Mary Butler (Waterford, Fianna Fail)
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I thank the Leas-Cheann Comhairle for the opportunity to mark World Mental Health Day 2024. It is a day that allows us to reflect on the importance of mental health as a vital element in the overall good health of every individual – there is no health without mental health.

It is also an appropriate day to reflect on the huge progress that has been made in mental health policy and service delivery in Ireland since World Mental Health Day was launched on 10 October 1992. Ireland has made significant advancements in recent years in promoting recovery-orientated care with input from service users and carers and a co-ordinated approach to stigma reduction around mental health.

Our current mental health policy, Sharing the Vision, and our suicide reduction strategy, Connecting for Life, both speak to these ambitions. The goal of our policies is to focus on the mental health needs of the whole population, framed by the underlining principles in Sharing the Vision of trauma-informed care, focus on recovery, respect for human rights, partnership and valuing and learning. I regularly speak about the hard work and effort it takes to reflect these principles in policy delivery. It is essential that the people who use our services are at the heart of the design, development and delivery of the supports we build to serve them. Lived experience must be central to all we do. I have seen the value of the service improvements achieved through including the voice of lived experience in service design on my visits to local mental health facilities and peer-support services as part of my work.

The HSE’s mental health engagement and recovery office was specifically set up to integrate lived experience expertise in the development, delivery and review of our mental health services. If we want our services to be really recovery-focused, they must be built on the twin pillars of clinical expertise and lived experience expertise. I firmly believe that mental health is everyone’s business, and I also believe that recovery is everyone’s business. This message is at the heart of all the work we do.

In August this year, to further strengthen the voice of lived experience in policy implementation, I approved a call for expressions of interest to join the national implementation and monitoring committee steering committee for a member with lived or living experience. I expect to appoint the successful candidate in the coming weeks. This inclusion of the voice of lived and living experience will bring an additional patient-focused voice to policy oversight. I look forward to the positive impact that will have in strengthening the recovery approach in policy implementation and new service design and delivery.

The theme of this year’s World Mental Health Day is “It is Time to Prioritise Mental Health in the Workplace”. It is important that we foster workplaces that are supportive and free of mental health stigma, and that we support those with mental health difficulties to find work, remain in work and benefit from the fulfilment, well-being and sense of purpose that can come with employment.

This morning I was delighted to support an event hosted by the HSE’s mental health engagement and recovery office on the continuing development of individual placement supports, or IPS as it is known. IPS is an internationally recognised, evidence-based programme to support people with mental health challenges returning to or commencing work. This event was designed to inform and support those involved in placement supports, including service delivery and planning for the growth of the service in Ireland.

I was pleased last week to be able to provide significant additional funding in the budget for peer-support workers and recovery co-ordinators, to continue to place the core concept of recovery at the heart of the services we provide and to ensure people can retain and find employment throughout their recovery journey.

For individuals with mental health challenges, the opportunity to work can be transformative. It fosters a sense of purpose, promotes social inclusion and significantly contributes to their recovery journey. We know, sadly, that traditionally people with mental health difficulties have a much higher instance of unemployment than the rest of the population and IPS is essential in addressing that issue. It became a mainstream programme under the mental health engagement and recovery office in June 2021 and since then I have secured a direct investment of €3.6 million for individual placement support. We have over 500 individuals currently being supported by IPS, a great success story. Reducing workplace discrimination through awareness, training and engagement with people living with mental health challenges creates healthier, more inclusive work environments.

We have been hugely successful in promoting open conversations about mental health difficulties and about reducing stigma, shame and discrimination, which in turn changes attitudes and approaches to mental health. This morning a letter from me was delivered to all Members of the Oireachtas, encouraging them to take the "Let’s Talk About Suicide" training programme which I launched for the HSE earlier this year. This presents a unique opportunity for all Deputies here today, and all Members of the Oireachtas, to contribute to the conversation around World Mental Health Day and develop their skills in this area. I also ask that they encourage and support their staff to undertake the training. It is so important.

Working with our voluntary and community partners in front-line and advocacy services, initiatives such as See Change’s green ribbon campaign encourage a culture where people are not judged or labelled because of their mental health difficulties. I congratulate Chime on a fantastic month of September in which it promoted the green ribbon every day of the week and encouraged people to wear it, end the stigma and talk about their mental health difficulties. We have invested over the years to support an environment where people do not hesitate to seek help and where early intervention supports are available for those in need, and we need to promote at every opportunity the concepts of positive mental health and recovery.

More and more people now talk openly about their mental health needs and receiving support and acceptance from family, friends and mental health services. However, I will always strive to do better and there is still much for us to do. One of the most significant pieces of work in mental health this year and a priority of mine since my appointment as Minister of State with responsibility for mental health in 2020 is the publication of the Mental Health Bill 2024 on 31 July. Containing over 200 sections, the Bill will replace the 2001 Act with a more human rights-based and person-centred approach to mental health legislation and put in place a more robust legislative framework in which mental health services will be delivered and regulated.

It will update the involuntary admission process, modernise provisions related to consent to treatment and provide enhanced safeguards for people accessing inpatient treatment. A new stand-alone Part relates exclusively to the care and treatment of children and young people. In addition, the Bill will introduce, for the very first time, a robust system of registration, regulation and inspection of all community mental health services, including community CAMHS.

I welcome the Mental Health Commission’s important role under the legislation to set appropriate standards for community mental health services. The Bill passed Second Stage in the Dáil on 18 September 2024 - I thank everyone for their support - and my officials are now working to prepare any necessary amendments as quickly as possible ahead of Committee Stage.

Continued investment and recruitment are critical to modernise a responsive mental healthcare service for those who require it, both in specialist mental health services but also in the key areas of mental health promotion, prevention and early intervention. Last week was my fifth budget in my role as Minister of State with responsibility for mental health and older people. I am pleased that the 2025 health budget secured a further rise in spending on mental health to almost €1.5 billion. This marks the fifth consecutive year that an increase in funding has been provided to develop and support mental health services and it exemplifies this Government’s commitment to delivering on our policy objectives.

