The Business Committee has agreed to allow one and a half hours for this debate. The proposer of the motion will have 10 minutes to propose and 10 minutes to wind up the debate. All other Members will have five minutes. One amendment has been received, and it is published on the Marshalled List. The proposer of the amendment will have 10 minutes to propose and five minutes to wind up.

I beg to move

That this Assembly expresses concern at the current state of child and adolescent mental health services, particularly the lack of child and adolescent in-patient beds and dearth of trained staff to run these services; and further calls on the Department of Health, Social Services and Public Safety to take urgent action to address this situation in keeping with the Bamford Review.

Go raibh maith agat, a LeasCheann Comhairle.

I thank the Business Committee for allowing this motion to appear on today’s Order Paper. I tabled the motion last Tuesday and its inclusion sends the clear message that the rights of children and young people are a priority for the Assembly.

I accept the amendment proposed by Dolores Kelly and Carmel Hanna, which adds to the strength of my motion, and I thank them for that.

(Mr Deputy Speaker [Mr Dallat] in the Chair)

During the debate, I shall refer to the cases of young people who recently died as a result of suicide. I offer my heartfelt sympathy and condolences to their families. I hope that they will understand that I am referring to their loved ones in order to bring about action that will help to prevent other young people and their families from suffering in the same way.

Last week, several young people died as a result of suicide in west Belfast. That is more than a tragedy. At least two of those young people were being treated for mental-health difficulties. One of them, Bronagh Gallagher, was the teenage mother of an 11-week-old baby. Bronagh had struggled with mental-health difficulties and had been admitted to hospital twice — in June 2006 and at Easter 2007 — following paracetamol overdoses. When Bronagh died last week, she was still waiting to be referred to a psychiatric nurse. The tragic loss of Bronagh’s life may well have been prevented if the North had the type of mental-health services that she needed, which offered the support that could have helped her through her difficulties.

Members will be painfully aware that our communities have been struggling for quite some time with the suicides of young people such as Bronagh.

In 2005, Daniel McCartan died as a result of suicide on the evening of the day on which he had requested to be admitted to psychiatric care. His request was refused because he was considered to present a low suicide risk and no adolescent in-patient beds were available. A complaint lodged by Daniel’s parents is being investigated. The results of that investigation should be reported soon, which, hopefully, will shed more light on what can be done to prevent such tragedies.

Between 2005 and 2007, what has changed for those young people who badly need access to professional care and support? The Bamford Review has been initiated, a suicide strategy has been formulated, and there has been a small injection of funding, but it appears that, in practical terms, very little has changed. I am gravely concerned about our ability to provide the services needed by children and young people who face mental-health difficulties.

In 2005, 213 people died as a result of suicide in the North. Of those, approximately 35% were aged between 15 and 34. In 2006, there were 291 reported suicides. West and north Belfast have some of the highest levels of suicide, with the rate in west Belfast standing at twice the regional average. Make no mistake: that experience is not limited to the North — it affects communities across the island.

There is a dearth of adolescent inpatient beds in the North, as well as in the Twenty-six Counties. In each year from 2002 to 2006, 60 or more local young people had to be placed in adult psychiatric wards because of a lack of appropriate beds.

The local child and adolescent psychiatric inpatient unit cannot operate at full capacity because of a lack of trained staff. There is evidence that, even now, the unit is operating under strained staffing levels that prevent it from using all its available beds and providing adequate staff cover for lunch and breaks. I commend the staff of the unit because they are working under enormous strain. I heard this morning that, on several occasions, no female members of staff are on duty, particularly during the night.

Added to that, and equally worrying, are reports that some of the anti-depressants prescribed for children and young people may have adverse effects and increase the risk of suicide. Surely the Minister will agree that we need an urgent review of the drugs that are prescribed to young people under the age of 18 and the impact of those drugs.

In January of this year there were 30 vacant posts in the mental-health profession, specialising in the treatment of adolescents. That requires a radical and urgent response. The response that young people need is much more complex than solely increasing the number of psychiatric beds or the number of health professionals — necessary though that may be.

It is estimated that 10% to 15% of adolescents face mental-health difficulties; locally, that means about 16,000 children and young people. However, only a tiny minority will need the sharp-end psychiatric services because many community-based services, if provided early, will make a real difference. It should be — and is — possible to provide the kind of care that young people need. The Assembly knows that the difficulties with Child and Adolescent Mental Health Services (CAMHS) are not simply at the sharp end but also in the wait for appointments and in providing young people with the kind of early intervention that can prevent at least some of them from needing more intense services.

Often, that requires a catalyst in the system that can co-ordinate and enable access for young people, and that needs to be developed and supported at community and family level. We need a focus not simply on mental health but also on emotional well-being. Good emotional well-being and mental health means having the capacity to build positive relationships and to cope with the ups and downs of life; it means young people being able to realise their potential and having the opportunity to develop emotionally and socially. We need to consider the whole of young people’s lives and not just focus on particular disorders or treatments.

