Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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I welcome this Bill. It was a long time coming. It is about two and a half years since it was before the Sub-Committee on Mental Health and I do not know why it has taken that long to come to this juncture, but I am sure the Minister of State has her reasons. It was 23 years ago that we last had a comprehensive review of mental health care. The Bill was probably cutting-edge, to a certain degree, 23 years ago but there is obviously very antiquated treatment practices as well as phraseology and terminology we would never use now, so it is good we are looking back to look forward when it comes to how we treat people with mental health difficulties. It is clear that if people with these difficulties get the right intervention the outcomes are extremely good. That is the good news, but they have to get that treatment and get it in a timely way.

I thank Mental Health Reform for giving me an understanding of this legislation and also over the past number of years giving us an understanding of mental health reform. There needs to be very serious reform of mental health treatment in Ireland because of the difficulties of trying to get services and so forth. That would be greatly welcomed. As I said, it has been 23 years since the previous Bill and much has changed in Ireland over those years. We have been good at talking about mental health, especially men, over the past five or six years. It is good to talk, because men generally had bottled that in and did not talk about their feelings. It is really good we are talking about things because when you talk about something and do not bottle it in, you feel better and it is good for your well-being and so forth.

I will touch on several aspects of the Bill. Deputy Shortall mentioned the phraseology and the rights-based emphasis of this Bill. With the assisted decision-making Bill that was very important, meaning it would be a rights-based rather than paternalistic approach to healthcare. At least we have that and it is very welcome.

Involuntary admission is quite complex. We should never be in a situation where members of the Garda are intervening generally in this situation. It is not their fault, but this was obviously part of the different mindset over 20 years ago where the police made that intervention. That could be very problematic and it is good we are changing that now in terms of family members and healthcare professionals. That is extremely important with regard to where this is going.

The regulation of CAMHS is extremely important and one of the most important parts of this legislation. I presume this legislation is going to pass within the lifetime of this Government, but when it is going to be enacted is a different matter altogether. It could take a while before this is enacted. I wonder, therefore, whether the Government would be open to certain parts of the Bill – I do not know whether this is possible – being enacted before others, because we could be waiting years for certain parts, especially around the CAMHS regulations. It is probably very important that regulation takes place as soon as this is legislated for.

On the rights of people aged under 18, especially 16- and 17-year-olds, it is good this age group has a say in what mental health treatment they get. That is very important, because in the past young people were dismissed and again it is that top-down ideology that is just not healthy in the context of healthcare.

Another complex area that needs to be spoken about is restrictive practices, namely, practices around restraint and seclusion of young people and how this is dealt with. In the past people were sometimes overmedicated. Sometimes people were violently restrained. If we talked about that now it would be completely alien to how mental health services have worked. Mental health services have evolved in the past 150 years. There were practices that were done that one would not believe were happening, but it is evolving through new legislation like this Bill. It is not perfect by any means and there are huge gaps in access to mental health care. That is the open wound in that when people need healthcare at a particular time and cannot find it, that leaves a huge grievance in society. That is something I hope the Government can address through better, more targeted funding.

Paul Donnelly (Dublin West, Sinn Fein)
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I welcome the Bill. There are many aspects of it we welcome. It is a step in the right direction and many mental health stakeholders are supportive and agree on many of the issues related to it, but unfortunately, due to delays, I do not believe it will be introduced within the lifetime of this Government. That is unfortunate. Mental health is a huge problem in all our communities. I doubt there is a single TD, Senator or even a person who works here who does not know somebody affected by mental health. In my community it is pretty bad at the moment and we have had a number of really tragic suicides. There were two recently from a bridge on the N3 beside Connolly Hospital. People are so worried and so desperately concerned they are contacting me to ask whether we can do something with the bridge. I say that the bridge is not the issue and that what is happening to their mental health is the issue. There is a lack of services. We need to focus on therapeutic interventions and family support to deal with the mental health crisis.

A couple of weeks ago I was on a walk in our community. The walk was from Whitestown to Mountview family and youth centre. There were more than 100 residents and mental health and youth workers on it. People came together as a community to try to raise awareness of mental health and the huge increase in suicides. That is a regular thing that is happening now. The community have put together several walks because they are so concerned in that area.

There are a couple of issues I wish to address and one is admitting children to an adult inpatient psychiatric ward. I recall, as a family support worker, working with a young person who was admitted to an adult mental health service. It is something that has never left me. It was the shock I experienced at that young person going into that mental health facility. He should not have been there. There should have been an appropriate mental health place for that young person. It is important the information is digestible and there is an explanation of the Bill to enable service users, key workers, families and other health professionals to easily understand and explain what it means because sometimes this can look like gobbledegook to people and it is important people can understand what it is in terms of their rights. I commend my colleague, Deputy Ward, on his advocacy and work in the area of mental health and for publishing a comprehensive mental health action plan. I urge people to look at it because it is clear we need to change the way we deal with mental health.