Mental health funding has increased by 44% in the lifetime of this Government. This clearly underscores the focus that we have placed on ensuring our mental health services are safe, accessible, modern, and person-centred. The additional funding allocated to mental health services since 2020 has allowed for significant expansion of the mental health national clinical programmes, including the eating disorders and the crisis resolution models of care. This has led to incremental but significant, service improvements. To date, I have secured funding of approximately €35.7 million for the development of the national clinical programmes under the current programme for Government. The national clinical programme on self-harm and suicide-related ideation is now in place across all our accident and emergency departments, and the programme is now being enhanced in our communities through the recruitment of suicide crisis assessment nurses, known as SCAN nurses, including six recruited last year. For eating disorders, 11 teams are in place with services now being delivered to people with eating disorders. In May 2024, I announced the establishment of a new team for Dublin south-west, Kildare and west Wicklow, which along with the further two I announced last week will bring the total number of eating disorder teams nationally to 14. One of the teams announced last year was a CAMHS eating disorder team to be based in the Limerick and mid-west area. We are just finalising where the second one will go. I am very keen that it will go to an area that does not have any such service currently.

I was particularly pleased to secure funding for a further four teams for ADHD in adults to complete the national roll-out of this programme. Budget 2025 will also provide funding across the national clinical programmes for two additional early intervention in psychosis teams, the two additional eating disorders teams I just referred to, two additional dual diagnosis teams, as well as posts for the programmes on mental health with an intellectual disability, self-harm and suicidal ideation, and psychiatry of later life. These are valuable developments in services that have been experiencing increasing demand. Thanks to this investment, more people across the State will have the opportunity to benefit from these services.

Connecting for Life is Ireland’s national strategy to reduce suicide. We continue to deliver on cross-sectoral policy recommendations in this area while commencing work on its successor strategy, which will build on its successes but also learn from its challenges. Last year, one-off funding was secured to enhance services in this area for those bereaved through suicide. Under budget 2025, this funding will now be recurring and additional new development funding will be provided for a variety of suicide prevention initiatives, including suicide bereavement liaison supports and funding for Pieta’s national counselling service for people affected by suicide and self-harm.

One of the measures I announced last week, which I believe is among the most important, is the provision of €2 million to expand counselling in primary care, CiPC, with a particular focus on men. We will work on expanding eligibility for CiPC to include those with GP visit cards. It is a priority of mine to make counselling supports accessible to more people. It really worries me to think of people, particularly men, not getting the help they need because of the cost involved in getting counselling. This expansion of CiPC will focus initially on engaging with men who as a group have been less likely to avail of counselling supports. We need men to reach out, and expanding access to this service means that appropriate supports will be there when they do.

I am happy to report that progress on developing a new whole-of-government national mental health promotion plan is at an advanced stage with publication intended before the end of this year. This will represent another milestone in implementing one of the key policy goals of Sharing the Vision. Positive examples of cross-departmental collaboration through the implementation of Sharing the Vision include the work of the high-level task force to consider the mental health and addiction challenges of those who come into contact with the criminal justice sector. This work involved extensive co-operation between the justice and health Departments.

I have secured an additional €2.1 million in funding to facilitate the opening of 18 beds in the National Forensic Mental Health Service in Portrane. Opening these beds will allow patients to move through the various levels of support offered by the care pathway in the hospital and, in turn, will allow for further admissions across the hospital. This important new measure advances key recommendations of the high-level task force report on mental health and addiction and will also greatly assist to help to alleviate pressures on referrals from the Irish Prison Service.

I also welcome the launch of the implementation plan for the National Housing Strategy for Disabled People. This implementation plan was launched by our colleagues in the Department of housing in June 2023. The strategy will directly improve outcomes for people with disabilities. Since 2017, more than 3,300 people with a mental health-related disability have been assisted to access housing in the local community, which provides an essential support to recovery. I have provided the HSE with additional funding to support the recruitment of housing co-ordinators to support people with a mental health difficulty to secure and retain independent tenancies. Policy should be about making a real, positive, tangible difference in people’s lives.

Travellers are identified as a priority group within the Sharing the Vision and Connecting for Life initiatives. They face many challenges in relation to mental health and suicide. Significant additional ring-fenced funding of €365,000 has been provided for Traveller mental health initiatives in budget 2025. In addition, funding of €200,000 for the national Traveller counselling service, which was allocated on a one-off basis for 2024, has been mainstreamed under budget 2025. This will bring the total funding for Traveller mental health to €565,000 for 2025. This money will be used to provide ring-fenced supports with oversight from the national Traveller mental health working group. This will build on previous years to expand the national Traveller counselling service and ensure this culturally inclusive counselling service receives the support it needs. In addition, funding will be provided for culturally appropriate suicide bereavement supports for Travellers in order to ensure that the services which are provided at a very sensitive time for families and communities are responsive to their particular needs.

As I said at the outset, it is my firm belief that there is no health without mental health. The Government and I, and my colleagues in the House, believe in the importance of well-funded mental health facilities. I believe the Government and I have shown our commitment to this statement through the provision of additional ring-fenced funding for mental health services and through our commitment to the introduction of a modern and fit-for-purpose legislative framework to provide human rights-based, person-centred and recovery-focused care. I look forward to hearing the views and opinions of my colleagues. I appreciate those Members who are present on a Thursday afternoon to speak about mental health and positive well-being. Gabhaim buíochas leo.

Mark Ward (Dublin Mid West, Sinn Fein)
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I do not know how many more engagements we will have from one side of the House to the other. On this World Mental Health Day I wish the Minister of State, Deputy Butler, and her staff all the very best. I know we have had political differences over the years but I wish you all the best on World Mental Health Day.

I want to thank everybody working in mental health services on World Mental Health Day, and particularly those in the community and the voluntary sectors for giving their time and their energy to people who need it so much. We are often critical in relation to some the statutory organisations when it comes to mental health, but I want to make sure that such criticism is based on the lack of funding, which sometimes stems from political decisions, and is not directed at the workers themselves. Those to whom I have spoken who work in the mental health area do so as a vocation and because they want to make a difference in people's lives. I want to acknowledge all the work they do.

I thank all the staff working in CAMHS, the psychiatric nurses, psychologists, psychiatrists, counsellors, psychotherapists and volunteers. I really need to mention the volunteers, because a lot of our organisations, especially in the community and voluntary sector, are run by volunteers who give of their time to help some of the most vulnerable people in society. I have probably missed a couple of people but I want to thank everybody who works in mental health services for the work they have done over the last number of years and continue to do.