There are proven models. For example, the Mount Sinai Medical Center in the United States offers a service that is centred on the young person: even if young people attend with a physical condition, they are offered a full review of their mental-health needs. That results in those needs being addressed quickly and successfully.

There is a need for both community-run mental-health services and more specialist tier three medical units to integrate and triage their provision. We have, at times, two tandem services: GPs refer to child and family clinics; and social and community services use community-based mental-health services. For example, community and voluntary organisations used to be able to refer a young person straight to CAMHS. Now, however, the pressure on the system is such that no new referrals are being taken and the community services are having real difficulty in accessing services. Children using triage need the right service at the right time.

I recognise that the Minister has just taken up his post and I want to thank him for attending today’s debate. However, I am sure that he will feel the tragedy of the situation affecting young people and recognise the need for urgent action. Although the outworking of the Bamford Review will make a difference, its sheer complexity and volume mean that we could lose sight of the urgent action that is needed now. Since the Minister is here, I want to ask him some questions.

Does he agree that there is a need for the following actions: an urgent review of the anti-depressant drugs that are prescribed to those under the age of 18 to ensure their safety; the development of a regional service that draws on international best practice for children and young people at risk of suicide; workforce training and development for all staff in the health and personal social services and in schools and youth and community work so that they can be a point of contact for young people at risk of suicide or with mental-health problems?

Does the Minister agree that there is a need to increase the resources available at community level for early intervention prevention services? Will he agree to look at the better integration of community and medical services? Will he ask the Regulation Quality and Improvement Authority to carry out a review of CAMHS provision at the Knockbracken Healthcare Park? Will he immediately address the staff shortages that prevent the full functioning of the child and adolescent inpatient unit at Knockbracken? Will he make funding available for the development of a full range of services and ensure that it is ring-fenced so that the funding cannot be used for other services?

I also encourage the Minister to consider the development of a children’s task force for areas of high deprivation where children and young people face severe problems. Organisations such Barnardo’s have been promoting that for some time.

I have asked the Minister several questions; I hope that if he cannot answer them today, he will read Hansard tomorrow and get back to me on some of those issues.

3.15 pm

There are Members still to speak in this debate who have, for a long time, championed the rights of children and young people. I hope that they will support the motion.

I beg to move the following amendment: At end insert

 “and provide an action plan with a timescale for implementation.”

My amendment calls for an action plan with a timescale and targets for implementation of the proposals contained in the Bamford Review. Its purpose is to add sharpness and focus to the motion.

Our community is emerging, slowly and painfully, from more than three decades of intense civil strife. There has been a significant fallout for our young people as a result of the killing of 3,700 people in our conflict and the injuries and trauma suffered by more than 30,000 others. Children and adolescents have either themselves been victims or have watched our society being brutalised. A breakdown of law, order and family values has occurred in many areas. We are reaping the whirlwind, and that price will continue to be paid by the vulnerable in our society, and those vulnerable young people who, even in a peaceful society, may find it difficult to get a decent start in life.

Before I entered politics I was employed as a registered nurse and midwife. I worked in the casualty department of the Mater Infirmorum Hospital through most of the Troubles. More recently, however, I worked for the South and East Belfast Health and Social Services Trust. Its headquarters are at Knockbracken Healthcare Park, which was formerly known as Purdysburn. That word still strikes a chill in the heart of many people of my generation, who grew up with a feeling of stigmatisation about mental health. As children, we were warned that we could be sent to Purdysburn.

The Bamford Review and other reports have, thankfully, shed some light and fresh air on mental health and have helped to destigmatise it. However, even in recent times, separate provision has not been available for children and young people with mental-health issues. Many still have to share wards with adults, and with psychiatric patients, often with far more serious conditions.

The Bamford Review made it clear that, because of Northern Ireland’s higher levels of social and economic deprivation, its civil strife and the higher prevalence of psychological morbidity in adults, the incidence of mental-health disorders in children and adolescents in Northern Ireland is greater than in the rest of the United Kingdom. The Chief Medical Officer for Northern Ireland, Dr Michael McBride, has reported that more than 20% of our young people suffer significant mental-health problems before they reach 18 years of age. That encompasses young people with eating disorders, substance and alcohol abuse problems, and with developmental difficulties often associated with mental-health issues. As Sue Ramsey said, it includes those at risk of suicide and young people who have committed suicide. We must explore the underlying factors in order to reduce and prevent any more of those awful tragedies.

In recent years, there has been a huge increase in cases in all of those areas, which underlines the urgent need to put an action plan in place with a timescale and targets. The Bamford Review did an excellent job in setting out the required actions. Now we must set aside the resources that will make those actions a reality and in an achievable timescale. I am sure that some Members know of the problems that are caused when no bed is available for a young person suffering an acute mental-health crisis. He or she is either not admitted to hospital at all, or is not admitted to the most appropriate setting. It is never what is best for that young person.

The Department of Health, Social Services and Public Safety and the trusts are aware of those problems, and more beds are becoming available.

