Emergency Mental Health Services: Motion [Private Members]

Deputy Sorca Clarke

I move:

That Dáil Éireann:

notes the report from the Mental Health Commission entitled "Acute Mental Healthcare in Hospital Emergency Departments in Ireland: A National Survey from the Office of the Inspector of Mental Health Services", which found that "international best practice… is not available in most emergency departments in Ireland";

further notes that:

— more than 50,000 people in mental health crisis present annually to emergency departments;

— hospital managers are reporting increased mental health demand in emergency care;

— the Mental Health Commission has found substantial variation in the quality of emergency mental health services across the State, which is having a negative impact on access to care;

— eight emergency departments do not have appropriate spaces for mental health crisis assessments; and

— professionals and advocates in the mental health sector have sought urgent policy actions, including a better mental health crisis model in acute hospitals, increased investment in community-based alternatives, and examination of an increased role for smaller hospitals in mental health emergencies;

considers that:

— a fully realised network of mental health emergency rooms, Suicide Crisis Assessment Nurse services, crisis resolution teams and community supports are essential to delivering the vision set out in "Sharing the Vision – A Mental Health Policy for Everyone", and ensuring that every person in crisis receives timely care;

— access to safe, specialised, emergency mental health care remains inadequate, leaving many in crisis without timely access to care; and

— mental health crisis centres are under development by the English National Health Service to provide safe rapid access spaces for people experiencing a mental health emergency;

recalls the commitment in the Government's mental health policy "Sharing the Vision – A Mental Health Policy for Everyone", to provide appropriate mental health emergency facilities in every hospital; and

calls on the Government to:

— require every Model 3 and Model 4 hospital to have a dedicated mental health emergency room, separate from chaotic emergency departments;

— commission an expert review of the role of Model 2 hospitals in providing crisis mental health services, and invest in a network of specialist mental health crisis centres;

— ensure every hospital has the appropriate complement of specialist professionals;

— ringfence investment in mental health crisis assessment and intervention services, including community-based alternatives such as therapy services, late-night outreach spaces, crisis resolution teams, and community-based assessment, support, and treatment teams; and

— develop an integrated crisis response pathway for children and young people experiencing a mental health crisis, including an improved child and youth liaison service, with emergency departments.

This motion seeks to reshape the way emergency mental health care is delivered. It sets out a clear plan for a dedicated and clinically appropriate emergency mental health system because, too often, people experiencing acute distress are brought into busy emergency departments that are simply not designed to meet their needs.

The 2024 Mental Health Commission national survey on acute mental health care found that international best practice is not available in most emergency departments. That is not a marginal issue; it is a systemic failure and has very real consequences. Just this afternoon, I received a response to a parliamentary question that clearly states there has been an increase in presentation numbers with self-harm and suicide-related ideation attending emergency departments each year from 2021 onwards. The 50,000 people who present to emergency departments each year in mental health crisis deserve a service fit for purpose. Yet, the commission also found substantial variation in the quality of care available, with access depending more on geography than need. I want to make clear that this is not through any fault of the front-line workers who work continuously doing extraordinary work, often under immense pressure. Eight emergency departments do not have an appropriate space to conduct an assessment, resulting in people in distress being assessed in corridors or other unsuitable areas. This is unfair to the person in crisis and also to the staff member. We would not tolerate this for physical health emergencies and we should not tolerate it for mental health emergencies.

This motion sets out a clear alternative, where every model 3 and 4 hospital has a dedicated mental health emergency room separate from the general emergency department. However, this is not only about our larger hospitals. Model 2 hospitals can support crisis care and that role must be examined and a network of specialist mental health crisis centres established, with ring-fenced investment in crisis teams and community alternatives. Children and young people are particularly exposed. Child and adolescent mental health services, CAMHS, are chronically under-resourced and limited out-of-hours provision means young people in crisis are often left without support or are brought to an unsuitable emergency department. At the end of November 2025, over 4,300 young people were on a CAMHS waiting list, with more than 1,000 waiting longer than a year. In crisis situations, these delays are dangerous.

Ultimately, this is about parity of esteem. Mental health emergencies must be treated with the same urgency as physical emergencies. By investing in dedicated facilities, strengthening community alternatives, proper staffing and ring-fenced funding, a fully fit-for-purpose acute mental health care system in emergency departments can be delivered.

Deputy David Cullinane

I second the motion because emergency mental health care services are not fit for purpose.

Too many people in acute distress feel they have little choice but to present to chaotic and overcrowded emergency departments that are simply not designed to meet their needs. This motion is about fixing and reforming the system, not managing its failures. Specialist care and safe spaces, such as assessment rooms, should be available 24-7, so that no person in an acute mental health crisis is left without care or left waiting in a chaotic emergency department room, as far too many people are. Far too often, these services are only available from 8 a.m. to 5 p.m. but, as we know, a crisis does not wait for normal business hours. This is no reflection on the staff in our emergency departments who do Trojan work. This is a resourcing problem and, I have to say, a political problem.

Every acute hospital should have a separate mental health crisis room. Every emergency department should have a full complement of psychiatrists, specialist mental health nurses and allied care staff. They should be working with a full complement of suicide crisis assessment nurses, linked in with GPs, to provide an alternative to chaotic emergency departments. When suicide crisis assessment nurse, SCAN, services are understaffed, it piles more pressure on emergency departments and leaves no alternative for a person in crisis.

In Waterford hospital, in the constituency the Minister of State, Deputy Butler, and I share, which has one of the best performing emergency departments in the State, there is a dedicated room made available, which I welcome, but specialist staff are mostly only rostered during normal business hours. The psychiatry department is not fully staffed and out-of-hours care can be reliant on on-call specialists who are off-site. There are just two full-time specialist nursing posts for the suicide crisis assessment programme working out of Waterford, when at least five full-time posts are needed to provide 24-7 cover for the south east.

That is replicated across the State. Nationally, every year, tens of thousands of people present to emergency departments in a mental health crisis, including experiencing suicidal ideation and severe mental distress. The Mental Health Commission has found that international best practice is not available in most emergency departments. The commission also found wide variation in quality across the State and that eight emergency departments did not have appropriate spaces for mental health crisis assessments. That exposes people to chaotic and unsafe environments.

This motion is about making sure emergency departments are equipped to deal with somebody who has an acute mental health episode. We also need to make sure services are provided at community level. That is very often not the case and it is unacceptable that, as a result, far too many people end up in emergency departments, where staff are dealing with the chaos that arises when people are on trolleys and so on. This is not the best place for people to end up. We need to make sure we have community services in place. When people do go to emergency departments, there should be dedicated spaces available and the best supports should be given to those who need help and support.

Deputy Matt Carthy

If I were to sum up Government responses to the multitude of questions it receives from Sinn Féin and other Deputies in the House in respect of mental health, the response could be summarised as "Wait until next year". That seems to be the answer I get to any question I put. It is shameful that we have to bring forward a motion in respect of people presenting at emergency rooms in a mental health crisis. This indicates that there is a crisis across the mental health spectrum, despite absolutely brilliant work being done by people in CAMHS and the mental health services. The truth of the matter is there are not enough staff and they are not provided with the services they need. That says to me, very clearly, that mental health services are not being prioritised by Fianna Fáil and Fine Gael in government.

To give one example, the Minister of State, Deputy Butler, and I had an interaction in respect of the acute mental health unit in Cavan hospital. The long-promised psychiatric unit at the hospital is needed for the entire region. I have a multitude of responses on this from both the Minister of State and her predecessors and what they amount to is "Wait until next year". In January of this year, the Minister of State told me again to wait. This is not about me or the Minister of State; it is about the people who depend on that service. Mental Health Commission reports have pointed out the unit requires an entirely new build above ground level. I ask the Minister of State to stop forcing people to wait and deliver the mental health services they actually need right now.

Deputy Johnny Guirke

Every year, more than 50,000 people go to the emergency departments in Ireland because they are in mental health crisis. These are people who are scared, overwhelmed and often at the lowest point in their lives. What happens when they arrive? They are put into busy, noisy accident and emergency departments. They sit for hours on hard chairs or trolleys, with some left in corridors. Some have no private space to talk and others leave before being seen because it is just too much.

The Mental Health Commission has clearly stated that international best practice is not available in most of our emergency departments. Hospitals do not even have proper rooms to access people in crisis. That is shocking in 2026. Families in Meath regularly have to travel to Drogheda with a loved one in crisis, only to wait hours in emergency departments that are already under pressure. Parents contact us about teenagers in distress being left sitting in waiting rooms all night. Gardaí are left minding people in crisis because there is nowhere else for them to go.

This is a failure of planning and a failure of delivery by Government. We were promised proper mental health emergency facilities under Sharing the Vision but instead we have delays, under-staffing and people falling through the cracks. Mental health emergencies should be treated like any other emergency. If someone comes in with chest pain, he or she is seen quickly in the right setting, but if someone comes in suicidal, he or she is often left waiting in chaos.

This motion is about simple and practical changes. We need dedicated mental health emergency rooms in Meath with proper staffing. We also need crisis teams in the community and better services for children and young people. People dealing with mental health crises do not need noise, lights and crowds. They need calm, privacy and trained professionals. At their worst moment, the system should not make things harder and they should not be turned away but right now in Meath and across the State, that is exactly what is happening and the Government must take responsibility for that.

