Ms Anne O'Connor:

I could not agree more with many of the points the Deputy made. We are acutely aware of psychological services and we have been seeking to improve them. This is our third full year of having a division dedicated to mental health. We have done a great deal of work on the core infrastructural aspects, looking at what exists for mental health in Ireland and how we can improve our various specialist services. However, in the past 12 months we have really realised, not that we did not already know, that there is a very significant gap at the early intervention stage for all ages. We are commencing an initiative with the under 18 year olds, with €5 million, to improve access to counselling for them in primary care. That relates to the recruitment of 120 assistant psychologists and a number of qualified psychologists. They will work with those under 18 years of age and keep them away from the mental health services, if I am honest, by providing that first line of defence and early intervention. This is something for which there is huge demand. I am not sure how we will get to the stage of meeting all the demand. We are starting with the under 18 year olds because we believe that is a huge gap and that we have young people bouncing into CAMHS as a result of that lack.

In terms of talk therapy at a broader level, we have the national counselling service and CIPC within that. This has sat slightly outside the mainstream services and we are now looking at embedding it within each CHO so that we have an approach to adult counselling services within CHO areas that is more integrated with all the other services. We are also considering bringing in a specialist lead to head up a programme of improvement around psychological interventions. Part of our difficulty is that there is such a wide range of psychological interventions. There are different types of service provision in different areas and there are different types of therapies associated with different clinical programmes. We are looking at what we should be providing for everybody everywhere. An initiative is starting on that and we will soon try to get a lead for it.

Sláintecare promotes a shift to primary care and early intervention. There is funding within that listed for counselling in primary care, psychology in primary care and a number of specialist mental health services. The mental health division has a clear focus on embedding recovery in all our services. The only way we will be able to address the mental health of the population is by ensuring sufficient access at primary care level in order that people can be kept well in their communities and, ideally, not need mental health services and by ensuring that they receive high-quality and efficient interventions when they do need to access those services. That is what the division is committed to and our work is very much planned in that way.

There is an accountability framework within the HSE whereby there are performance contracts in place. Every chief officer has a performance contract with me, as the national director for mental health. In turn, I have one with the deputy director general. The heads of service for mental health are now also held to account within their areas. They are the people who are charged with operationally managing mental health services in their geographical patches.

The social determinants for health are acknowledged. We see that clearly. All the evidence suggests that we must do more on specific groups. Within Connecting for Life, a number of vulnerable groups are identified as priority groups, such as those who are homeless, Travellers, LGBTI people and others. We are focusing on those with the range of interventions listed in the operational plan. Social protection is an issue and we are already working with the Department of Employment Affairs and Social Protection on some of our initiatives. We have an initiative under way to examine individual placement and support, IPS, and supporting people in employment. We face a challenge in respect of mental health because people are often penalised in a way for going back to work-----