I am not sure that the exact number of beds required has ever been quantified, but it must be done. The level of provision needed will become more apparent when other parts of the strategy, including good mental-health promotion and early intervention within the community, are in place. When that happens, it will be easier to quantify the exact number of acute beds required.

More importantly, as with healthcare in general, prevention is better than cure. We must get to grips with and tackle the causes of mental-health problems in young people. Early intervention, at a stage where the impact of the illness on the young person may be less severe and where there is a far better chance of early recovery, is necessary. The positive health agenda must be tailored towards the needs of young people so that more of them will never have to consider using and abusing alcohol and substances.

Many in society are obsessed with celebrity, body image, competitiveness and consumerism, with the aim of making some people a lot of money. Many of those obsessions can impact badly on young people — who perhaps do not have much self-confidence to begin with — lowering their self-esteem. Parents, educators and anyone who is in contact with children need to spend more time listening to them. That issue will feature in this afternoon’s debate on children who are looked after by the state.

The Bamford Review mentioned at length the need for professional staff and training in the education sector, because schools have been found to have been very effective settings for intervening in aggressive and acting-out behaviours and involving pupils in initiatives to promote better behaviour. In order for schools to play an effective role, teachers need greater access to training in the skills and knowledge necessary to address the mental-health needs of young people, including fostering good mental health in the classroom and knowing when pupils need to be referred to more specialised staff.

Where appropriate, mental-health professionals should work in schools, providing help to individual children who are beginning to show signs of mental-health difficulties. Those difficulties sometimes arise because young people are vulnerable, perhaps due to domestic violence, bullying, parental alcohol and substance abuse, and family separation. Providing well-delivered services can help young people to develop coping skills. That requires the Department of Health, Social Services and Public Safety and the Department of Education to work together.

The need for the training and development of the workforce that delivers mental-health services is covered in detail in the Bamford Report. Qualities such as a positive attitude and sensitivity must be developed. Although caring for young people with mental-health problems can be very challenging, it is also very rewarding. Good working conditions for staff are imperative, as is appropriate, regular and updated training.

I wish to refer to the rights of the child in relation to the issue of mental health. The United Nations Convention on the Rights of the Child has been ratified by the UK Government, and its principles and practices must be the basis of all our actions. The UN Convention gives children the right to the highest attainable standard of mental-health care that is culturally and medically appropriate and is provided in a safe environment. Mental-health provision should not discriminate, but should always be in the best interests of the child, and the child’s view should be respected.

I appreciate that the Minister is still getting to grips with the most complex of all Government briefs, of which mental health is a specialist area. I wish the Minister well in his term of office, and all Members will wish to be supportive. After responding to the motion, I hope that he will bring a detailed action plan and appropriate timescales before the Assembly in due course.

I add my condolences to those already expressed to all families in Northern Ireland who have suffered the tragedy of a suicide. Suicide knows no barriers, be they of religion, colour or creed.

Most Members agree that the entire area of mental-health provision is abysmal. A root-and-branch reform to tackle the deficit of provision across all areas of mental health, including for depression, anorexia, potential suicide victims, self-harmers or children who are abused and at risk, is required.

The key theme of the Bamford Report for children and adolescents is the development of a holistic and integrated mental-health service for children and young people that crosses organisational and institutional boundaries. Closer partnerships and better working relationships will be vital if such a vision is to succeed.

I want to take this opportunity to concentrate on the role that collaboration with the education sector can play in child and adolescent mental health. The Bamford Review’s July 2006 report — ‘A Vision of a Comprehensive Child and Adolescent Mental Health Service’ — recognised the important role of the education sector and its interface with children and young people. It was recommended that the Department of Education and the Department of Health, Social Services and Public Safety should aim for greater co-operation in planning and commissioning services in mental health and education — even through the establishment of firm interdepartmental links.

Schools have been found to be very effective settings for intervening in aggressive and acting-out behaviours, as was recognised in the Audit Commission’s report ‘Misspent Youth’. The crucial contribution that could be made by people in the education sector — both in schools and in youth services — must be appreciated. Partnerships with other agencies will enhance the effectiveness of school-based interventions and are to be encouraged. Practitioners in education need to have greater access to knowledge and to training in the necessary skills to allow them to address the mental-health needs of children and young people. Such skills will include the fostering of positive mental health in the classroom and awareness of when it is appropriate to refer someone on to more specialised staff.

Another recommendation in the Bamford Report was that a study of the mental-health needs of children in Northern Ireland should be commissioned as soon as possible; otherwise, we will not have the most reliable information for the planning of services. The Hardiker model of four levels of need is used extensively in the planning of children’s services; the Bamford Review proposed a similar four-tier model. An opportunity exists for health and social services planners and commissioners to co-ordinate their services much more effectively. That would encourage the development of common language across the services in social care, education and mental health.

