I thank Sinn Féin for tabling this very important motion. I welcome the opportunity to speak on it because it goes to the heart of one of the most serious failings in our mental health system, namely how we treat people when they are in deepest crisis. The Mental Health Commission’s report on acute mental healthcare in hospital emergency departments painted a harrowing picture of adults and young people arriving in hospitals in terrible distress and then being left for many hours in noisy and chaotic settings that were never designed to be therapeutic environments. This was a harrowing but all-too-familiar and all-too-normalised picture. More than 50,000 people who are in the midst of a mental health crisis present to emergency departments each year. Many hospitals still lack appropriate assessment spaces. There is substantial variation in quality across the State. This is not a marginal problem. It is a core test of whether our mental health policy means anything in practice for tens of thousands of people, many of whom are caught in a revolving door of return visits to hospital emergency departments. Twenty years ago, A Vision for Change promised a system built around strong community services, crisis teams, rehabilitation and recovery teams and humane therapeutic responses to those in severe distress. It envisaged agile, well-staffed crisis services, community supports and alternatives to hospital admission in order that emergency departments would no longer be the default for people in acute distress. These supports were only partially delivered. Too many people have fallen through the cracks in the meantime. What happens when community services are thin on the ground, crisis teams are understaffed and early intervention for those with psychosis is unavailable? Pressure builds in emergency departments. People deteriorate while they are waiting. Staff are overwhelmed and the most vulnerable pay the price. The Government spoke soothingly about trauma-informed care in Sharing the Vision. That language is welcome, but rhetoric without sufficient resources does not calm a distressed person at 3 a.m. in a crowded emergency department corridor. It does not provide privacy, dignity or psychological safety. While we absolutely agree that there is a need for better crisis-care alternatives, such as crisis rooms, crisis assessment services, community crisis centres a core issue remains, we must also strengthen community and early-intervention supports in order that far fewer people reach crisis point in the first place. That means properly resourced community mental health teams, primary care services, youth services, addiction supports and crisis teams. It means developing the crisis houses that were recommended in a Vision for Change and that never materialised. When these are either not in place at all or are not fully in place, emergency departments become the pressure valve for a system that has failed further upstream. We also need to look at models of mental health care that are far removed from the medicalised bureaucratic system we have. In this regard, I refer to Kyrie Farm in County Kildare where recovery is fostered through a deep sense of community and therapeutic enterprising connection with nature. The Minister of State is to be commended for increases in mental health funding during her tenure, but the reality on the ground is that funding still falls far short of the scale of need and for families navigating the system access to timely care can remain a postcode lottery. The motion before us calls for dedicated mental health emergency rooms in model 3 and model 4 hospitals, an expert review of the role of model 2 hospitals, ring-fenced investment in community alternatives, specialist staffing and a fully integrated crisis pathway for children and young people. These are sensible, evidence-based proposals. We also need to come back always to investment in the workforce. We can construct crisis rooms and centres but without psychiatric nurses, social workers, occupational therapists, psychologists and doctors to staff them, they will be mere shells. Mental health services cannot function without adequate staffing. We cannot continue to see crude, blunt recruitment restrictions imposed through the Government’s pay and numbers strategy. That approach may satisfy those who produce spreadsheets in the Department of public expenditure, but it fails patients and it burns out the staff who remain. Last week, representatives from the HSE failed to provide basic information on the number of approved psychology posts in mental health services for older adults. That was a clear attempt on the executive's part to conceal the deficit in staffing. We know that older adults with mental health difficulties are more at risk of distressing, unnecessary repeat emergency department admissions that will, in turn, lead to a worsening in the state of their mental health. The stranglehold on recruitment must end. We need proper multi-annual workforce planning, funded posts, clear staffing benchmarks as we had in A Vision for Change and long-term certainty, not annual emergency firefighting. We also need serious capital investment in therapeutic settings, spaces designed for calm assessment, de-escalation as opposed to containment in corridors. The Mental Health Commission’s findings on care for children in emergency departments are especially disturbing. One example cited in the report captures the reality behind the national picture. Cavan Hospital’s emergency department described: ... major issues involving young patients with mental health difficulty, between the ages of 15 and 18, presenting in crisis situations, especially those young people seeking a place of safety. Such crises can persist for several days or more. Staff feel insufficiently resourced to manage this cohort of patients, resulting in frustration for clinical teams, patients, and their families. That is an indictment of the system. The guidance is clear: every 24-7 emergency department should have defined access to CAMHS assessment through a simple and straightforward referral procedure supported by dedicated CAMHS liaison and on-call services available around the clock through a single point of contact. Despite this, survey respondents told the Mental Health Commission that in some model 4 hospitals and several model 3 hospitals these