Mary Butler
Waterford · Fianna Fáil · Ireland
“Major improvements are happening across services: enhanced access to proactive and preventive healthcare to support a better quality of life; the embedding and upscaling of women's health initiatives put in place through the implementation of the previous women's health action plans, including, as the Senator knows, free contraception, sp…”
“In relation to any proposal, a proposal for a new location requires a detailed business case, a premises, support from the regional HSE management, and the necessary funding to resource the staffing of the service. That is where I come into it and what I will be trying to do.”
“We are currently working closely with it to support the expansion of Jigsaw services to Waterford and the south east, as well as to County Clare. The location of Waterford was picked because we have no services in the south east at all. It is great that we will have the hub and spoke model the Senator spoke about.”
“That is where I do not agree with the Senator. I believe €180 million of funding ring-fenced for women's health, when we have come from a low base, is absolutely unbelievable.”
“The plan will build on our knowledge of women's health through research and innovation and will spotlight important areas such as endometriosis and cardiovascular health. Recently, the Minister announced €2 million in funding for women's health research.”
“This plan will continue to focus on how we can improve access to specialist endometriosis care and treatment. As the Senator knows, we have established two super-regional specialist centres, one in Tallaght University Hospital and another in Cork, alongside the development of five regional endometriosis hubs.”
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“The reason is that much of the Bill grew out of the expert group review recommendations and given that, currently, only a consultant psychiatrist can make an admission or a renewal order, it does not appear to be the right move at the moment. However, it is a matter worth considering in the future, in parallel with discussions on what professions can become clinical directors.”
“The expert group review of the Mental Health Act did not recommend that a professional other than a consultant psychiatrist could become the inspector of mental health services. In every registered acute mental health centre, the clinical director is a consultant psychiatrist. Furthermore, the only profession that can make an admission or renewal order is a consultant psychiatrist. As such, it would appear rational to continue to limit the role of chief inspector to the consultant psychiatrist profession. However, I believe it is a matter worth considering in future reviews of this Act, in parallel with discussions on what professions can become clinical directors. At the moment, I am not minded to accept this amendment.”
“I move amendment No. 210: In page 105, line 7, to delete “former members of the staff of the Commission” and substitute “former members of the staff of the Commission and former Chief Executive Officers”.”
“Some teams accept more referrals while others accept less. All I can say on the floor of the Dáil is my commitment to trying to provide additional funding. We have 81 teams. We have relocated many CAMHS teams into good primary care centres, which have good locations, yet we are still seeing the waiting lists grow. We have 1.2 million young people in the country, whereas five years ago, we had 900,000. This is a 25% increase. We are seeing more presentations since Covid. We are seeing an exponential growth in the number of young people presenting with eating disorders and self-harm issues. I know I am digressing now but I put much of it down to social media and what young people have access to on their phones.”
“Parents often come to me in my constituency office to say they cannot get into CAMHS or they are not accepted into CAMHS because the team has deemed the child has not met the criteria. One of the worries with that is it varies from team to team.”
“In fairness, 97% of all urgent referrals to CAMHS were responded to within three days up to April 2025, and they are the latest figures I have received. What often happens is children might present to CAMHS and whatever diagnosis they have may not be as severe as others and they become the long waiters. That is the area I am not happy about. The other thing is the consultant psychiatrist and clinicians in the multidisciplinary team determine whether the child meets the criteria. I do not have a clinician's background and cannot determine whether a child meets the criteria. Children must have a primary diagnosis of mental health to be accepted into CAMHS. Many children will also have a dual diagnosis. They may have mental health plus ASD or mental health plus an intellectual disability.”
“I have a couple of points to make as I have spoken extensively on the waiting lists. It is important to acknowledge, however, that last year there were 233,000 appointments allocated by CAMHS and approximately 8% or 9% were not attended for a myriad of reasons. For some, they may have aged out and, for others, they may have gone privately, and there may be other reasons they did not attend. By the end of April of this year, CAMHS had already offered 85,000 appointments.”