It was suggested that the promotion of mental-health services, and the prevention of mental-health problems, in the school setting should be developed across all schools to include independent schools’ counselling services, the health-promoting school and pastoral-care initiatives. There is a need for educational, health and mental-health professionals to work in schools to provide early assistance for children who are beginning to show evidence of mental-health difficulties. Independent schools’ counselling services provide children and young people with a listening ear and someone to turn to in the school setting. Those services provide accessible one-to-one support for vulnerable children and young people in coping with a range of issues including domestic violence, bullying, parental abuse and family separation.

This topic is so vast and wide that five minutes is insufficient to consider all the problems that we all acknowledge exist within the mental-health structures. However, when the Committee for Health, Social Services and Public Safety sits, I would like to think that it will undertake an in-depth review of the outpourings of the Bamford Review and that it will hear from the people delivering the services at the coalface about what they think of the Bamford Review.

When Members consider how to tackle and treat mental-health problems, we can see that one of the biggest problems is found in society itself; and when we remember that the answer to mental-health problems in the Victorian age was to lock people away, and when we realise that there may be a patient in Northern Ireland who has spent the past 38 years in an institution, we begin to realise that the difficulties remain.

The existing mindset is one of the greatest challenges to attempts to change attitudes to mental health.

Those who were involved in the development of the Bamford Review believe that it lays the foundation for future policy in Northern Ireland. It is one of the most important policy papers to be produced during the last two decades on the treatment of children and adolescents. The review recommends not only an aspirational framework, but a practical set of guidelines that should govern how we assess the success or failure of the treatment of young and adolescent mental-health patients. The proposer of the motion painted a vivid picture of the difficulties that are experienced by families affected by teenage suicide, which makes one realise that the time has come for politicians to take this matter seriously and to do something about it.

We have undoubtedly inherited a legacy of neglect, but the Bamford Review shows where we must travel. Now that we have assumed responsibility for our own affairs, we must strive to make the Bamford Review a reality, instead of an aspiration. The norm should be individualised, comprehensive, inclusive services with minimum restrictions, a family focus, early intervention, a guaranteed transition between child and adult stages, and a case-management approach. Make no mistake: that will take time.

There are major cultural requirements. A widespread understanding of mental disorder is required, which must include an understanding of the differences among mental problems, disorders and illnesses; the grades of severity and recurrence among those states; what constitutes normal and non-normal behaviour; and the importance of environmental factors in the treatment and diagnosis of problems. Above all, we need understanding and tolerance, and an open-minded and positive approach.

Mental-health issues recently hit the headlines due to the Muckamore case, on which I do not wish to dwell. However, that case taught us that there was a problem in the system. Members must be vigilant and ensure that there are no more hidden defects.

The Chief Medical Officer has estimated that one fifth of all young people suffer significant mental-health problems by their eighteenth birthday. It has also been estimated that 45,000 children and young people, aged five to 15, suffer from moderate to severe mental problems, and that 340 of those people should be hospitalised to some degree.

Of the young people suffering from mental-health problems, 38% are homeless. That brings a new dimension to the problem because history and statistics have proven that young people who suffer from mental defects experience a series of mental problems later in life. Furthermore, children with learning disabilities are more vulnerable to the full range of mental disorders, and it is believed that one in 10 children indulge in self-harm. It is sobering to think that one in six people who were killed during the Troubles were under the age of 19. The time has come for Members to take this matter seriously and do something about it.

As an Alliance Party representative on the all-party group on mental-health issues, and as an ardent supporter of the recommendations contained in the excellent Bamford Review, I support the motion and the amendment. Everything that can be done to improve mental-health provision for children and adolescents in Northern Ireland must be a priority for the Department of Health, Social Services and Public Safety.

As Members have said, the 2006 Bamford Review contains many recommendations. Paragraph 4.6 states:

“The Department of Education and DHSSPS should set up an inter-departmental group to facilitate joined-up planning and commissioning of services in mental health and education”.

Recommendation 2 states:

“A study of the mental health needs of children in Northern Ireland should be commissioned as soon as possible.”

That recommendation is based on paragraph 3.68, which states:

“One of the targets set in the CAMH policy statement was that a commissioning strategy for delivering services based on identified need, and meaningful and measurable objectives should be in place by 1 April 2000. While there has been some progress towards a commissioning strategy the issue of properly identifying need was never addressed.”

As has already been said, the Northern Ireland Commissioner for Children and Young People (NICCY) has highlighted the importance of the United Nations Convention on the Rights of the Child, which has 54 articles and was ratified by the UK Government in 1991. Article 27, paragraph 1, states:

“States Parties recognize the right of every child to a standard of living adequate for the child’s physical, mental, spiritual, moral and social development.”

The Government are responsible for assisting parents and other persons who have responsibility for children to implement that right. Carmel Hanna referred to that issue in her contribution.

It has been noted that children who live in deprived areas are very vulnerable. Save the Children launched the annual child poverty report for 2007, ‘A 2020 Vision: Ending Child Poverty in Northern Ireland’, in this Building today. It refers to the Department of Health, Social Services and Public Safety’s ‘Investing for Health’ 2006 update, which offers section 75 analysis of suicide and self-harm in Northern Ireland. There is much to be gained from reading that report.

