Mental Health Services

I want to raise the vacancies in CAMHS services and occupational therapy posts in Dublin North-West. We are going to be talking about vacancies in services but it is important to recognise that behind every one of those services is a child waiting, a parent fretting with concern and a situation that is long past untenable that is having a detrimental impact upon children the length and breadth of this country. In particular, how many occupational therapy posts are vacant in CAMHS Dublin North City and West? I am open to correction but I believe the number is four. The Minister of State has been in this Chamber a lot longer than I have and one of the things I have found most difficult during my time is each time I have to see a parent bring a child into the Gallery, or a representative regardless of party or whether they are an Independent, and stand and talk about the individual service that is not being given to the child which they should be able to take for granted. They talk about a vindication of a right, be it a wheelchair, access to a school place or therapy that can improve the life of that child. I am going to speak about one individual child and I find it regrettable that his mother Niamh has had to give me permission to come to the Dáil Chamber and speak about her pain and the lack of dignity afforded to her child by the State. The child's name is Tom. He is nine years of age. Tom has autism, dyspraxia and ADHD. He has significant sensory and emotional regulation needs. His mother has done absolutely everything we constantly ask parents to do. Tom was referred to CAMHS in March 2025 but it was October, seven months later, before there was any engagement at all from CAMHS. Since then, his mother Niamh has engaged with CAMHS and pursued an assessment of need. She brought her child to the hospital when things became so difficult that he needed urgent care to keep him safe. She has been imploring each of us as public representatives in the area for help, and not only that, but has advocated, organised and brought collections of other parents together in Dublin Central and around the country to better advocate for services across the board. Throughout all of this, occupational therapy was identified as something that could help her son, Tom. In July, I thought we finally had made some progress. The HSE wrote directly to me about Tom and told me very clearly "this young person has been offered an appointment for occupational therapy intervention in CAMHS." In August, after Tom's assessment of need had been completed and occupational therapy recommended, his mother was told the occupational therapist in CAMHS North Great George’s St was on long-term leave. There was no certainty on when that person would return so we wrote to the HSE again. His mother was brought in for a meeting last week and told that the occupational therapist is expected to return at the end of September. However, here is the part I find difficult to understand. Even if the occupational therapist returns at the end of September, all that is currently on the table for Tom is another assessment, not occupational therapy. It is just an assessment to determine what, if any, intervention can afterwards be provided. Tom and his mother have done everything asked of them. They were told a service would be provided. They have now been brought back in and told they are going to need another assessment for a service they do not know will actually materialise. Too often in this State an assessment of need becomes an assessment of things that simply are not available to a child who needs them badly. I want to ask the Minister about CAMHS, occupational services in Dublin North-West. He might have some information for me, and I might talk to him about how we can help Tom.