I received the Department's leaflet on the Let's Talk About Suicide programme. This is very welcome. It is a conversation people need to have. The more people become aware of the appropriate language to use around suicide, the better. I will not give other people lectures on what language should be used but it is an important issue. Yesterday, Deputy O'Rourke and I, along with other colleagues, met members of Save Our Sons and Daughters, SOSAD. Since 2007 this organisation has worked to raise awareness and help prevent suicide in Ireland. It works tirelessly in communities to help those in need, support them and let them know they are not alone on their journey. SOSAD offers support and services for people who are struggling with suicidal ideation, self-harm, depression, bereavement, stress and anxiety. It is a space for people to talk. SOSAD has seven offices, based in Cavan, Louth, Meath, Monaghan and Laois. So far this year the organisation has seen 1,600 individual clients and delivered 18,000 counselling sessions. I was not aware how acute the issue was but yesterday the SOSAD representatives told us they are in real danger of having to close their doors this year, with only a couple of months left in the year. It does not receive any statutory funding. The representatives said that they have contacted the Minister of State's office a couple of times and been directed to the HSE. That is where the barrier seems to be. When they go to the HSE, it appears that the HSE simply does not want to know.

The Minister of State will be getting a letter from me and the team very soon. I ask her to meet with representatives of SOSAD and have a member of the HSE present. If all the stakeholders are in the one room at the same time, it would be really beneficial. I do not know how we could plug that gap of 18,000 counselling sessions in some of the constituencies I mentioned.

Mary Butler (Waterford, Fianna Fail)
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I will meet them.

Mark Ward (Dublin Mid West, Sinn Fein)
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I thank the Minister of State. I really appreciate that. As she knows, this is a vital, life-saving organisation.

I often criticise Government policies so I want to spend a bit of time talking about some of the things Sinn Féin would do if it had a chance to be in government. We have produced a mental health action plan comprising several policy documents over the past while. The plan contains a number of commitments that would transform how we deliver mental health services across the country. It sets out an absolute commitment to deliver widespread and significant change and a fresh start in mental health care. We would ensure that services are based on need and not on where a person lives, thus moving away from the postcode lottery of services. Our plan is based on fairness, access to high-quality local services, early intervention, prevention and suicide reduction. It is a raft of measures that would transform how mental health care is delivered.

I welcome the Mental Health Bill 2024 which, if passed, will reform the Mental Health Act. I hope we will get to Committee Stage of the Bill. In reality, it will not go through all Stages in the lifetime of this Government. I hope the next Government will pick it up and we can start running with it. I have mentioned to the Minister of State previously that, as it stands, CAMHS is still not regulated. It would be a great legacy for the Minister of State and the Government to regulate CAMHS before the election, whenever it is called. That would give parents and children who access the services the security of knowing they will get the care they need. I mentioned earlier that the staff who work in the service are really good and they really care. Sometimes they are let down by the systems and governance, however. Any regulation put in place before the end of this Government would be very welcome.

Sinn Féin would also deliver 47 additional CAMHS teams and 17 CAMHS-ID teams. Earlier today we heard Maggie's story and how there is no CAMHS-ID team in her catchment area. She is another victim of the postcode lottery. We need to have universal care across our services.

Sinn Féin would also deliver another 41 inpatient CAMHS beds. I was interested to hear what the Tánaiste said earlier. When the Government came into power, there were 72 CAMHS beds. There are 51 operational at the moment. That is a reduction, but only 36 or 37 of the beds are occupied at present. The reply I received yesterday to a parliamentary question I tabled stated that in 2023 - I do have the figures for 2024 - 740 children were admitted to paediatric wards for mental health care. I cannot see the reason for that if there are vacant CAMHS beds for people who need specialist mental health care. Why are these beds not being utilised? I acknowledge that the number of young people ending up in adult psychiatric facilities has been going down but we need to set the bar high on this and aim for zero.

In her opening statement the Minister of State referred to beds for people with eating disorders. There are still only three such beds for adults with eating disorders. We really need to improve on this. People with eating disorders are going onto general wards or non-specialist psychiatric wards and they are not getting the help they need.

I will give up my time and allow my colleagues in.

Darren O'Rourke (Meath East, Sinn Fein)
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I will pick up on the point regarding SOSAD. It provides such an important service in my county. It is very difficult to measure these things but the organisation is living up to its name and saving sons and daughters. It delivers tens of thousands of hours of counselling and support to thousands of people. In my own county, it delivered 4,500 counselling sessions in the past year, while it delivered 10,000 in the neighbouring county of Louth. I echo Deputy Ward's point about the invaluable service SOSAD provides. It was born out of a demand to fill a gap for the State. We cannot afford to lose it. I thank the Minister of State for agreeing to meet representatives of the organisation. As Deputy Ward said, it is important that representatives of the HSE be present at that meeting. We need to put this service on a sustainable footing.

Martin Kenny (Sligo-Leitrim, Sinn Fein)
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World Mental Health Day brings into sharp focus the problems we deal with all the time throughout the country regarding mental health issues. Practically every family, to some extent or other, is affected. As public representatives, we deal with this on an ongoing basis. When I was a councillor, we used to say we were counsellors as well as councillors. When people came into our offices to talk to us about various issues, that private space to talk to somebody facilitated the conversation and we ended up developing skills without ever getting training on how to deal with people in those circumstances.

There is an acute element here that we really need to look at and that is the provision of services for people who are suicidal or self-harming and have really serious and long-lasting problems. Reference was made to SOSAD. In my region, there is an organisation called North West STOP. It was set up by families who had lost children to suicide. It provides counselling and other services for people. If this organisation did not exist, many more people would drop through the net. It cannot receive funding because it is not a national organisation, yet without it we would be in turmoil.

Maggie was mentioned earlier. She lives in my constituency. I spoke to the Minister of State about her before. I have raised the matter several times, in fact. The issue is that CAMHS will not deal with her because she has an intellectual disability and there is no intellectual disability team. I thought it was ironic that in her opening statement the Minister of State mentioned that a CAMHS eating disorder team will be set up in Limerick. What about the rest of the country? What about a child from Louth, Leitrim, Mayo or somewhere else who needs access to that team? I take it they will not have it if it is not in their CHO.

