Ms Orla Gogarty:

I thank the committee on behalf of St. Patrick's Mental Health Services for the opportunity provided to our organisation to present today. In particular, I thank Senator Joan Freeman for her tireless efforts in bringing a spotlight to this very important and serious issue in our society. I am a director at St. Patrick's Mental Health Services, which is Ireland's largest independent, not-for-profit mental health service provider. It is committed to the provision of the highest quality mental health care, the promotion of mental health, advocacy and the protection of rights and integrity of those experiencing mental health difficulties. These principles are central to how we deliver care. Willow Grove Adolescent Unit, an approved centre for our organisation, provides inpatient care and community care through our Dean Clinic in Lucan for children between 12 and 18 years of age. It is the only child and adolescent mental health service in the country to provide service users with a dedicated advocacy service for young people to support them to assert their rights and entitlements while being treated for their mental health difficulties as an inpatient.

I wanted to state that, having looked at some of the submissions from last Thursday, much of what we have to say has the themes of resourcing, integration and systematic integration of how we approach this problem. There are a number of points we want to emphasise in our submission. A report on the implementation of A Vision for Change, produced by Mental Health Reform in 2015, outlines that progress continues to be hindered by shortfalls in staffing and the lack of a clear, integrated implementation plan. According to this report, the development of all areas of specialist mental health care delivery has been weaker than anticipated and, indeed, Dr. Geoffrey Shannon referenced there being much vision and less change.

This is especially true of child and adolescent mental health services. The fifth and most recent HSE child and adolescent mental health services, CAMHS, report, published in 2014, indicates that more than 100 children are admitted to adult inpatient units annually. The HSE performance report for October to December 2016 indicates that in excess of 1,250 children and adolescents waited for longer than three months for a first appointment, and that more than 200 waited for longer than a year. The report indicates that in 2016, of the children and adolescents admitted to inpatient units, only 69.2% were admitted to dedicated child and adolescent inpatient units, despite this being considered a priority issue.

The Mental Health Reform report on the progress of implementation of A Vision for Change outlines that there are no CAMHS-specific quality standards and guidelines and no quality and outcome monitoring system for CAMHS in Ireland. The report identifies that in March 2015, the operational capacity of the child and adolescent acute inpatient units was 58, out of a total existing bed complement of 66, and we know the trajectory in recent months has moved downwards again. A Vision for Change recommended 118 child and adolescent inpatient beds, based on the 2011 census population data. Dr. Brendan Kelly has spoken about the need to revise the proportionality of bed provision with regard to population growth.

The report further identifies a number of specific gaps in specialist services for children and young people, and a lack of capacity in primary care services - which we just heard about - to detect effectively, treat and refer appropriately child and adolescent mental health difficulties. In addition, a number of children are sent annually by the HSE to the UK, the USA and Canada for highly specialised inpatient treatments which are not available in Ireland. Apart from the HSE, independent service providers in Ireland, like ourselves, also provide inpatient services. St. Patrick's Mental Health Services also provides a community-based mental health care clinic, our Dean Clinic. Waiting times for admission to independently run inpatient services is short when compared with statutory services.

I will let our CEO, Mr. Paul Gilligan, speak.