I welcome the Minister of State to the House and thank her for all her work on this important issue, which affects many people and families in my county, Kerry.
Mental Health and Child and Adolescent Mental Health Services: Statements
I welcome the opportunity today to restate the Government’s commitment, as well as my own personal commitment, to the continued development of mental health services and supports. It is important that we have the opportunity to revisit and debate what happened in south Kerry child and adolescent mental health services, CAMHS, together with the broader reforms which are under way in the area of child and youth mental health. This includes the significant enhancement of specialist eating disorder services.
It is almost a month since the publication of the Maskey report into the care delivered by south Kerry CAMHS. Senators will be aware that the HSE has considered the report locally and nationally, has acknowledged the devastating and systemic failures which occurred over a sustained period, and has accepted all recommendations.
I have previously set out in detail the many contributory factors which led to this catalogue of failures, including an absence of clinical oversight and appropriate governance, organisational and management structures. Work is under way to implement the full suite of recommendations as a matter of priority. There are 35 in total. Of these, 6 have already been implemented with 13 having commenced implementation. I have sought fortnightly updates from the HSE on progress made to ensure momentum is sustained.
I have requested that the HSE commission the independent nationwide audit of compliance with existing CAMHS operational guidelines by all CAMHS teams immediately. I am in ongoing discussions on the independently-led prescribing audit for each of the CAMHS teams, which I sought as an additional action, beyond the recommendations set out in the Maskey report. It is important to me that this audit is comprehensive and robust. It will cover community and inpatient teams and it will be independently led.
The HSE is finalising the details of the further independently-led audit of case files in north Kerry. Alongside these audits, a separate independent review will be carried out by the Mental Health Commission and is expected to commence over the coming weeks. In tandem, the HSE will commission qualitative research to identify the experiences of children, young people and their families using CAMHS nationwide. I have also requested that this research experience study commence immediately. This will be undertaken by an academic group. I continue to work with my colleagues in the Government and the HSE on the reinstatement of a national director for mental health to ensure vital strategic direction to the development and improvement of mental health services.
Importantly, the Government has committed to a non-adversarial scheme for compensation for these children, young people and families affected by the report. The HSE, the Department and the Attorney General are collaborating intensively to confirm the arrangements. A number of meetings have been held to date to discuss and finalise details of the scheme as quickly as possible. It is of critical importance to me and the Government that we minimise the stress and anxiety for families involved, acknowledging the significant distress and upset experienced by many families already. This is the aim behind the non-adversarial scheme. These families have been through enough and I do not want to put them through any more.
I am in regular contact with the HSE locally and nationally regarding supports for the children and young people involved. I will be meeting with a group representing the families next week when they travel from Kerry next Wednesday. The HSE has assured me that it is in ongoing direct communication with the families. This follows the HSE writing to all of the young people to let them know what the review found in their care; meetings between the families and the HSE to discuss the care deficits they received; and a verbal and written apology for any harm caused. Families and young people affected can still meet with the HSE, if they did not wish to previously.
Of note, there was clear evidence of significant harm caused to 46 children, with this number likely to change as new information becomes available from meetings with those affected. On Friday, 18 February, the HSE wrote to these 46 children and their families, to advise them of this and to offer face-to-face meetings to discuss this further. The HSE has provided families with key information and referral to appropriate services and supports. This includes counselling supports and appropriate services from within child and adult mental health services. An information line is open on 1800 742 800 and will be open from 8 a.m. to 8 p.m., seven days a week, for anyone affected by the report. Through this support line, the HSE can provide external counselling.
The HSE will have a clinical support team in Killarney to support families and it is anticipated that this will be up and running in a number of weeks. The HSE will be in direct contact with the families shortly with details of this team. The HSE is also working with two CAMHS consultants from outside the area to provide support and ongoing care. There is no doubt that 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 where harm is caused.
As we all know, the vast majority of people who work in our health system, including our mental health services, are experienced, skilled and deeply committed to supporting and empowering people who need our services. The work that needs to be done as part of implementing the recommendations of the Maskey report is not a judgment on dedicated staff, but is about providing reassurance to children and families across the country that their confidence and trust in the services is not misplaced.
Broader developments in child and youth mental health will be supported through funding allocated under budget 2022. Specifically, it provides for two new CAMHS telehubs and €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 53 clinical CAMHS posts recruited in 2021. This is in addition to more than 400 new posts between 2012 and 2019.
On consultant psychiatrists, 93% - 80 whole-time equivalents - of CAMHS posts are filled, and where there are recruitment gaps, which is currently six posts, community healthcare organisations, CHOs, look at every option to ensure the least impact on service provision. The Cathaoirleach will be interested to hear that the post in Kerry that had been vacant since 2016, was filled by a non-consultant hospital doctor. Unfortunately, we are here six years later and even though that post has been funded for six years, it was still not filled. We are acutely aware of that and are doing everything we can to try to recruit somebody in there.
Eating Disorders Awareness Week is beginning next week on 28 February and will provide an excellent opportunity for us to learn more about the impact of eating disorders and how we can best support those affected, and their families and friends. Sadly, many of those who present with eating disorders - this has especially been the case during the pandemic period - are young. In response to the growing demand for specialist services in this area, a total of €6.85 million has been allocated to the eating disorders national clinical programme, reflecting the Government's ongoing commitment to providing and expanding high-quality treatment and support for all of those affected.
I recognise that while significant progress has been made in the development of eating disorder services to date, further substantial improvements are necessary. In 2021 I secured the balance of €3.94 million for the development of specialist eating disorder services, including further investment in specialist posts. This allows for the completion of the three existing specialist eating disorder teams of which two are CAMHS, and the establishment of three new teams of which one is CAMHS. Among the three existing teams of CHO 7, CHO 4 and CHO 6, 25.2 new staff have been recruited, with additional posts in the recruitment process. All of these posts are funded. With regard to three new teams I announced last year, CHO 4 is adult, CHO 9 is adult, and CHO 2 is CAMHS, and 19 new staff have been recruited to date, with remaining posts being progressed. That is a total of 45 staff.
For the purposes of budget 2022, I ring-fenced €1.15 million in funding for the national clinical programme for eating disorders. This will enable further development of specialist eating disorder teams throughout this year, including another dedicated CAMHS team. More specifically, it will provide for three full-time additional eating disorder teams and two additional partial teams, bringing the total of nine full teams and two partial teams by the end of the year. This will mean that all nine CHOs in the State will each have one eating disorder team.
This year, we will also be investing in the development of online guided self-help resources to support people through early intervention for eating disorders. In addition, the Government continues to provide annual funding for Bodywhys, the national eating disorder association, which allows them to run a helpline and support groups for adults and young people with eating disorders. The HSE has also developed a self-care app, which provides valuable information for those with, or the people who care for somebody with, an eating disorder.
I acknowledge that we have significant challenges in our mental health services. I am fully committed to driving the necessary reforms in line with Sharing the Vision, our national mental health policy, and the current overhaul of our mental health legislation.
I thank the Minister of State for her work on this very important issue.
I welcome the Minister of State to the House to talk about this important issue. There is not one of us who was not shocked and horrified by the story of the many children who were failed by the CAMHS system in Kerry. It was absolutely shocking and heartbreaking to think that these children, in trouble with their health and needing support, not only did not get support but that further harm was actually done to them. That is shocking and horrifying. Parents from other parts of the country have contacted me worried that maybe something similar may be going on in their area. It is very important that what happened there does not happen any place else. There must also be a full audit of all the other areas to ensure it is not happening in order that people can have confidence when they go to get help that it will be the best high-quality help available for their children. I know that the Minister of State is committed to that, and that she is acting very promptly in dealing with it. I am also glad that a non-adversarial system of compensation has been established for the families. The last thing they need at this moment is to face into a court battle.
I was happy to hear the Minister of State indicate that a clinical support team will be established in Killarney. At the time, people had said, "Yes, a problem occurred but where do we go from here?" These children are still struggling and perhaps even more so than when they presented. This is very important. It is good that it will be resourced and that everything will be kept on top of it.