Many Members have referred to the Bamford Review, and I cannot praise it highly enough. Recommendations 5 and 15 are important on the issue of child provision in mental-health issues. Recommendation 5 states:

“Practitioners in education must be given training in the necessary skills and knowledge to address children’s and young people’s mental health needs, including fostering positive mental health in the classroom, and referring to more specialised staff when appropriate.”

Recommendation 15 states:

“Mental health promotion and prevention in the school setting should be developed across all schools to include Independent School’s Counselling services, the health promoting school and pastoral care initiatives.”

Members had the pleasure of debating the Bamford Review in the Transitional Assembly. Every party agreed that, when we are in a position to do so, we should implement the review. The Minister of Health, Social Services and Public Safety is still in the Chamber, and I implore him to implement the review when he has the opportunity to do so. That implementation will take some time, but we must make a start and be seen to do that.

Northern Ireland needs more professional staff and funding for good mental-health provision. For too long, mental health has been the Cinderella of the Health Service, a fact that has been acknowledged by everyone involved in mental-health issues.

I offer my sympathies to the proposer of the motion, Sue Ramsey, who has experienced suicide in her area. Throughout Northern Ireland, we are all affected. In my constituency of Strangford, there has been a number of suicides.

The Member’s time is up.

Am giein ma’ bakin tae tha ammendement an aa’ unnerstaun that tha topick is emoativ an taks in a wied range o’ issues an proablims.

Tha issue o’ “inpatient caer” is sumthin aa’ wush tae haylicht especially as it hiss’ bin broucht tae my attentshun by my constituents twa mony tiems in shokin an sad waes.

But nae metter aboot tha different coverin o’ tha single proablim tha unnerlyin issue still houls aa’ disturbinly saem soart o’ theem – an that is aa’ lack o’ suppoart.

I support the motion completely. This emotive topic spans a wide range of issues and problems. I wish to highlight the issue of in-patient care, because my constituents have brought it to my attention in shocking and saddening ways too many times. No matter how it is cloaked by the individual problems, the underlying issue retains the disturbingly similar theme of a lack of vital support.

I want to dwell upon the issue of children with autism, as the lack of time allocated to this debate prevents me from highlighting all the issues that I would like to. I am familiar with the scenario of the care of one autistic boy. His parents do everything for him — they wash him; dress him; cook for and feed him; they clean, bath and toilet him; they amuse him; and they hug, kiss and love him. He depends on his parents for his every need. When he is at school, they do the washing, ironing, cleaning, shopping and try to find time to work in order to pay the bills. They love their son with all that they have and all that they are, but, sadly, love is not enough to get the family through the sheer exhaustion and the emotional and mental strain.

It is up to the community and to us as elected representatives to step up to the plate and help that boy and his parents. We can do that by supporting them and offering them the best that our society can to ensure that they do not reach the point of no return.

The major problem with the current system is simply that there are not enough places available. That is an issue worth highlighting too. It is estimated that one in 100 children has some degree of autism. That means that more than one in 100 parents has the additional stress of caring for a child who needs extra care and attention. Depending on the severity of the disability, that care can range from helping with a few extra hours of homework to doing everything for the child for the whole of his or her lifespan, which is likely to be just as long and healthy as anyone else’s.

For example, I know one family with an autistic son and two young daughters. The mother, who gave up her job to care for the family as best as she could, applied for respite care to enable her to take a break and spend time with her other children. She was put on an emergency waiting list, but, two years later, she still has not had a weekend off. For three hours a week, a trained professional provides care for her son to allow her to spend time with her daughters, but that is the sum of her relief.

She has sought help from all the organisations and charities, such as Home-Start, and they have tried to help. However, the crux of the matter is that the volunteers are not trained to deal with her troubled son. Autism is a severely misunderstood condition, and only trained professionals with patience and understanding know how to deal with autistic children. Even those who are trained can find the work a strain, due to the unpredictable nature of the disability.

There will not be enough resources to deal with the ever-increasing numbers of children suffering from autism. The Welsh Assembly has found that the number of children diagnosed with autism in Wales has increased by 124%. I might table a question to the Minister concerning the figures for Northern Ireland, because I believe that there has been an equal increase here.

There is no long-term plan in place; there is insufficient funding, and, therefore, there is no hope for the parents and the children. To be forewarned is to be forearmed. The number of children with autism is rising, and we sense the effect that that is having on society and on individuals. I cited two examples of families in my area who are suffering. We must stand up for those people and develop a plan so that we and the Department of Health, Social Services and Public Safety can do everything possible to help.

These families are not asking for much. They are not asking for more than they are entitled to. We are being asked to give them only what they need and what we can provide, which is support. I therefore support the motion.

Mr Deputy Speaker, I congratulate you on your elevation to high office. I know that you are very capable of carrying out the duties of your new post.