Deputy Pa Daly

I spoke to the Minister of State last week about the passing of Stephen McCarthy who took his own life in August 2024. Over the weekend, I received a text from his brother Shane who lives in London. He said that:

If you have a family member yourself and people that you care about, no matter what community you're from, as everyone probably knows I'm from the Traveller community, my brother Stephen was also but at the end of the day, it doesn't matter where you're from or who you are, nobody deserves to die through suicide. We're all meant to die when we're old and live our life to the fullest with lots of achievements along the way and it aches my heart that my brother Stephen won't have that chance.

There are serious problems among Travellers. The suicide rate for Traveller males is nine times the rate in the overall community. Since Covid, the age profile has totally changed based on my conversations with people who are working in mental crisis. There have been 87 deaths between 2022 and 2024 in Kerry alone. We all know the history of the CAMHS fiasco scandal in Kerry and three years later, we are still waiting for the north Kerry report. I know it has been completed but has not hit the Minister of State's desk. It is there but we do not know what is happening with it.

Kerry is one of 11 counties without a suicide crisis assessment nurse. If we could achieve one thing through this, it would be that every county should have a timely nursing service as set out in Sláintecare - right treatment, right time and right place. That is what is needed. I am begging the Minister of State to make that available for the people of Kerry to address the crisis there.

Deputy Rose Conway-Walsh

This motion is about real people in real crisis right now and a system that is failing them in plain sight. I will begin with the case of a woman from County Mayo who has been in an adult mental health unit since June of last year. She was admitted in acute distress but was otherwise physically well. Today after repeated incidents in what is meant to be a secure unit, she has suffered a choking episode, a broken hip and most recently a broken wrist requiring surgery. Her family now describe her as frail, traumatised, frightened to walk and deteriorating before their eyes. This is not good enough. When her brother sought answers and intervened to have her removed to a nursing home, he was told that there was nothing that could proceed without written consent from a woman who by every account is not mentally well enough to give informed consent. This is not patient-centred care. It is bureaucracy used as a shield while families are left desperate and unheard.

At the very same time, a highly qualified psychiatric nurse born and raised in Mayo with ten years' experience in the NHS wants to come back to work in Mayo but is being told that there are no jobs. In a county experiencing profound mental health distress, including the tragic loss of life to suicide, a highly skilled psychiatric nurse is being told she is not needed. We need to join up the dots. We cannot continue to funnel 50,000 people in mental health crisis into chaotic accident and emergency settings that are not fit for purpose. I have already spoken at length in this House about the shortage of ambulance services in the west and overcrowded emergency departments at our hospital. This is why this Sinn Féin motion matters.

Deputy Louis O'Hara

The reality is those lives continue to be lost because of the State's failure to care for people experiencing a mental health crisis. We know that each year, 50,000 people try to access mental health services for the first time through hospital emergency departments. This is not an appropriate setting for people who are in severe mental distress at their most vulnerable. I think the Minister of State has to accept that. The Mental Health Commission report has confirmed that general emergency departments are failing people in mental health crisis every day. That report stated that mental health patients in both Galway hospitals - UHG and Portiuncula - are left waiting for prolonged periods in the emergency departments. In Galway, there have sadly been multiple instances of people taking their own lives after presenting at a hospital emergency department. I acknowledge the work of Joe Loughnane, who sadly lost his brother Adam in these circumstances almost one year ago. Following the tragic death of his brother, Joe has campaigned relentlessly for the establishment of specific mental health accident and emergency departments and has gathered over 20,000 signatures to his petition calling for this.

This motion is calling for dedicated mental health emergency rooms staffed by specialist professionals separate from the chaos of general hospital emergency departments and real investment in community-based crisis care so that timely and safe mental health support is available to everybody who needs it. The NHS in Britain has introduced mental health emergency departments. It can be done here and it will save lives. We have to stop sending people experiencing a crisis to inappropriate settings like overcrowded accident and emergency departments. People at their most vulnerable deserve 24-7 urgent crisis care in dedicated facilities, so this is a hugely important motion and one that I call on Government to support but crucially to act on as well.

Deputy Louise O'Reilly

The Minister of State knows what accident and emergency departments are like. I am sure she has been in them. The nurses who spend a lot of their time training and engaging in continuous professional development are forced to nurse patients in conditions that when I describe them as being slightly less than ideal, I am being very kind to the Government. The Minister of State knows what accident and emergency is like. It is chaotic and noisy and there are bright lights and a lot of activity. It is hard for people who really need to be in accident and emergency to visit an accident and emergency department. It is so tough for the healthcare workers - our nurses and our doctors - to do their best in a system that is overcrowded with nurses forced to nurse people on chairs or on trolleys who are waiting, waiting and waiting for a bed. I represented psychiatric nurses in 2006 when A Vision for Change was launched. There was no place for people in mental health distress then but the Minister of State, her Government and previous Governments have ensured that what was deemed to be a crisis in 2006 is now even beyond that.

Accident and emergency is no place for a person who needs psychiatric care. It is no place for him or her and yet that is where he or she ends up. The Minister of State knows that this is where he or she is going to end up because there is no other door. I have heard her talk about the Government's "no wrong door" policy. There is no door - only accident and emergency - and that is where these people have to go.

I spoke to a woman in my constituency last week whose son was experiencing suicidal ideation. She was petrified as any mother would be so she took the only option open to her and brought her son to accident and emergency in Beaumont Hospital. They sat there for nine hours. When I tell the Minister of State that this contributed to making that young man's mental health worse, it really did. He entered in crisis and came out even worse with a letter that was completely meaningless. It was a referral to CAMHS for an appointment he may never get. He will be aged out before it even happens. I ask the Minister of State to not just support this motion act but to act on it.

Deputy Ruairí Ó Murchú

I think we have all been in emergency rooms. I have yet to be in an emergency room where staff were not dealing with a number of cases of people with drug and mental health issues. In some cases, it was across the board. That is that unfortunate place where people are Venn diagrammed and it crosses over. The fact is it is not the place for them. It is not the place for others who are there. We have often been there with our children and none of it works, which puts incredible pressure on staff.

The Sinn Fein motion put forward by Teachta Clarke is straightforward.

It means that we have adequate staff 24-7, because many of the cases we deal with, particularly psychosis, happen late at night, and that we have an appropriate setting, away from the chaos that is emergency medicine. That is what we need.

We have our own particular issues in Our Lady of Lourdes Hospital in Drogheda and mental health services have spoken to hospital management. Hopefully, and this is not the first time I have brought this up, an arrangement can be made later this year that there will be some sort of 24-7 facility within the hospital for proper assessments. At times, people get sent over to Drogheda Department of Psychiatry in Crosslanes and the problem is that is an operating hospital, so people may have to wait a huge length of time and that does not work.

The Minister met the group regarding Maxi’s law. We need to see not only community and early interventions but also emergency beds, as we do not have a sufficient number in our area. There are ten beds promised as an extension. That needs to happen in relation to Our Lady of Lourdes Hospital. We need to see the primary care setting to ensure the community services we have are at least in appropriate accommodation.

Minister of State at the Department of Health (Deputy Mary Butler)

Gabhaim buíochas leis na Teachtaí as an rún tábhachtach seo a thabhairt chun cinn anocht, rud nach gcuirfidh an Rialtas ina choinne. Cuirim fáilte roimh an deis chun díospóireacht a dhéanamh ar thacaíochtaí éigeandála sláinte meabhrach; réimse ar thug mé aird mhór air i mo thréimhse mar Aire Stáit le freagracht as sláinte mheabhrach.

I thank Deputy Clarke for bringing forward this important motion. I welcome any opportunity to discuss mental health. Neither I nor the Government will oppose this motion. When I read it last Friday evening, there was nothing I did not agree with in it. I am not familiar with the work being done in the NHS but we will certainly look into it.

I welcome the opportunity to debate emergency mental health supports. This is an area of critical importance for people facing a mental health crisis, and for their families and loved ones trying to support them. This evening I want to set out the range of actions by Government to invest in and deliver vastly improved crisis supports and services. This covers services in our hospitals but also, crucially, as Deputy Cullinane said, a major expansion of alternative supports in our communities. This motion highlights an area of Government policy where significant focus and substantial investment is already under way.

As Minister of State, I have been working for a number of years to expand our crisis supports. Government resourcing of mental health and suicide prevention has increased by almost 60% in my time in this office. Last April, I received the Mental Health Commission’s thematic report on mental health and our emergency departments. The Government welcomed the report, and I again thank the commission for its work.

The measures I have funded in budget 2026 directly address the issues raised. They follow detailed discussions with executive clinical directors, the College of Psychiatry, front-line clinicians, people with lived experience, which is very important, and the author of the report. Budget 2026 provides an unprecedented 300 additional whole-time-equivalent staff for mental health services this year, with more than €15 million in ring-fenced funding to expand crisis supports and targeted suicide prevention initiatives. This includes €2.8 million for new specialist crisis nursing teams - advanced nurse practitioners and clinical nurse specialists - working out-of-hours in emergency departments to support people presenting in distress.

These teams will operate under the national clinical programme on self-harm and suicide-related ideation, which is now active in all emergency departments. More than 50 staff already work in this programme, ensuring compassionate, prompt assessments, family guidance, and safety plans for patients and their GPs.