Mary Butler (Waterford, Fianna Fail)
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That is No. 14 of 16. I am getting there.

Martin Kenny (Sligo-Leitrim, Sinn Fein)
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I accept that. The big issue we have in many areas is that people feel left behind because they do have access to the teams they need and that the CAMHS or other teams simply do not have the resources to provide the necessary services. At the end of the day, all of this is down to funding and resourcing. Many of the problems we come across with CAMHS and adult mental health services arise when people go looking for a service. I have come across situations where a family has brought in a family member who is suicidal and in a terrible state. After a couple of days, they are sent home and told they will have an appointment in two weeks.

The two weeks go past and the person does not turn up for the appointment. What happens? It is written down that he or she must have got better. It is never followed up. In most cases, the person has got worse and is not even able to motivate himself or herself to go to the appointment. There is a big block and a gap in the service there that needs to be filled. If people are being let down, there has to be some comeback. The service must have some responsibility to ensure that people are looked after properly because too often we have come across situations where people have lost their lives in such circumstances, having looked for help but not been given adequate help. I will pass my time on to others.

Catherine Connolly (Galway West, Independent)
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I call on Deputy Ellis.

Dessie Ellis (Dublin North West, Sinn Fein)
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Tá mé síos le haghaidh ceithre nóiméad go leith níos déanaí.

Catherine Connolly (Galway West, Independent)
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Más mian leis an Teachta, is féidir leis labhairt anois.

Dessie Ellis (Dublin North West, Sinn Fein)
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Is féidir gan amhras.

Catherine Connolly (Galway West, Independent)
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He will not get the two slots.

Dessie Ellis (Dublin North West, Sinn Fein)
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Tá ceann amháin maith go leor. Today is World Mental Health Day. It is a day for raising awareness of mental health issues. It is also a day when we talk about mental health in a way that breaks down the stigma around mental health. It is a day that shows those struggling with mental health issues around the world that people really care about them, empathise with what they are going through and want to show that they are there to support them and to tell them that it is okay to not be okay. Today is important but we should be conscious of the struggles people go through every day of their lives, all of the time. We should not just think about it one day in the year. We should always be mindful of the stresses and pressures on people who suffer from mental health issues and understand the impact this has on those around them, their immediate families and their friends.

Since I became a TD, I have spoken on mental health issues on many an occasion in the Dáil. I have spoken on Private Member's Bills on mental health, I have raised mental health issues as Topical Issues and I have spoken on them during Questions on Policy or Legislation. One of the areas of mental health I have a particular interest in and have spoken about previously is the area of dual diagnosis. Over the years, I have been a strong advocate for the acceptance of this concept by the medical and psychiatric professions. Having a dual diagnosis means that you have both a mental disorder and a substance use disorder with either alcohol or drugs. It was very frustrating for people who presented to a hospital with mental health issues to be turned away because of their addiction issues. This attitude in the health sector left many people outside of available treatments that were necessary for both their mental health issues and addiction issues.

Mental health and substance use disorders often occur together and studies have shown that many people who have substance misuse issues are also diagnosed with mental disorders. The reverse is also true in that many people with mental disorders will develop a problem with substance misuse. This occurs for many reasons. At its simplest, mental disorders can contribute to substance misuse because people with mental health issues may get temporary relief from using drugs or alcohol. This is a form of self-medication.

Progress has been made in that the understanding of dual diagnosis has grown. It has become a more accepted diagnosis in the medical and psychiatric spheres. It should be acknowledged that the acceptance of dual diagnosis is in part down to the long campaigning and advocacy of voluntary groups such as Dual Diagnosis Ireland and particularly that of Barbara Condon of that organisation and individuals such as Dr. Eamon Keenan, a HSE consultant psychiatrist in substance misuse. Both Ms Condon and Dr. Keenan have travelled throughout Ireland educating people about dual diagnosis and advocating for the appointment of a clinical lead in dual diagnosis.

In 2023, the Keltoi centre in St. Mary's Hospital, Phoenix Park, Dublin was designated the national dual diagnosis rehabilitation centre. At the moment, the centre only offers a day service. During the pandemic, it was converted into a Covid-19 isolation unit. There was some doubt and concerns were raised as to whether it would be returned to its intended use afterwards. No funding was allocated for its re-establishment in the budget. The centre's redesignation is to be welcomed but it is urgent that progress is now made to renovate the building to bring it up to HIQA standards, particularly in light of the significant loss of a substantial number of beds across a number of facilities that treat addiction.

There is a lot more to be done in the provision of mental health services. Mental Health Reform has done great work in highlighting many of these issues over the years. Charities and voluntary organisations cannot be expected to substitute for Government services that are poorly funded and overburdened. Mental health is important at every stage of life from childhood and adolescence through to adulthood. Without increased investment and properly resourced mental health services, we are failing not just the people who suffer from mental health issues, but the country.

Catherine Connolly (Galway West, Independent)
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The Deputy gained both ways. He got in earlier and got a longer slot, given the topic in question.

Niamh Smyth (Cavan-Monaghan, Fianna Fail)
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Today is, of course, World Mental Health Day. I thank the Minister of State for the work she has done in her role since her appointment as Minister of State with responsibility for this very important issue. I know she feels it with her heart, in her head and with all of the work she does in respect of policy, legislation and funding. I thank her for making sure that Cavan and Monaghan got their suicide crisis assessment nurses, SCANs. That is something I long campaigned for when we were in opposition. When we were in government, the Minister of State listened to that call and came to see the work the HSE is doing on the ground in St. Davnet's Hospital, Monaghan, and the facilities it is delivering.

I concur with many speakers around the House. SOSAD is one of those groups that is really on the ground across Cavan-Monaghan. That has to be said. The volunteers give their time to be at the end of the phone. The counselling service SOSAD provides is incredibly important. I urge the Minister of State to lend the organisation her support in any way she can.