I mention Genesis, a counselling service in Corduff. It is a low-cost and free service. I have been trying to advocate over the past three years for a simple sum of €100,000. That may sound like an awful lot of money, but in the general scheme of things, that is not huge.

The service could double its counselling hours, providing 4,000 more hours in a year, at less than one third of the cost of a bike shed.

With regard to a new youth and mental health service up to the age of 25, the most frustrated I have ever been was when I was a family support worker trying to access child and adult mental health services, CAMHS, for young people. It is difficult to access that service. The threshold is so high that many children and young people have fallen through the cracks.

The provision for 20 beds for people with eating disorders is very important. There are many young people with eating disorders who cannot get that type of service. We need to fund that service.

I mention emergency departments because it is heartbreaking. We worked with a young lad who I knew really well. He went to the emergency department looking for help three times. After the third time, which was on a Saturday night, he went to the local park and hung himself because he did not get the service. He was told a psychiatrist could see him four weeks later. That is not appropriate and should not be happening in this country with the amount of money we have. We are talking about billions of euro in budgets at the end of the year. These are real lives, and people are dying because of the lack of access to mental health services, counselling and therapeutic interventions.

I thank the Minister of State for bringing forward the Bill. I urge her to get around the table before the budget and get the money we need for mental health services.

Peter Fitzpatrick (Louth, Independent)
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The public interest in this Bill has been overwhelming, and it is no wonder. For too long, our mental health legislation has been outdated and people with mental health issues have faced delayed treatment, limited access to services and a lack of clarity surrounding their rights. It is in this context that the amendments to the Mental Health Bill 2024 come into play. They are critical to moving forward as a compassionate and inclusive society.

Enforcement of the Mental Health Bill 2024 will be a key factor in ensuring its provisions translate into real, positive change. This is why the Government recognises the importance of ensuring all mental health services are fully registered, regulated and inspected by the Mental Health Commission in its role as the independent regulator of mental health services.

I will touch on some of the most significant benefits of the Bill. First, under the new amendments, informed consent is now at the forefront, with patients having more control over decisions in line with international human rights standards. This shift empowers individuals and ensures their voices are heard in the treatment process. In cases where individuals are unable to give consent, independent advocates will act as a safeguard, ensuring the healthcare providers adhere to the principles set out in the Bill.

Second, one of the standout features is the provision for increased funding and resources allocated specifically to mental healthcare facilities. One of the most transformative aspects of the Mental Health Bill 2024 is its emphasis on and expansion of community-based mental health services. By increasing funding for local mental health centres, expanding outpatient services and improving integration between health services and social care providers, the Bill will make it easier for people to access the care they need when and where they need it. On the ground, this will mean more beds in psychiatric units, improved outpatient services and bolstered community mental health teams. Such enhancements are vital in ensuring that individuals facing mental health service crises receive timely and adequate support, reducing strain on emergency services and promoting early intervention. Community mental health teams will play a key role in integrating support systems, including social services and education, with the broader mental health care framework.

Third, one of the most pressing issues we face as a society is the mental health of our young people. Early intervention is key. Hence, this Bill acknowledges the unique needs of young people and aims to expand access to youth mental health services. These services will be more widely available, better funded and more easily accessible for those aged under 18.

The Bill also includes provisions for mental health education in schools. By promoting public awareness campaigns and education initiatives, it seeks to challenge misconceptions and foster empathy and understanding towards those affected by mental health issues. Such societal shifts are crucial in building a community where mental health issues are a cornerstone of well-being and productivity.

The Mental Health Bill 2024 marks the beginning of a new era for mental health in Ireland and represents a significant step forward in Ireland's commitment to mental healthcare reform. By improving patient rights, modernising the definition of mental illness, expanding access to community-based care, addressing the mental health needs of young people and supporting families and caregivers, these amendments create a more equitable, compassionate and effective mental health system. In essence, the Bill represents a paradigm shift. No longer will mental health be an afterthought in our healthcare system. It will stand side by side with physical health and the individuals affected by mental health challenges will have access to the treatment and support they deserve. A healthier, happier population contributes to a stronger, more resilient Ireland. Together, we can create a future where mental health is a priority, stigma is eradicated and all individuals can thrive.