I share the concerns of those who have already spoken in this debate. The current poor state of the child and adolescent mental-health service is unacceptable in twenty-first century Northern Ireland. The lack of trained staff to run mental-health services, coupled with the lack of child and adolescent inpatient beds, is appalling. I accept that no single agency can deal with these problems on its own, but as a matter of urgency I call on the Minister of Health, Social Services and Public Safety to meet with the various agencies with an interest in this in a bid to resolve this crisis while, at the same time, keeping within the recommendations of the Bamford Review.

Some months ago, I attended a school in Dungannon for the education of mentally handicapped children and adolescents. On my arrival, I met a young lady with triplets of seven- or eight-months-old, one of whom was mentally handicapped. She handed me the child, which I held in my arms. I knew what the child required in terms of funding and support methods. Yet when the child’s mother asked me about funding and support, I could only state what was currently on offer, and it was pitiful, to say the least, that I had to tell her that there was little or no help available. I vowed that day that if ever I got into a position where I could help in the area of mental health, I would do my utmost.

This situation is untenable. We must never forget that we are talking about human beings, and we are obliged to note that we, as elected representatives, have the ability to help as the terms of reference of the Bamford Review state:

“to recognise, preserve, promote and enhance the personal dignity of those with mental health needs”.

At some time in their lives, one in four people will be affected by mental illness, which is the equivalent of 27 Members out of the 108 in this House. That is a shocking statistic. Carers of those with mental-health needs must not be forgotten — they continue to play a key role in caring for those in our society with mental illness. Carers and their work are often forgotten. If we are to solve these problems, carers should be afforded the right to make an input, as they have the experience and understand what needs to be done. We must provide immediate solutions that are imaginative, practical, even radical, cutting right to the heart of the matter and meeting the needs of all those with mental illness. This can only be achieved with collaboration and co-operation with all relevant stakeholders, from both inside and outside the health and social services sector.

The solution must, in all ways and at all times, reflect the needs of the children and adolescents with mental illness.

I am pleased to support the motion.

It was said earlier that this is a very complex issue, and that is no exaggeration. First of all, I put on record that I am committed to improving the mental-health services for children and adolescents. It is essential that our children and young people receive mental-health services that meet their needs, and that is why I intend to implement the recommendations of the Bamford Review for children and young people. Indeed, I accept all of those recommendations.

As Members are aware, the full report of the Bamford Review is due to be published this summer. However, the section dealing with children and adolescents was published last July, and some of its recommendations have already been implemented. It is clear that prevention will be the key element in improving services for children and adolescents. Indeed, the Bamford Review revealed the staggering statistic that more than 20% of young people could have significant mental-health problems by their eighteenth birthday. It estimates that 45,000 children and adolescents in Northern Ireland, aged between 5 and 15, could have a moderate to severe mental-health disorder that requires intervention from specialist child and adolescent mental-health services. The estimates also suggest that around 340 children and adolescents need inpatient services.

Those statistics give some indication of the size of the challenge that we face. Of course, mental health has been the Health Service’s Cinderella service since time immemorial; indeed, Bob Coulter talked about the Victorian approach of locking people away in their hospital beds. However, we have moved slowly away from that culture.

The statistics highlight the extent of the problem that our young people face, and they also make clear the need for all of us to take sustained and determined action. After all, children are our future, and if people are our biggest asset, then children are of utmost importance. They are our responsibility. We want to prevent young people from suffering as a result of mental-ill health, and we want to promote good mental-health by providing accessible and effective treatment services. We can do that by developing a comprehensive and high-quality range of services, from early intervention right through to specialist inpatient treatment. If we have effective services upstream when young people first face mental-health problems, we can reduce the risk of those young people’s developing more serious problems that require inpatient hospital treatments at a later date.

Some Members may be aware that the post of director of mental health and learning disability, the establishment of which was a key recommendation of the Bamford Review and which was announced in March last year, has now been advertised twice. Although interviews were held in March, we have been unable to appoint anyone to the post. In order to avoid any further delay, I have made the key decision to not advertise the post nationally and regionally again but to appoint immediately a board of experts who will advise ministerial colleagues and me about the implementation of the Bamford Review. That board will fulfil the role of the director.

As Members are aware, mental health and learning disabilities are two distinct streams, and this board can act as a champion for both streams — a new mental health and learning disability board to give greater impetus to the Bamford agenda. The Bamford Review will finally deliver in full this summer. The role of the board will be to challenge my Department and others who provide these vital services to some of our most vulnerable. Until the post is filled, Bamford will not be driven forward seriously enough.

I hope that that step will go some way towards meeting some of Carmel Hanna’s concerns about implementing an action plan. The board will drive the process and will challenge my Department. Having a body of experts to advise me on mental-health issues reflects the fact that we are making a priority of this issue, and it shows clearly that it is a complex and diverse subject that needs urgent attention.

The new arrangement will ensure that innovative thinking and different perspectives will be brought to bear on many issues. I have asked officials to let me have proposals on how we will put this in place, and I expect to see that work completed quickly.

