Mr. Bernard Gloster:

I thank the committee for the invitation to attend today. I am joined as a witness by Dr. John O’Mahoney, executive clinical director for mental health services in HSE mid-west community health care organisation, CHO 3. My colleague chief officers have introduced their witnesses and I can advise the committee that we did consult to ensure a mix of some different roles in the make-up of those attending the committee today.

I am the chief officer of HSE mid-west community health care, referenced in previous HSE national submissions to the committee as CHO 3. I am responsible for the overall management of all health services, excluding acute hospital care, in the mid-west. Specific to this committee, the mental health service of the mid-west is one of four service divisions which make-up community health care. The service in the mid-west is part of a national system of nine CHO areas and with regard to mental health I refer the committee to the evidence already given by the national director for mental health and her team in recent months.

The HSE mid-west area covers Clare, