Pat Buckley (Cork East, Sinn Fein) | Oireachtas source

I echo the Chairman's words and I thank the witnesses for their work. It is much appreciated. The more information we have, the more we can work on. I have a number of questions I will open to all the witnesses. My first question has been partly answered but I will put it to the witnesses. What are the key reasons for the difficulty in recruitment and retention of mental health staff across the country? How can such challenges be addressed and what measures need to be put in place? One of the briefing documents that we received earlier deals with some of it but it has me slightly confused. It states that funding provided to mental health is ring-fenced for mental health, yet on the next line it states money that is unspent in respect of recruitment is allocated to the improvement of mental health infrastructure. I can understand that but it also then mentions agency staff. We have a major issue with recruitment and retention. We have been over and over this, even in the Committee on the Future of Healthcare. The HSE has told us that it cannot get staff, yet there does not seem to be any problem in getting agency staff. Why can the HSE not start to recruit these staff directly? Is there an issue with contracts?

That is just one issue. I have a couple of other questions which I will put to the witnesses which relate to recruitment. Is there an issue with salary conditions and pay rates in Ireland? If there is, why can we not address that and do what is being done in England, where packages are being enhanced so that staff can actually be recruited and retained? I know it is a challenge but we will have to break the mould and start somewhere. There was also an issue with out-of-hours access. An initiative was mentioned here last week. What was the initiative the witnesses were talking about? There was an initiative for community mental health services. How many in the country are operating on a seven day week, if any? An issue close to my heart goes back to preventative measures, which are that prevention is better than any cure. Does the HSE have a plan to roll out the 24-7 access to crisis mental health services in every area in the country? We are all looking for an update on the development of the new clinical approach to dual diagnosis. The Minister of State, Deputy Jim Daly, was here a couple of weeks ago and mentioned the possibility of a one stop shop, or, as he called it, the no wrong door policy. Has that been flagged with the HSE? We have spoken about it among ourselves here. We need a pinch point where everybody in the country has at least one access point and service can be distributed to wherever it is needed.

There was a worrying piece in the media last week or the week before stating that over 600 people left emergency departments who were in crisis. Do the witnesses have numbers of people who were either highly intoxicated or under the influence of drugs who were refused admission to the acute section of the services? Is it possible to get those numbers? Is a record kept? Primary care is the main issue here. It goes back to the bottom-up approach. It is a similar issue to what I said a while ago about people trying to access counselling services. The waiting lists are so long that people are being discouraged and, unfortunately, left behind. Does that go back to recruitment? Does it go back to the lack of service when assisting general practitioners, GPs? GPs are normally the first port of call. No matter what ailment one has, a person will usually go to a GP first. Another issue which I saw last night and see many nights, and which is not only prevalent in Dublin but countrywide, is that of homeless people. What steps, if any, are taken to assist people who are homeless? If they are taken in and assessed as having mental health issues, is there a follow-up or are they just assessed and left back out? Is any accommodation or assistance at all offered? It is heartbreaking and soul-destroying to see these people.

Most of these people are in a bad place, temporarily. I am also concerned about mental health service provision to people in the criminal justice system? Not everybody is aware of services in their local communities. Information is key and there appears to be a lack of support in this area.

Ms O'Connor mentioned in her opening statement that 90% of these issues should be addressed through primary care. The words "should" and "can" are two very different words. I would prefer to use the word "can".