Out-of-hours cover has remained a challenge and resolving it is a priority. The new crisis nursing teams will work late nights and into the early morning, providing support at the times when people in crisis are most vulnerable. They will be rolled out to all model 4 hospitals this year, and to the Mercy University Hospital in Cork, due to its high volume of mental health presentations. That includes ten hospitals, four staff funded for each hospital, clinical nurse specialists and advanced nurse practitioners. Recruitment commenced immediately. I intend to expand them to all model 3 hospitals in future budgets, starting with next year's budget.

A crucial part of this model is ensuring dedicated mental health assessment rooms in emergency departments, and Deputies have spoken to that tonight. While most hospitals have such a space, an audit found that eight do not. The national clinical programme is actively working with those hospitals to address this.

Last year, I launched the national model of care for consultation liaison psychiatry, which guides specialist mental health input in emergency departments and general wards. Liaison psychiatrists play a vital role for people presenting with self-harm and suicidal ideation, and I am funding further posts this year. However, as Deputy O’Reilly said, busy emergency departments are often not the right setting for people in mental health distress. I could not agree with her more. That is why I am prioritising real alternatives, particularly crisis resolution services and the SCAN nurses that Deputy Daly discussed.

In 2023, I published the innovative new model of care for crisis resolution services to shift our response for people in distress into much more appropriate settings in the community. These out-of-hours teams provide rapid assessment and intensive intervention, supported by crisis or Solace cafés - safe, non-clinical spaces offering peer support and links to services.

Crisis services now operate in six counties, and this year I am funding new services for Donegal, Kerry and the midlands. I understand that early data shows these services are responsible for an 18% reduction in emergency department presentations in areas like Cork and Galway.

GPs remain the first point of contact for many in distress, and at primary care level the SCAN service is an essential safety net. SCAN nurses provide timely, expert assessments for people in suicidal crisis. I am expanding access to the SCAN programme to new areas in every budget, with funding for 12 additional posts this year, bringing the current total to over 30. However, I want to see SCAN nurses in every single location.

Deputy O’Hara mentioned Portiuncula. For the first time ever, in the 2025 budget, I funded two SCAN nurses specifically for the Traveller community to be located in Portiuncula and recruitment is under way. We had the highest level of presentations of self-harm in relation to Travellers at Portiuncula Hospital and that is the reaction to that.

In Limerick, a new joint initiative between An Garda Síochána and the HSE, the community access support team, CAST, is piloting a co-response model for 999 calls involving trauma or mental health crisis. Early results are extremely positive, and the pilot will inform a national rollout.

Mental health NGOs continue to be essential partners, providing round-the-clock phone and text supports, digital services, and counselling. Government now provides more than €127 million annually to the sector. Funding for Pieta, for example, has increased by 25% between 2025 and 2026 to more than €4 million for crisis and bereavement counselling.

Four out of five deaths by suicide in Ireland each year are men, and I have spoken about this many times in the Chamber. I want men to know that help is there and encourage them to reach out. There is free counselling for any man in a crisis or who needs to talk to someone. I thank the Deputies for spreading this news in their constituency offices. This service is underpinned by a package of supports I announced last September, with recurring annual funding of €2 million. I encourage everyone to promote yourmentalhealth.ie/men. It is as simple as that; all the details are there. Men can reach out for these supports from their own kitchen table.

I will shortly publish Ireland’s new self-harm and suicide prevention strategy, a whole-of-government and whole-of-society approach informed by extensive public consultation. Crisis supports and emergency department experiences were key themes raised, and these concerns are reflected in the strategy.

A major evolution since the previous strategy has been the central role of lived experience in shaping policy. This is now embedded across mental health policy, enabling true co-production and more effective, recovery-focused services.

Finally, the Sharing the Vision oversight group has been tasked with bringing all of these initiatives together under a new national crisis response framework. This will align patient pathways, integrate crisis supports, and identify and address gaps in service provision.

I thank Deputies again for this important debate this evening. I want people to be in no doubt that this is one of my main priorities for reform in mental health, and the programme of work under way and investment we are making will deliver meaningful change for how people experience mental health services when in distress.

Anyone facing a mental health crisis deserves a rapid, compassionate and effective response to their distress that meets them where they are, no matter how or when they present. Making this a reality is my priority for this year. The Government acknowledges that this is an area where there are gaps and where services are not as comprehensive or responsive as they should be. We know what we need to do to effect change and are doing it.

I look forward to hearing other contributions tonight during the debate. I will not be opposing this motion because I believe it is too important to play politics with. We cannot play politics with mental health. Nobody in opposition is trying to do so. I acknowledge the tone of everyone who has spoken so far. We are in a difficult situation where people are very challenged in relation to their mental health. If only one thing comes out of tonight’s debate, it is that. Four out of every five suicides are men and there are very high levels of suicide within the Traveller community. We have seen a reduction in the number of suicides since 2000. The rate is down by 28% over 25 years, and that is due to the amount of really good work being done on the ground by staff. I acknowledge the work of everyone, whether they are working in the public sector, private sector or voluntary sector. There is a huge amount of good work being done. I direct people to the website yourmentalhealth.ie/men. We should all encourage people to reach out and ask for the supports available.

I thank Deputy Clarke again for her motion.

Deputy Réada Cronin

I heard the Minister of State’s speech and appreciate its tone but she has to admit that our mental health services are at crisis point. More than 50,000 people with a mental health crisis present annually at emergency departments, yet many hospital emergency departments are simply not equipped to deal with such incidents. That speaks volumes about how the State treats those who are experiencing bouts of chronic depression, schizophrenia or anxiety, to name just a few conditions.

In Naas General Hospital, in north Kildare, 1,200 people with mental health difficulties were referred to the emergency room in 2023 alone. That is a staggering figure, pointing to the increased pressure on hospital services due to increasing numbers presenting for emergency care for mental health issues.

Mental health conditions do not exist in isolation. It is big-picture stuff. The housing crisis has contributed massively to the rise in the figures. We cannot talk about mental health without mentioning our housing crisis. People without a home do not feel safe ever. They are constantly on edge and worry they might not make it through the night if sleeping outside. If in an unsafe homeless shelter, they fear for their safety as they try to sleep. Many such people end up in jail instead of being properly treated for a mental health crisis. A constituent of mine in north Kildare who was struggling with homelessness and addiction has been constantly in and out of jail. Jail is not what he needs; he needs mental health services and a home, and that goes for so many people in jail. We hear a lot about the need for more jail space. We need more mental health services as well. My constituent should be availing of services in an adequately resourced Lakeview unit beside Naas General Hospital, not behind bars. We desperately need to help these people instead of casting them aside. The Government needs to invest properly in our emergency departments to properly accommodate those who report with unstable mental health. We are letting people down.

I appreciate that the Minister of State is not opposing the motion. There is no better Teachta than an Teachta Clarke with whom to work collaboratively.

Deputy Paul Donnelly

As has been said repeatedly, mental health services are in crisis. We all know this because we deal with people. I express my solidarity with all of the people who work in mental health services, including in the community and in hospitals, because they are doing their best to cope with the situation they are in, despite the lack of staff and supports.

By the time many people end up in hospital, they will often have tried to access community mental health supports over and over again, sometimes over years. We all know that early intervention is the most important thing. I have constantly raised the case of Genesis, a counselling service in Dublin 15. For a relatively small amount of money, an extra 4,000 hours could be provided for people in the Dublin 15 area. Could we look into something like this? Genesis provides low-cost counselling for people in the Dublin 15 area.

Six years ago, I used to work as a child and family support worker and used to try to access CAMHS supports for young people. To be honest, circumstances are probably worse now than when I left the job. That is really bad because we are talking about children and other young people trying to access services. Early intervention is so important.

Just last year, in response to several serious incidents in Dublin 15 and Connolly Hospital, Transport Infrastructure Ireland constructed railings across a bridge where there were two suicides. It is terribly sad that we are building infrastructure outside a hospital to stop suicides. It should be inside. That is the most important thing. We desperately need separate facilities for people who present at hospitals with mental health issues. They should not be in the normal emergency department as it is not appropriate. They should be in a separate space receiving mental health services.

Deputy Donna McGettigan

I commend Teachta Sorca Clarke on this very important motion. We urgently need fundamental reform of the State’s emergency mental health services. The failure is being felt in Clare and the mid-west.

Let me tell a personal story. A few years ago, my nephew was found hanging but we were extremely fortunate that he was still alive. He was taken down and brought by ambulance to a hospital but, because it was at the time of Covid, his mother was not allowed to travel with him. When he arrived at the accident and emergency department, he was placed on a chair – it was one of the most overcrowded emergency departments – and told he would have to wait for hours to be seen. He was alone, traumatised and completely overwhelmed. He rang his mother, my sister, to say he could not cope and he walked out of the hospital. We were lucky to find him before he could do himself more harm. Other families have not been so lucky.

To provide a wider picture, in 2023 Clare recorded the highest suicide rate in the State. In 2024, it had the fourth highest. Yet, when my colleague, Teachta Sorca Clarke, received a reply on suicide crisis assessment nurse services, we learned that Clare and the mid-west have not one clinical nurse specialist. Is it any wonder that people feel abandoned by the Government when it comes to emergency mental health care?

To make matters worse, mental health presentations at Ennis hospital are not even properly recorded. There is no established process to identify patients who need access to a mental health liaison team. This upsets and angers me. People already feel they have no worth, and the absence of services tells them exactly that. People are dying. Dedicated mental health emergency rooms save lives. This must be sorted now.

