Ward on bringing forward the Bill and welcome all the families and parents in the Gallery for the debate.

I come from County Cavan which, unfortunately, has a very high suicide rate. Cavan is among three counties that have double the national average of suicides and many of them, unfortunately, are adolescents who had engaged with CAMHS. According to parents, there are umpteen problems with CAMHS and how CAMHS teams work. Parents are regularly waiting months for an initial appointment when their child or young person is referred to CAMHS. There is an over-dependence on medication in the CAMHS teams and often patients are not monitored or not monitored sufficiently. The use of alternatives such as counselling and play therapy does not seem to be considered. There is no out-of-hours service and a huge turnover of staff. Psychiatrists are regularly on sick leave and are replaced by locums, which means that young people have to relive their trauma by informing a new person of their issues. They have to introduce themselves to a new person and get used to that person but the next time they come back, they meet somebody different and they have to go through it all again. I have talked to many parents who have actually withdrawn their children from CAMHS because they felt the interactions were so poor and inappropriate that they were causing regression in their young person. Those families are in crisis and have nowhere to turn.

Children with an intellectual disability and neurodiverse children who have a dual diagnosis of mental ill health face an even greater battle because there is such poor collaboration between services. There is a lack of training for health and social care professionals. Autistic children are regularly referred to CAMHS with anxiety or mental health issues but are turned away because the CAMHS teams will not deal with autistic children. This has to stop. There has to be collaboration between the services to ensure that children get access to planned and continued care.

CAMHS is not regulated under the Mental Health Act but this Bill will ensure that children's mental health services are regulated under that Act. The Mental Health Commission can make recommendations on governance and clinical reforms in CAMHS but it does not have the statutory authority to make sure the recommendations are implemented. This Bill will give statutory powers to the Mental Health Commission to oversee and assist the HSE in its implementation of its recommendations. I urge Members to support this Bill.

Deputy Sorca Clarke

The crisis in youth mental health has turned into an emergency under this Government and there is no way the Ministers of State can deny that. Under this Government, the CAMHS waiting list for first-time appointments in CHO 8, which covers my constituency of Longford-Westmeath, has grown from 270 in July 2022 to 695, which is the last available number. The number of young people waiting over a year is 115, the second highest in the State. Behind each and every one of those figures is an actual young person or young child. In 2018, a six-year old was referred to CAMHS but that referral was refused. In 2019, the child was referred to community psychiatry and her parents did the Timid to Tiger programme. In 2019, she was referred again to CAMHS. At this point, she was seven. I am speaking here from first-hand experience because I am speaking about one of my own children. In 2020, while I stood in Dunnes Stores in the period between the general election and the Dáil's first sitting, I got a phone call from the community psychologist to tell me that my daughter's referral had landed back on her desk and there was nothing she could do except send it back to my GP. Finally, after a third referral, she was seen in 2022, having been on the list for around three months. These figures go nowhere near explaining the sheer scale of this issue in our communities. Our children are suffering. My child certainly suffered. She is doing very well today, unlike many others who are still suffering, and that is wrong. The Government has the opportunity tonight to do the right thing. Let us regulate CAMHS and make it fit for purpose. Let us make sure that no other child suffers for almost half of his or her life while trying to access a service when there really is no need for that to happen.

Deputy Paul Donnelly

Children and young people in this State deserve better mental health services and should not have to wait for a significant length of time to access them. Children with dual diagnoses of mental ill health and an intellectual disability are falling through the cracks, as are neurodiverse children. This is something I saw at first-hand as a child and family support worker in Tusla. I commend all those working in the area of youth and children's mental health. They are doing a very important and demanding job.

I received some statistics from Families for Reform of CAMHS which are absolutely shocking. People in this State have the highest level of difficulty accessing mental health services across 27 EU member states. Approximately 44% of Irish people had difficulty receiving treatment for a mental health issue compared with the EU average of 25%. In 2021, Ireland ranked in the bottom one third of 41 countries in the EU and OECD for child mental health. In 2020, the number of children aged between ten and 14 who were self-harming increased, indicating that the age of onset of self-harm is getting lower. Also in 2020, one in every 128 girls and one in every 233 boys between the ages of 15 and 19 presented to hospital due to self-harm. In 2017, Ireland ranked the highest in Europe for girls dying by suicide. These statistics are absolutely shocking.