The Minister of State will know that I have felt for a very long time that visibility is incredibly important as regards mental health services. I still feel very strongly about that. Cavan-Monaghan has certainly seen very difficult times over recent years with the loss of many young lives, including very young lives, and the lives of people in their more mature years. It affects every family, every demographic and every part of the constituency. I have felt very strongly that we need the visible presence of a service such as Jigsaw. I know the Minister of State has listened to me. We have had a number of meetings on this issue and she is working on helping me to deliver on that. I really believe this is incredibly important for a number of reasons. It is a signpost and provides a visible physical presence in a county. We cannot have them in every community, as we might like to. In fairness to SOSAD, it is out there running hubs in various more rural communities but the visible presence of an organisation like Jigsaw is one of the best preventatives we could have. I want to see prevention. That is critically important. If we have prevention, we do not need the cure.

There was a very heated and robust debate here this morning about mobile phones and social media. Principals, teachers and school communities are really up against it in trying to support young people and allow them time away from technology. Many families who have been impacted and affected by the loss of young people through suicide point to the phone as a facilitator. It is a facilitator for real pressures on young people's mental health. It is a facilitator for people who want to use them in an untoward way to carry out bullying, using them as a silent vehicle to torture, torment and relentlessly pick at and destroy the lives of young people. There has been a lot of criticism of these pouches for schools but I am all for anything we can do to resource schools to make this easier. I would be the first to admit that some principals have told me that they have rules in place such that students are not allowed to bring their phones to school and must leave them at home and that they do not need the pouches. That is fine but I also know principals who are struggling to police this, to manage it and to support teachers to support their students to keep away from technology.

It is not just about the distraction in the classroom but it is also about that mental health piece where the torture and the continuing picking on someone can be relentless. This is the way to do it. This is the unseen way to do it. Parents can go through months of that invisible torture where something is not tangible to them. Sometimes it can be too late when they find the phone and find out about the relentless torture that has gone on on the other end of it. It is a wise decision by the Minister to provide that resource to support teachers in schools because it is one of the most important areas of a young person's life. Young people leave their house at 9 o'clock in the morning and some do not return until 4 o'clock or 5 o'clock in the evening. If they can have that break from their phone, it is to be welcomed.

I appeal to any of the social media platforms which are listening in. I do not feel they are playing their part or that they are doing their utmost in terms of the take-down of information, hate speech or torturous posts that people put up on their social media platforms. We know it is the wild west. In my committee, we have done as much as we can on online safety. It is the preserve of Coimisiún na Meán to step in here and ensure that the social media platforms do as much as they can to support parents, schools, principals and An Garda Síochána. Those platforms, such as Facebook, Instagram, Twitter and TikTok, have the greatest responsibility and resources available to them. I believe they should be resourcing our Government, education system and mental health services to deal with the negative impact social media can have on the mental health of our young people.

My final ask to the Minister of State, Deputy Butler, relates to Jigsaw. I know we are possibly coming to the end of a political cycle but it is not an issue that will go away and it is not an issue I intend to move away from. I intend to keep campaigning for that very visible signpost, such as Jigsaw for Cavan-Monaghan, for young people, because I believe it provides an important service for counselling and prevention. We need to get to our young people in time and for them to know where that service is, otherwise they are not so aware of it. Jigsaw and some multiple health services did an incredible job during Covid to have the teleservice online, to do Zoom calls and so on, but you cannot beat that face-to-face service. That is why I feel that the physical presence of a service like Jigsaw would be incredibly useful, supportive and engaging for young people across Cavan-Monaghan.

I thank the Minister of State for the suicide crisis assessment nurse, SCAN, positions in the HSE in Cavan-Monaghan. If there are more available to us, please assign them. I am sure the Minister of State knows the statistics and numbers better than I do. Families across Cavan-Monaghan have suffered greatly in one way or another, whether it is the family directly or the entire community, because we know it impacts on everybody. I ask the Minister of State to give the resources that can be given.

Róisín Shortall (Dublin North West, Social Democrats)
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I welcome this opportunity for statements on mental health to mark mental health week. This session is overlapping in a health committee meeting where we are dealing with legislation so I am afraid I will have to leave after I speak and I will not be able to stay for the Minister of State's wrap-up.

Mary Butler (Waterford, Fianna Fail)
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I understand.

Róisín Shortall (Dublin North West, Social Democrats)
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For too long, mental health difficulties were seen as a personal failure and something to hide or be ashamed of. I think we are all familiar with those days, which I hope are becoming more distant. While that damaging misconception is changing, which is a welcome development, underlying stigma persists, particularly self-stigma. Last December, St. Patrick's annual attitudes survey found that 22% of respondents would "consider it a sign of weakness" to seek mental health supports for themselves, compared with just 9% if it was a friend, family member or colleague from work. This shows that internalised stigma is still one of the biggest barriers to seeking help.

While there is no doubt that we all need to challenge how we think and feel about our own mental health, this does not absolve the State of its responsibilities. Even when someone does take the positive step to seek help, too often, they find that the services are just not available or not available on any reasonable timescale. This is borne out by the long waiting lists that exist. In May, 491 children were still waiting for over a year for CAMHS. While unacceptable, it is not really that surprising, given that 35% of CAMHS psychiatry posts remain vacant, which is a shocking indictment. In primary care psychology, which is less of a headline grabber, a shocking 9,239 people have languished on the waiting list for over 12 months. More than 8,000 of those are children.

I do not doubt the Minister of State's commitment to improving services but those figures are just inexcusable. Almost 9,000 children have been waiting over a year for mental health services on the Minister of State's watch. We cannot become numb to this or even accept it in any way. These children are being utterly failed by the State. Parents who have sought help for their child are effectively having the door shut in their face. That is why the continued lack of regulation in community CAMHS is extremely concerning. An election is looming, as we all know, and the new Mental Health Bill has only just completed Second Stage. It is hard to see that Bill even reaching Committee Stage in the lifetime of this Dáil. We have waited too long for it. That is why the regulation of community CAMHS should have been prioritised as I and others were calling on the Government to do. It could have been done via an amendment Bill last year. In both the Mental Health Commission's interim and final reports, its primary recommendation was the immediate regulation of CAMHS. It is inexcusable that we are still waiting for that to happen.

