Dr. Shari McDaid:

I will respond in the order in which questions were asked. Senator Colm Burke asked where the staff shortages are but I do not have exact figures with me. He asked me a number of questions around figures and I would be happy to forward them to him after the meeting as I do not have all those figures with me. The staffing numbers, to which we refer when we mention a shortfall are the numbers that were developed by the expert group. In all of the international information on good practice that is available, there are not necessarily figures indicting that X number of doctors, social workers or occupational therapists are needed because it depends very much on the population, its needs, specific make-up in terms of, say, disadvantage and its age profile. We have a particularly young population and we might need more child and adolescent mental health services than other jurisdictions. It is not easy to do a straight like-for-like comparison in terms of this is what is provided elsewhere and this is what we should have. What we have is what the expert group came up with. This is the expert group appointed in 2014 to develop the mental health policy. It gave its considered and consensus views on what the staffing levels should be, and that is what we are working off now.

The percentage of the health budget that goes to mental health services in Ireland is still only about half of the percentage of the health budget that goes to mental health services in the UK. We must recognise that we are coming from a very long legacy of decline in spending on mental health services. In the 1980s, 13% of the health budget was spent on mental health and it is now down to 6% or 6.5%. I would have to check the most budget and once we have the HSE service plan for next year we will have a clear indication of where it is at for 2015. We still have a long way to go and for all the reasons I outlined earlier it has been very difficult to get an increase in spending because of the difficulties in recruiting and retaining staff.

Deputy Colm Burke wanted to know whether the difficulties in recruiting the staff arises from action not being taken by the HSE or from it not being able to recruit. It is a combination of both. On the one hand, the HSE has been very slow in deciding where it wants to spend the money. We know it is only as of September of this year that it was able to say that this is exactly where it wants to spend the 2014 allocation. We hope they will be in a much better position to know where it wants to spend the funding for 2015 but that is the third successive year the funding has been delayed, in part because the Health Service Executive has been slow to determine where to spend it. On the other hand, we have to take account of whether the recruitment package is attractive enough to get people into the service. That is a wider issue across the health service.

Deputy McLellan asked the reason we would have a shortfall of nurses but psychiatric or mental health nursing is a specialist discipline. We need people who are particularly trained in mental health nursing and, generally speaking, it has been difficult to recruit nurses.

Deputy Catherine Byrne wanted to know if there are any private agency nurses involved. My understanding is that to make up deficits agency nurses are used, but I do not know the extent of that at this time. I do not have a breakdown of that. We would have to go to the HSE to get a breakdown of the where we are at in terms of the waiting lists in the counselling and primary care service but if that would be helpful, we would be happy to seek that information. The Deputy wanted information on the fact that the majority of people who take their own life will have seen a health professional. I would have to double check that. I believe it comes from research carried out by the National Suicide Research Foundation but I will confirm that because I would like to be sure of the information I am providing.

I would agree with the Deputy that as we have travelled around the country, and we hold four public meetings every year to make sure we are hearing what is happening to individuals trying to access services and their family members, we have heard of good services being provided and the difference a good service makes. Where an individual has good access to a mental health nurse in terms of having their telephone number and being able to ring them whenever they are concerned, or where the mental health nurse gives a family member their telephone number directly so that they can access that kind of follow-on support after discharge from hospital, that is very valuable and appreciated and can work very effectively to keep well and out of hospital. I agree with the Deputy on that.

Senator Crown asked for some specific information, which I would be happy to provide at a later date. The numbers in A Vision for Change were set out by the experts involved in developing the policy, therefore, that is the basis upon which we are saying that there is a shortfall of psychiatrists. However, there is scope for looking at those numbers again with regard to Ireland's population to see if they need to be improved upon. The Senator asked about routine procedures referral by general practitioners into mental health services and the waiting period in that regard; I hope I am correct that this is what he asked. To clarify, if someone goes to a GP with an addiction they will not be referred to mental health services because there is a separation of services in Ireland between mental health and addiction services. That is a difficulty in that many people with mental health difficulties also have addiction issues that need to be addressed. That is something that needs to be examined.

In the adult mental health services I believe the target being worked towards in terms of people being seen is 12 weeks. That can be seen on the HSE's published information on its performance monitoring reports. It is working towards a target of 12 weeks, which is the reason it seems to take a long time to get access. However, this is the first time we have had a target and we need to consider now whether that target will be adequate. When a GP refers someone into a specialist mental health service he or she generally has significant concerns about that individual because only people with severe mental health difficulties are referred to the mental health services.

On the other hand, we need to provide more support to GPs in order that they feel more capable of responding and providing mental health support to individuals, both those at risk of developing a more severe mental health difficulty and those with mild to moderate difficulties. We are looking to some of the clinical care programmes being developed in the HSE to improve the supports to be provided to GPs. For instance, there are plans for an early intervention in a psychosis clinical programme within the HSE. A key function of that programme is to improve the consultancy support for GPs in order that where they are concerned that someone might be developing psychosis, they are quicker to refer the person to the mental health services but are also more able to provide a range of supports. The early intervention psychosis programme has been discussed for a couple of years and it needs to be implemented.

I think I have answered the question from Deputy Mitchell O'Connor about the waiting list for adult services. With regard to the number of suicide prevention organisations that have arisen in response to suicide in local communities, there is a difficulty with the co-ordination of those activities. We are looking to the new suicide prevention - what I hope will be a mental well-being framework as well - to address better co-ordination of the local initiatives on suicide prevention. It is widely recognised that while people initiate local programmes out of very sincere desire to improve the situation, there will be a better impact overall if those supports are co-ordinated throughout the country. We need to see in the new suicide prevention framework what specific actions will be taken by the National Office for Suicide Prevention to improve the co-ordination of those initiatives.

On the question of why support groups might not be available, co-ordination would help with that. With the launch of the Little Things campaign - I am wearing a Little Things badge today - the Samaritans have a phone number which is 116123 for people to call which has been provided to the Samaritans by the National Office for Suicide Prevention. This is a way of getting the message out to the public that there is a centralised highly skilled service available for individuals who are feeling like they are in danger of harming themselves. This initiative will be helpful.

In reply to Senator MacSharry about out-of-hours social worker access, the mental health policy sets out that every community mental health team should have a 24-7 intervention arrangement. It does not specify what that arrangement should look like. We consider it should be a combination of the seven day a week day hospital with telephone access to acute wards with good family education in order that families will know how to respond to a person in crisis, as well as home treatment in order that families are supported by intensive home treatment where a family member is going through a crisis period. Those are some of the components we would expect to see in a 24-7 service.

With regard to the ten suicide prevention officers being recruited, I do not have the exact number of existing suicide prevention officers but these ten would be additional-----