Having dealt with the Minister of State for some years, I will be honest with her - she is a good listener and she always tries to help people. However, the one word I will keep using tonight is "help". This is because of the number of young people who come to me with their families in need of help, and the help is not there. I do not think the issue is money. We need to get the system right. There are a lot of good people out there. The word "stigma" is used. When people are sick, they want help. People come into my constituency offices and hold their hands out. Mothers and fathers ask for us for help and we contact the Department, GPs and everyone else.

The Bill sets out a good way of going forward. I wish the Minister of State the best. The work she has done in recent years has been very well done. The thing I like about her is that when I ring her Department, she or one of her assistants always gets back to me. I wish her the best going forward.

Carol Nolan (Laois-Offaly, Independent)
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I welcome the opportunity to contribute to this very important debate on the Mental Health Bill 2024, which, I acknowledge, the Minister of State has personally prioritised. The Bill proposes to deal with some of the most complex and contentious aspects of mental health treatment, particularly those involving consent and involuntary admission of persons who may lack capacity. Many of the new provisions are positive in that regard. Given the seriousness of the issues around involuntary treatment, however, it is critical that the Government gets the issue right.

The Bill also proposes to fundamentally alter how CAMHS is regulated. We know that this is urgently needed, as the volume of reports on CAMHS published in 2023 alone testifies. The report on the look-back review into child and adolescent mental health services - the Maskey report - found unreliable diagnoses, inappropriate prescriptions, poor monitoring of treatment and potential adverse effects, thereby exposing many children unnecessarily to the risk of significant harm. These are not the markers for a clinical service to which any child should be referred. I accept that much work has been done in this regard, however.

The key issue here is not the Bill we are dealing with per se, although there are numerous aspects I wish to speak to at length. The real issue in this State continues to revolve around access to mental health treatment supports, especially clinical supports. In my constituency, I frequently see parents and children going through severe and traumatic levels of distress as they try to access adequate levels of support. This causes huge upset and frustration. In this regard, updating or modernising the law will amount to an exercise in futility or political window-dressing if there is not an equal determination to take action and deliver on-the-ground service provision. The Maskey report identified as much when it spoke to the wide variation in scope and capacity of CAMHS teams resulting in a postcode lottery for parents and young people.

Another issue I would like to raise include the proposal in the Bill to make changes for children and young people, including provisions to allow 16- and 17-year-olds to consent to or refuse mental health treatment. I also want to highlight section 44 in Chapter 3 regarding determining a person's consent or otherwise by a responsible consultant psychologist.

Do we have sufficient numbers of consultant psychiatrists in the State to meet that need? My fear is that we do not have those numbers.

Michael Collins (Cork South West, Independent)
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It is envisaged the new Mental Health Bill will replace, reform and overhaul the Mental Health Act 2001. The Bill contains over 140 sections and introduces, for the first time, a robust system of registration, regulation and inspection of all mental health services, including community CAMHS. Will this happen, however? Every week, I hold clinics all over west Cork. I know from families, parents, brothers, sisters and friends the devastation that mental health issues can cause. I have seen it at first hand. In one particular case, a young lady has so many mental health issues that it seems nothing can be done for her. She goes into hospital. A few days later, she is back out living on the streets, sleeping on a couch or in a car. Her family contacted me and my team helped to get her a house. A few months later, she was back living on the streets with no way of helping herself. She was again admitted to hospital. Afterwards, she was yet again back on the streets with no help. The issue here is the revolving door. She goes into hospital and she is sent back out again with no help. Where does this leave her? Her family are at their wits' end and cannot deal with her. She is in and out of my office on a regular basis and there is only so much we can do to help.

The Mental Health Act must be better than what is in place already. This Bill needs to be introduced immediately without delay. We need to invest in early intervention. I mentioned CAMHS and different issues. Services are not there for people. People who are looking for autism spectrum disorder services and access to CAMHS can wait for 27 months. That is an astonishing wait for anybody. It is leading to savagery and stress on parents. I feel for the parents. One constituent was waiting for four years for an appointment. That is an astonishing failure. I am not blaming the Minister of State personally, but it is a failure on her side of the House that a service was not delivered for so many years. Nobody should have to wait four years to meet anybody. It causes stress for people who need help and are crying out every day. Unfortunately, many of them end up self-harming.

I am delighted that a unit in Bantry has been done up. I welcome that. I give out and fight for services but when they are given we must praise them and meet the road as it comes before us. I went in to see the lovely new unit. We need a stand-alone unit in west Cork because the service needs to be developed. Space is so tight that I do not think the unit can be developed further. That may lead to fewer mental health beds than required in Bantry in west Cork. These beds are needed. I am not here to blow my trumpet and say we are never happy no matter what the Government gives us or that it is not good enough. The unit has been done up, which is very welcome.