“That area has seven CAMHS teams, and it must be complimented on having reduced its waiting lists by 90% for those waiting more than 12 months and reduced numbers for those under nine months by 59%. My point is that, if they can do it in some parts of the country, why can they not do it in all of them? I accept it is under my watch and that is why I am in the weeds of the teams to see if we can get more output.”
“I am pleased to see the Cork and Kerry region, where I met with the REO, Dr. Andy Phillips, has come back with a comprehensive plan to reduce its waiting list for anyone waiting more than 18 months and then for anyone waiting more than 12 months and to work this down. It has a good approach down there for ADHD - I think it is called SNAP-IV. The agreement is any young child or young person presenting with ADHD will be seen quickly by that particular team. They will then be referred back to their CAMHS team in the area, having a diagnosis and medication if appropriate. We are taking the learnings from different areas to see if we can streamline it, but I must give all credit to Limerick.”
“When I came back after my re-election and reappointment as Minister of State for Mental Health, the waiting list was at 4,200. I was not one bit happy. None of those children deserves to be on a waiting list. I have a complete focus on this at present and my officials know that. As I said, we are visiting these areas but I cannot understand how some of the country and teams can produce a really good outcome. We are delving down into how many referrals they get, how many are accepted and the standard operating procedures, but I am not seeing any output or improvement in output. I do not say this lightly but I have not seen any improvement in output of the number of children being seen with the additional €30 million provided in the past two years. We have 81 CAMHS teams across the country now.”
“From what we have seen, the amount of referrals have grown exponentially in the past four to five years. We are also seeing young people and children presenting with much more complexity than they were previously. Young people who receive the support of CAMHS, if they meet the criteria, can often be in its support for three to four years. Once upon a time, when a child entered CAMHS, we had another child leaving, whereas now the situation is that for every three children coming into CAMHS, we have only one child leaving. That is what I am currently at. I have visited four of the areas and have two more to do. As I said, an additional €30 million has been provided in the past two years plus a waiting list initiative. Just before the election last year, the waiting list was at 3,700.”
“I have asked that there not be anyone waiting more than 12 months. We have some waiting more than 18 months and some more than 12 months. I asked as a first step that this be reduced, and it was. I get the figures every week. What I am saying is that we have three areas carrying 70% of the waiting list. We have one area doing extremely well, which is Limerick, at about 4% of the waiting list, and we have a few other areas - the Galway area in the west, Dublin south east, and our area, the southeast of the country, carrying 7% to 8% of the waiting list. I am trying to delve down into some of the issues because there are some areas where they have the most staff and a smaller catchment area but their waiting list is higher than what it should be.”
“They had seven on the waiting list the day I was there, but Deputy Ó Murchú's area, and we have discussed it many times, is very challenged. There are 19 teams in that area and you would wonder how some teams can do so well and others do not. I travelled to Limerick a couple of weeks later, and Limerick is an exemplar at this stage. It has reduced its waiting list of more than 12 months by 90% and its waiting list under nine months by 59%, down to a total of 167. The current challenge we have, and the Deputy will see this from the parliamentary question response, is three regional health areas in the country are carrying 70% of the entire waiting list for CAMHS. Dublin south east and my area, which is also that of Deputy McGuinness, are the only areas in the last quarter which showed a reduction in their waiting lists.”
“In 2025, the budget is €167 million, an additional €30 million in two years, which is a lot of money. I am not seeing the output for that additional money, however. Recently, I undertook a tour of CAMHS teams all over the country. I started in Cork and Kerry. Deputy Quaide would know well that they have the highest waiting list for CAMHS in the country of approximately 24%. I do not have the figures in front of me. I visited several CAMHS teams, some in the counties and some in the city. It was stark to look at the waiting lists and see where some teams are performing very well and others are not performing as well. I continued to Ashbourne, County Meath and Swords. I visited there as well. The real contrast was with Monaghan and Cavan which have no waiting list for CAMHS.”