This Bill states that the Mental Health Commission should be given statutory powers to oversee and assist the HSE in the implementation of the commission's recommendations on governance and clinical reform. It will also allow for the Mental Health Commission to monitor the implementation of any such recommendations and to publish a yearly report on progress. The Bill provides that the Mental Health Commission would publish an annual report on the status of the recommendations. Earlier today, my party leader, Deputy McDonald, asked for support for this Bill. I am very disappointed to hear that the Government will not be supporting it and will propose an amendment. The people in the Public Gallery tonight and our constituents will not forget this. Children deserve better mental health services.

Deputy Pearse Doherty

Níl dabht ar bith ach go bhfuil gá le níos mó infheistíochta agus níos mó a dhéanamh ó thaobh CAMHS de mar go bhfuil páistí na tíre seo á ligean síos mar gheall ar an Rialtas atá againn agus an teip atá air ó thaobh meabhairshláinte agus an tacaíocht atá á fáil ag páistí ar fud an Stáit, go háirithe i mo chontae, áit a bhfuil go leor daoine ar liosta feithimh.

Children deserve better. They deserve better mental health services than they are getting under this Government. The sad reality for so many children and parents across the State is that they are waiting far too long to access mental health services in this country. Early intervention is key and a deterioration in a child's mental state often occurs when he or she is waiting to access services. Across the State the CAMHS waiting lists for first appointments have almost doubled in the space of a year, with nearly 4,000 children and young people waiting to be seen as of August 2023. In my own area of CHO 1, which includes Donegal, 294 children and young people are languishing on waiting lists and over half of them have been waiting more than three months. It is a postcode lottery for these children. Children and parents are anxiously and desperately waiting for the support they need. Many who have dual diagnoses of mental ill health and intellectual disability continue to fall through the cracks. These children and young people are the most vulnerable in our communities but they are being failed over and over again.

Parents have spoken about meeting the Minister of State. They said she was shocked but nothing has changed. It was July when they met her and now it is February. In Donegal, one of the CAMHS teams has no psychologist, social worker or occupational therapist but that is no longer unique or shocking. It is the norm in terms of what parents and children have to put up with, day in and day out. Parents are looking at their child who is anxious, depressed and suicidal and who is waiting, in some cases, for a full year to get a first appointment. It is an indictment of this Government that it is letting down the most vulnerable in society. This cannot continue for young people and their parents in my county and throughout the State.

The legislation that my colleague, Deputy Ward, has brought before the Dáil would provide for the regulation of children's mental health services, which was the first recommendation of the Mental Health Commission's report on CAMHS. The Bill proposes to give the commission the statutory powers it needs to implement the remaining recommendations. The legislation before us would help to improve services and tackle waiting times for children, young people and their families. It is a first step in ensuring that children in Donegal and elsewhere can access the mental health services they need and deserve. It is appalling that the Government is planning to pause this. If it was not so serious, it would be laughable because for most of these families, their life is on pause. That means another nine months waiting for an appointment or a follow-up.

The Government today is planning to pause the implementation of this legislation, which was the first recommendation made by the Mental Health Commission.

Minister of State at the Department of Health (Deputy Hildegarde Naughton)

I move amendment No. 1:

To delete all words after "That" and substitute the following:

"Dáil Éireann resolves that the Mental Health (Amendment) Bill 2023 be deemed to be read a second time this day nine months to allow for the issues contained in the Bill to be further examined in consultation with the Deputies and on the basis that the Government's Mental Health Bill, currently in the final stages of drafting, and which will be published and will be introduced to the Oireachtas in the summer legislative session, will introduce the registration, inspection and regulation of all community mental health services, including Child and Adolescent Mental Health Services on a statutory basis in a much more comprehensive manner than provided for in the Sinn Féin Bill.".

I thank Deputies Ward and Cullinane for initiating the Bill before us on Second Stage and for the opportunity, along with my colleague, the Minister of State with responsibility for mental health and older people, Deputy Butler, to discuss child and adolescent mental health services and the regulation of all community mental health services. The Minister of State, Deputy Butler, will make the closing statement.