Regarding the mental health budget, we are still some way off reaching that 10% figure of the overall health budget. While it is welcome that investment has increased, next year's mental health budget will still only represent 5.8% of the total health budget. That is only a 0.1% increase on this year's funding. If Ireland is to catch up with the rest of Europe and provide services in line with international best practice, then funding must be increased substantially. This year, the specialist group on acute bed capacity identified an immediate shortfall of 832 acute psychiatric inpatient beds but instead of taking urgent action to address this deficit, the HSE has established another group to assess the situation and deliver a strategic capital plan.

In 2018, the Joint Committee on the Future of Mental Health Care recommended increasing the acute psychiatric inpatient capacity to 50 beds per 100,000 of population by 2021, three years ago, but we are still only at 23.8 beds per 100,000 people. That shortfall needs urgent attention. Unfortunately, the reality is that the State is failing people at every level. Talk therapies and other early intervention services are chronically under-resourced and the service generally is overly reliant on medication as a stopgap. This overmedicalised model is not good for people experiencing mental health difficulties. The lack of community services is putting further pressure on acute services as conditions are left to deteriorate to the point where they become an emergency.

Our mental health system needs a radical overhaul to create a proactive and community-based service supported by fit-for-purpose emergency care. This will not be achieved with piecemeal policies and initiatives. We have a plan but it needs to be implemented. Since Sharing the Vision was published in 2020, only 48 of the 100 policy recommendations have progressed, with only three fully completed. This Government is good at saying all the right things on mental health but where is the follow-through? Statements are no substitute for services.

Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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I thank the Acting Chair for this very important debate. It is world mental health week and today is World Mental Health Day in the workplace. I read an article before I went out which stated that 37% of all people surveyed who came through the services of St. Patrick's hospital, Dublin, experienced work-related stress and work-related incidents in their workplace. Stress-related situations in our workplaces are very noticeable, including bullying, which can have a very insidious effect on a person's mental health. It is very important we call this out and highlight it. It is very important on the basis that years ago, maybe two generations ago, we did terrible things in this country to those with mental health difficulties. We institutionalised them. At one stage, Ireland had one of the highest per capita rates of institutionalising people with mental health difficulties. Thankfully, we have moved away from that model.

There is a better model of people at least talking about mental health difficulties and their mental health. That is very good, especially regarding male mental health. For too long, men just would not talk about difficulties or even get help. Once people get help and share some of the difficulties they are having, if they are going through a crisis, the main thing is they get the service and intervention. Once they get the intervention at the right time, there is recovery and hope, but if they do not get it at the right time, the consequences could be catastrophic. It is very important we have the services in place regardless of someone's age.

On the mental health of young people, which was spoken about, there is a crisis in their anxiety levels. This is all fuelled by social media. It is negative. A lot of the stuff on social media is about competition and negative messages all the time. There is only so much of that people can correlate and take in. It can have a bad and detrimental effect on a young person's health and well-being. Social media companies do not really care at this stage but young people do care. It is important the State cares about their well-being.

One of the things I am a big supporter of is social prescribing. It is a fantastic model. In the past, and it is still contemporary, we overprescribed. If somebody is in difficulty, we prescribe medication. That is needed in some cases, but social prescribing is very good. Social prescribing does not work for everybody but it works for some, including getting involved in activities, going for a walk or running. It is amazing what physical exercise can do for your well-being. It is fantastic. One thing I love more than anything in the world is going for a walk in the forest, where there is complete silence and the only thing you can hear is nature and your own thoughts. As I said, it is not for everybody but it is a great way of detaching yourself from the world and sometimes seeing what nature is.

Social prescribing is much more than that but it is one model, if it is done properly, that can work for people, with engagement. We are all social animals at the end of the day. Human beings love other human beings to a large degree. When we are together, we work very well collectively. Mental health, collectively, is very important. There is nothing like that collectivisation of our thoughts and well-being. One thing that got us through Covid, even though we were very separated across the world, was that coming together in a virtual sense. There was also that collective sense of all of us being together and vulnerable. Everybody is vulnerable in this world. Things can go wrong. There is trauma in people's lives but we should have a more caring and kinder world. We should be kinder to ourselves because we can be very hard on ourselves. It is important to not be as hard as we could be. I am the first one to say that sometimes we go hard on ourselves. We should take time to say, "I am a good person. I try to do my best. I try to do good for others and be kind to others", because in a kinder and better world, all our mental health will benefit.

John Lahart (Dublin South West, Fianna Fail)
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Deputy Kenny and I were councillors on South Dublin County Council at the same time. While the mental health of politicians is not more important than any other profession in life, a section of the people who impact the mental health of politicians are other politicians. Something we should bear in mind is the low levels politicians stoop to and the level of personalised attack. The abandonment with which people throw out comments and phrases completely disregards the potential impact they have. It happens more in politics than any other profession. In some other professions it might be behind the scenes, but politics can get very personal. What public representatives miss, and I hope this does not sound patronising, is that I am not here as John Lahart. I am here as a representative of people. You would love to think that we could get to a point where other public representatives appreciate and realise that if they insult me or have a go at me, they are having a go directly at the people who chose to elect me to represent them. I am not here for me. I am here representing other people. I have a right to be here until I do not have a right to be here and until other people decide they do not want me to be here. That is not even getting into the social media piece and the rest of it.

My background is in mental health. I was a psychotherapist for a number of years. There are lots of phrases from old lecturers that we often remember from college in whatever walks of life we are in. One that sticks with me, and people who might have come to me over the years will be very familiar with hearing this, is "Lack of expression leads to depression", which is that ability to take the risk of talking about what is going on with them. As Deputies were talking, I thought that we often think of the negatives. The Minister of State has been to the fore in advancing very positive change in this whole area. She has my huge admiration and the admiration of my colleagues.

There are things in society that did not exist even just a few years ago, such as men's sheds where, certainly in my constituency, very often men of a particular age, maybe retirement age, get together regularly and continue to live full and dynamic lives. We now have women's sheds as a result of that. It is one thing setting up these. It is another thing that the Government funds them. This Government is again to the fore in recognising the roles they play. I think of all the sheds groups in my constituency and Dodder Valley Park in the summer where, when you pass by, there are people doing yoga en masse, due to the amazing South Dublin County Council.

That is the kind of stuff that we used to associate with other countries. Local authorities are playing a quiet but really effective and impactful role in connecting people's mental health with their physical health.

