Mental Health Bill 2024: Committee Stage (Resumed)
Seanad Éireann — 2026-01-28
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Mary Butler (FF), Waterford

I will speak to both amendments. They have been grouped together because the commission is mentioned, but they are quite different so I will speak to both of them individually, if that is okay. First, in relation to the Senator’s amendment, this was presented on Committee Stage in the Dáil and I have looked at it, but my position remains unchanged and I will tell the Senator why. I do not think it is appropriate for primary legislation. The commission is independent in its functions, and I would have concerns about dictating in primary legislation what the commission must include in its annual report.
Second, the commission is not responsible for implementing mental health services. It would be inappropriate for the commission to be responsible for estimating the required number of staff members or funding in mental health services. We do not ask HIQA to do that, for example.
It is important to look at what exactly the role of the commission is. The role of the commission is to regulate mental health services, including the inspection of mental health services, promote the improvement of mental health services by setting standards for best practice in those services, encourage adherence to those standards, promote public awareness of the regulation of mental health services and other matters provided for under this Act, and take all reasonable steps to protect the rights and interests of persons detained in registered acute mental health centres. It is not the role of the commission to deliver services or to dictate how State resources should be allocated. The allocation of State resources is solely the responsibility of the Government of the day, made up by the elected Members of the Oireachtas. It would be entirely inappropriate to place the responsibility of delivering services and-or allocating State resources on the Mental Health Commission. It just would not be possible.
I have a very good working relationship with the Mental Health Commission. I have had my disagreements with it as well, let me tell you, over the past five years, as have my officials in the Department. However, in relation to CAMHS, I wrote to the commission last year, when the Bill was going through the Dáil, to request that it begin working on developing national standards that will apply to child adolescent mental health services. The work is already under way, and the commission has formed a working group and is actively working towards delivering the standards this year. The standards will help inform the future regulation of community camps. That is the complete independence of it. It is doing that at the moment. Members will actually have seen that the organisation reached out on social media looking for people who have had experience of having their child in CAMHS or who have been in the care of CAMHS themselves. They could be involved and there is an opportunity for them to make a submission to that.
Regarding the reference to CAMHS in this amendment, CAMHS is not defined anywhere in the Bill, nor are the child and youth mental health services, CYMHS. I would not be in a position to start putting it in now. In relation to what we are trying to achieve, I visited 21 CAMHS teams just before Christmas. For about six months, I took to the road and travelled all over. I am trying to understand why some CAMHS teams are performing extremely well. We have approximately 770 people working in CAMHS. We have 80 consultant psychiatrists, clinical psychologists and multidisciplinary teams all over the country. However, when we compare and contrast CAMHS teams, I have to give a shout-out to Limerick, for example, which has just done an unbelievable job of turning it all around and now holds 3.5% of the waiting list in the whole country. Limerick reduced its over 12-month waiting list by 89% and its up to nine months waiting list by 59%. Limerick has eight CAMHS teams in that particular area. Other areas have more, but with a dedicated focus led by a consultant down there, Dr. Eithne Foley, it has managed to turn the whole situation around, working closely with the regional executive officer in that area. We need to give good practice a shout-out as well.
I travelled to Donegal for a full day and met with all those providing mental health supports there. I was extremely struck by the way the three CAMHS teams work together and by the fact that I was located in one area and the clinical director from the department of psychiatry came to meet me. Three GP left their practices to come to meet me. They are all pulling together. Their ask was for a crisis resolution team in Donegal and a Solace café. I provided funding of €1.3 million this year to deliver that on what we call the peninsula, because it is so far removed from an awful lot of services. I was struck by the way they all work together.
I visited CAMHS teams that are located in the most beautiful primary care centres, with 16 or 17 members of staff, with the highest waiting lists in the country, and not the highest catchment areas. I am trying to get under the bonnet of how some CAMHS teams perform extremely well. I cannot understand how we can then have teams that are not doing well, and while I do not want to start saying where they are, anyone can look at the data. I was very struck after the Maskey report, when I asked the Mental Health Commission and the HSE to do an independent audit and review, that an awful lot of the CAMHS teams work in independent silos and are not supporting each other, even in the same counties. I did not see that in Donegal or Limerick but I have seen it in other areas. I visited one particular facility where one CAMHS team was only accepting emergencies and another CAMHS team had capacity. I actually asked for one team to support the other and I did not get a positive outcome. That is the reason I travelled.
As I said, I will be issuing a report on it to the HSE to let it know the reasons I am disappointed and reasons I am pleased. Lucena in the Kildare area is doing an absolutely phenomenal job. All the teams get additional funding to try to manage their waiting lists, especially those over 12 months. What I was really pleased with was they were doing dialectical behavioural therapy, DBT, with families, and the whole family was included in supporting the young person. I have seen really good practice, and it is not fair to say we have not. We also have to appreciate that the additional referrals that we have seen to CAMHS teams in the past five years have been unprecedented. The population has grown. We had a situation back in 2016 or 2017 where we had 900,000 young people in Ireland and we now have 1.2 million. That is an increase of 20%. Services are going to be under pressure. I digress but I just thought it was important to put it on the record that we have a huge amount of really good work happening. Children are presenting with more complex needs and they are a lot longer in services than they used to be. Previously, when a child came into a service, another child was leaving. That is not the case anymore, and that is why waiting lists are always inclined to go up over the winter period. I do not know for what reasons they always fall during the summer, but it is one area I am keeping a close eye on.
In relation to amendment No. 312, and Senator Black spoke to this as well, I do not believe this requires an amendment in primary legislation. It is not appropriate to dictate what the commission carries out in this report. If it is a requirement as part of the pre-commencement work on the Bill to research existing complaints, procedures and services, I will direct officials in my Department to look at this as part of the commencement plan. The Bill strengthens the requirement that people receiving treatment in a registered acute mental health centre be given information in relation to the complaints procedure in the centre. That is in the Bill. This is true for both involuntarily and voluntarily admitted people.
The 2006 approved centre regulations include a regulation related to a complaints procedure. These regulations will be replaced under the new enactment, and I expect significantly more detail in relation to complaints procedures will be included in the new regulations. The regulations will be comprehensive and will deal with how complaints have been made. The Department will also look at advocacy that can be provided. As I said, I met with patient advocacy services this morning. I want to see it rolled out as soon as possible. However, we cannot lose sight of the fact that the Bill also requires that every admitted person must be given information about the services complaints mechanism.
Regarding Your Service Your Say, I have dealt with people who have had a good outcome from it and many who have not. At the same time, that is the system we have across the HSE at the moment, and there is an awful lot that we are going to deal with in secondary legislation. I will not be found wanting in doing that.

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Retrieved: 2026-08-14T04:54:33+00:00
Sitting date: 2026-01-28