Danny Healy-Rae (Kerry, Independent)
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This is the most serious issue we have to deal with on the island of Ireland. CAMHS has a waiting list of over two years for appointments. As therapeutic supports are extremely hard to get, many doctors feel the only option available to them is to prescribe antidepressants. That is not fair on young children. Imagine a little girl of 13 years who is harming herself and whose parents have to take it in turn to stay with her 24 hours a day, seven days a week. CAMHS cannot get her into any place or get residential care where she would be minded properly. The family need a chance. There are several cases like this. The people are driven into the ground with pressure and worry, and there are so many of them.

I do not know how much time I have, but I have to talk about suicide. It is a desperate thing that is happening. Many families are finished and hurt forever by the loss of a family member. Many people know their brother, sister, father or mother has a problem and they cannot get them in anywhere.

Catherine Connolly (Galway West, Independent)
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I want to clarify something. The Rural Independent Group has this slot and 12 minutes are left. The debate adjourns at 8.21 p.m. It is between Deputy Healy-Rae and his colleague to decide, if his colleague wants to speak.

Danny Healy-Rae (Kerry, Independent)
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I have to say this because it has been in my head for so long. Some years ago, a doctor and a family member could get someone in danger of harming themselves into residential care where they would be minded one to one all day and night until the person got better. We cannot do that anymore. It is not happening anymore, but it has to happen because so much of this is happening across the country, in Kerry, Cork and everywhere else. Family members know that something has gone wrong, but they cannot do anything about it. They talk to their family members, but so many of them are not trained. Many people do not have time. They have their own lives and problems. They are working and taking children to school. We have had so much of it in recent times. I ask the Minister of State to look at this. Why can we not do something to deal with it? The other problem is we do not even have residential places. People are let out of care on a Friday evening and families are thrown into jeopardy. Who is going to be with the person all evening, all night, the following morning, on Saturday morning and through to Sunday and all of the following week? I know so many cases where this is happening. They are let out of hospital, no one is there to mind them and we lose them. It is very sad and very bad.

Richard O'Donoghue (Limerick County, Independent)
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How can we help people who suffer from mental health problems? Like everything else, we have to start at the start with early intervention. The biggest problem we have with early intervention is that services for early intervention are not available. Where they are available, people will wait for 18 months or two years. Some of the people who have come to us looking for help move into the adult bracket before they can get early assistance. More and more younger people with mental health issues are coming to us looking for help. Early intervention could help them. An awful lot of this is due to the pressures coming from mobile phones. Young people are exposed to an awful lot more than we were when we were younger. Through the Internet and everything else, they are exposed to an awful lot more and they have to deal with an awful lot more than what we had to deal with.

If we look at our upbringing, we had a simple life because we only saw what was on the television or heard what was on the radio. Nowadays, young people are interacting with people all over the world. That is an awful lot for a young person to process and understand and it can add to the pressures. Given that, why are early intervention services not being put in place? We need to focus a lot more on that to help children from a younger age rather than keeping them waiting, which puts pressure on families who are trying to care for their loved ones and are afraid of what can happen.

Many good friends of mine have committed suicide. With a bit of early intervention, some of them could have been helped. Many people from the generation ahead of me who suffered from mental health issues would be alive today if they had got help at the time. The statistics going back 50 years would show that. I know people who went to school with me and had yearly or ten-year reunions. Many of them say they have not lost anybody through mental health problems or suicide. However, if you talk to a child today, how many of them have witnessed this at an early age? That was not the case previously. Does that not suggest we must put things in place to help people at an early age? It would not only help people with mental health issues; it would also help the families of people who are suffering, no matter what is contributing to the problem. A lot of this can be attributed to inflation. Two people who are working and trying to put food on the table see there is nothing left at the end. They are fighting for their mortgages because of the inflated cost of housing, childcare and medical bills but because both of them are working and earning money, they qualify for nothing. This adds further pressures which creates more mental health difficulties.

The responsibility for ensuring services are in place to help children and adults lies with the Department. Why are they not available?

To look at this from the point of view of hospitals, I met nurses and midwives today who said there is a cap on additional resources but they need 150 more nurses. Imagine how existing staff are suffering as they do extra hours to try to cover what they have. There is a cap and staff tell us that for cancer patients and in oncology and emergency departments, the strain is being put on the workforce. This has knock-on effects, which are creating strain for families. This can lead to mental health difficulties.

The Minister of State is a mother. She has done a lot but there is a lot more that can be done in our Departments to make sure funding is put in place in order that the proper people ensure people can be helped at an early age. That is down to funding and resources but also infrastructure. If we do not have the proper infrastructure, we cannot do anything.

Catherine Connolly (Galway West, Independent)
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The Deputy will be in possession when the debate resumes tomorrow.