It is no secret that there have been, and continue to be, difficulties in the local statutory provision of specialist mental-health facilities for children and young people. Sue Ramsey made the point that there are difficulties in accessing appropriate treatment and that when inpatient treatment is necessary, the shortage of beds has been a problem. Currently, there are 15 available beds for young people up to and including the age of 13 in the child and family centre, and eight beds in the interim unit at Knockbracken.

As Members know, there have been major problems at Knockbracken, not least of which was that it took until 2006 to recruit a replacement for the consultant who was suspended in 2004. At one stage, when one unit was closed down as a result of that suspension and another had been burned in an arson attack, there were no beds available for adolescents. That major shortage of beds is being rectified, but not quickly enough. By the summer, 12 additional beds will bring the total number available to 27.

In addition, the health and social care trusts are taking steps to deal with recruitment difficulties. Highly specialised skills are required, and the trusts are striving to bring staff levels in the units up to the necessary levels. It is often a question not of finding beds but of sourcing the staff to man them.

Progress is also being made on two new specialist mental-health facilities at Forster Green Hospital, for which significant investment plans are in place. The one for adolescents, costing around £5 million, will replace the existing facilities and provide 18 beds. The second facility will replace the current child and family unit and will have an important educational facility and a specialist psychiatric hospital for children. It will also replace an existing 15-bed unit, giving an anticipated total of 33 beds by 2009, which is well within the range suggested in the Bamford report. However, the report also stated that the number of beds should be reduced and that ways should be sought to deal with mental health conditions outside the hospital environment, with inpatient care as a last resort. The conclusion of the reassessment was that 33 beds would be sufficient for the community service infrastructure, and that is the situation as is stands. I accept that it is not wholly satisfactory, but the focus is on early interventions to reach children with mental-health problems at the earliest stage, and the recruitment of staff with appropriate skills will be crucial in achieving that.

No one can deny that mental-health services for children and adolescents have suffered from chronic underinvestment. That must change. Significant funds are being, and must continue to be, invested. New money has come from the children and young people funding package, and another key factor to come out of the Bamford Review was the establishment of crisis intervention teams.

To some extent, that relates to the point that was made about urgent intervention and action to prevent suicides. One such team is already in place in the Eastern Board area and encompasses several skills. The first of the crisis intervention teams, which will have the ability to treat patients immediately or involve other specialists as necessary, will be operating by June 2007. It is hoped to increase the number of teams to one per board in order to provide immediate intervention, help and referrals.

Those proposals do not provide all of the answers, but they show that steps are being taken and that the situation is being addressed. Crisis intervention teams will assist in providing appropriate, timely clinical intervention for young people, with the aim of preventing patients’ problems from developing into more serious conditions. In some cases, they will remove the need for inpatient admissions. Around £500,000 is being channelled into the crisis intervention teams for 2006-07, and a further £1 million will be invested in the following year.

Although there have been some difficulties in recruiting staff, the boards have used in-year funding to improve other services to children and young people with mental-health problems; for instance, waiting lists have been addressed. Waiting lists are too long, but I am told that they have been halved in the past two and a half years. At that time, over 1,000 young people were awaiting a first appointment, but that number has been reduced by half. The waiting lists remain too long and are unacceptable, but progress has been made.

Mrs Robinson mentioned the important role that schools have in promoting mental-health services. Additional money has been provided from the Department of Education, through the children and young people’s fund, to provide counselling support to pupils so that problems are identified and dealt with as early as possible. Funding of £750,000 was provided for 2006-07, and £1·8 million is being invested in 2007-08. That investment has enabled all post-primary schools to have access to counselling. I share Members’ concerns about the need to do more to develop those services, and I will ensure that those issues are urgently responded to and treated as priorities.

As Members know, the Bamford Review has a major resource implication. Total funding for mental health in Northern Ireland is around £175 million per annum. The Bamford Review conservatively estimated that that figure needs to be doubled. The additional funding will not be granted in one year, because the required staff skills are not available, but that is the level of resource implication involved. However, we must make provision for those funds. We are doing approximately half of what needs to be done, and our efforts need to be literally doubled.

I accept the Bamford Review and its recommend-ations. I share the concerns of the proposers of the motion, and of the amendment, and the other Members who have spoken. I will seek to ensure that the Department performs appropriately and shows urgency in dealing with the issues that have been brought before the House. I have stated some of the measures that are being brought forward, but there is still much to do.

All parties in the Transitional Assembly welcomed the publication and recommendations of the Bamford Review, and we all shared the dismay of mental-health practitioners, sufferers and their carers at the failure of direct-rule Ministers to give any additional financial resources to implement the recommendations. I thank the Minister for attending the debate. Such a show of support already shows the dividends of a devolved Assembly. Across Northern Ireland, there are high expectations that the devolved Assembly will listen to, and act in the best interests of, the people.

Several Members talked about the conflict and its impact on the mental health and well-being of our children and young people, as did the Bamford Review. It is unfortunate that neither the First Minister nor the Deputy First Minister was able to secure any additional funding for a peace dividend to look at the emotional, psychological and physical needs of our children and young people.