“Second, what Sharing the Vision has that A Vision for Change never had was the national implementation and monitoring committee, which holds me, the HSE, service deliverers and the Department of Health to account. It meets regularly. We are now on our second iteration of it, with Catherine Brogan as its second chair. I set it up in November 2020. Every quarter without fail, a report is laid on its website, where people can read about the short-term, medium-term and long-term aspirations and where we are. It is a really important aspect because it shows us where we are on target and where we are not. Deputy Clarke raised CAMHS waiting lists. I am not one bit happy about the waiting list. There are 4,544 people on it. I have been doing a couple of things. The budget for CAMHS in 2023 was €137 million.”
“We could not have a situation where the commission becomes responsible for implementing mental health services and policy and being responsible for allocating resources regarding funding and whole-time equivalents. As the Deputies know, that is properly the role for the Minister for Health and the Government of the day. The Government is accountable to the Irish public and must be in control of the State's purse strings. The commission is a key partner in the delivery of mental health services, but the Government, any government, must be responsible for the allocation of services. I take Deputy Quaide's point regarding A Vision for Change, but our policy since 2020 has been Sharing the Vision. What I like about Sharing the Vision is that it is person-centred.”
“A huge number of people have good supports and good outcomes in CAMHS. Asking them to move on to adult mental health services is difficult. That is an area is which we have done a huge body of work to try to make that transition more streamlined. I agree with Deputy Clarke regarding safe staffing levels. They are really important. The problem we all have, as the Deputies know, is that the Mental Health Commission has a defined role within mental health services. It is responsible for the regulation of mental health services, of vindicating the rights of involuntarily admitted people through the operation of mental health review boards and setting of standards for best practice. It has a similar role to what HIQA does.”
“When discussing increasing the transition to age 25, it is important to note that this would pertain to community supports. It would be much more difficult to do it with in-patient supports. We could not have a situation where in-patients supports for young people are extended to age 25. There might be a 13- or 14-year-old young girl with an eating disorder such as anorexia nervosa. There could not be a situation where they would be treated alongside a 22- or 23-year-old. We concentrated on the outpatients' perspective in that regard. We are looking for a more streamlined approach. Take the example of an 18-year-old in the care of CAMHS for a couple of years. The child is probably doing the leaving certificate and going to college for the first time and is being asked to leave the supports that are very good.”
“I thank all the Deputies for their comments. The reason amendment No. 206 is not being accepted is because this amendment duplicates what is already in the Bill. There are 223 sections in the Bill. It is huge and very complex. There is a lot in it and it is hard to take every bit of it in, but that amendment is a duplication. That is the only reason why it is not being accepted. I do not disagree with the Deputies regarding the upper age for CAMHS. Some of the Deputies might know Mark Smyth, who was head of the Psychological Society of Ireland for a long time. He chaired a committee under the national implementation and monitoring committee, NIMC, for the last number of years looking at the whole transition between CAMHS and general adult mental health services.”
“The 2006 approved centre regulations include a regulation relating to complaints procedures. These regulations will be replaced under the new enactment and I expect greater detail on complaints procedures will be included in the new regulations. I refer again to what I spoke about a few minutes ago, regarding patient advocacy services in every long-term residential care facility. We are rolling these out at present.”
“Other elements of the action plan include robust governance structures that enable national oversight of the implementation of the enhanced transition plan and continuing to survey people to seek their views and experience of transitioning from CAMHS to adult mental health services. This will ensure that when young people move from child and youth mental health services to adult mental health services it will be a seamless transition of care. I do not intend to support amendment No. 212. I do not believe this requires an amendment in primary legislation. The Bill strengthens the requirement that people receiving treatment in a registered acute mental health centre be given information on the complaints procedure in the centre. This is true for involuntary and voluntary admitted people.”
“The plan includes implementing the enhanced transition plan developed by the Sharing the Vision youth mental health transitions specialist group for children moving from CAMHS to general adult mental health services. The enhanced transition plan recommends that moving from CAMHS to general adult mental health services be treated as a continuation of care, rather than as a new referral, which is important. The action plan also includes revising the CAMHS operational guidelines to ensure the recommendations from the enhanced transition plan are considered and ensuring any operational guidance for general adult mental health services aligns with the recommendations of the enhanced transition plan.”