This Bill seeks to amend section 33 of the Mental Health Act 2001 by inserting two additional functions for the Mental Health Commission. The first addition is to permit the commission to develop standards and rules for the provision of community CAMHS following consultation with stakeholders. The second addition is to monitor the implementation of these standards and to publish an annual report on progress. I have moved a timed amendment of nine months to this Bill, so that it might be read a Second Time later in the year. Our reasons for seeking this timed amendment are twofold. First, the Bill as written does not provide for the regulation of community CAMHS. Second, the Minister of State, Deputy Butler, will introduce a Mental Health Bill in the summer Dáil session to comprehensively update and overhaul our current mental health legislation. I will set out the reasons in detail.

I appreciate that the Deputies’ intention with this Bill is to grant additional regulatory functions to the Mental Health Commission to effectively register, regulate and inspect all community CAMHS. We can all agree that we are here, as public representatives, to make sure the health services and, in this case, the youth mental health services young people use daily are fit for purpose, person-centred and accessible. However, the intent of the Deputies’ Bill is not what the text of their Bill reflects. The Bill provides for the commission to make standards and rules in relation to community CAMHS. Under section 33(1) of the Mental Health Act, the commission already has the power to make standards across all mental health services. In fact, it is one of the commission's core functions already in the current legislation to "promote, encourage and foster the establishment and maintenance of high standards and good practices in the delivery of mental health services." Furthermore, under the current existing legislation, it is within the gift of the Mental Health Commission to monitor the adherence to any standards it has delivered and to report on its monitoring as it pleases. This is exactly what the Mental Health Commission did in 2022 and 2023 when it undertook a comprehensive national review of CAMHS. As such, I cannot see how the Bill, as currently written, meaningfully adds to the existing functions and powers of the commission. In addition, the Bill does not provide for the regulation of community CAMHS, which is the stated aim of the Government and is in line with the recommendation of the Mental Health Commission’s report on CAMHS last year. Under the current Mental Health Act, all inpatient services, adult and CAMHS, are registered, regulated and inspected by the Mental Health Commission.

The Inspector of Mental Health Services is granted the power to inspect all inpatient services under section 51 of that Act, and the regulation of those services is provided for in Part 5 of that Act. Secondary legislation was made to add further detail to the regulation of inpatient services, most significantly the Mental Health Act 2001 (Approved Centres) Regulations 2006. This legislation exemplifies the fact that in order to effectively regulate a service there must be a robust legal basis for such regulation. This basis seems to be lacking in the Bill before us and, as a result, the Government would have serious concerns about the legality of any regulatory powers underpinned by the two proposed amendments to the Mental Health Act put forward by Sinn Féin. In particular, there are no enforcement mechanisms and no penalties for non-compliance where a service does not meet the standards or rules proposed in the Bill. Therefore, even if the commission made new rules and standards under the additional functions set out, it would not have the ability to penalise a service for not complying with them.

In reality, it is difficult to see what these amendments would contribute to the regulation of community CAMHS. We can all agree that the regulation of community CAMHS will bring a high level of scrutiny to this sector for the first time, with a significant percentage of private service providers in the sector. Children and young people accessing community services, and the service providers delivering these services, deserve a regulatory system backed by a clearly defined, robust legal framework.

At this point, I emphasise how much the Government and Department of Health support the regulation of community CAMHS. My Government colleagues and I all recognise the importance of ensuring all mental health services, both inpatient and community and both adult and child and adolescent, are fully registered, regulated and inspected by the Mental Health Commission in its role as the independent regulator of mental health services. It is a matter that Department of Health officials have been carefully considering in the drafting of the mental health Bill.

The mental health Bill, which the Minister of State, Deputy Butler, will introduce to the Oireachtas in the summer Dáil session, will comprehensively address the expansion of the commission’s regulatory remit to include all community mental health residences and services, including all community CAMHS and adult services, and ensure there is a robust legal framework in place for mental health service regulation. The provisions in the Bill have been subject to ongoing and lengthy consideration by officials in the Department of Health and the parliamentary drafters working on the Bill. I understand that a Part of the Bill, with approximately 35 separate sections, is specifically devoted to the regulation of all mental health services and will provide a strong legal underpinning to regulate community CAMHS. In addition to expanded regulation, the forthcoming Government Bill will overhaul the involuntary admission and detention process, modernise provisions related to consent to treatment, provide enhanced safeguards for people accessing inpatient treatment and provide a new, discrete Part that relates exclusively to the care and treatment of children and young people in inpatient settings.