On the issue with recruitment and the position that has been open for a number of years, will the Minister of State address whether or not she has looked abroad? We have a lot of medical professionals abroad. Have we actively gone out to the places they are based in to try to get them to come back to their home country to provide CAMHS in places like Kerry? There are also other gaps in the system there.
Mental health has been to the forefront of our minds, alongside the normal Covid health issues over the past two years. Everybody has been aware of the deep impact of the pandemic on everybody's mental health, but particularly on children and young people. The ongoing housing crisis is also impacting on children's mental health with the isolation felt by them during the Covid crisis. There are also children from the LGBTQI+ communities who have particular issues in the normal scenarios but during the pandemic those issues were heightened even further. Traveller and Roma children face particular challenges in accessing healthcare and their mental health suffers a lot more than that of other children. We are aware that they have much poorer health outcomes. Extra supports should be directed in the direction. The waiting lists for diagnoses are very long and need to be shortened. I am aware that the Minister of State has made significant inroads on those waiting times since she had taken office, but a little bit more work needs to be done on it. I know the Minister of State is on top of that.
There is a particular issue when people reach the age of 18 and then transition into adult services. We are all aware that an 18 year old is still a young person. We should really look at keeping them within the youth health services until the age of 24 or 25, when it may be more suitable to transition into an adult service.
Children in care have a particular need for mental health supports. Every child in the care system should be given mental health supports as standard. Shockingly, it is awful to think that one quarter of the children who died in care died by suicide. That is a very stark figure. They should be given more supports because they are already dealing with a lot of challenges. It is not fair to put them into a system where they must prove that they are facing challenges.
The announcement of the 45 new staff recruited for the eating disorders health service is very welcome. Again, the pandemic meant that many more people were presenting with problems relating to eating disorders. It was very good to hear about this recruitment today because I was quite concerned looking at those figures that have been growing for the past two years. One bright light, other than the recruitment of 45 new staff, is that 81% of people presenting with an eating disorder actually get the treatment and support they need within four weeks. That is an excellent figure. Of course, there is always more that can be done. We must remember the 19% who do not receive the help within the timeframe, and we need to look at that. This is very good but there is a great deal of work that needs to be done in respect of eating disorders. There is still a great stigma there, and especially for young boys and men who present with eating disorders. We need a lot more public awareness about it and around what the rest of society can do to support people who are facing the challenges presented by eating disorders.
That kind of education and public information campaign would be really welcome. It would help us because we all know family members, friends in our social circles and people in our communities who are struggling with eating disorders. We need to know how to spot them and support them as they are going through that. I am glad that there has been some progress and I know that more progress will be made. I hope the Cathaoirleach will facilitate the Minister of State to come back in a few months. I know she is meeting the families from Kerry next week. I look forward to hearing of progress coming from that meeting. I wish her the best of luck.
I thank the Minister of State for coming to the Seanad to discuss the very important issue of mental health and particularly the mental health of our young people. I could not even read the Maskey report. I regularly deal with the parents of children who are fighting for mental health support. It is scandalous that in 2022 the State has once again let down 46 children that we know of and there could be more.
There is not a town, village or parish that has not been touched by problems with mental health. Very often it is left to local leaders and individuals to scramble to try to heal what is going on in the area and we do not have the answer. Social workers do not have the answer. Very often people are nearly left counselling the social workers themselves to try to give them strength to carry on. Those social workers and people working in mental health services need to be looked after, otherwise they will leave and we will need to replace them.
The mental health area needs urgent attention. No one in Ireland is untouched by it through themselves, a family member or a friend. The impact on communities as a whole is keenly felt. The estimated prevalence of mental health disorders is relatively high in Ireland compared with other European countries and yet spending on mental health is relatively low, according to OECD figures for 2018. In 2021, Ireland's mental health budget was €1 billion or 5% of our overall health budget compared with 12% in New Zealand and the UK. The Mental Health Commission reported in 2019 how change in our mental health service provision is unco-ordinated, ad hoc and slow. Issues highlighted included the need for best practice to be applied consistently across the country; for specialist inpatient approved centres to be up to the standard; and the need to continue moving the treatment and recovery model to specialised professional community care.
The professional body of psychiatrists has identified a deficit of approximately 100 permanent consultants in mental health services. According to the HSE's medical workforce planning for the specialty of psychiatry report published in March 2021, 526 consultants are delivering psychiatric care in the public mental health system with an additional 55 consultants working exclusively in private mental health care. It is projected that an estimated 276 consultants will leave the publicly funded workforce over the next ten years due to retirement. The review found that 825 consultants would be required by 2030 to meet demand. Where will the psychiatrists come from? If they are here in Ireland, what do we need to do to get them into the job? If they are not in Ireland and we need to recruit them from abroad, how do we get them into the country and working? We need answers to these questions.
I have been advocating for this for ten or 15 years, including two years as a Senator. We need a dedicated counsellor in every primary and secondary school. Our children are our future and they need us. None of us in this Chamber knows what it is like to grow up as a child in Ireland today. Our children do and they need someone to talk to about that who will help and guide them. A one- or two-year waiting list does not cut it. Teachers are the first people who will be able to tell us something is wrong with a child. Having a counsellor in-house in the school for a child to relate those fears to is very important. It may take 18 months to get an appointment with CAMHS. Having school counsellors is really important.
We need community crisis groups, trained teams that can move to a town or community that has experienced a suicide or is having a mental health epidemic, and offer concentrated and dedicated support to anyone who needs it. In my town, we had five in the space of one year. In my own parish there were four in one year. Those people are grappling to try to find solutions. We need some sort of NGO that is funded to get into those towns, do a health check there and give the town or parish the support it needs.
We need to do more on online safety for our children. They need to be taught in an age-appropriate manner about the dangers of the Internet, social media, how to engage in good online behaviour and things to avoid doing online. We need to build resilience in our young people. We need to give them scope and have them understand their place in the world and its history and how strong they really are. We need to empower them to take control in their lives. We need to let them know that school and social media are not the world and that there is so much richness and full life out there just waiting for them to experience. We just need to give them hope.
Having confidence and resilience classes available to our youth in our communities is really important. Money should be provided to youth clubs for confidence and resilience building.
Children in care are probably the most precious because they are the ones who have not experienced love from day one. The care system has been very good. When it comes to getting a child into CAMHS they do not have to wait very long to get into the services. Sometimes the auxiliary forces for the counselling that they need are not available on tap. They are very often given pills to medicate the issue, putting a plaster on it temporarily to get over that bump. That is never the long-term solution. As any parent knows, giving a pill to a child does not fix the problem. It is all about talking and counselling.
If they are not in education or after-care when they turn 18, everything stops. Their access to mental health support is completely gone. That age threshold needs to be increased to 26 or 27. Those young people will continue to have mental health problems throughout their entire lives if they are not given the supports after the age of 18.
Before I call Senator Conway, I welcome the Minister of State, Senator Hackett, to the Visitors Gallery along with her daughter. She is a canvasser of great renown.
I also welcome Minister of State, Senator Hackett, and her daughter to the Chamber.
The Minister of State, Deputy Butler, who has become a regular visitor, is very welcome to the House. I know this particular issue is of great interest to you, a Chathaoirligh, given the locality involved. What happened should not have happened, but it did happen. It is not about what happened but about how it is dealt with. Once the system became aware of it, it put the necessary procedures in place to deal with it. We need stronger and more robust checks and balances in the system. There needs to be auditing and constant oversight, access and accountability. Proper auditing, oversight and accountability will not prevent it happening in its entirety because there will always be situations where something like this can happen, but when it happens it must be identified quickly and dealt with promptly. That is what we need to see happening because we have had too many examples with the Brandon report into what happened in Donegal along with what is happening in Kerry.
I am sure there have been other pockets around the country. However, that cannot take from the good work done by the services when people access them and the many people who have been helped and supported by the services. The problem is there are not enough services and positions have been left vacant. There has to be a completely renewed commitment to dealing with this. The Minister of State is well able to fight her corner within Government in terms of getting resources. These and more resources are needed. The resources have to be wisely spent in such a way that delivers the results we all want.