“Furthermore, the reference to CAMHS in this amendment is inappropriate. The term "CAMHS" is not defined anywhere in the Bill, nor are child and youth mental health services. However, I believe in the importance of the transition from child mental health services to adult mental health services. Recommendation No. 36 of Sharing the Vision indicates that appropriate supports should be provided for on an interim basis to service users transitioning from CAMHS to general adult mental health services. The age of transition should be moved from 18 to 25, and future supports should reflect this. This is being progressed under the implementation of Sharing the Vision. The enhanced transition between CAMHS and general adult mental health services is also a key theme of the new child and youth mental health action plan, which was launched recently.”
“The commission is independent in its functions and I have concerns about dictating what the commission must include in its annual report in primary legislation. The commission is not responsible for implementing mental health services; it is the regulator. It would be inappropriate to require the commission to estimate the required numbers of whole time equivalents and funding in mental health services. Similarly, it would be inappropriate to require the commission to develop a youth mental health clinical specialty. The allocation of fully staffed mental health services and estimating levels of new additional funding are both resource allocation matters for the Minister for Health and the Government as a whole to consider as part of the annual Estimates process, and is not a function appropriate to the commission.”
“Section 177 also provides for the commission to amend or revoke a code as necessary. Section 181 of the Bill, as initiated, provides for the Minister to make regulations regarding care plans. I note there is an amendment from Sinn Féin to delete and replace section 181 so that the Minister would not have the ability to make regulations on care plans. I believe section 181 of the Bill, as initiated, is necessary. Amendments Nos. 209 and 210 are technical amendments to insert a reference to the CEO with the staff of the Mental Health Commission, in regard to amending the superannuation scheme, as the CEO is not covered in staff of the commission provisions. I do not intend to support amendment No. 211 because I do not think that this is appropriate for primary legislation.”
“I move amendment No. 205: In page 95, line 6, after “the” to insert “rights and”. Amendment No. 205 is a technical amendment to include protection of a person’s rights, along with their interests, in the functions of the commission. I do not intend to support amendment No. 206 as this amendment duplicates what is already in the Bill elsewhere. Section 177 of the Bill provides for the commission to make codes of practice regarding various matters under the Bill, including the preparation and issuing of a code of practice on capacity assessments. Section 177(2) provides for the commission to publish a draft of any code of practice and allows any person to make representations about the draft. The commission is required to consider any representations before finalising and issuing the final code.”
“It is important that any service user in any long-term residential care facility, especially after what we saw last week on the "RTÉ Investigates" programme, has access to advocacy services. I will continue to roll that out.”
“On patient advocacy services, when I took over as Minister of State with responsibility for older people in June 2020, I discovered very quickly that there were patient advocacy services only in public and community hospitals and public nursing homes. I moved very quickly to expand patient advocacy services across all public, private and voluntary nursing homes. I am currently expanding this provision to mental health, long-term residential care facilities. Some 10% of residential care facilities have patient advocacy services. I will seek more funding in the budget for these services. The organisation that provides advocacy services has had to scale up considerably. We are working with it and I will continue to expand that service.”
“I move amendment No. 202: In page 93, lines 34 and 35, to delete “consultant psychiatrist responsible for the care and treatment of the child,” and substitute “child’s responsible consultant psychiatrist”.”
“I move amendment No. 200: In page 93, lines 25 to 29, to delete all words from and including “(1) Subject to” in line 25 down to an including line 29 and substitute the following: “(1) Subject to subsection (3 ), the responsible consultant psychiatrist or another member of the multidisciplinary team of a child admitted under section 61 , 63 or 65 , shall inform the parents, or either of them, or guardian of the child as soon as possible after admission of the application of restrictive practices on children in that registered acute mental health centre.”.”
“I move amendment No. 194: In page 91, after line 37, to insert the following: “(5) A registered proprietor of a registered acute mental health centre shall notify the Commission, in the form and manner specified by the Commission and within the period specified by the Commission, of each application of a restrictive practice in respect of a child in that registered acute mental health centre.”.”