standards simply did not exist. Delayed assessments were leading to prolonged and inappropriate placement of children in emergency departments or acute medical wards. This is not just inefficiency; it is harm. Oversight is another critical issue. HIQA inspects emergency departments but it does not assess the quality of mental health assessments carried out there or the suitability of the environment for those in psychological distress. The inspector of mental health services has a statutory duty to report on the quality of care wherever it occurs and this report is very welcome but it must be honest about its limits. A survey-based exercise, while useful, cannot provide a full picture. Some respondents had no data on mental health presentations and some could not supply staffing information. The report acknowledges that a deeper assessment of emergency departments' mental health provision is beyond its scope. Will the Minister of State indicate whether the Mental Health Bill will close the gap in oversight and inspection of mental health care in emergency departments? These are high-risk high-volume environments, and they cannot remain in a grey regulatory zone. A further issue which demands attention is that of restrictive practices. Based on anecdotal reports - the fact that they are anecdotal is a problem in itself - restrictive practices are being used on people in acute mental distress in emergency departments largely because these spaces are not designed or resourced to provide safe therapeutic care. The use of such practices in emergency departments appears to fall into a regulatory vacuum. As far as I am aware, neither HIQA nor the Mental Health Commission has formal oversight in this regard. There is no national data, no consistent reporting system and no routine external scrutiny. This is unacceptable because people who come to hospital in mental health crisis usually come in a very vulnerable and distressed state of mind seeking help, not further trauma. We cannot discuss this issue without acknowledging the devastating consequences when the system fails. The absence of appropriate supports in emergency departments and a lack of viable alternatives have had tragic results, including in the case of Adam Loughnane in Galway whose family continue to campaign for Adam's protocol. Adam's experience underlines the reality faced daily by emergency department staff and the difficulty of providing constant one-to-one supervision while people await assessment or onward placement, particularly in overcrowded emergency departments that are under extreme pressure. This gap in services worsens chronic overcrowding and piles strain onto front-line professionals. The emotional toll on affected patients, families and staff cannot be overstated. I welcome what is contained in the motion. The message must be clear: we need ring-fenced investment for all tiers of service including emergency services. We need 24-7 CAMHS pathways that exist in reality. We need oversight that ensures that emergency mental health care is humane and sensitive to the trauma and adversity that service users have experienced, that is accountable and consistent across the country and not subject to a post code lottery. People in crisis cannot wait another decade. They need the State to meet them with a sense of urgency and containment consistently and in every part of the country. I conclude by coming back to the Mental Health Commission, which is often referred to in the public domain almost as a sacred moral authority in the area of mental health that is beyond rebuke or question. It is important to acknowledge that it does very important and essential work, and has highly committed and capable personnel. However, it needs to answer questions on how there was such a gulf of difference between its inspection report findings into Bloomfield Hospital in south Dublin and the day-to-day reality of abuse and neglect that persisted there for residents until a very courageous staff member blew the whistle and an independent investigation was undertaken. The Mental Health Commission inspection ratings of over 90% compliance across consecutive reports needs to be called into question in that context as does its whole way of carrying out inspections. We also had the commission's cold, detached handling of the closure of the Owenacurra Centre in Midleton across 2021 and 2022 and the transfer of vulnerable adult service users from a single-room, town-centre location where they had lived and become integrated into community over decades, only to be moved to dormitory-style long-stay wards in a relatively remote location in Glanmire and also in St. Finbarr's Hospital near the city. The Mental Health Commission initially declined to meet with family members of residents who were embroiled in this traumatic upheaval and later agreed to do so in a very cursory manner under political pressure. There was no vindication of the rights of some of those residents who did not have family representation. There was no use of soft power on the part of the Mental Health Commission to even express concern about what was happening. All of this played out very publicly at the time. The Mental Health Commission claims it was legally constrained from commentary and yet it was able to comment following the publication of the Kerry CAMHS reports and make a case for an extension of its own regulatory powers into child services at the time. Representatives from the Mental Health Commission showed an aggressive defensiveness against any formal questioning of these measures at an Oireachtas committee meeting in December 2022, saying they were constrained from commentary due to regulatory processes. This will despite the fact that the commission had briefed the media on its position at other junctures. The recent Mental Health Commission report on restrictive practices was encouraging at first sight, showing a declining rate of chemical restraint. However, the report did not provide information on what it termed enduring cases of chemical restraint. It does not inform us in those cases of how long people were restrained even though there is a duty on the part of services to provide the Mental Health Commission with that information. The number of those cases is considerable. This is a very curious omission, and one that needs to be clarified.

Sentiment score: -0.14