I thank the Deputy for raising this very important issue, and for raising the case of Tom, who is nine years of age, and of his mother, Niamh, who has sought assistance and help from the Deputy and many others. It is a priority for the Minister and Government to ensure that children who need mental health services can access them and access them on time. We recognise the impact that vacancies can have on service delivery. The Minister of State, Deputy Butler, has made clear that filling approved CAMHS posts must remain a priority across all regional health areas. The Government continues to invest significantly in youth mental health services. Under Budget 2026, the Minister secured an additional 94 posts for youth mental health initiatives covering crisis response, early intervention, specialist services and inpatient care. Over the past three budgets, 2024-26, the Minister of State, Deputy Butler, has allocated a total of 220 development posts to child and youth mental health services, representing 34% of all new development posts approved during that period. National community CAMHS staffing has continued to increase. Staffing stood at 730 plus seven clinical whole-time-equivalents, WTEs at the end of 2025, and had risen to 749.5 clinical WTEs by June 2026. There are five Community CAMHS teams within the IHA area of Dublin North City and West which cover the districts of Cabra, Ballymun and Finglas, north inner city and Clontarf, Blanchardstown and Blakestown. These community CAMHS teams are experiencing significant increases in the volume of referrals received to the service coupled with increasing case complexity. For context, the volume of referrals to the five community CAMHS teams serving the integrated health area, IHA, of Dublin North City and West increased by 72% between 2021 and 2026. These five CAMHS teams have recorded 12,258 attended appointments in 2026 so far serving an open caseload of 1,173, including 491 new cases. The overall staffing level for the five CAMHS teams currently stands at 58.7 WTEs. The five CAMHS teams are currently carrying eight unfilled posts, all of which have been approved through the IHA Dublin North City and West employment control committee and are at later stages of further approval. The HSE has acknowledged that recruitment remains challenging in a highly competitive international market for healthcare professionals, particularly for specialist mental health, psychology, occupational therapy and intellectual disability roles. In response to workforce challenges, the national office for child and youth mental health, established by the Minister of State, Deputy Butler, published its youth mental health action plan in February 2025. A key commitment in the plan is the development of a comprehensive recruitment and retention strategy for youth mental health services. The Minister of State has engaged directly with regional health areas on the need to increase activity and innovation in youth mental health services and has written to regional executive officers requesting that recruitment to approved CAMHS posts be prioritised. Particular attention has been given to ensuring multidisciplinary teams can recruit across the range of disciplines required to provide comprehensive care.

We hear about numbers, facts, figures and commitments of Government. I do not believe anybody wakes up in the morning and intends to do bad or ill; I believe everyone has the very best of intentions. However, when I hear that recruitment remains challenging, I think to myself that what is unimaginably challenging is for a mother - I used the example of Niamh because she gave me permission to do so - seeing her child's development impacted by the absence of a post. Are we doing everything in our power to fill those posts? What are the gaps? When will they be filled? The Minister of State spoke of an increase in demand. That reflects well on society. We are more conscious of the complexities in a child's development which require therapeutic interventions. These are choices that can be made. Do we need to pay more? Do we need to develop more education pathways for people into CAMHS? The situation at the moment is not tenable. We are watching the erosion of children while parents are making themselves legal experts and experts in therapy. They are organising among themselves. They are providing education to their children in very difficult circumstances. All the while the State is saying that things remain challenging. I cannot believe we will go into a budget in a couple of weeks' time with tax cuts on the table while we have such need among children in this country. They are asking for the basic necessity of access to therapy so they can live their lives in a way regulated to the needs of the society we are asking them to live in. It is a gross shame on us collectively as a State that this remains the situation. I hope we can find a solution for Tom and for as many children who need therapy as possible.

As the Deputy outlined, recruitment is challenging. We hope a solution can be found for Tom and his mother and for many children in that situation. The Government remains committed to strengthening CAMHS through sustained investment and improved workforce planning and targeted recruitment so that vacancies are reduced and children and young people can access the care they need as quickly as possible. The ambition to expand child and youth mental health services is delivering for children and young people. Budget 2026 continued the investment in early intervention with new services across the country. The programme for Government commits to a new model of care and pathway for primary care psychology for young people, which is in development. The aim is to intervene sooner and reduce the need for CAMHS intervention. This year will also see the establishment of a new specialist CAMHS eating disorder team and two new specialist CAMHS mental health with intellectual disability teams, and an increase in CAMHS inpatient capacity by 18 beds. This is not all about new resources. The Minister of State, Deputy Butler, completed a national tour of over 20 CAMHS teams and identified a series of necessary reforms to improve access to CAMHS, including a new dedicated ADHD pathway which is in development. The HSE is implementing a single point of access for children's primary care disability and mental health services, which will reduce inappropriate referrals and place the burden on services rather than families having to navigate a complex system. A no-wrong-door approach is also being trialled in youth mental health services in Donegal, Dublin and Galway to connect young people with services that can meet their needs if they are not deemed to meet the threshold for specialist CAMHS care. These developments, coupled with the existing wide range of HSE youth mental health services, will ensure children and their families can access care supports that make a real difference to achieving recovery.