The Minister of State, Deputy Butler, and the Department of Health acknowledge that the development of the Bill has taken longer than expected. This is because many of the issues addressed in the Bill are legally and ethically complex and required consultation with key stakeholders and extensive legal advice. Furthermore, it is a very lengthy Bill, which, I believe, will have in excess of 130 sections. Despite its length and complexity, I am happy to say that the Minister of State, Deputy Butler, has confirmed the Bill is now in the final months of drafting and will be published in the next Dáil session, which begins in April.

Work also continues to improve CAMHS at service level with many actions being progressed under implementation of Sharing the Vision, our national mental health policy, to enhance the provision of mental health services and supports across a broad continuum. I again thank Deputies Ward and Cullinane for the opportunity to speak to the Government’s commitment to CAMHS regulation and progress in drafting the new mental health Bill. The Minister of State, Deputy Butler, will give further detail on CAMHS and improvements in her closing statement.

Deputy Mairéad Farrell

I listened intently to the Minister of State's response to the Bill, which I commend my colleagues for putting forward. The reality is that we have worked with the Bills Office on this Bill. We have worked with and listened to families and parents and we have listened to children on this legislation. The Minister of State is kicking the can down the road with a promise of action down the line. The mantra we hear from Government is that children can wait. We on this side of the House are clear that children cannot wait. We know from children, parents and families how difficult it is. Let us be frank. Most families have been affected by this in one way or another. We know from children and parents how difficult it is when they are in a dark place and cannot get the help they need and have nowhere to turn and nobody to speak to.

We came here today with a Bill, having tried to work on a solution, but all I am hearing from the Government is that we have to wait and that children have to continue to wait.

The reality is that it is not just a situation where this wait ends at 18. The third level students I deal with in my portfolio, as well as doctors, lecturers and people working in third level institutions, continuously come to me to say they are not getting the assistance they need in terms of mental health supports. Local GPs come to me to say they are inundated when trying to help students in the third level sector because there are simply not the supports available for that sector. I would like the Government to rethink this decision.

Deputy Pádraig Mac Lochlainn

I was present earlier when my party leader, Deputy McDonald, questioned the Minister, Deputy Donohoe, about the Government's approach to all of this and he proceeded to read out statistics in soft language. I want to testify to the reality in my home county of Donegal for children with mental health challenges. We have a defective block crisis. It has been described as an earthquake happening in slow motion. A huge number of homes are affected, 1,000 private and public houses, and that can be multiplied by seven, eight or nine, so it is 8,000 or 9,000 in reality. The Minister of State knows the population of Donegal and she can figure out the percentage of the population that is impacted by this. It is devastating. Can she imagine the impact on families, given the realisation that all of their hard work, all of their savings and everything else is falling apart?

We have a major mental health crisis. People took their own lives because of this crisis, and some of it has been documented and some of it has not. What supports have been put in place for children? Supports have been requested again and again by the Donegal Education and Training Board and by campaign groups but there has been nothing substantial or additional for those families. That is the reality on the ground.

With regard to a recent development that has been raised with the Minister of State, we have a pastoral centre counselling service. These are tremendous people who are offering their services at a much reduced rate because they see the gaps. They stepped up and they wanted to provide a service. Some of the service was funded through fundraising by families who lost children and the campaigns and funding efforts are named after the children. They stepped in due to the absence of State provision of services. They were getting some supports from Tusla and the HSE but they were getting no supports in terms of clinical oversight. For example, they had asked for a director of counselling, and we know of the failure of clinical oversight within the CAMHS system in parts of Ireland. Here, professionals were offering that but they had no administrative support.

An Leas-Cheann Comhairle

The Deputy should conclude.

Deputy Pádraig Mac Lochlainn

I thought I had time left.

An Leas-Cheann Comhairle

No, it is two minutes each. I call Deputy Daly.