I am familiar with a great organisation ExWell which in theory is set up to do cardio rehab and physical exercise rehab with people who may have chronic illnesses or are recovering from all sorts of surgery. That is fantastic and it is certainly the core of what it is about, but it is also an incredible mental health sustainer and a great socialiser of people who may otherwise not have an opportunity to socialise through exercise. It is free some of the time but certainly very cheap and affordable for people who cannot afford to avail of gyms. It maintains and sustains people's ability to live independent lives. It certainly helps to combat isolation and loneliness. All of those things - being able to live independently, being able to meet other people and being able to go out - certainly assist all walks of life in combating depression.

What I yearn for, as I am sure the Minister of State does, is that one day we will get to a point where we see mental health and physical health as the one issue, and that we have a world health day and in celebrating or marking that, we mark both our physical and our mental health. However, we still have an awful lot of work to do and as a member of the Oireachtas health committee I am acutely aware of the challenges we face.

While I feel that people are much more open, on the other side more antidepressants than ever are probably being prescribed. There are some great initiatives under this Government. Funding has been shifted from health to education. I think this is the first Government to recognise that mental health is not just a Department of Health issue. It is an issue that every Department should take an interest in.

I am particularly interested in what we have done in the education area. There are a few pilot programmes, including one that a school in my constituency is involved in. The Minister of State will know this topic is close to my heart. The idea behind it, which came from schools themselves, was to have some kind of discretionary budget that allowed schools to deal with some mental health and well-being challenges that might come across their desks. The Minister, Deputy Foley, has been very much to the fore in that. I have no doubt that will be rolled out even more widely. We should not underestimate the impact of hot school meals in terms of mental health by relieving some of the stresses and pressures on family incomes.

A recent survey from St. Patrick's Mental Health Services showed that 37% of respondents named work-related issues as a factor that influences their mental health and well-being. In a previous life more than ten years ago, I did well-being work with some companies in the private sector. Some companies recognised this issue and had a mental health week. I will name one of them, the Shelbourne Hotel. I remember doing some work with that hotel. At that time I met a group of employees who were really happy. They seemed very content in their workplace and seemed to be very well looked after in their workplace. The well-being week it had included interventions and provided a range of well-being initiatives free to the employees. It could have been someone coming in to perform head massage on anybody who wanted it. Some male employees had use of the barber's. It provided a picnic for the staff in St. Stephen's Green. There was fishing out in Howth. It was essentially a kind of a pause in the normal work to say, "We value you. We want to do something for you and intervene in this way." Another company I worked for brought in a gym instructor on one of the days during the week for an hour. It was then increased to a second hour after a period of time because the workforce responded so positively to it. Mental health initiatives do not always have to be aimed at the head. While I do not think this was intended, there was also a positive productivity implication of doing this.

There is an awareness that sometimes we need space and time to rejuvenate and recuperate. Someone recently mentioned to me that some countries allow 12 weeks off over a person's working life. Individuals can avail of periods of time over their entire working career amounting to 12 weeks, which seems a lot initially but over a lifetime of work it is not. That provides a little bit of timeout, over and above holidays and sick leave. This is a recognition over a lifetime of work and it happens in some other countries.

After the local elections my party had a really nice initiative. There was a recognition in the party that not being successful can be a devastating blow. It takes a phenomenal amount of effort like an athlete training for a particular event. The people who are unsuccessful very often train as hard and put as much into it as those who are successful, and the difference between success and failure can be marginal. The general secretary of our party sent a letter to candidates who had been unsuccessful on this occasion. The general thrust of that letter was showing sensitivity, understanding that this might be a challenging time and offering supports to individuals who find it challenging. That kind of intervention and sensitivity would not have been there previously. Defeat can be lonely. It can go on for quite a long time and can go completely unnoticed. Instituting those kinds of supports is a really valuable input.

Those are a few things I wanted to put on the record. I welcome the opportunity to make statements on the day that is in it. I thank the Minister of State for her outstanding work and I wish her continued success in it.

Ruairi Ó Murchú (Louth, Sinn Fein)
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We have just heard the news of Israel deliberately firing on three UNIFIL positions in Lebanon. Our thoughts go out their families and those people who are engaged for us and others in peacekeeping. Obviously, this cannot stand in any way, shape or form. I imagine there is agreement across the House on that.

I am very glad we have this opportunity to speak about mental health. I am sure all elected representatives will have come across instances and issues in relation to families. The Minister of State and I have dealt with some difficult and complex issues for individuals and for families.

I could not have this conversation today without mentioning the recent loss through suicide of Mark Maxi Kavanagh who had a really close connection with Dundalk FC. People will also remember Harry Taaffe who was also lost to suicide in July 2020. From my own personal point of view, because unfortunately this is an issue that strikes every family, I wish to mention my wife Annemarie's brother, Paul Conroy, known as Molly, who we lost in December 2015. I would like to remember them and many others at this time. It highlights the importance of ensuring we have the supports to deliver the best service we possibly can.

I think some of my colleagues have spoken spoke about SOSAD, Save Our Sons and Daughters.

We are talking about an organisation that does huge work across the board and across a number of counties. I will talk specifically about County Louth in 2024. In Dundalk, there are 211 individual clients and 1,920 total sessions offered. In Drogheda, there are 553 individual clients and 6,857 total sessions offered. You are talking about an organisation that will get referrals from State services and other services that are funded. There is a particular issue. I know there was communication with the Minister of State on this but we seem to be caught in a crux. A meeting is required between SOSAD and - whatever about us - the Minister of State and the HSE, making sure that all the correct people are in the room, and that we can bring about a solution because it could be facing closure. That would be a disaster for a huge number of those people. I appreciate the Minister of State is open to that.

Earlier in the week a lot of us spoke about CAMHS and the fact the issues still have to be addressed. In 2020, there were 2,115 children waiting on a first-time appointment but there are now, as of our last read, around 3,681, and in CHO 8, which includes my area, that is 807. Five years ago, 223 children were languishing over a year on a waiting list for CAMHS. That number today is 504, and 141 are in CHO 8. We know all the issues that need to be delivered, whether we are talking about bed provision, community provision and the entirety. That is why it is absolutely vital.

