Jigsaw warmly welcomes the opportunity to contribute to the vital work of the Chair and committee members once again. As Ireland’s primary youth mental health charity, supported by the HSE and other funders, Jigsaw has, over the past 15 years, established a track record in achieving better mental health outcomes for young people by providing a range of primary care therapeutic services for young people aged 12 to 25 and creating supportive communities around them.
From the start of the Covid 19 pandemic, we were adamant this would not change. In the past 15 months, we have seen how Jigsaw has constantly evolved in response to an ever-evolving situation. From early on, we were acutely aware that Covid-19 and the measures taken to contain it had the potential to negatively impact on the mental health of young people. The restrictions, though necessary, took aim at our collective need for closeness in personal relationships with family and friends, autonomy, control, direction and a future to aim for, which are all key components of our mental health. Young people, in particular, have been disproportionately impacted over the course of this pandemic in terms of significant disruption to education; important milestones and transitions lost; opportunities for developmentally important social interactions removed and employment opportunities all but wiped out. Many see their future as being unrealised and a youth unspent.
In response, Jigsaw adapted by offering choice to young people about how they could access our services; in person, on phone or via video. In tandem with this, we developed a range of online supports and services aimed at marrying the opportunities technology affords with our expertise and experience. It is a union that has offered real and tangible supports to many young people, across a range of platforms and throughout the country.
How has Covid 19 impacted on our young people’s mental health? Research and reports carried out by NUI Galway, NUI Maynooth and the ESRI, more recently, and reports this week from BelongTo and the Ombudsman for Children paint a picture of increased isolation, rising anxiety, worry, stress and fear among many cohorts of young people. At Jigsaw, our data support and follow this.
Over the past 15 months, we have seen significant periodic variations in the referral levels to Jigsaw, in line with stricter public health guidelines. We saw 67% fewer referrals in the initial period from March to May last year, during the first lockdown. That was down a further 17% in the second lockdown in September. In the third lockdown, we saw referrals significantly down by approximately 35%, but we have also seen a periodic increase once it begins to open back up.
Looking at the characteristics of those young people who were coming to Jigsaw during that time, our data show that the levels of psychological distress of those we have supported have been relatively stable for the 17 to 25 year olds, but there has been a slight but significant increase in distress levels for younger people aged 12 to 16. In terms of the concerns identified by young people, most of the concerns would be similar to what we have seen before, except there are increased disturbances around anxiety and sleep. While anxiety has always been a top-presenting factor in Jigsaw, both pre-pandemic and post-pandemic, factors contributing to anxiety, the system around that and how it manifests are shaped differently. We may talk about that later.
There has also been an increase in the proportion of younger females, aged 12 to 16, coming to Jigsaw. This has changed from 35% in 2019, to 39% in 2020 and 44% in 2021. We have engaged extensively with schools and communities over the past 15 months, with more than 12,000 online teacher course registrations, close to 1 million page views on jigsaw.ie and more than 1,300 in attendance for our Jigsaw Connect webinar series; that is teachers, parents and young people participating in online training. What is hugely important is that behind each statistic is a young person, teacher or concerned parent.
Jigsaw has taken significant learnings from this time. We must look forward and use the opportunity presented to us to face some long-term challenges facing our young people and system of care. We are acutely aware Covid-19 has only exacerbated a worsening situation regarding our collective mental health. Long before Covid-19, mental health services across primary and secondary care were overstretched, disjointed and under-resourced; rates of self-harm were on the increase and young people throughout the country were experiencing significant levels of anxiety and stress. Suicide was and remains, the single biggest cause of death among young people.
Wait times for primary mental health services were excessively long; staff recruitment is a significant challenge; overall investment in mental health is well below international comparisons and the demand for services such as Jigsaw’s was growing year-on-year; in our case, at an increase of approximately 25%. Long before Covid-19, areas such as research, schools, third level and community supports remained chronically under-invested.
For us, Covid-19 has the additional challenges which have been presented but it has simply exacerbated an already dire situation in terms of youth mental health. We need to take action now. What is important is to think about the hope on the horizon. There is a good policy environment now in terms of tackling some of these fundamental issues. Given the increased political and public will around Sláintecare, Healthy Ireland, Sharing the Vision and the more urgent needs among young people, doing nothing is no longer an option.
We need to think about new and fresh perspectives and looking at spirit of flexibility, agility, openness and doing things differently to focus on the short years young people have in terms of their mental health and trying to support them. While we are aware there is no easy fix or miracle solution for mental health challenges, which can be complex and challenging, there is much the Government and policymakers can do to better support young people those who are experiencing mental health difficulties.
Increasing the funding for mental health is hugely important. That is something others would argue and support. It is important to look at not just dividing the budget but increasing the overall budget and looking at supporting upstream and early-intervention services in particular. It is important to look at how we enhance the workforce planning around mental health. Recruitment of sufficient numbers of appropriately qualified mental health professionals is a significant challenge to all agencies within the sector, Jigsaw included. What is clear is there is a limited number of mental health professionals graduating into and entering the system and many of them leave the country to avail of better opportunities overseas.
There is significant competition for posts between services. We are all struggling to resource teams and this is especially challenging in certain geographical areas. We end up competing against each other. With regard to some of the elements which will contribute to addressing this issue, we would be looking at increasing the numbers at the university courses, especially in relevant disciplines.
We would look at the allied health professional training courses to include a greater emphasis on youth mental health, thereby facilitating a smoother transition for graduates into mental health services. We also see increased family focused, more flexible, well-being focused employment in the field, along with the promotion of the mental health field as a progressive, recovery-focused place to work where you can make a real difference in the lives of others.
As well as the funding and recruitment, it is about the system integration. Members will be aware that the Pathfinder Project report on youth mental health in 2017 looked for a whole-of-government approach to address the challenges facing the current youth mental health system. Jigsaw believes that a director of youth mental health needs to be appointed without delay to drive this forward. It would look to bring together the recommendations of the task force in youth mental health and the mental health Pathfinder report and have a strong holistic and systemic focus. We believe that a truly co-ordinated, integrated mental health system across primary, secondary and tertiary services would ensure access to the right mental health care at the right time and in the right place, and that this would make sense. These are the principles enshrined in Sláintecare.
We call for increased funding for Jigsaw and, importantly, that this funding be multiannual. With more than 15 years’ experience of delivering and evaluating youth mental health services and supports, we are uniquely placed to provide some fresh perspectives. At Jigsaw, we are committed to exploring and demonstrating how new models of community-based, person-centred early intervention mental health care can be expanded in a sustainable manner that will deliver a demonstrable positive impact on the mental health of young people. Our aspirations in this area can only be accomplished with multiannual funding. We believe such increased investment would consolidate our work and create a new evolved and blended service offering across in-person, video, phone and online services and supports that would make a significant difference in creating a more responsive front-line mental health service for young people and would contribute to reducing wait times, alleviating pressures on specialist services and provide greater support for communities.
As an organisation fully committed to working with and supporting government agencies, we thank Senator Black and the committee members for this opportunity to meet with them today. Given the ever-growing demand for mental health services and supports in a world that has changed now more than ever, with the support that is there, real opportunities are at hand to address these challenges. While the current cost of the Covid-19 pandemic to individuals, families, schools, communities and society at large is uncertain, we are clear and certain that we all have a role to play in developing these new solutions. At Jigsaw, we are fully committed to playing our part, and I hope members will continue to support us in these ambitious plans. I thank the committee for their time.