Mr. Jim Ryan:

There were two issues raised in regard to 24/7 cover. As mentioned earlier by Dr. Dodd, 73% of our services provide 24/7 cover. Where that cover is not available, the issue is staff recruitment and retention, which has been well rehearsed over the last two days. It is not the case that the HSE is not trying to recruit staff or that it does not have the resources to recruit staff rather it is that between nursing and consultants cover in particular it is proving extremely difficult to recruit in some parts of the country and in some of the roles. We have done recruitment internationally and a group will shortly go to Geneva for a conference on recruitment. We will work everybody and anybody on this issue. We have engaged with a number of different international recruitment companies. The problem is often that as staff numbers decrease, teams feel disempowered and disengaged and it becomes difficult to recruit. Our job, as part of the leadership that has been spoken about, is to rectify this. As mentioned earlier, there have been increases in the number of staff and likewise the number of referrals over the last five or six years. We are dealing with an increasing population, an increasing number of referrals and there are times when we have to try to ensure that the services we are delivering are being provided in a robust way 9 to 5, 7 over 7 and 24/7. In regard to a young person arriving at an accident and emergency department in the early hours of the morning, we accept that this is not ideal from the point of view of any young person's mental health.

We do try immediately to have an assessment done by a CAMHS team to ensure the appropriate treatment is provided as quickly as possible. The committee has seen from the figures that the numbers admitted to adult units have been reduced. There was an increase in the month of January of which we were aware. There was a particular reason for that. Some of the cases involved were quite difficult to manage and we and our colleagues in Tusla were working hard to try to provide solutions which were appropriate to the young person's needs.

Dr. Dodd may wish to address a number of the points that were raised. I would like to address the issue of the waiting lists. Two years ago, we had in excess of 400 young people on a waiting list for more than 12 months. A colleague and I literally went down through each of the 400 and identified whether he or she was appropriate to mental health, primary care, social care, or potentially the National Educational Psychological Service, NEPS, in education. As a result of that exercise and through the redeployment of some our staff who are in current CAMHS positions, we reduced the number to less than 200. Unfortunately, we have lost certain key posts and as a result those numbers have gone up again.

In respect of legislation, the Mental Health Act provides that each young person attending a child and adolescent mental health service has to have a named consultant psychiatrist. That is in the Act. It is different from other jurisdictions where they have what is called an accountable clinician, who can be someone other than a consultant psychiatrist. That has implications for the ability of other professionals to see, assess and treat young people. If the young person has to have a named psychiatrist, then in fairness that psychiatrist has to have an overview of the case. It is simply a fact. We have to work within the legislation.

On admissions to adult units, we have already gone through the protocols that have to be put in place. A point was raised about the acute units not being in compliance. When a young person is admitted to an adult unit, the unit is not in compliance. However, this does not mean the protocol we have in place for the occasions on which a young person is admitted are not followed. They are followed.