When we talk about Louth-Meath mental health services and those 55 full-time equivalent positions that are not filled, that needs to happen. I was at an event earlier in Drogheda organised by the INMO, SIPTU and Fórsa on what they would call the suppression of posts. These are particular issues that need to be addressed as well as the ten-bed extension for the Drogheda department of psychiatry at Crosslanes. I mention resources because we know the Mental Health Commission has looked at Crosslanes and has seen a lack of staff at times.

There is also a big issue that I need to mention regarding assessment. In most hospitals, as I understand it, assessments are made in accident and emergency.

Marc Ó Cathasaigh (Waterford, Green Party)
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I thank the Deputy. We are over time.

Ruairi Ó Murchú (Louth, Sinn Fein)
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That is not the case. What happens in Crosslanes is that sometimes people are brought in there. The assessment is made but that is only done after the inpatients are looked after-----

Marc Ó Cathasaigh (Waterford, Green Party)
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Deputy, we are over time.

Ruairi Ó Murchú (Louth, Sinn Fein)
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-----which means time goes by. There is no night-time service in Our Lady of Lourdes Hospital for assessment-----

Marc Ó Cathasaigh (Waterford, Green Party)
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Deputy Ó Murchú, we are late for the next speaker.

Ruairi Ó Murchú (Louth, Sinn Fein)
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-----with regard to mental health. We also need the daytime service to be up to scratch because it is not at the minute. I think that involves all stakeholders.

Cathal Berry (Kildare South, Independent)
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I wish the Minister of State a good evening. I am very happy to be in the Chamber again this evening to make some very brief comments with regard to World Mental Health Day on behalf of the Regional Group. Why? I very much identify with what this day is trying to achieve, which is to raise awareness, and to reduce stigma and, unfortunately, shame as well. We can all certainly identify with that.

I welcome the theme of this year's day, which is mental health in the workplace. I have worked in many different workplaces but perhaps, in the national Parliament here, it is quite unique. Most coworkers and colleagues at least attempt to get on well with each other but there is this trend inside the national Parliament where we have a habit of getting a bit overly nasty to each other, and unnecessarily. This is my first Dáil term but if you speak to people who have maybe been around for 20 years, there is a discernible trend in the wrong direction, and the trajectory is not reassuring. Instead of addressing the question, we have become too quick to personalise, polarise and demonise. If we are talking on this day and trying to focus on mental health in the workplace, this is the place where we should be leading by example. We are on live TV, even right now, and it is important that every word we utter is appropriate, and that we do not stray across that line.

I would also say that prevention is 100% better than cure. Where prevention is not possible, then early intervention is important. I was struck by what Deputy John Lahart said, and he is obviously very experienced with regard to Men's Sheds and Women's Sheds. I want to double on what he said, in that more funding from central government is probably a good way to go, if we are serious from a prevention perspective.

We should always remember that mental health, while it is precious, is also very fragile. Sometimes we look after our cars better than we look after our own bodies and minds. We do the NCT every year for a car, or every two years, depending on the age of the car. Unfortunately, we do not put the same emphasis on our own mental health which, unfortunately, is a bit of a downer.

I welcome the additional funding in the budget for mental health. It is almost €1.5 billion this year, which is progress. It is up about 40%, I think, from the start of this Dáil term, which is very positive. It still falls short of the 10% rule of thumb around the world - that 10% of health funding should be going towards mental health. While there has been progress that I absolutely acknowledge, I guess we can try harder and do better from that point of view.

With regard to social media, our time growing up was before it. It is not easy out there. First, I give my backing to the banning of smartphones in secondary schools. I was in a school in Newbridge last week, the Holy Family Secondary School. They asked me to pass on a message, and I am very happy to do so. They have banned smartphones for the last eight years, at no cost at all. Students just hand in their phones in the morning and pick them up on the way home. The phones are available for transit, and for linking up with parents pre- and post-school. I was very happy to pass that on to the appropriate authorities. It can be done, and most of the students are quite happy with that as well.

Also on social media, we need to mindful of the algorithms out there. Social media is, on balance, a good platform. On balance, it is a good phenomenon for sure. I use it myself but it needs to have some guard rails, which I am not convinced it has. After the Covid-19 lockdowns, people almost overdosed on social media with the obvious effects.

I want to mention gambling which is a big issue, particularly for Irish men. In the past, you would have to go to a retail outlet and physically hand over cash to bet on a horse or a game. Now you have a casino in your pocket, and it really is the unseen addiction. People are in their bedrooms, bringing their phones with them, and their thumbs are handing over hundreds of euro with the obvious detrimental effects.

I was also struck by what Deputy Ó Murchú said. I have been to two funerals in the last fortnight. Both were for men who took their own lives. Interestingly enough, one was in his early 40s, a good friend of mine, Andy Brady; and the other was today in Roscommon for someone who was in his early 50s. It is not just a phenomenon among teenagers or young any more; it is much broader than that. We place a lot of emphasis, quite rightly, on the statistics for roadside fatalities. We do not place the same emphasis on death by suicide. There are about ten a week, I think, which is the unfortunate, grim statistic at the moment. It is one and a half people per day. It is an epidemic. We need to get ahead of it and see if we can do more.

I welcome the Mental Health Bill 2024, which has gone through Second Stage and will be going to Committee Stage soon enough. I have one question, and perhaps I should know this already. If the Dáil is dissolved, what happens the Mental Health Bill? Does the Bill fall or can it continue and be picked up? How easy will it be to pick it up in the 34th Dáil? It would be a travesty if this Bill is not fully signed off on Report Stage before we finish up proceedings here.

I will end with the Minister of State's own phrase: "There is no health without mental health." In one last appeal, I would urge the next government and the next Dáil to try to get the mental health budget up to the 10% rule of thumb. It is a good way to go, and prevention is better than cure. I thank the Minister of State.

Joan Collins (Dublin South Central, Independents 4 Change)
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First, I welcome these statements on World Mental Health Day. It is vital we mark what has become a crisis that has touched practically every family in the country. I wish to express my solidarity with the many people suffering with mental health and depression, with those families who have lost loved ones to suicide, and also people working within the mental health services. Everybody should be recognised not just today but every day into the future.