I am on the Joint Sub-Committee on Mental Health, which is chaired by our colleague Senator Black. That committee has been engaging with stakeholders for the past year and a half. These are people who are very much at the coalface: people who use the services, people who provide the services, as well as people who work within the services, in the HSE, the voluntary groups and the different angles. In listening in detail to their presentations, some of the solutions are very straightforward and simple. I always ask all the groups that come before the committee if they know where there is international best practice. Where can we copy and look at building our system around that? There has never been a universal answer. It has always been that there is good and bad everywhere. It is hard to pull the good from everywhere to try to create a system here. The system here is good if it is properly resourced and built on properly. We need to start having conversations about mental health with young people in primary school - the early years. It was a taboo subject 20, 30 years ago but it is not anymore and it should not be. The more open we are in the conversations we have with young people, the better we will equip them in dealing with it going forward.
Senator Keogan made a strong point about the transitional period, where someone who is one month under 18 years old can access all the youth supports and services, but when he or she is one day over 18 years, he or she cannot access these services. We need to look at a transitional approach where if someone who is over 18 years can benefit from the services offered to those under 18 years, we do not just shut that service off and expect that person to go into an adult service. Senator Ruane had an interesting group of people in the audiovisual room yesterday, and that was the common thread that came through their experiences, the issue around those turning 18. These were people who were in care, left it, and have been lucky enough to rebuild their lives and have fruitful and successful lives. Some work might need to be done on how best we can deal with that, because it is not like flicking a light switch. It does not and should not work like that. We have to ensure everything is gradual and phased.
In terms of resources, we can never spend enough money equipping this area of our health system. Whatever moneys you get, you will never have enough. We are building on a system that was underinvested for decades. When we are trying to do that in as quick a time as possible, it is not easy and it is certainly challenging. What happened in Kerry was terrible. I am glad the support structures are being put in place to deal with that, but I want to see lessons learned in terms of accountability, oversight, proper auditing, and ensuring we have the proper checks and balances in place to protect the most vulnerable in society, whom we all want to protect.
Cuirim fáilte roimh an Aire Stáit. She has done very well since taking up office. She was handed a poisoned chalice, as were many other Ministers, unfortunately, and especially during a time like Covid. As someone who has worked with many young people, I have always come across the mental health stresses young people have. We have never had enough supports for them but we need them now more than ever before.
I acknowledge the great work the Minister of State did in fighting for an allocation of €24 million to mental health in the budget for the development of new services, in addition to the €13 million to support existing services, which was welcome, as well as the funding especially for young people for two new child and adolescence mental health hubs. Of course, we need many more of them as well. More than 11,000 children and teenagers accessed this service last year by the end of November, which is 20% more than the demand the health service had expected. It just shows that, even with those figures, the demand is there.
I wish to focus specifically on two areas: family resources centres and eating disorders. Next week will be eating disorders awareness week. I know people personally who have been dealing with these issues with their own children. I welcome the news that the Minister of State, Deputy Butler, has ring-fenced €1.15 million in funding for the eating disorders programme this year. Some €6.8 million has been allocated to the eating disorders national clinical programme, which is also very good. However, I have concerns. We were supposed to be recruiting 47 specialist posts that were promised. I think the number is 20 so far. Perhaps the Minister of State might provide an update on the recruitment. What is the status of the 16 specialist hubs promised over five years ago in the national clinical programme for eating disorders, which was published by the HSE in 2018? I presume the Minister of State was landed with that problem two or three years later.
Caring About Recovery From Eating Disorders, Cared, Ireland is a group I have been meeting. It would like to come in to make a submission the Joint Committee on Health or to have a meeting with the Minister of State, Deputy Butler. Cared was set up by a group of voluntary parents. Like most issues, it is left to the carers and volunteers to create structures of solidarity for each other. I have had to send people to this voluntary organisation to get supports because it can empathise and understand better than any of us because those involved are dealing with the issues themselves. It is a voluntary group of parents and carers of people with eating disorders, set up to provide support and share knowledge with each other, which has led to people being able to stay with their children and do what they need to do to help support them.
Research shows that most people can and do recover from eating disorders if they get effective evidence-based treatment from eating disorder trained staff. The trained staff in this regard are very important. Early intervention has also proved crucial to recovery. There are such sad stories about teenagers becoming three or four stone in weight, and it is so late in the day for intervention at that stage. Too many sufferers express feelings of being misunderstood, abandoned and lost while begging to be heard and taken seriously so they can recover and live normal lives. There are a total of three specialist beds available to treat adults with eating disorders in the country. They are located in St. Vincent's University Hospital Dublin and are only available to those living in the Dublin south east, Dublin south, and Wicklow areas. Cared Ireland is also calling on the Government to recognise eating disorders under the Mental Health Act 2001, because currently it is not, whereas it is in other jurisdictions. It would be important for this to be part of the Mental Health Act. Eating disorders are a mental health issue.
As somebody who lives in the country and has used counselling services in the past, I was able to get subsidised sessions when I did not have a lot of money. When I could afford it, I paid quite a lot of money. There is an affordability issue there as well. I see the family resource centres in rural areas often being the only place a person can go to to get counselling of any kind, especially for young people who do not want to ask their parents to drive them into the town or city for counselling.
I will give one example of a family resource centre with which I have been working and for which I have fundraised, the North West Clare Family Resource Centre. It would reflect the issues in all family resource centres. It has received no extra funding to deliver community affordable counselling for any adults or adolescents since Covid. The family resource centre spends approximately €30,000 a year, but only about €4,500 comes from Tusla. The rest of the amount is fundraised. That is too precarious a situation. The centre cannot be confident about the services it can provide. It has provided great services at affordable prices to people who would not have got counselling otherwise, which is amazing, but the centre is under stress to ensure it can provide that service.
The demand for mental health services is there but not the resources. In north Clare, they are trying to establish a play therapy service for children. This has become a significant issue due to increased anxiety among our children. They have a very limited budget of approximately €3,000 to deal with this issue. That is to set up the whole room and provide the services. There is a great need to fund and resource community counselling adequately to benefit all, particularly in rural areas where there are no other services. Teenagers ring me asking where they can go for counselling and say to me not to tell their parents.
I want to be able to send them to the family resource centre with confidence and knowing that if they only get a fiver or tenner, they will still get the help they need. I currently do not have that confidence. Are there any plans to give family resource centres extra supports?
There are many issues and it will not be easy for the Minister of State to sort them all out. Everybody wants money for everything. It is deeply saddening that some secondary schools have up to two guidance counsellors but others have none. Some have six hours of counselling while others have 22 or full hours. It is not mandatory and funding is not ring-fenced. Schools that are strapped for funding may often take the wages that might be best spent on counselling and put them into other areas of education. It is really sad.
In one case a school had a full-time guidance counsellor with 20 years of excellent experience who was really passionate about her job. Her contract was ended and the school perhaps used the money for special needs assistants and other resources; it had to make that tough decision. A lovely old nun in her 80s is now the only person in the school of nearly 1,000 girls who is available for counselling services. I have nothing against lovely old nuns but she is not qualified and does not have a clue about any of the matters that young teenagers might deal with. It is a major issue. If we could ring-fence funding for counsellors in schools, we would help the teenagers and we would not have to wait for them to ring and ask me to look for family resource funding and get that funded. It is really important we look at secondary schools and ensure we have the personnel to support our young people.
I welcome the Minister of State, Deputy Butler, to the House. I get the impression every time she attends the House that she is very passionate about this topic, which is quite refreshing. I wish her well. People speak about mental health and it may well be too black and white to say it is a generational issue; it is certainly not but people are now so open about whether they go to therapy. It is refreshing.
It has been clear for some time that mental health services in this country are over-stretched. The publication of the look-back review of the south Kerry child and adolescent mental health service, CAMHS, which uncovered significant malpractice, is an appropriate moment to examine the failings across CAMHS, as well as wider non-acute health services for children. I welcome the debate in the Chamber and again I thank the Minister of State for always making time to come here.