Deputy Pa Daly

Work should have been done on this a long time ago. While regulatory powers are important, material resources are also key. The system that developed in Kerry, not just in south Kerry CAMHS, was a product of pressure, carelessness and a lack of oversight, where medication was the only solution provided, and the psychological therapies and behavioural, developmental and other issues were not focused upon. The persistence of families and young people, many now adults, through the reviews is a case study in dignity and standing up for the right thing. The reports clearly demonstrate the overmedication and inappropriate care that took place in south Kerry between 2016 and 2021. It is worth placing on record the devastating effects, the emotional issues and the physical changes in children's bodies, all compounding the issue faced by one of the most vulnerable cohorts in our society, children with mental health difficulties.

For those in the south Kerry area, the redress scheme has been introduced but I reiterate my call for the scheme to be extended to those who have already received an apology from the HSE. It is totally unfair that they have been excluded from it. Their needs are no less demanding than the needs of the other people in the scheme. It is especially needed for those individuals in order that they can take a case about what happened to them to get justice. They are not wealthy people. Natural justice demands that they are compensated as quickly as possible.

Deputy Donnchadh Ó Laoghaire

The Government's response is a nonsense. A programme for Government commitment remains unacted upon. We are expected to simply wait because the Government is promising an all-singing, all-dancing Bill, and it promises us that it will be better than what we have, but nobody has seen it. I do not think that is good enough and it is no reason to not support this legislation. We could work with this through Committee Stage, absolutely, and I am sure there are elements that can be worked upon, but there is no reason to delay the passage of this Bill, given how long it has been promised.

The system is in crisis and getting worse. I was just looking at the numbers for my own community health organisation, CHO, area. We talk about statistics and while these are so much more, they do tell a story. There are 574 more people waiting now than there were in July 2020, and there are 348 children in Cork and Kerry waiting longer than a year for a CAMHS appointment. That is more than there are in some of the other CHOs on their own. It is a scandal.

I am not sure that everyone necessarily understands. I know the people in the Gallery will understand how difficult it is to even get into CAMHS because there is such an impulse to try to push people back into primary care. There are people I have encountered who have primary age children who are self-harming, and they have been told they are not severe enough for CAMHS. That is how severe people have to be to even get into CAMHS. One of the problems the Mental Health Commission should be addressing is the criteria and CAMHS not accepting things it would have accepted in the past. To even get into it at the minute is very difficult and people in some of those cases are waiting longer than 12 months. That issue needs to be addressed. There are people who cannot even get into CAMHS because while they are too severe for primary care, they are not considered severe enough for CAMHS. It is a huge issue that needs to be addressed.

Deputy Rose Conway-Walsh

I will follow on from that because it is a very serious issue. One of the impacts of what happened in Kerry during that scandal is that CAMHS started to push children and young people out of the system and back to their GPs. That is the absolute fact of what has happened in the west. The Minister of State should know that and if she does not, she needs to investigate it properly. We have seen a sixfold increase in the number of children on mental health waiting lists in the west, which means six times as many children waiting as when this Government came into power.

This is practical legislation but there are things that need to be done immediately. I ask those in the Government to put their egos to one side and put the young people who are suffering first. Autistic children with serious mental health issues are going untreated. I would not even be able to describe the cases that come across my desk, for example, the way autistic children with mental health difficulties and their families are treated. It includes children with suicidal ideation being turned away from CAMHS and children with intellectual disabilities having no CAMHS service. An immediate response is needed. I ask the Minister of State to look at the family resource centres to see if the Government can put in some funding there. Every day that we come in here, we are told there are millions and millions of euro everywhere but that is not getting to the young people and their families who desperately need support to save their lives in many cases. What is happening is totally wrong.

This Bill is straightforward and is a practical step that can be taken. It provides for the implementation of the first recommendation by the Mental Health Commission. If passed, it would give the commission the powers to implement the other recommendations. This is what families and stakeholders want. We have talked about this for years. I worked in community development myself, as the Minister of State knows, so I know that this has got worse and worse in the past 20 years. It is beyond crisis point at this stage. Please, leave the egos outside the door and put the children and young people first in this case.

Debate adjourned.