The SDLP has no difficulty with the content of the motion, but we were concerned that, similar to the Bamford Review, it did not set out a clear action plan with detailed objectives to be achieved within a reasonable time frame. The Bamford Review on child and adolescent mental health services contains a number of recommendations that do not necessarily require additional funding, but rather new ways of working.

We heard the Minister referring to the unfortunate failure to have the new director in place in March 2007. However, I welcome his commitment to having a panel of experts. My only plea is that they should be real and true advocates and not be tied to a trust, Department or board for any source of funding — they should be true advocates for the people who are suffering.

The Bamford Report sets out a four-tier approach to working together, and we have heard many Members speaking about the need for collaboration between the Department of Health, Social Services and Public Services and the Department of Education. Indeed, the Minister has also given a commitment to having more coherent working in his Department, as regards health and social services personnel, as well as interdepartmentally.

Levels of deprivation are much higher in Northern Ireland, and there is also poverty. One Member mentioned the launch of the new report from Save the Children, the fact that 100,000 children are living in poverty in Northern Ireland and the impact that that has on their mental, emotional and psychological well-being. However, the report also refers to funding deficits, and the Minister has said that we are only half way towards getting the funding that is needed.

Many Members highlighted personal experiences and have spoken well about the people they have known as friends, neighbours and children who took their lives because of poor mental health and, perhaps, other factors. Everyone in the Chamber can relate to someone who has taken his or her life, and it is unfortunate that services were not there at the point of need, and that not enough beds were available. I welcome the fact that the Minister has said that additional beds will be made available. However, as he rightly said, there will still not be nearly enough.

Specialist beds are required for different conditions. Members talked about the particular needs of carers — for example, those who care for people with autism and other learning disabilities. Although there is a need for inpatient services and treatment intervention, respite for carers is needed also. When the Minister is looking at the provision of services, I trust that he will look across the whole of Northern Ireland and, in particular, to the region west of the Bann. Parents who may have other children, and other caring responsibilities, should not have to trek across to Belfast on a regular basis to visit their children.

The Minister outlined clearly a number of actions that he is already taking. In fairness, and given that the Health Service is complex, he does seem to be hitting the ground running, and I congratulate him.

However, perhaps he will confirm that one of the key recommendations of the Bamford Report was that a study of the mental-health needs of children in Northern Ireland should be commissioned. That is long overdue, and indeed some work and a report were to have been completed by 2000. Planning to meet needs must start from a baseline, and I ask the Minister to ensure that commissioning that study will be one of the key actions he will take on board quickly. I trust that he will report progress to the Assembly at the earliest opportunity, and well within the year.

Go raibh maith agat, a LeasCheann Comhairle. I am delighted to hear the Minister’s remarks about the Bamford Report, and that he accepts the report in its entirety. That is very welcome.

Every Member who spoke in the debate has pointed out the lack of attention that has been given to services for children and young people. There has certainly been a lack of coherent planning and investment.

Our higher levels of deprivation have also been mentioned, and the legacy of 30 years of political conflict on mental health and emotional well-being has not yet been fully realised. Child and adolescent mental health services are wholly inadequate and have resulted in some of the cases that Sue Ramsey mentioned earlier. The difficulty is that young people and their families wait for months and sometimes years for appropriate treatment.

We have learned that young people are now being transported to England for treatment, with no regard being given to the social disconnection and distress that that causes them and their families.

Despite the practical and technical difficulties that the Minister outlined about securing staff and resources, the fact must not be ignored that that is a flagrant abuse of the rights of children and young people under the United Nations Convention on the Rights of the Child. The Assembly must ensure that everything that can be done will be done. It must invest heavily in mental health services for children and young people to ensure that that culture does not continue. Financial investment is needed, and many young people need individualised care. Pathways will evolve through the integrated provision of services that includes the Youth Justice Agency and other agencies from the education, community and voluntary sectors.

I accept the points that were raised by other Members, who acknowledged the role of the education sector at the interface with children and young people. That has been widely recognised. The Bamford Review recommends that the Department of Education and the Department of Health, Social Services and Public Safety should set up an interdepartmental group to facilitate and collaborate in that field. That group must be established as soon as possible. The Minister of Health, Social Services and Public Safety must contact the Minister of Education on the matter forthwith.

Much has been said in the debate, all of which is welcome. Members are encouraged by the Minister’s prioritisation of mental health for all and, in particular, for children and young people. I support the motion and the amendment. Go raibh maith agat.

Question, That the amendment be made, put and agreed to.

Main Question, as amended, put and agreed to.

Resolved:

That this Assembly expresses concern at the current state of child and adolescent mental health services, particularly the lack of child and adolescent in-patient beds and dearth of trained staff to run these services; and further calls on the Department of Health, Social Services and Public Safety to take urgent action to address this situation in keeping with the Bamford Review and provide an action plan with a timescale for implementation.