There are 71,000 children waiting for life-changing treatment across occupational therapy, physiotherapy, speech and language therapy, dietetics, psychology and mental health services. An agenda for change is required in children's mental health services focusing on the filling of vacancies, for example, which has been mentioned numerous times, and addressing the causes of vacancies, including those that led to the situation in south Kerry and which could lead to worse. They have already led to similar malpractice in other parts of the State.
Following the review of south Kerry CAMHS, it was found that 240 children received substandard care and were exposed to unnecessary risk of significant harm by their misdiagnosis or poor treatment. Of those, 46 suffered significant harm, 13 were across other doctors and 227 related to a single doctor. The review found unreliable diagnoses, inappropriate prescriptions and poor monitoring of treatment, as well as poor monitoring of treatment and potential adverse effects, which led to a recommendation of a fundamental review of services across the State. The Taoiseach confirmed there will be a full nationwide audit of compliance with CAMHS. Meanwhile, the initial whistleblower, Dr. Sharma, recently left the service, feeling pushed out after being reassigned to administrative duties following his complaints, which led to the review. He felt the review was too limited in scope.
We need to protect children's mental health and fix our mental health services. We need to immediately put in place supports for children and families affected in south Kerry and to broaden the CAMHS review across the State. Some of what the Minister of State indicated in her comments is news to me. I note she requested that the HSE would commission an independent nationwide audit of compliance with existing CAMHS operational guidelines by all CAMHS teams immediately. She indicated there are ongoing discussions on the independently led prescribing audit for each of the CAMHS teams, which she sought as additional action beyond the recommendations set out in the report. I welcome that.
There are significant workforce challenges in psychology, as has been mentioned today, as there are insufficient numbers of graduates to fill the posts. My colleague, Deputy Mark Ward, called for a plan to address that major shortage of psychology staff in CAMHS. There are figures released from the Psychological Society of Ireland indicating a deficit of 98 psychologists in CAMHS, based on recommendations from Sharing the Vision from 2006. Representatives of psychologists have been warning successive Governments for years of the shortcomings in public psychologist numbers. A review into CAMHS is welcome but we need action to address these shortcomings and vacancies.
I also want to raise something that has not yet been brought up, which is the need for a review into the treatment of the south Kerry CAMHS whistleblower and the circumstances around his change in duties, which led to his resignation from the service. As soon as he was appointed, he saw the problems and he must be credited by this House for acting on them. His treatment as a whistleblower should be acknowledged and a review of that should be published. He resigned because he felt his position undermined and that must be examined.
I thank Mental Health Reform for the briefing document it shared with the Oireachtas. It is a reminder that on Mental Health Day 2018, I co-signed a Bill put forward by my former colleague, Ms Máire Devine, about the ability of 16-year-olds and 17-year-olds to consent or refuse treatment. I will not go into it but the Minister of State knows it well. As I am out of time I thank the Minister of State for coming here today. I appreciate the time she always gives to the Seanad.
I thank the Minister of State for coming to the House today to address this critical matter. My colleagues and I in the Civil Engagement Group are very passionate about mental health and the inequality that young people from disadvantaged communities experience in the mental health system. Yesterday my colleague, Senator Lynn Ruane, brought forward a motion on a drugs citizens' assembly but, unfortunately, it was voted down in this House. I am standing here even more disheartened as a result. Although we are hearing good and positive comments, we should not be very positive when speaking about mental health issues in Ireland. I have a strange feeling that what happened in Kerry is just the tip of the iceberg, unfortunately.
I have listened to many of my colleagues speaking today. I will not repeat what has been said but at the same time with many issues we have no choice only to repeat them and it is important we do. The key to CAMHS is young people and we must think of all our young people, including those who are marginalised, those in direct provision, migrant people and young people in care services. Yesterday, Senator Ruane spoke at a meeting in the audiovisual room, which I attended, of people working with young people in care. It struck me that she said if the State thinks it is better than a child's parent when putting a child into care, by God the State needs to be able to provide for that child.
Especially when it comes to mental health services, when children reach the age of 18 they are in many cases still children, in my eyes, maybe because I am a mother now. They are still at a very vulnerable age and need those critical supports. As some of my colleagues have said, it is paramount that we, as a society, are more open about mental health. There should no longer be a stigma towards people with mental health issues. To me on the ground and to many a youth worker, in here everything seems to be doom and gloom. We are doing so much, but that is not evident on the ground, to be fair and honest. I have worked for many years in youth services in Ballyfermot. A significant number of young people in Ballyfermot have mental health problems, and the supports are not there. I have dealt with many cases, including recently. A young person may go to an accident and emergency department to seek help but find that the supports are not there. A lot of the time we tell people to go get the supports. They are not 100% there.
I wish to make one very important point. The coalition Mental Health Reform has reported that Ireland has the third lowest number of inpatient psychiatric beds in the EU, so I do not know if we are doing a good job. We need to be totally honest. Society is more honest about mental health problems. As representatives of society, as leaders, we need to be more honest about it as well. From young people I have spoken to, I understand that age is a problem when accessing help and supports, as are one's background, membership of the Traveller community and status as a young migrant person. There is an intersectionality to it all. We need to listen to these young people. We are here making decisions for young people in their absence. That should not be the case. We should have young people around the table with us. We should provide good working conditions for healthcare professionals who work with young people with mental health problems.
As for implementation, in 2006 we had A Vision for Change, one of the recommendations of which was the delivery of culturally appropriate services. Those culturally appropriate services, in my opinion, from working on the ground, are nowhere to be seen. I met with the National Traveller Mental Health Network two days ago and Thomas McCann told me that what the network is looking for is a stand-alone plan that was in the Government plan for the Traveller community. There is a mental health crisis in our Traveller community. I hope that the Minister of State will come back to the House not next week but the week after if I table a Commencement matter on this issue to have a further discussion about Traveller mental health. I would really appreciate that. I thank her again for coming in today and for listening to our views.
If the Cathaoirleach selects that Commencement matter, I will be here.
I know. I am just putting that on the record. I thank the Minister of State.
I am sure we will be able to accommodate the request-----
I understand that. I am still very new to all this.
The Senator is doing fine.
You are doing a great job, Senator Flynn. Thank you for raising that important issue.
Senator Flynn is doing very well, just as well as any of us. It is no harm saying that.
It is great to be a part of this debate. I have great faith in Deputy Butler as a Minister of State. I do not think we could have a more hard-working Minister with responsibility for mental health. Apart from her everyday duties as part of a Government, she travels up and down the country to engage with people: the people who run the services, people who use them and people who want to use them. I wish to remember all the people who, day after day, sometimes at weekends, make sure that so many people get the services, whether paid for through the HSE or voluntary. I think we all know that in many respects those who provide the services take a lot of abuse. That is never referred to.
I recently dealt with a very unusual situation involving mental health. Parents contacted me about their daughter, who was being made a skit of because she was practising religion. She is a Catholic. That does not matter. It could have been any religion. This girl had got into an extremely agitated state, full of anxiety and heading for mental health difficulties because some of her female friends were telling her she had a screw loose to be practising religion. Such situations needs to be taken into account as well.
There are many areas in society that we do not look at when it comes to mental health. We had Frances Haugen in the Houses yesterday to discuss social media. She is a very impressive lady. I did not get a chance to go down to the committee meeting but I have spoken about her. To me, Frances Haugen is a hero. She had a very lucrative job in a major company. I am sure that, financially and otherwise, she has lost a lot. It should be remembered that she is coming from the inside looking out. We talk a lot about social media but we never really seem to say they are having an extraordinary effect on mental health. I know families living in fear, not knowing how to handle children of 12, 13 or 14 being influenced by all sorts of unsavoury issues on social media. How do you handle that? Do you take their phones away? How do you talk to them? These people, families up and down this country and in other countries, are utterly frozen by social media. Therefore, when we talk about mental health, I want to hear people talk about social media and speak straight out about the damage social media have done. We all talk about the good sides of social media and we all use them, but we all have to realise there is a very significant downside to them. Until we all start speaking about the damage and the downside of social media in mental health debates, we will not be able to look after our people satisfactorily.