Deputy Maurice Quinlivan

Too often in Limerick, we see the devastating impact of mental health challenges. Over the past decade, Limerick city has frequently recorded the highest suicide rate in Ireland. Tonight, I want to acknowledge the volunteers who will be out tonight in the appalling weather we have been having in the past couple of days. Limerick Suicide Watch and Limerick Treaty Suicide Prevention both patrol the riverside in Limerick. Haven Hub and others also do fantastic work. Many a life has been saved because of the presence and interventions of the volunteers.

The Minister of State will be well aware of the work of the CAST pilot over the past 12 months. Following years of delay, it was initiated on a trial basis. Since its initiation, it has delivered positive results for those in need of assistance. In the first five months of 2025, the team conducted over 200 interventions, with indications that 80% of these had a major impact on the person in crisis. Speaking in Limerick about CAST, the Minister for justice, Deputy Jim O’Callaghan, said we need to roll it out across the country. The pilot project has been working well but I am concerned that it has not received its own funding. We must ensure it becomes permanent. Having spoken to senior HSE staff and Limerick gardaí, I note the project has already saved lives and kept people out of prison and emergency departments. A senior garda told me it is a godsend. It is a no-brainer. CAST must be retained, fully developed and resourced. It should be retained permanently in Limerick through central government funding and the model must be extended to other areas. In the Minister of State’s speech, she said early results are extremely positive and that the pilot will inform the national rollout. It is a no-brainer; it works and it should be rolled out where appropriate across the State. We think about how such a simple project is working so well, saving lives and keeping people out of prison and emergency departments.

Deputy Martin Kenny

Hundreds of people around the country have good outcomes when they access mental health services but there are also hundreds who have very bad outcomes. Many with bad outcomes end up self-harming or worse.

For many, the tragedy is that suicide is the outcome, but for some, what happens is that person goes on to kill someone else. I want to call the Minister of State's attention to people in my constituency. First, this letter is from Jodie McGuinness, whose sister lost her life in 2015.

The loss of my sister Natalie McGuinness in 2015 was not an isolated or unpredictable tragedy. Her murder was carried out by an individual already known to State bodies, including the HSE mental health services, An Garda Síochána, the criminal justice system and this was a case involving multiple prior convictions, psychiatric concerns, violent episodes and, most disturbingly, missed opportunities for intervention and public protection.

That is Ms McGuinness writing to the Minister. She went on to say:

While I appreciate the Department's acknowledgment of our family's loss, I must express my deep frustration that, once again, serious concerns have been met with procedural deflection rather than meaningful engagement.

That is the experience of a family that lost a loved one. That was Natalie in 2015. In 2017, another young man, Jimmy Loughlin, was also killed in Sligo by a man who was in the mental health services. I have written to the Minister of State and raised it with the Taoiseach several times.

These two families want engagement around this issue. Each time we are told that we are waiting for a report or for this, that and the other. The experience of these families is that these reports are blocks in the wall to stop them from making any progress. It was last July that the Minister of State told me in this Chamber that this report would be ready within weeks and then she would meet the family. That did not happen. What does that tell that family? What does that tell the hundreds of other families around the country whose outcome may not be that the person who was failed by the mental health services killed themselves? Those people are in the same position. The responsibility of this service's failure lies with Government and Government must step up to the mark and take responsibility. If the Minister of State is hiding behind reports, she is not taking responsibility.

Deputy Marie Sherlock

I thank Sinn Féin for this important and very timely motion on emergency mental health services. It is very timely because we are all acutely aware of the sheer level of demand that is there for mental health services and we know all too well of the lapses in timely care and the devastating consequences when there are those lapses in care. Far too many are being failed by the lack of 24-7 care and of appropriate space within our hospitals. It is unacceptable that assessments are taking place in inappropriate emergency department, ED, spaces that are not specifically designed for those with mental health issues. Broken bones, heart attacks and strokes are well set up within the ED. Yet mental health, which can be as serious and has the potential for fatal consequences, is very much the Cinderella of our health service, particularly within our EDs.

We know there are 51,000 presentations to acute mental health services every year and the Mental Health Commission report on acute mental health and hospital EDs painted a very stark picture of an inconsistent service with inadequate assessment spaces. That, in many EDs, patients are cleared for medical issues before being assessed psychiatrically is simply unacceptable. That practice has to end. We have asked the Minister of State these questions before. I know there are efforts being made. It is not happening in every ED but there are certainly EDs where it is happening. We know the lack of 24-hour mental health emergency care is having an impact. There was an announcement this year and we welcome that announcement but it is only 6 p.m. to 2 a.m. and that is not 24-7. The number of presentations after 2 a.m. may be very few but the reality is that if somebody at three or four o'clock in the morning is presenting with suicidal thoughts or whatever, that service is not there. The reality is that back in 2016, the Government promised to roll out 24-7 pathways and a decade on, we still do not have them. They are going to be introduced in a very limited way to 2 a.m. but, of course, it is only for the level 4 hospitals.

Deputy Mary Butler

Next year.

Deputy Marie Sherlock

That means there are significant gaps across the country so we need to see it for the model 3 hospitals also. It is great if it is going to happen next year.

The other key issue I want to raise is in regard to the assertive outreach or on-street mental health teams. Again, it is a really important provision within the community. When we submitted parliamentary questions on this, the replies indicate there are huge gaps across the country. There are no assertive outreach or on-street mental health teams in Waterford, Wexford, Carlow, Kilkenny, south Tipperary, south Dublin, Wicklow, north County Dublin and the north and west of the city. That is simply unacceptable, particularly when we see the great work being done in Sligo-Leitrim and Cork, and by the community access support team in Limerick Garda station. There are models of care there that we need to see rolled out across the country.

We all have not just stories but accounts from families of the devastating consequences of when there is not timely care. Maud Coffey was tragically killed by her partner in 2023. Her case speaks to the failings of emergency mental health care. Her partner had a mental health condition. He had presented looking for help. It was known that he had not been taking his medication for some months. He was suffering from a relapse of schizophrenia and he sought help from the team on the day he murdered Maud. He was given an appointment for the following week, despite it being known that he was not taking his medication for at least three months. Maud's family have been incredible in their fortitude in the midst of this incredible grief, to be able to speak out and talk about it being two lives that were destroyed three years ago and two families torn apart, and that it could have been avoided.

Maud's family spoke so eloquently after the case concluded a number of weeks ago, where they talked about the systematic failings, both for Maud, who lost her life, and also for her former partner, who should have got some sort of attention on the day he went on to kill Maud. Our only hope is that after Maud's loss of life, her legacy should be that those interventions are there when people present. I know many others in the Chamber know of other desperately sad cases.

My plea to the Minister of State this evening is in regard to the 24-7 care. It should be 24-7 care and not part of that, and it should be for the model 3 hospitals as well. Second, with regard to the assertive outreach and on-street mental health teams, it is crucially important that we see that rolled out across the country. Critically, it is to prevent situations such as the killing of Maud and indeed other people who are at risk, such as families, friends, neighbours and other supports who are trying to help people through mental health crises. Their lives are at stake if the health system does not step up to the mark.

Deputy George Lawlor

I am very pleased to support this motion. It contains some excellent proposals, many of which I know the Minister of State would take on board and agree with. It recalls the commitment in the Government's mental health policy, Sharing the Vision: a Mental Health Policy for Everyone, to provide appropriate mental health emergency facilities in every hospital. It calls on the Government to require every model 3 and 4 hospital to have a dedicated mental health emergency room separate from chaotic emergency departments.

I know the Minister of State is familiar with the situation in my county of Wexford, one of the most populous counties in the region, heading for 180,000 people. There is a terrific general hospital there but simply no facility to cater, from an acute point of view, for people with mental health difficulties. If you arrive between 9 a.m. and 5 p.m. in Wexford General Hospital, you will be seen by a psychiatric nurse and excellent staff working to the pin of their collar but after 5.30 p.m., there is nobody. At weekends, there is nobody; you will be seen on Monday. You may be referred to the psychiatric unit in University Hospital Waterford but, as the Minister of State knows, while the staff are doing an excellent job there, it is not fit for purpose.

It is not fit to meet the needs of the entire region, responsibility for which, essentially, has been forced upon it.

I am told that if you are referred by a doctor or a hospital to the HSE unit in Summerhill in Wexford, you might have to wait up to three months to receive an appointment. I am also told that there is an excellent psychiatrist there - I wrote to the Minister of State about this recently – who has not been retained by the HSE. Whether that is the physician's personal choice or is down to the fact that she has not been retained by the HSE, the matter needs to be investigated nonetheless. I have been contacted by numerous families and parents who stated that this person provided excellent care for the people in her care.

There is no sign of the promised 54-bed unit in Waterford coming on stream. What we require in Wexford, which has a population of 180,000, is a dedicated ten-bed unit adjoining Wexford General Hospital and operating in conjunction with the acute facilities there. There is an urgent need for such a unit. Wexford is a county that is above the national average in terms of the rate of suicide. There is a serious mental health crisis in County Wexford. There is also a serious crisis in CAMHS in County Wexford in the context of mental health. I was recently approached by two young people who gave testimonies to me, which I will send on to the Minister of State, which decried the care they received. I know we will always get good and bad, and we probably hear more about the bad. Where people are not being cared for in the manner you would expect, however, particularly when it comes to CAMHS, there is a need for change.