“I move amendment No. 190: In page 90, lines 1 and 2, to delete “after such application, but no later than 24 hours after the application concerned” and substitute “, but no later than 24 hours after the initiation of the application”.”
“I am agreeable to deleting section 83 with the opportunity to reintroduce a section 83 along the lines of what we have discussed. There may be no need for it but I must keep the opportunity open in case wording is required. However, its purpose will be that we will not be legislating for 16- and 17-year-olds to have access to ECT.”
“I have only landed this on my officials in the past hour and a half. I have spoken to several consultant psychiatrists on this this afternoon and they varied on it. However, my opinion, as someone who has put four years into this Bill, is that I am not minded to include it in the Bill. Because I am not prepared, the only thing I can do now is to remove the section, withdraw it for now and reintroduce it and I will work with the Deputies in the interim to come up with a wording that is suitable to us all. I give my word on that.”
“Contrary to what my colleague in Waterford, Deputy McGuinness said at the weekend, namely, that I was not prepared to accept any amendments, I am prepared to work with all Deputies here to get the correct wording because we cannot have any unintended consequences. If the Deputies are supportive, I propose to ask that section 83 be withdrawn at this time and reintroduced, if required, so that there are no unintended consequences. For anyone aged 18 years or over, ECT is available if that is the clinical decision and they agree. They may not agree, as the case may be. We are changing consent in this Bill down to age 16 years, but I still think we need to protect the 16- and 17-year-old in relation to ECT. This Bill does not provide for ECT from ages 16 and below. I want to work with the Deputies on this.”
“Okay. I have heard Deputy Clarke and I have read what the other Deputies have sent in. I do not have a prepared speaking note because I want to work with both Deputies on getting this right for Report Stage. We know that in the past ten years there have been no cases where ECT has been used on 16- or 17-year-olds. We also know it is necessary to go to the High Court to get approval. I have thought long and hard about this since last week and have thought long and hard about it all afternoon. I do not feel comfortable with legislating even as it is in the original Bill, where it would have to be brought to the High Court. I have asked my officials to consider a new amendment on Report Stage to prohibit ECT for children aged 16 and 17. It is already prohibited for those aged 15 up to 16 years. I want to work with everyone here.”
“I move amendment No. 180: In page 79, lines 8 and 9, to delete “it is unsafe or it is not in the best interests of the child to do so” and substitute the following: “there is an immediate and serious risk to the health or welfare of the child by releasing the child into the care of that person or persons”. This amendment was drafted following consultation with An Garda Síochána, as queries were raised as to how "unsafe" might be defined and who would be responsible for assessing whether a situation was unsafe or not. The wording aligns closely with section 12 of the Child Care Act 1991, which provides for the use of Garda powers in relation to taking a child into safety.”
“I move amendment No. 178: In page 79, between lines 2 and 3, to insert the following: “(7) Where the member or members of An Garda Síochána make a request to the Executive under subsection (6) , the Executive shall comply with the request as soon as practicable.”.”
“I move amendment No. 176: In page 78, lines 39 and 40, to delete “it is unsafe or not in the best interests of the child to release the child into the care of that person or persons” and substitute the following: “there is an immediate and serious risk to the health or welfare of the child by releasing the child into the care of that person or persons”.”
“I move amendment No. 172: In page 78, to delete lines 20 to 25 and substitute the following: “(4) Where a member of An Garda Síochána takes a child into custody under subsection (1) and the parents of the child, or either of them, or guardian, or, in the case of a child the subject of a care order, the Child and Family Agency are contacted, the child shall be released into the care of that person or persons, unless in the opinion of the member or members of An Garda Síochána responsible for the child there is an immediate and serious risk to the health or welfare of the child by releasing the child into the care of that person or persons.”.”
“I move amendment No. 168: In page 77, after line 42, to insert the following: “(8) The Executive shall notify the Commission, in the form and manner specified by the Commission, of the decision to involuntarily admit or the decision not to involuntarily admit a child under this section.”.”