There are huge financial commitments. I am not going to turn this into a political debate. The figure allocated to mental health in 2022, €1.49 billion, is huge. We have issues with staffing. There is no doubt about that. In many respects we cannot get the staff. I do not know if this will be of any assistance to the Minister of State, but I believe we should target Irish people in health services abroad and go out of our way to entice them back to fill some of those positions. Some of them would say that when they apply for jobs they do not get satisfactory answers. Some of them, particularly in the NHS in England, are very experienced people who would come back to their roots here and work within the system. Maybe we should target them.
Those are all issues we need to deal with. We need to begin to fill those vacancies. In an awful lot of cases, however, the shortcomings in staff numbers are not down to money issues or to the Government.
As for CAMHS, I wish to speak about the e-mental health hub in Castlerea, which was announced in 2020 by the current Tánaiste. It is unique and the first of its kind in Ireland. I think two more will be set up now because of the Minister of State's good work. The one in Castlerea is on the site of the old Rosalie centre. We have discussed that centre many times in the past. It was a centre for people with mild mental health issues.
It was their home and when it was to be closed down, a process that started in 2015 and 2016, there was a big ruaille buaille but it closed and people were transferred to other places. We got an e-mental health hub in Castlerea. It is developing but as with everywhere else, the story is that some staff positions cannot be filled. When politicians speak about mental health, I ask that they speak about the facts. I make that point specifically about Castlerea. I will finish on this point as quickly as I can. It is not true to say that the e-mental health centre in Castlerea is not operating, there are no staff in it and all we can see inside is a big television screen.
Hear, hear.
I invited the Minister of State, Deputy Butler, to visit the centre. This is important. Every politician has the right to criticise and question, but we must all deal with the facts. There is no doubt there is a shortage of staff because the HSE cannot get the positions filled. That is the reality. There is a service, however, and children are being treated at the centre. There is also an outreach programme. I visited with the Minister of State, Deputy Butler, but I also went of my own accord, unannounced, and I saw the centre in operation. We need to be truthful and careful in what we say. We are dealing with families with children and we want to try to solve the problems, not exacerbate them.
I welcome the Minister of State. We meet again. I again express my gratitude to her for the commitment she is showing to change the existing mental health services. She has a significant challenge after years of underinvestment. I say that first, before I get into the negatives and positives.
What is positive is that there has been a reduction of 19% among under-18s waiting for more than 12 months in primary care psychology following an allocation of €4 million, which is easing pressure on acute services. Funding of €6 million has also been provided for the expansion of mental health teams, including CAMHS, with two new CAMHS telehubs and a Galway CAMHS connect hub. I am not familiar with the latter but people in the sector speak highly of it and encourage its roll-out. There has been an investment in national clinical mental health programmes in areas such as eating disorders. A sum of €4 million has been allocated for new specialist centres, in addition to the existing three centres, and there are 29 new mental health staff in CAMHS. Those are the positives.
What happened to children in Kerry is truly shocking. We felt for the parents. We could hear their anguish on the airwaves - the ones that knew in their gut that this was not right but trusted the professionals who let them down. That is one of the worst feelings in the world. Forty-six young children were severely impacted and suffered weight gain from sedation. There was also unreliable diagnosis, inappropriate prescribing, poor monitoring of treatment and potential adverse effects. That is truly shocking. I welcome the Minister of State's comments on the steps that are to be taken. We know CAMHS is overwhelmed. Referrals increased by 40% between 2011 and 2019 and there are more than 3,357 children on the waiting list. Of the 18,000 children referred to CAMHS in 2020, only 11,000 were seen. We all feel this in the pit of our stomach. The geographical inconsistency is just not good enough.
I visited Blanchardstown paediatric outpatient and urgent care centre, which is a fantastic facility in my area, where I had a heartfelt conversation with staff about how hard it is to have such numbers of children coming through whom they cannot help. The centre is for broken bones, infections and minor injuries and it has to send people away, which is truly heartbreaking.
I know the Minister of State is working on a budget, but she knows how I feel about resources and workforce planning. The shortage can be addressed but we must be aggressive about how we do that and how we ensure a pipeline of the right mental health supports and staff resources to deal with a need that is only growing. For example, the Psychological Society of Ireland, PSI, reported a shortfall of 118 psychologists in 2018. It speaks of the need to increase the number of psychologists by 110% by 2032, yet here we are again talking about the inequity in the system. People can dedicate their lives to becoming a clinical psychologist, paying money to do so that makes my eyes water. I would never be able to afford to have my children take on such a vocation. They must pay their way through college and then do a master's degree. It is only recently that they have started to be paid €27,000 as an assistant psychologist. If they choose to go into educational psychology or counselling, which we want them to do, they must do a doctorate and work for free for three years, while paying €10,000 to €15,000 a year. Clinical psychologists rightly get 60% towards their fees and they get paid. We need to make that equitable across the board. We have a shortage of educational psychologists, yet the people who are working for free are in educational placements for us and we are making them pay €45,000 for their doctorate. We need to address that issue. Workforce planning is needed. Let us increase the number of psychologists coming through. Currently, there are just 66 clinical psychologists coming through each year. We can do better than that. That obviously means engaging with the PSI on workforce planning.
The disability access route to education, DARE, scheme allows people who have mental health challenges to get into third level. A consultant psychiatrist is currently required to approve an application. We are moving away from the medical model so a chartered psychologist should be able to do that. Again, these are issues that I look at and I do not understand the barriers. When people who go abroad to gain international experience as psychologists come home after ten years their qualifications are not recognised. That is also an area where we can improve.
Tax relief has been extended in budget 2022, making counselling and psychotherapy a qualifying health expense. The new national eating disorder recovery centre is not yet approved by the VHI and we must move on that. I will talk to the Minister of State again about social anxiety. She is aware that I am on the board of Social Anxiety Ireland. That needs to be brought in as part of our national programme. We are ready and willing to talk to the Minister of State. The numbers are off the charts.
The Minister of State is very welcome to the House. I congratulate her on the great work she has done on a difficult system since her appointment. As Senator Currie has highlighted, there is a lot of positive work being done in the Department. The Minister of State succeeded in securing one of the biggest ever budgets for mental health. She is well aware of the "buts", which are always a factor when a new Minister and a new Government are trying to fix everything. It is very difficult.
As a parent and citizen, I want to highlight how trust needs to be built back into the system after what happened in Kerry. We must ensure we trust all our medical services. Personally, I have a lingering mistrust in many of our services.
This is based on personal experience. I had to fight for a diagnosis for myself and people did not believe me. I was not trusted. I have this innate mistrust myself. When I heard the desperate revelations in Kerry it instilled in me a sense of mistrust. I am here as a Government Senator who wants to trust and who wants to make sure the system is the best it can be. I wish the Minister of State luck with that. The work she has to do is very important.
The Minister of State said there is a massive budget and I very much welcome this. A lot of work is being done. I have a fear about how we are possibly putting a lot of money into a system that is broken. We cannot get enough answers. Even in disability services we see a system that needs to crank up and start listening to patients and look at local scenarios and what suits people. I agree with the previous speaker. There are staffing issues and issues with morale among staff. How do we as a government party support the Minister of State in her role to make sure we have trust in the system, morale and more staff? How do we make sure the system is reformed and people are accountable? We must have the ability to make people accountable for what they do wrong. In many situations this is how the citizen feels.
We need to make sure we fund State services. We have fantastic charitable organisations that do fantastic work. It is quicker to fund the charities because there is less rigmarole in putting people in place than there is in the HSE. We need to change this so it is easier to hire people in the HSE so we have them and the State controls the hours they work. They should work in the system and not outside of it. We really need them. This is not to downgrade what the charities do. We need people in the health services. We should not have to go to charities for critical care. I wish the Minister of State the very best of luck. I congratulate her on the hard work she is doing. She has a very big task. She has all of the support we can give.
I welcome the Minister of State to discuss this very important issue. I have been working with a number of mental health organisations based in Limerick that do fantastic work, including the Limerick Mental Health Association. I thank the Minister of State for all she has done since taking over the role. I know her commitments and dedication to resolving the issues. When we look back at what happened in Cork and Kerry it is frightening. A total of 46 children came out damaged. That is 46 children too many. We are supposed to be there to help children and support them and their families.
In his contribution Senator Murphy referred to social media. In her speech the Minister of State referred to the fact that next week is eating disorder week. During the pandemic it was reported that young people were self-harming. It is all about being bullied by their peers. People say things to them that hurt their feelings. Because there was no social interaction children felt there were no supports. It is frightening to think about this. While there is a positive side to social media and a lot of interaction there is also a harmful side. We must address this balance.
I want to mention some of the statistics discussed at the meeting I had with some of the local mental health associations in Limerick. Ireland spends a comparatively low percentage of the overall budget on mental health. The recommended spend is approximately 12%. The UK spends 13%. In Ireland we spend 5.1%. This is quite low. We need to increase this to 10% of the health budget and invest in primary care and prevention. Prevention is the way to go. In the report that came out of Kerry, it was revealed that many people were prescribed drugs. This is not a solution. It is a stopgap or a hold but it is not an overall solution. Others have referred to the lack of counselling services. In the CHO 3 area the waiting lists are very long. Last March there were 2,700 children on waiting lists in our region. This is a huge number of children waiting to see a relevant person to have treatment or an assessment. I dealt with a family with three children waiting on services. One child had seen services. One of the children, who is aged 16, had been waiting a number of years but still had not been called for an assessment. There are children who fall through the system.
It was recommended in the budget for 2021 that the Government should allocate additional revenue funding of €50 million to mental health reform through resourcing the short-term recommendations of Ireland's new mental health policy, Sharing the Vision. Multiple sources show we are in the midst of a mental health crisis not only locally and nationally but also globally. Preventative care advocacy and community services represent good value for money, particularly if done by voluntary organisations. There are many voluntary organisations out there. Limerick Mental Health Association sought a budget of €69,000. It received €58,000, which was the same as the previous year. This pays for four staff. The numbers have doubled so the budget needs to increase. These organisations do fantastic work. We need to find a way to resource them. They have the experience of working with children. While budgets have increased we still need to look at smaller organisations, particularly voluntary groups. They have built up a relationship with many of these children and the children trust them. Much of it is about trust and relationships. I compliment the Minister of State and thank her for her commitment. I look forward to working with her.
The Minister of State is very welcome. Ireland has one of the highest rates of mental health illness in Europe, with approximately 18.5% of the population suffering. A study carried out by Mental Health Ireland reveals that in general women have a lower well-being score than men and those who are younger score lower on the well-being scale than those who are older. In the past ten years, and in particular the past two years, things have changed dramatically for young people. There is still the added stress of the junior certificate and leaving certificate exams and now we have the added pressure of social media, Covid restrictions and cyberbullying. Young people are now more likely than ever to experience mental illness during junior cycle of secondary school.
To add to the comments of Senator Murphy, I am a member of the Oireachtas joint committee that met Frances Haugen. I concur with the Senator's comments. I said to Ms Haugen yesterday that millions of people around the world will benefit from what she has done.
I do not know how to say this, but, as a result of her actions, many millions of children around the world will be in a safer place. It will make us reinforce our discussions and ensure that we have a tight Online Safety and Media Regulation Bill. We have spent nine months on pre-legislative scrutiny on this. We took it that seriously. In excess of 60 organisations made submissions or met with us in respect of it in order to ensure that we covered everything that we possibly could in the Bill. It is important that the individual complaint mechanism should be part of it. The mechanism is not really provided for in the Bill at the moment. I know that consultations are ongoing. It has to be part of the Bill. We met with the Australian commissioner as part of our discussions. Australia's commission has been set up and is working. That is what we need to aspire to; not just for Ireland, but for all of Europe. Millions of kids will benefit from it.
Guidance counsellors are unable to cope with the numbers of students who need support, given that some mental illnesses and issues are so severe. Social, personal and health education is a mandatory subject at junior and senior level in secondary school. The subject was reformed in 2021 to include LGBTQI groups. There is clear evidence that mindfulness has many benefits for teenagers and children. It can help them gain self-awareness and emotional maturity. It can also improve the overall mental health and decrease behavioural issues. St. Patrick's Mental Health Services offers free Walk in My Shoes mindfulness resources for teachers at primary level. Mindfulness needs to be taught to children in primary school and to be continued through junior and senior cycle. By helping children to become aware of their emotions at a young age, when they become teenagers the will be confident to speak openly about their feelings and get help when needed. The discussion around mental health can be encouraged in secondary schools through wellness, anti-bullying weeks or lunch clubs for those who might be struggling to make friends.
In order to alleviate the pressure on guidance counsellors, each year group should have a designated teacher to discuss any mental health issues or worries with students. This person should be have training in dealing with mental health issues. Mental health services in general are not strong enough to cope with the numbers of people who are in crisis. Therefore, we need to tackle this issue at a young age to ensure that children can identify their feelings and emotions and to communicate them with a trusted adult. The more open the discussion about mental health, the earlier we can intervene to help young people before the issue reaches a point of crisis.
Research that was carried out in 2017 showed that 32% of schoolboys are fitter than their female counterparts. Many girls quit sports in secondary school, leading to them missing out not only in the context of the physical benefits but also the emotional ones. There is clear link between exercise and better mental health. In that context, there needs to be a move away from secondary schools only having the traditional sports, such as camogie, hockey, football and soccer. Other forms of exercise should be offered. Yoga, Pilates and dance fitness classes should be created, particularly in all-female secondary schools. This would mean that girls who do not enjoy the pressure of team sports could keep fit, meet friends and improve their physical and mental health.
Early intervention is essential in tackling mental health issues in teenagers. Mindfulness classes at primary school level would encourage children to become more aware of their emotions and to discuss them, as I said, with a trusted adult. Moreover, it is an amazing skill for anyone, of any age, to have. If it is learned at a young age, it will continue to be used into adulthood. Secondary schools should have a designated teacher for each year group, as I say, to help students who are struggling. In addition, young girls need to be encouraged to continue playing sports and exercise in schools. A different variety of sports to cater for each student is essential to ensure that girls continue to keep fit, to socialise and to improve their mental health.
Before I call the next speaker, I welcome to the Gallery Deputy Pringle and his guests. I am delighted to have them in. It is great to have guests in here from the Lower House. They are more than welcome. I am sure they do not want to stay here permanently, but we like to have them here temporarily anyway. I now call Senator Dolan.
The Minister of State is very welcome to the House to speak with us about CAMHS. I am a member of the Joint Sub-committee on Mental Health. As many colleagues have said this evening, we have seen the impact of Covid-19 over the past two years. It has been shocking. We have heard from our experts. We have heard from psychiatrists. We have had communities come in to speak to us.
I know that the Minister of State is aware of this. I know that she has taken to this brief with commitment and with clear goals that she wishes to achieve. However, what has happened, particularly in the case of CAMHS in south Kerry, is just shocking. I know that the Minister of State commissioned reports and that there are recommendations that she is seeking to implement. However, to me, this comes down to the clear issues of recruitment oversight, recruitment protocols and, as the Minister of State mentioned, oversight of governance. One of the clear issues she pointed to is the fact that we need a national director for mental health. Can we have a timeline as to when one might be appointed?
Directly afterwards, I spoke with CHO 2, which deals with Galway, Roscommon and Mayo. I spoke to some of the team there. They were in shock; they were so disheartened. They have struggled so much because they have been dealing with such a mental health crisis over the past two years. Everyone involved in healthcare is at the point of burnout and breakdown. People struggle sometimes to continue. We are seeing so many people moving away from healthcare. This is another matter of concern. How do we retain the excellent people we have in our healthcare system, particularly those working in mental health? Burnout is a major issue. In many cases, GPs are very much on the front line in this regard.
I would very much welcome the Minister of State’s support, and that of the Minister for Health, in respect of WestDoc and in ensuring that the region it serves has 24-7 support. This is because many of the GPs in the Ballinasloe and east Galway area do not have access to WestDoc. In other words, many of these GPs are working night shifts. They just do not have the wherewithal to continue doing that. As stated, burnout is a major issue. GPs are on the front line. They get families coming in and knocking on their doors. I ask for the Minister of State's support regarding access to WestDoc. Perhaps it could be considered in the context of the budget.
The other matter I want to note relates to the helpline number the Minister of State mentioned. That service was launched last year, and I want to acknowledge that. The number is 1800-742-800. The service is available from 8 a.m. to 8 p.m. Can the Minister of State confirm that that is still active? I believe it was set up last year for these families.
I highlight for the record what our community healthcare west services and CHOs around the country do. These are specialist mental health services. Their range of activities include acute inpatient services, day hospitals, outpatient clinics, community-based mental health teams, CAMHS, general adult and psychiatry of later life services, mental health and intellectual disability, community, residential and continuing care residential services and sub-specialties, including rehabilitation and recovery, eating disorders, liaison psychiatry and perinatal mental health. That is an incredible breadth of expertise and activities that are being done by our community healthcare organisations. Yet, they are in our primary care setting.
As the Minister of State will be aware, I always speak about technology and about how we will use it to connect with our hospitals. Our primary care areas have been left in the wilderness because we still do not have electronic patient records to connect people’s healthcare when they end up in an acute setting to what they have been doing with their GPs and within the day hospitals in different regions. Technology is crucial.
The investment that has been made in eHealth within the Department of Health also has to benefit mental health. It has to come to the Department. We have to make a difference with this. That to which I refer is to do with early intervention and whether we look at more virtual consultations. Senator Murphy spoke about Castlerea and the wonderful CAMHS unit that has been set up there. This is absolutely fantastic. It is a change maker, but we need more investment in that. We need it to be seen that early intervention is something positive. If we can do that in a virtual way, it can be triaged, if further intervention is needed at senior and serious level that that would happen as soon as possible.
I mention also what I have noticed, as, I am sure, have my colleagues, over the past number of months regarding suicide and loss of life. It is rampant, shocking and scary. It devastates families' lives. It is happening in urban settings and, in particular, in rural areas. I know that this is happening in many of our towns. There have been incidences in secondary schools. It is heartbreaking for those families. It is hard to know what to do, because when that happens, it is too late and when a family’s life is destroyed forever in some ways. What can we do now? How can we engage, as Senator Carrigy and other colleagues asked, with schools at an earlier stage? How do we stamp this out? The Joint Committee on Education, Further and Higher Education, Research, Innovation and Science has seen that one in three children are impacted by bullying. How do we change the culture and attitude in that regard?
These are the key questions. I want progress on the recruitment of the national director for mental health. What is the timeline for that? On technology, we have online counselling supports, such as MyMind.org, and for anyone listening, its 24-7 anonymous text line number is 50808. Does the Minister of State have any further comment on investment in the technology within her Department? Of course, €1.149 billion has been allocated for mental health, which is a wonderful investment and an increase on previous years. However, I want to know about the recruitment and, in particular, how we are supporting our community mental health teams. What is the Minister of State's opinion on access to acute 24-7 psychiatric advanced nurse specialists or clinical nurse specialists for all of our acute hospitals that do not have psychiatric departments, so they would have access to a healthcare expert within the psychiatric area, who could be at a clinical nurse specialist level?
I thank all the Senators who contributed and all of those who have stayed to the very end, which is much appreciated. It is one of the most serious issues that we are all dealing with. There was a common denominator running through many of the presentations and I will try to deal with that.
I was struck by the point made by Senator Keogan, who said she was not able to read the report. I do not think I will ever forget that Sunday evening when I got the report. I had to drive to my office in Dungarvan, approximately 30 minutes from where I live, to print the report. I came home and I went into a room on my own, and I did not come out of it until 10 p.m. I will never forget the feeling of reading that report and learning that 240 young people had been identified as not receiving the standard of care they should have had from this service, that there were 46 children with significant harm and that a further 13 other children were found to have been unnecessarily exposed to a risk of harm from other doctors.
I want to say one thing that is important to put on the record of the House. The chief officer of CHO 4 in Cork and Kerry acted very swiftly when he became aware of this. He put in place a look-back scenario and Dr. Sean Maskey from Maudsley Hospital in London, who works for the National Health Service, NHS, and is independent, was brought in to do it. They did a random sample audit of 50 files and red flags were raised by that. They then looked at 1,500 files and found 500 children who were not medicated and 500 who were medicated to the correct degree, but they then discovered there were 240 young people who were challenged.
We can go back and look at 2016, when the consultant psychiatrist role could not be filled. It was funded and it was not an issue of funding. What was decided at the time was to put in a non-consultant hospital doctor. He had three years' experience dealing with adult mental health issues and he was put in there with the correct supports, apparently, for governance and oversight, but there was none there and it all fell apart. What pains me the most is that it was flagged in 2018 by a locum doctor who came in to try to reduce the waiting list. However, it was not acted on, and it was 2020 before it was acted on by another locum doctor who came in. It was finally acted on but it pains me the most that two years of overprescribing could have been halted. He came in during 2016 and it was flagged in 2018, but it was not actually stopped until 2020.
Of those 46 children and their families, I have spoken to some of them and others are coming up next week from Kerry. No family or child heard about it on social media, they did not hear about it in the playground and they did not hear about it in the shop or on the street. It was handled correctly from the very start. There were 198 meetings with families. I spoke to one man and asked how long his meeting was, and it was three hours. A consultant psychiatrist was brought in to do the meetings, with social workers there just to support the families. I want to reassure people that, from that perspective, it was all handled correctly.
It is a difficult situation. What I have to do now is build confidence in the 73 CAMHS teams in the country. After reading that report on the Sunday night, and then reading it again and reading all of the ancillary supports that went with it, and having listened to parents, with the support of the team in the Department, we decided very quickly that we needed to do an audit. The audit I looked for initially was an independent random sample of all 73 CAMHS teams in the country, similar to what had been done, to see if there are any red flags in regard to prescribing. The other audit that has been agreed on is academic, which will be done in one of the universities, where we will look specifically at young people and their families who avail of CAMHS services all over the country to see how they got on with CAMHS, how they interacted and whether they got the support they needed, and we will have data from that. The third piece is looking at the composition of the multidisciplinary teams that make up a CAMHS team, in what areas they are challenged and whether they have the full composition of psychiatrists, psychologists, mental health nurses, dieticians, occupational therapists, social workers, mental health nurses and the whole way down.
We spent €125 million on CAMHS last year so it is very important to for me to have this real-time data to know where we are in regard to the composition of the teams, what governance is there, whether they are carrying out their standard operating procedures and so on. We hear about children who are referred to CAMHS who do not meet the criteria, but why is that? We hear about children who are caught between two CHOs and they are not part of this CHO or that CHO because of their address, but why is that? These are the questions. Believe it or not, I welcome that this research will be done. It is not going to be easy but I welcome it because a huge amount of good work is being done on the ground.
A week and a half ago, I met with the Mental Health Commission, which is the independent oversight body for mental health. It is doing a similar review and that is almost under way. In fairness to Dr. Susan Finnerty, who will be leading out on this, she has secured a consultant psychiatrist from Scotland already and another from Ireland who is not currently working in the HSE.
From that perspective, the most important thing I want to do is reassure parents that when a child is referred to a CAMHS team, they can have confidence. There is so much good work being done every day of the week, and I want to acknowledge that. It is only fair to acknowledge that during the Covid pandemic over the past two years, 85% to 90% of all mental health services were available and did not close. They were not like respite in that, initially, disability services were closed. Mental health services stayed there the whole way through. Many of them had to move online or move to a blended approach, but they stayed there, and I want to acknowledge that.
CAMHS currently has a waiting list of approximately 3,300 children. As Minister of State, I find that very difficult. Cases are very complex. It is not just about one visit to a consultant given a child might need six, eight or ten appointments, or more. It is important to know that we are acutely conscious of that. I travelled to many of the CAMHS teams and approved centres around the country, when I was able to do so to meet with the teams and to see what challenges they have on the ground because it is important for me to do that.