About 13 years ago, I and some of my friends in Wexford town, led by a man called Frank Flanagan, set up a group called Wexford MarineWatch. Very simply, we do suicide prevention patrols around Wexford Harbour and in the Wexford Bridge area. There was almost an epidemic of people using Wexford Bridge for self-harm or attempted suicide. We have literally encountered hundreds of people since our establishment. In some instances, we give these people vouchers to attend It’s Good to Talk counselling in Wexford town - we have come to an arrangement in that regard – and this has worked very well. However, we have also seen situations where we intervened with people and where gardaí came along and cared very well for them and where those individuals were brought to Waterford and were discharged the next day. This was despite the fact they were clearly in crisis. It is my belief and that of many people in Wexford who have had interactions with the psychiatric unit in Waterford that it is not fit to meet the demand that exists across the region.

We worked very closely with Waterford Marine Search and Rescue, which has been very helpful. The Minister of State will agree that it does terrific work. We assisted Claddagh Watch in Galway with its establishment. The intervention of these organisations opens our eyes to what is happening on the ground in terms of people who are in crisis. Ours is only one organisation.

The ten-bed acute unit for Wexford General Hospital is not too much to ask for, given the mental health crisis our county is facing and its population of 180,000. I ask the Minister of State to please intervene and provide that unit for the people of Wexford.

Deputy Liam Quaide

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 and 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 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.

Deputy Charles Ward

I thank Sinn Féin for bringing forward this incredibly important motion on emergency mental health services. It is essential that we appreciate this is a vital area that needs to be looked at. For these reasons, I strongly support the motion that calls for every model 3 and model 4 hospital to have a dedicated mental health emergency room, separate from the emergency department. A dedicated mental health emergency room would be a game-changer for the likes of Letterkenny hospital. It would allow patients suffering from mental health illness to get immediate specialised care which is far too often delayed and inaccessible, and in cases in Donegal completely absent.

It is devastating that in this day and age we still treat mental illness with less urgency and seriousness than physical illness. The consequences are just as real and detrimental. Left unaddressed, mental illness increases the risk of physical disease, isolation, homelessness and death. Minimising this does not reduce its impact. It allows preventable suffering and loss to continue. Research tells us that one in two people in Ireland will directly or indirectly experience a mental health crisis at some point in their life. Investing in emergency mental health services makes sense and it would have wide-ranging impacts.

The Mental Health Commission has reported that each year an estimated 51,000 people access mental health services for the first time through a hospital emergency department. That should not be the case. There should be a dedicated fully staffed place where people experiencing mental health difficulties can go. Our emergency departments have been reduced and we have not had significant investment in years. Donegal is suffering and is facing a significant mental health crisis characterised by long waiting lists, rising demands and overstretched services, compounded by the defective concrete crisis currently going on and the mental health crisis that is causing.

I have raised Oisin Keenan's research many times before. I will continue to do so because it continues to be relevant. Oisin's study, An Earthquake in Slow Motion: The Mental Health Impact of Ireland's Defective Concrete Crisis, has shown that rates of depression, anxiety and trauma-related disorders are significantly higher among adults living with defective concrete in their homes compared with the general population of Ireland. More than a third of the 393 adults surveyed reported experiencing suicidal ideation and suicidal thoughts. The research conducted on the children living in defective concrete homes has showed a similar trend, which is heartbreaking. Children being raised in homes with defective concrete already experience profound and lasting effects to their mental health and emotional well-being.

Many individuals are affected by uncertainty, instability and chronic stress when growing up. This can stifle their development, increase the risk of anxiety and depression and cause behavioural issues. You can imagine just how difficult it is for children with disabilities and special needs living in these circumstances and the impact is not confined to childhood. Early exposure to prolonged stress has been shown to impact long-term physical and mental health. The crisis is intergenerational. The pressures and trauma experienced by parents and caregivers are directly influencing their children's sense of safety.

It is having a profound effect on their mental health as their lives progress, causing unprecedented levels of mental illness in Donegal. Without timely, sustained intervention, the defective concrete crisis creates a serious risk these mental health difficulties will be carried forward and become generational, deepening inequality and placing further strain on already stretched services. For this reason, we urgently need to develop an integrated crisis response pathway for mental health in Donegal involving our emergency departments, which is vital.

We have had a significant rise in young people seeking mental health support. According to Jigsaw, 744 people in Donegal sought support between January and October last year. That is a massive 34% increase on the previous year. The defective concrete crisis is one of the causes. It affects more than bricks and mortar; it affects marriages, families and children and severely impacts our elderly population, who feel abandoned. They have contacted me. They are in vulnerable situations and are going through the later stages of life in severe peril and depression. Their mental health has gone. They are broken. We need to address this and realise how serious it is.

I have been in contact with the Minister of State in the past regarding the old convent in Carndonagh, a recovery-focused, crisis intervention step-down facility. There is a seven-day outreach service which will support people to remain in their own home and integrate with their local community as planned. As well as this, day services and acute short-term services will reduce the number of admissions to the department of psychiatry. Funding for a new crisis resolution team is needed.

We need significantly more mental health facilities in Donegal to deal with the issues we are experiencing, with many more to come. Will the Minister of State inform us of a timeline indicating commencement and completion of the transition and prioritise mental health facilities in the north west? Down the line, this will be an absolute epidemic.

Deputy Richard Boyd Barrett

I commend Sinn Féin on tabling this motion on the need for emergency mental health services and stating they should be 24-7 and involve dedicated mental health emergency rooms in level 3 and 4 hospitals, investment in model 2 hospitals and proper staffing for mental health services.

The second last point is particularly important, from my experience. It refers to "mental health crisis assessment and intervention services [and] community-based alternatives... late-night outreach spaces, crisis resolution teams, and community-based assessment, support, and treatment teams". I say that because on a number of occasions in my clinic, either I or my staff have faced terrifying situations where people have called us or come into us and said they are feeling suicidal. We have no idea what to do.

If I could ask the Minister one thing, it would be to put together guidance for public representatives faced with these situations. Our staff are traumatised. We are dealing with traumatised people and we do not know what advice to give them as to where to go. Usually, we end up being told to call the police. That is literally all that is available - call the police if somebody is threatening suicide.

Two of our emergency departments, in St. Michael's Hospital and Loughlinstown hospital, had their opening hours reduced to 8 a.m. to 8 p.m. a number of years ago, which we campaigned strongly against. The only emergency department available out of hours is in St. Vincent's Hospital, which is overrun and chaotic.

I do not know if it is mentioned in the motion but we often get reports of dual diagnosis. People are turned away from emergency departments because they also have problems with abuse of drugs or alcohol. There is often unwillingness to treat people in that situation. I do not blame the staff for that. I blame the lack of specialised dual-diagnosis mental health services, as well as services in the community. Before people end up in an emergency department, there should be community-based alternatives, as the motion states, and crisis intervention teams, so there are other supports available for people in these situations.

It is good the Government is not opposing the motion but we need to see the resources in place. We also need to think beyond this motion. Many of the mental health crises in this country involve our young people. I strongly believe, and have said it a number of times in here, that we should have a psychology department in every school. This is the case in many countries, where schools not only have individuals but also have actual psychology departments. We should have the same so there are places to go in schools for young people facing mental health crises.

The Government should not be trying to deal with the consequences of such crises on one hand, while, on the other, failing to act against some of the forces in the world fomenting such crises and leading young people to feel suicidal. I am referring to some social media companies and their reckless, irresponsible behaviour in having recommender algorithms which push stuff at young people that foments much of the mental health crises they are experiencing, including suicidal ideation, body image issues and so on, which can have a big impact on young people and can lead them to mental health crisis or even suicide. Algorithms pushing stuff about suicidal ideation at young people is absolutely shocking. There is profiteering from it, as was highlighted by Deputy Paul Murphy in the Bill we tabled to do away with these algorithms that are pushing dangerous stuff at young people.

There are many aspects to the mental health crisis that faces many in our society. It will affect many people at some point in their lives. What is put forward in the motion is an important part of the response. I hope the Government will act on it and provide the staffing and resources to make it happen. There are also things beyond this which the Government needs to consider.

Deputy Paul Lawless

I support the motion. It is a fact that emergency departments across the country are overburdened. In Mayo, there are significant delays in waiting times and so on. For individuals suffering from mental health difficulties or suicidal ideation, I do not believe an emergency department is appropriate or the best place. Every year, 51,000 people access mental health services for the first time through an emergency department. That is an extraordinary figure. It is extraordinary for the individuals who have to go into the emergency departments, but equally for the healthcare professionals. It is crucial there is a dedicated room, with dedicated professionals available on a 24-hour basis, within emergency departments. It can be done. It is a practical solution to a major crisis.

Recently, a constituent of mine who was suffering from addiction attended an emergency department. The response was simply inadequate in terms of being able to provide the level of care that was needed. There were significant gaps in care and the detox programme. I submitted a number of parliamentary questions to the Minister of State on this. I was trying to identify gaps and variations in delivery of addiction services and issues with female-only spaces, and the level of response was simply inadequate. I intend to submit questions again to the Minister of State and to write to her on this issue because mental health and addiction services are intrinsically linked. One question I put to the Minister of State was on the level of demand. It is extraordinary that this does not seem to be captured by the Department. These are people who are suffering immensely and the way in which we are dealing with them is unacceptable. The Department's capture and management of the data also need to be looked at. I support the motion and I look forward, hopefully, to its implementation.