“In 2008, there were 247 admissions of children to adult units and there have been two so far this year. Every effort is being made to prevent that happening, but when you have to choose life over death by admitting a young person to a hospital because nothing else is available other than a place in an adult psychiatric ward, in a room of their own and being monitored 24-7 for a short space of time, I will pick life any day of the week.”
“when a young person who may be self-harming or suicidal is in front of a consultant psychiatrist. We must consider such a situation in a context where the consultant psychiatrist was not in a position to offer supports overnight, with the support of that young person's parents. It is important to make this point. I want us to get to a situation where zero young people have to be in those circumstances. It is disappointing, however, that Deputy Clarke would align one of her first comments with a lack of funding. The mental health budget has increased by 44% over the past five years. When I took office in 2020, the mental health budget was €985 million, while this year it is €1.5 billion and I will do more again in next year's budget. We have built on supports and services across Ireland incrementally year on year.”
“We did speak about this aspect last week. I explained to Deputy Clarke, and she took on board, that that amendment was ruled out of order not by me but by the Bills Office. It is important to state that good progress has been made over many years. Last year, for example, five young people aged 17 plus were admitted, with the consent of their parents, to adult psychiatric wards for a short time. We are in June now, and two young people have been admitted so far this year. No consultant psychiatrist in the multidisciplinary team wants to do that but I cannot tie the hands of a consultant psychiatrist in a unique situation in real time. I have said that, I will continue to say it and if it was included in the Bill, I would stand over saying it. It could be 2 a.m. or 3 a.m.”
“I inform the Deputies present that section 59 provides for the application of the relevant provisions of the Child Care Act 1991 to proceedings involving the courts in this Bill. I will move further amendments in this regard on Report Stage. I just wanted to flag this point.”
“I move amendment No. 154: In page 65, between lines 33 and 34, to insert the following: “(5) A registered proprietor of a registered acute mental health centre or designated centre shall ensure that the Commission is notified, in the form and manner specified by the Commission and within the period specified by the Commission, of each application of a restrictive practice in respect of a person in that registered acute mental health centre or designated centre concerned.”.”
“I move amendment No. 152: In page 65, line 18, to delete “registered acute mental health centre or designated centre” and substitute “registered proprietor of a registered acute mental health centre or designated centre”.”
“We looked carefully at amendment No. 149. I had to take advice from the Office of the Parliamentary Counsel. Initially I thought that we would be able to accept it but "in the care of" is used 11 times in the Bill already. Seclusion and restraint, as the Deputy said, are some of the most serious infringements on bodily rights. Under careful consideration, the Office of the Parliamentary Counsel and the Attorney General felt that "in the care of", after having been used 11 times in the Bill already, is a term that is appropriate in this context. That is the reason I am not accepting the amendment.”
“The Bill includes separate Chapters in relation to the use of restrictive practices for adults and for children. The amendments I am moving in relation to restrictive practices do not make any significant changes to the provisions in the Bill as initiated. Amendments Nos. 147, 152, 153, 155, 156, 189, 190, 193, 196, 197 and 199 are mainly technical in nature. Amendments Nos. 150, 154, 156, 191 and 194 all provide for increased safeguards, such as the requirement that any use of a restrictive practice is deemed to be the least restrictive option available and that the commission is informed of each episode of a restrictive practice being applied. Just to reiterate, the Mental Health Commission will make regulations in respect of the use of restrictive practices, for any use of a restrictive practice.”
“The new safeguards in the Bill include provisions related to the process of applying a restrictive practice, such as who can order it and who can apply it, and principles that underpin the application of a restrictive practice, including that it should only be for as short a duration as possible, where there is no safe alternative and in rare and exceptional circumstances. The Bill provides for the Mental Health Commission to make regulations in relation to the use of restrictive practices - it is really important that it is the Mental Health Commission that will make the regulations in relation to the use of restrictive practices - and for any use of a restrictive practice to comply with those regulations. The Bill also contains provisions in relation to the recording and notification of a restrictive practice.”