The issue of primary care psychology was raised. When I came into post a year and a half ago, there were 10,000 children under 18 waiting for primary care psychology and approximately 5,000 were waiting more than 18 months. I put in place a targeted approach. What I learned by putting in place that targeted approach is that it does work. I secured funding of €4 million from September to December last year. We got in touch with all of the CHOs and asked them to look at their primary care psychology list for those waiting more than 12 months and to try to buy capacity. Some of the consultants had late clinics on a Tuesday and Thursday night, others hired locums and we outsourced some of it privately. I just asked them to take the children off the list and we got 1,600 off it between September and December, many of them complex cases.
Since then, I secured just over €1 million for January and February and there is a memorandum going to Government next week looking for another €5 million. We want to keep the momentum going. However, as we take children off the list, more are coming onto it the whole time. I want to focus in particular on those waiting more than 12 months. I am a parent myself. If a child is waiting more than 12 months, the parents are devastated.
Everybody said it here; early intervention is key. The earlier a person can get to those supports, the better. Oversight and accountability across all mental health supports is really important. As Senators will all know, the new legislation is currently being worked on and many changes will be made to the 2001 Act. I put it out to consultation again last year. There are 142 recommendations that have to be factored in but one of the areas, which I believe Senator Warfield mentioned, is with regard to capacity issues for 16-year-olds and 17-year-olds. That will be changed in the Bill, which I know will be very welcome because before they would have had to have parental consent.
One of the issues that was raised quite a lot was with regard to 18-year-olds and aging out. One of the recommendations in Sharing the Vision is that we should look at this area. An 18-year-old could be doing the leaving certificate examination, leaving home for the first time or going to college. It is a very difficult area. If that person has been in the care of CAMHS for three or four years with an eating disorder, the last thing he or she wants to have to do is change and go into an adult team, which Senator Flynn raised.
The national implementation and monitoring team, which has been put in place to look at the implementation of Sharing the Vision, has put in place three subcommittees, one of which is in relation to CAMHS. The team is specifically going to look at this area, however. A person might age out at 21, 23 or 25. I am actually open to all the ages; I am there to be persuaded. It is a much easier solution for outpatient services, however. It is not as easy for inpatient services.
As Senators will know, we have four CAMHS units throughout the country. We have one in Merlin Park University Hospital, one in Cork at Éist Linn and two in Dublin. I have visited them all. We have capacity there but the difference is that it would be very hard to put a 12-year-old with an eating disorder, who might be really challenged and be a slight little slim girl, with an 18-year-old or 19-year-old male or female, perhaps with psychosis. It would be an awful lot easier to deal with from an outpatient perspective than an inpatient one. Maybe we would have to look at having services for those between the ages of ten and 16, and also for those between the ages of 16 and 23 or whatever. We are actively looking at that.
One of the issues raised was that we have 25% fewer beds than we should have or that we have fewer beds than other countries in Europe. That 25% of our capacity is bought from the private sector never gets factored into any of the correspondence that Members get. It is important to know that. We spend a huge amount of money every year buying private capacity.
One of the other things I want to mention, which was brought up a bit as well, is with regard to NGOs and whether we should be outsourcing to private hospitals or whatever. I look at organisations such as Jigsaw, which is absolutely fantastic and provides coverage to 66% of the country. It is moving very quickly now to provide online coverage everywhere. A person aged between 12 and 25 can self-refer to Jigsaw. It does absolutely phenomenal work. I am a really big fan of it.
As part of the €10 million I secured during the year, secondary schools and third level colleges will be doing a new initiative this year to provide support. I know an awful lot of people raised that issue. I will also discuss that with the Minister, Deputy Foley, and the Minister of State, Deputy Feighan, who has responsibility for well-being. Much of this comes into well-being and emotional distress as against mental health. This is the first step and then it might develop into mental health challenges.
I produced a mental health leaflet last year and this year that points out exactly the supports people need. It was sent to all 4,000 schools in the country. I decided it was better to send it in paper form. It is online as well. It is really important that a young person might bring this leaflet home and see what supports are available, whether it is support from Bodywhys in respect of body image or an eating disorder, LGBT+ support, support related to self-harm or suicidal tendencies, or some other form of support. I felt that perhaps if they put the leaflet into their schoolbag, they might look at it that evening.
I also produced a mental health leaflet last year and this year that points out exactly the supports people need, which was sent all to all 4,000 schools in the country. I decided it was better to send it in paper form. It is online as well but it is really important that a young person might bring this leaflet home and see what supports are available, whether it is bodywise in respect of body image or an eating disorder. LGBT+ support or to do with self-harm or suicidal tendencies. I felt that if they put the leaflet into their schoolbag, they might look at it that evening.
We are doing other work with regard to the national implementation and monitoring committee. We are looking an awful lot at lived experience, which is hugely important, and minority groups. When I was allocating the €10 million before Christmas, I allocated €1 million to MyMind, which is an organisation that provides counselling. It provided counselling for us all during the Covid-19 pandemic. I funded it for another 12 months. It provides free counselling in 15 different languages. A person can be referred through his or her GP to that organisation. It is really important that it is still there.
We have heard much about community groups. I have allocated another €1 million to this area. It is being dispersed now through the Mental Health Ireland website, and the closing date is next Monday, 28 February. There will be amounts of between €5,000 and €30,000. Applicants can go online to mentalhealthireland.ie to see whether their organisation is suitable and meets the criteria to get funding. This is for groups that would not normally get Government funding. It is really important for this to be done by anybody who wants to do so.
I am conscious of how hard Senator Flynn works with regard to raising issues for minority groups. As I have said, we have three subcommittees that are looking at women's health, minority groups and CAMHS. I am acutely aware of the issues. When we were putting the national implementation and monitoring committee in place, it was important for me that we had every single category represented. We have a service user on it and Senator Flynn's organisations in respect of the Traveller group were included. It is not only that all minorities are included across the board, which I felt was really important; it is also that we have to move to lived experience and peer support, crisis cafes and day hospitals. If a person has a mental health difficulty, the most important place to try to avail of the supports is in his or her community first.
One of the issues I am worried about and which many people have spoken about is suicide. I have attended three funerals in the last two months; those of a 13-year-old, a 32-year-old and a 57-year-old. They were all male and all died by suicide. We see the devastation and effect it has on families and friends but the whole community is devastated. Thankfully, during Covid-19 over the last two years, and these are only preliminary figures, we did not see any rise in suicide levels, believe it or not. I am concerned about the last three to four months, however. Every single elected Member here, whether they are in the Dáil or Seanad, tells me they were at a funeral this week or last week. We have to be acutely aware and conscious of that. When I attended these funerals, on the way home I wondered if these people knew that help was out there but did not know where to get it. That is one of the areas about which I am really concerned.
Other than that, we are putting a huge emphasis on the clinical programmes, which I want to continue to fund. Money has been secured for those with eating disorders, mental health difficulties and intellectual disabilities and in respect of self-harm and suicide. All these areas are being fully funded. One of the areas into which I put much emphasis this year from a funding point of view, again, was community mental health teams. I really believe it all starts in the community. If a person can get the supports in the community, that can make the real difference.
I thank everyone for their time. My door is always open. It is so important. Every day is a learning day; when I hear about different things, I take them on board.
I thank the Minister of State for her very comprehensive reply to the issues raised. Members will note it was not scripted, which will tell them that the Minister of State knows her brief comprehensively and entirely when she is able to outline all the work that is being done within her Department. She is right across the whole breadth of what is being done within her Department and has a huge knowledge of the issues. Not only that but she is also implementing the solutions. I thank the Minister of State for being here today on this very important issue.
When is it proposed to sit again?
Next Tuesday at 2.30 p.m.
Cuireadh an Seanad ar athló ar 3.50 p.m. go dtí 2.30 p.m., Dé Máirt, an 1 Márta 2022.
The Seanad adjourned at 3.50 p.m. until 2.30 p.m. on Tuesday, 1 March 2022.