Deputy Paul Nicholas Gogarty

Last year's Mental Health Commission's report entitled Acute Mental Healthcare in Hospital Emergency Departments in Ireland, confirmed, as other speakers noted, that emergency mental health care is simply not available in most of our emergency departments. I am repeating myself here but every year more than 50,000 people in acute mental distress present to emergency departments. A number of Deputies referred to this but it is important to emphasise it. What the report shows is widespread inconsistency in the quality of care people receive. Hospital managers acknowledge rising demand. The report highlighted, among other things, that eight emergency departments lacked even the most basic appropriate spaces for crisis mental health assessments.

Professionals, families and other advocates have been very clear that the current model is not working. People in crisis are being assessed in totally unsuitable chaotic environments, where access to timely specialist care depends too heavily on where people happen to live. As such, I wholeheartedly support calls in this motion for a dedicated mental health emergency room service in every model 3 and model 4 hospital, separate from overcrowded emergency departments. I also support establishing an expert review of the role of model 2 hospitals and investment in a network of specialist crisis centres, including at community level. This is a fundamental point, both in terms in emergency departments in general but also in mental health services. People should not necessarily have to go to an emergency department to access emergency mental health services. Care could be community-based. If we had a nationwide network as part of the primary care centre system, people would not have to attend hospital emergency departments for many less complex medical procedures. That is another day's debate but community care is required.

All of this will require proper resourcing and will not happen overnight. The Minister of State and previous speakers pointed to some areas of improvement. While improvements have happened, a lot more is needed within a shorter timeframe if the Government is to finally deliver the safe, rapid-access mental health emergency care promised in its policy report, Sharing the Vision, for the period from 2020 to 2030. Such care would ensure every person in a crisis gets timely invention in a setting that provides them with privacy and, dare I say it, basic human dignity.

Deputy Richard O'Donoghue

I welcome and support the motion. Not a day goes by that I do not think of my great friend of many years who died from suicide. I was with him the day before he died. At the time, he had even fooled me. I think of members of the emergency services who have to deal with things on a daily basis. I think of the Garda, the fire service, and suicide watch and search and rescue organisations. All these people, many of them volunteers, go out and do their best to help people. Then, I see investigations in the HSE where it takes eight years for a person to admit they were wrong and hundreds of thousands of euro wasted on legal fees because somebody did not put up their hand and say they did wrong. This money could go into services that save the lives of people suffering from mental health problems.

The same is true in the Garda. We saw yesterday that five gardaí were found not guilty after a long seven or eight years. That cost hundreds of thousands and had gardaí off the street when they could have been helping people. That could have been dealt with in a more timely fashion, which could have helped services that are badly wanted for people with mental health difficulties. We have to get this right. We have to make sure the funds available to us are used to resource the most needy, namely, the elderly and people who suffer with mental health problems. With all the challenges they have now, we have to make sure they get the best treatment. To do that, we have to stop waste and fix the issue with accountability, so that if people get something wrong, they put their hand up and say they got it wrong, learn from it and move on. That is what we have to do. Until we do that, we will have hundreds of thousands of euro being wasted on legal challenges that could help people in need. I ask for the Minister of State's help with that. I hope we do not have to wait for seven or eight years for other cases in the health services to conclude when they could be fixed if people put up their hands and were accountable. We need to learn from our mistakes. That goes all the way up the chain to the very top. We need to stop the cover-ups and help people who are in need.

Deputy Michael Collins

I welcome this hugely important motion. I have been fighting in the business committee to have a discussion in the House on mental health services. It is certainly an emergency. I think every TD in this Chamber knows the reality. When people are in a mental health crisis there is almost nowhere for them to go. We see it in our clinics every single week.

Deputy O'Donoghue said we have to get this right. Sadly, it is not right. It is a broken system, an absolute disastrous system, to be honest. I have had family members very close to me commit suicide but I also have a constituent who recently tried to commit suicide. The astonishing situation was that I was asked to help and, my God, I could do nothing. I asked two Ministers to help and they could do nothing. That is a serious situation. Basically, the person made a suicide attempt at home and was brought into hospital. He was supervised overnight in hospital and the following morning, the family were told to take him home or he would be dropped off by taxi. Good God almighty, the poor man was still saying he was in a crisis and needed help but he was sent home. The fact that there was self-harm involved meant he had to come back the next day and get medical treatment. Basically, as far as the hospital was concerned, the mental health side of it was finished with. It was not. This man was still in a dreadful position in life.

People in that situation need help, and it is not there. This goes back years. A relation of mine was in the same situation but the help was not there. There were a lot of phone calls after the event but that is no good to anybody. After the event is no good. There needs to be a massive rethink here as to how mental health issues are being dealt with in this country because it is certainly not working. That is a shocking indictment. It seems to me that people are only a number. When they are gone, they are gone and we move on. That is not the way it should be. If you were struck down with cancer or a heart ailment tomorrow morning, you would expect to get the medical treatment you deserve. A mental health situation is a medical issue but it is being ignored by Government continuously.

We sometimes point the finger. I have great understanding for staff in mental health units because they are under immense pressure. It is a very difficult job and we all know it is not the fault of front-line staff who do their best in impossible conditions. This is a failure of leadership and planning at the top. The system simply is not built to deal with mental health crises safely. Families come to us in absolute despair. They know their son, daughter or partner is suicidal but they cannot get them admitted anywhere.

They are told the person involved has to seek help. Even when they do, the help often is not there, as I have just outlined. There is nothing worse than a family begging for help and being told there is nothing that can be done. We all know the pain of losing someone to suicide. Too many families in this country have been devastated by it. It is heartbreaking to think that some of those deaths could have been prevented if there were proper crisis supports, real crisis rooms, real alternatives to emergency departments and real follow-up care.

I plead to the people out there who have a mental health illness to look for help and seek help. They should talk to friends, talk to neighbours or talk to someone. I appreciate being given an extra bit of time because it is a very serious issue. I know a lot of people are very ill with it. It is sad. It is very sad.

Deputy Albert Dolan

This conversation is very welcome. I welcome the motion. I speak regularly with young people in my constituency and young families. The reality is that when somebody is in a crisis situation or finally gets to that point where they realise they are not okay, they need support and help and they reach out for help, it is vital that the State is ready to meet them where they are at. We have all heard too many heartbreaking stories of people who have been left waiting, people who have felt unheard or people who have just been in the wrong place at the wrong time. The impact that can have on a family, friends and entire communities cannot be underestimated.

It is also important to acknowledge the front-line professionals. From nurses to clinicians, gardaí and volunteers, oftentimes the people on the front line go above and beyond. They do everything they can to help. They sit with people through their darkest hours. They deserve credit for that but they also need a system that will enable them, support them properly and ensure that when they are trying to support people, they have the support in place to do that effectively. That is a really important point. We need a system that supports our front-line workers.

I welcome the debate primarily because it is a chance for us to have an honest conversation about the gaps that exist while still acknowledging progress. The Government has a clear policy here about the need for the right care in the right place at the right time. Oftentimes, emergency departments are not the best setting for a person to present in a mental health crisis. It is already a chaotic environment and there is no doubt that can contribute greatly to how somebody would be feeling at that time of despair. It is really important that we look at that, acknowledge the merits of this motion and move forward collectively, all seeking the best outcomes for anybody who ends up in a position where they have built the courage to present. They need to know the State is right there beside them.

It is important to look at what happened in the budget. It was a major step forward. It included 300 additional mental health staff and more than €15 million ring-fenced for crisis supports and suicide prevention. Speaking as a man, there were 15,000 hours allocated for men's counselling last year. That was really welcome. I know there are new, specialist crisis nursing teams that are working out of hours in major hospitals. These are all things to show the Government is taking this seriously and we want to see serious improvements in this. It is also a reflection that more has to be done because we all know the cases. We all know families who feel their person who ultimately took their own life was let down by the State or services and it is really important that we minimise those encounters and situations. They cannot be allowed to happen. We have to be there to support people. The system has to be there to support people. We also have to be really solution-oriented here. All of those investments I spoke about there are the direction of travel.

It is important to discuss how hospitals respond as well. There are national clinical programmes in all 26 emergency departments now. There are proper assessments, safety plans and follow-up care. I will finish with one last point. Everybody here can agree that when somebody is in a crisis or somebody has an emergency, the State needs to be there to meet them.

Deputy Danny Healy-Rae

I am glad to get the opportunity to talk about this very important issue. I am glad Sinn Féin has brought it forward here this evening. Every one of us has known a lot of people who committed suicide. It is very sad when you lose very fine people that way. We would all love to do a whole lot more for them. We need to do more because the national survey from the Office of the Inspector of Mental Health Services has found that international best practice is not available in most emergency departments in Ireland.

I can honestly say we do not have enough facilities in Kerry to deal with the number of people who have problems, especially young people. What happened with south Kerry CAMHS and north Kerry CAMHS is just the tip of the iceberg. In 2016 I had only been up here a very short time when I got a call from a young family, the brothers and sisters of a young boy who was threatening to commit suicide. His father had done it five or six years before that. They were up day and night with him. They had him in a certain hospital at this time and the hospital was letting him go home. They were dreading the weekend and wondering how they would mind him for another weekend. I rang the hospital and I was very glad that a senior nurse came on the phone to me and promised she would look after him. She kept him for three weeks in that hospital. He is perfect today and, even if I never do anything else in my life, I will be glad of that. We are not able to do it for enough people.

