Ms Kate Mitchell:

I will do my best to try to answer the committee's questions as comprehensively as I can. If I miss anything or if members have any follow-up questions, I ask them to come back to me.

Deputy Keaveney asked where we are at, and where we are going, with regard to A Vision for Change and its resourcing. The first thing we need to address is the huge challenge that is being faced in the recruitment of mental health staff. I refer particularly to child and adolescent mental health services. We know the HSE has been driving international recruitment campaigns. The number of people applying for nurse and consultant mental health positions, including child and adolescent mental health positions, on foot of those campaigns is relatively low. I will say a little more about that when I respond to Senator Burke's questions.

Another matter we need to look at is the recognition of some underdeveloped areas since the publication of A Vision for Change. There have been commitments to invest in the area of eating disorders for children and adolescents. We know this service will be part of the new children's hospital and that training for mental health staff in the area of eating disorders for children and adolescents has progressed this year. However, other areas of need have been somewhat overlooked, including, for example, mental health and intellectual disability. In A Vision for Change, approximately 15 teams were recommended to be dedicated for mental health of intellectual disability and yet we only have approximately four MHID posts in place. That is a significant issue. There is also the question of children and adolescents presenting with issues of dual diagnosis of mental health difficulties and substance misuse. Anecdotally, we hear stories from organisations and families to the effect that they experience major difficulty in accessing the mental health supports that children and adolescents require. A Vision for Change recommended that there would be two dedicated teams to address these issues but we have not seen the establishment of those teams. We still have a way to go in terms of developing specialist services, some of which have received little attention since the publication of A Vision for Change.

There is also the issue of developing capacity in other areas such as primary care. At the moment, there are major concerns to the effect that the capacity simply does not exist to detect mental health difficulties and refer patients appropriately. This even extends to concerns over awareness of other community mental health supports that may be of benefit to children and adolescents. The area needs significant investment and attention, as do other areas such as out-of-hours crisis services.

Members referred to the monitoring of what is happening in terms of service provision relating to mental health outcomes for children and young people. The standard operating procedures for child and adolescent mental health services, CAMHS, was published some months ago. These were developed for inpatient and community CAMHS. This was a major step forward in trying to standardise service provision for children and adolescents. We know that one of the bigger concerns is the variation in service provision for children and adolescents in accessing services throughout the country.

One of the questions is what should happen next. There needs to be implementation of these standard operating procedures throughout the country in all mental health services for children and adolescents. This is something the Children's Mental Health Coalition and Mental Health Reform will be keeping a close eye on. There is also a need for a system of monitoring appropriate outcomes. This has been recommended by the World Health Organization and is in line with international good practice. This is something the Children's Mental Health Coalition has been advocating. It is most important.

Deputy Ó Caoláin asked a question about early intervention. The area based childhood programme is funded by the Department of Children and Youth Affairs. It contains elements of mental health promotion and at a local level specific ABC programmes in certain areas have specific mental health programmes within them. However, we recommend that there should be a national roll-out of these. Moreover, there needs to be clear recognition of mental health components within early intervention programmes.