I am glad that the Minister of State when she spoke earlier said she would increase services in Kerry. By God, we certainly need them. I am appealing to her to get hold of the HSE and ensure that happens. I hear many other Deputies talking here about how ordinary emergency departments are not the place. They certainly are not. We should have a separate room and separate people to deal with these young people - it is often young people who go in. They have troubles from different things, possibly including addiction.

There is savage pressure on youngsters now who are going to college, trying to compete and trying to stay in education. It might be hard for them to find their path and which way they want to go. There is so much we could do. We certainly need more psychiatrists but we need more psychologists as well to talk to them and to understand. It is only people like that who can understand the problems they have. Some of it can be hereditary. It has been in families and we know that. We are all united here together that the services must be enhanced and increased. We must help these lovely young people and people who often leave this earth too soon. We have all been at the funerals. We know the trauma it leaves behind for families. It is serious. We have to do more.

Deputy Barry Heneghan

I really welcome Sinn Féin bringing this motion forward. I welcome the fact the Government is not opposing it. I thank Deputy Cullinane and Deputy Sorca Clarke for their calls for reform. This morning, I spoke at an event for Movember. I was not invited there just because I have a moustache. Before I got involved in politics, when I was shouting from the outside of this House during lockdown, I ran an event for Movember called Movement for Mental Health. It was when we were in those confined areas. I was trying to get people out and put it on their social media that they were moving and getting active. We raised €20,000 and it was great. From that, my passion came forward.

I have lost friends, be they schoolmates, people I used to serve or people I was always working for and working with, to suicide. The Minister of State is very well aware of this. It is the hidden fact of mental health. I was very lucky that, when I struggled with mental health when I was younger and in those developing years, I went to a university that had a free counselling service.

I know people who look at me now might ask, "How did he struggle?" It is the people we do not think are struggling who are struggling. I have seen that with my friends. We are always going back and wondering why we did not ask him or her about it. That is the part we can all resonate with in Ireland. One in five people experience it in their life.

Can the Minister of State see the badge I am wearing? It reads, "It's OK Not to Be OK". That was started by a lady named Theresa Kelly, from Edenmore. What she has done is to not accept the delays in legislation. She has taken something into her own hands. It is good to see Dublin City Council getting behind it. It is good to see other Deputies and other councillors from Dublin getting behind it. What she has done is create a badge for people to wear to break the stigma on mental health. I was at schools recently giving out the badges. Everyone is getting behind this campaign.

There are people in crisis who are waiting hours, sometimes days, on trolleys in emergency departments, as everybody across this House has said. It is not the hard-working men and women in our hospitals who are the problem. The problem is the current system for getting people the help they need. As I said, I was lucky to have been going to a university that had it. Some people do not have that chance. There is a huge statistic on the economic barriers people are facing for mental health.

Regarding the "It's OK Not to Be OK" badge, it is a small badge, but there is also a little card they give out. What the card does is give people information on eight free services they can go to, be it the Samaritans, Pieta House, Woman's Aid, Men's Aid, Childline, Alone, the Dublin Rape Crisis Centre, homeless emergency accommodation and all these great organisations. Giving people that little card with all the information in one place gives them that option. It is not just that, however. It is the fact that it is being supported across the House. I love when it happens that there is an issue and people put aside politics and just get to the solution. The leadership I have seen from Theresa has been unbelievable for someone who is not in politics. To have her work rate is something I aspire to. She does not have an off switch.

Now, we see that for young people in Ireland mistakes and rejection are made public. People only show the good side of their lives on social media. Statistics show that young people are experiencing mental health issues at a higher rate because of social media. It is because of the pressures that are on them these days. I welcome the motion, and I would love if youth services were properly funded, community counselling was more widely available and for addiction services and family supports to continue to be rolled out. There is great work being done across those Departments. It is not just about normalising the struggle. It is about how "It's OK Not to Be OK", and it is absolutely okay to ask for help. If there is anyone watching us in this Chamber on a Tuesday night and we can change one life and show people how to reach out, then we have been successful. I thank Sinn Féin for bringing forward this motion.

Minister of State at the Department of Health (Deputy Jennifer Murnane O'Connor)

First of all, I want to thank all the Deputies for their contributions on this important motion this evening. These are vitally important services, and the Government has taken action to reform, reorganise and invest in the services for people facing into a mental health crisis. There is still much work to do to build supports up to where we know they need to be today.

As my colleague, the Minister of State, Deputy Butler, highlighted earlier, this work covers both our hospital-based supports and our community-based alternatives. We know that emergency departments are often not ideal settings for people experiencing a mental health crisis. However, they are an essential 24-hour service, and we know that people will continue to present there when they need immediate care. This fact underlines the dual approach we are taking to mental health crisis service reform in rolling out specialist nursing teams in emergency departments and building up our new crisis resolution services in our communities. The main objective of Sharing the Vision, Ireland’s national mental health policy of which we are all aware - I thank everyone who spoke about it tonight - is to enhance the provision of services and supports across a broad range, from the promotion of positive mental health to specialist mental health service delivery. Actions under the policy cover prevention and early intervention, service access, co-ordination and continuity of care, social inclusion and accountability and continuous improvements. Implementation is being driven by the national implementation and monitoring committee. This group has been reviewing the issues of mental health crisis supports. A specific work team is developing an overarching framework to better integrate the range of out-of-hours and crisis services and supports available. One of the things that was highlighted again tonight was the crisis service and the supports available. As we continue to expand alternatives to hospitals for those in crisis, this work will deliver on an overarching crisis response framework to align patient pathways, integrate crisis services and address specific service improvements to fill any gaps in provision that are identified.

Mental health is a priority for the Government, demonstrated by the record funding increase since 2020. Funding has increased by over 50% in this time and this has allowed us to recruit more staff, develop new digital services, provide more counselling and roll out specialist services across the country. The ambition of the Government is to provide timely and responsive access to safe, high-quality mental health services for people in mental health crisis and deliver the right care in the right place at the right time. This means effective, compassionate and responsive services in the community, but also in our emergency departments and hospitals. The wider shift to community-based services is particularly significant for mental health where, as we have noted, emergency department and hospital-based services are often not the most appropriate setting for people in distress.

Building on this progress to date, in budget 2026, we are making real practical investments to help people in crisis when they need it most. First, we are investing €2.8 million this year to begin the establishment of the specialist nursing teams in every major hospital emergency department during the busiest out-of-hours periods. These teams, made up of highly trained advanced nurse practitioners and clinical nurse specialists, will be there to provide immediate support to people who arrive in crisis. We are also opening the three new crisis resolution services, with teams made up of expert mental health professionals, and Solace crisis cafes, which are staffed by lived experience peer support workers. These services already operate in six counties and in 2026 will expand to serve communities in counties Donegal and Kerry and the midlands. These will be safe, welcoming drop-in spaces for anyone who is feeling distressed or overwhelmed. There is a further €4 million dedicated to early compassionate community-based supports, which is really important. Community supports are really important. This year, we also funded 12 additional suicide crisis assessment nurses. These nurses work directly with GPs to support people who come forward in distress. This represents a €1 million investment. We are providing €415,000 for suicide prevention initiatives designed with the Traveller community. This is by the Traveller community, ensuring culturally appropriate support where it is needed most. We are significantly increasing funding to voluntary and community organisations, including Pieta House, HUGG and SOS, by €1.7 million, recognising the vital role they play on the ground every day.

We are creating a new crisis response pathway for children and young people. This includes 19 new specialist CAMHS doctors to cover emergencies and out-of-hours needs, along with five new adult liaison psychiatrists. This is a major €4 million investment in timely and responsive care. Taken together, these measures show clearly that the Government is serious about strengthening crisis supports, investing in prevention and ensuring help is available when and where the people need it most.

The national clinical programme on self-harm and suicide-related ideation works in our hospitals to make sure that anyone who comes to an emergency department after self-harm or because they are thinking about suicide is treated with compassion and gets a quick assessment of what they need. They are then given support and advice on staying safe and a written safety plan that is shared with their GP. Staff also help link each person with the right follow-up care. The programme is run by teams of specialist mental health nurses and it is now in place in all 26 emergency departments across the country, including every model 3 hospital, with approximately 50 staff involved. The programme also gathers important information on self-harm presentation and shares it with the National Suicide Research Foundation, which keeps Ireland's self-harm register. This data is published every year. In 2024, 12,621 self-harm presentations were reported, a 10% drop compared with 2014. A key part of the service is having a dedicated room in each emergency department for mental health assessments. The national clinical lead has been working with hospitals to ensure these rooms are available.

While most hospitals already have such a room, an audit found eight emergency departments still do not have one. The programme is actively working with those hospitals to put that right.

In 2025, we launched a new model of care for consultation psychiatry, which gives hospitals a strong and clear framework for developing these vital services. Liaison psychiatry is the team that supports people who come to emergency departments or hospital wards in need of both physical and mental help, including individuals experiencing eating disorders, self-harm or suicidal thoughts. These services play a crucial role in ensuring people receive the right mental health support when they need it most. As part of budget 2026, we are providing funding for five additional full-time staff to help to put this new model into practice.

The Government will shortly publish Ireland's new self-harm and suicide prevention strategy, as referred to by many speakers. It will build on the success of the existing strategy, Connecting for Life, while addressing gaps and areas that require more focus. The new policy implementation structures will be supported by a lived experience panel hosted by the National Suicide Research Foundation. We continue to embed lived experience into Government policy formation and delivery.

Last year's public consultation involved surveys and a series of in-person consultation sessions. The online survey closed with 1,895 submissions and 200 people were involved in the in-person and online sessions. Access to mental health crisis services and poor experience of presenting to emergency departments emerged as the key theme in these sessions, as detailed in the report on the consultation published by the Department of Health last year. That was the main issue identified. The Government has listened to this, as the new measures we are funding this year demonstrate.

Reducing deaths by suicide is a very complex task but evidence and experience internationally show that measurable improvements in suicide prevention can be achieved through effective cross-sectoral, cross-government and cross-functional working. Connecting for Life adopted this approach and, as a result, suicide reduction initiatives have advanced in many areas, including local government, justice, media, agriculture and health. The strategy had strong cross-departmental support, including from the Departments of Social Protection, justice, education, higher education and agriculture. This will continue and will be strengthened in the new strategy. The Minister of State, Deputy Butler, has allocated €1 million in dedicated funding to begin the new strategy, which will be published in the coming months.

As we bring tonight's debate to a close, I thank all Deputies for their contributions. We each know constituents who have faced profound crises and have turned to us, as their public representatives, at moments when they felt most alone. The actions the Minister of State has taken and the investment the Government is delivering will ensure our response is more compassionate, more effective and will deliver in the right settings. The Government's ambition is clear and the programme for service reform, integration and expansion is well under way. The Minister of State is committed to improving emergency mental healthcare and welcomes this opportunity to set out the range of initiatives the Government is resourcing to make this a reality for the people in our communities who need to access these vital services. I thank all who contributed this evening. It was really important to have this debate.

Deputy Dessie Ellis

There is a crisis in how mental healthcare services are delivered across the State. The lack of proper services means people experiencing a mental health crisis must present at hospital emergency departments. A person so presenting may, at the time of presentation, be in a state of psychosis and, having had to wait a number of hours for treatment, may come out of the psychosis. Some of them have then been sent home. This is highlighted in a recent report by the Mental Health Commission, which also showed there are often substantial delays for people undergoing a mental health crisis in terms of mental health assessments, especially in the evenings and at weekends.

Existing emergency mental health services are being placed under great pressure and strain as they currently face a surge in demand. This is particularly prevalent among young people, who have also been heavily impacted by the housing crisis. Demand for mental health services among this demographic has increased by more than 50% in recent years. An EU report in 2025 showed significant concerns with regard to mental health levels in Ireland, with the State receiving the lowest average score on a mind health index among the nine European countries surveyed. For a number of years, Ireland has been ranked as among the worst countries in the world for mental health. Services in this area have been haemorrhaging highly qualified staff, who are not being replaced.

We have been talking about these matters for years. It is unacceptable that there has been such a poor response from the Government in tackling this mental health crisis. Sending those experiencing a psychotic episode to Garda stations or ill-equipped hospital emergency departments is not the solution. At the very least, every hospital should have dedicated spaces with specialist mental health teams available 24 hours a day, seven days a week. Ireland will continue to rank as one of the worst countries in Europe for mental health if we do not implement these changes.

Deputy Seán Crowe

Emergency mental health services in this State are virtually non-existent. On any given day, more than 100 people will present at an emergency department in extreme distress and there will not be the services and facilities to support them. Emergency mental health services remain underfunded, understaffed and largely unavailable when people need them most. That failure is costing people's lives and it is unacceptable.

Among the cases that have come through my office, I remember a young man coming in who produced a bread knife, which was very scary. He rolled up his sleeves to reveal he had been self-harming. There were no supports for that young man, who ended up in the local Garda station on that occasion. He is no longer with us. People and their families have been crying out for help and we are powerless to do anything other than suggest they go to an emergency department, where they can hope to be one of the lucky ones who get help.

The healthcare professionals working in our hospitals are amazing but they are not miracle workers and cannot magic up services that do not exist. We cannot continue to funnel people in crisis to emergency departments that are not equipped or resourced to help them. We must ensure hospitals like Tallaght hospital have the appropriate complement of specialist professionals. We must ring-fence investment in mental health crisis assessment and intervention services. Particular attention must be paid to developing an integrated crisis response pathway for children and young people experiencing a mental health crisis. Surely people in the darkest moments of their life deserve a calm, safe and professionally staffed environment. Is it too much to ask for dedicated emergency mental health services, 24-7 crisis teams and local supports? We need them now, not in five or ten years.

Deputy Pat Buckley

I thank Deputy Clarke for tabling this motion and all the speakers, including the Government speakers, who contributed to the debate on this very sensitive subject. I thank the Mental Health Commission for its work.

I welcome the opportunity to again address the House on the topic of mental health services, having first done so back in 2016. I am sad that there has been very little change in the ten years since. We tell those suffering with their mental health to seek help but that help is not always there. I know this myself. Colleagues may know that I lost two brothers to suicide. It has been a while and I still do not know how my mam, brothers and sisters deal with it. That pain is always there but nobody talks about it.

Many emergency departments do not currently have suicide crisis assessment nurses, as several speakers have noted. I want to be clear that I do not blame the staff, who spend years training for this work. They have been totally let down by the system and by the Government. It is a system that undervalues them, overworks them and does not listen to them. That has been going on for years. I spoke about it ten years ago.

In the brief time remaining, I will talk about the people who are left behind after a loved one's suicide. It is absolutely harrowing. The Government is not opposing the Bill but I will give the Minister of State a very quick synopsis in the 26 seconds I have. When my brothers died, the coroner's reports were crap, the HSE service was crap and how everybody dealt with death was crap. An Garda Síochána and all the emergency services were amazing, in fairness, but we never got counselling. We have moved on from that but the point I am making is that I do not want to be here in another ten years repeating myself. We do not want to have to keep talking about this. We need to improve the services and we must do it now.

Deputy Johnny Mythen

My home county of Wexford has been left behind in many facets in the past two decades, especially when it comes to mental health services.

As far back as 2009 or 2010, St. Senan's Hospital was no longer permitted to take in new acute mental health patients, which immediately resulted in the closure of ten mental health acute beds. Mary Harney was the Minister for health at the time and ten new acute mental health beds were promised in the five-year plan, A Vision for Change. They were to be located in Wexford General Hospital as a new acute mental health unit. Some 16 years later we are still waiting on that broken promise. County Wexford still does not have a dedicated, 24-7 acute adult inpatient unit despite a population of almost 180,000 citizens.

There are currently 1,400 children in the Wexford-Wicklow area waiting to be seen by CAMHS. What is even more disturbing is they are waiting over 52 weeks for their first appointment. The Minister of State knows, and indeed everybody knows, that emergency departments are not a fit place for people experiencing emergency mental health problems, especially people who may have suicidal tendencies. The least that should happen is that every model 3 and model 4 hospital must have a separate emergency mental health room with appropriate specialist professionals. Investment in mental health crisis assessment and intervention must be copper-fastened and ring-fenced. Again, I ask for a commitment to a 24-7 acute mental hospital adult unit in Wexford and for the ten-bed unit promised by consecutive governments since 2010 be facilitated in Wexford General Hospital.

I welcome that the Government is not opposing the motion.

Deputy Sorca Clarke

I welcome that the Government is not opposing the motion but the Minister of State and her colleagues need to act, and act much more quickly than they have to date. At the current rate it will be the mid-2030s by the time we reach the target under Sláintecare. People in crisis cannot wait that long. We are going to lose people. People are going to lose quality of life between now and then. I have heard the lack of service provision being described as "gaps" throughout this debate but these are not gaps but black holes of absolute service deprivation. In some areas services simply do not exist. A "gap" gives an indication this is something that is easily fixed but it is not as there is nothing there to link up in some areas and it is grossly unfair. We cannot keep sending people to emergency departments and calling that care because it is not. Those people should never be in emergency departments and would not need to be there if the proper structures were in place in the community, if we had suicide crisis assessment nurses and ring-fenced investment and if we as a State examined every possible potential specialist and activated each and every one of them, from our community therapists to our psychologists, our psychiatrists and our wonderful staff who are already in the mental health services. Each and every one of them needs to be activated.

The Minister of State, Deputy Butler, spoke earlier about the suicide rates and four in five suicides being men. I do not believe in pitting one area of need against another. I do not believe in pitting one geographic area against another. However, when we speak of suicide and of mental health there is a group of people we do not recognise enough and they are the people who make the badges. It is the people who are not charities, are not NGOs and are not linked in formally with any structure of the State. I am going to be parochial here, which I very rarely do in the House, but I want to acknowledge on the issue of men's mental health Blue Balls Ireland, Blue Balls Midlands, Blue Balls Bull Wall and the newly-formed Blue Balls Wicklow. They do tremendous work and they are community-driven and grassroots-led.

One thing has been very clear across every contribution this evening, which is that the current system is not working, that it is failing people in need and that it is failing the people who work in the services as well. I ask the Minister of State to act on this motion rather than just not opposing it.

Question put and agreed to.

Dáil Éireann díospóireacht - Tuesday, 27 Jan 2026

Emergency Mental Health Services: Motion [Private Members]

Dáil Éireann díospóireacht -
Tuesday, 27 Jan 2026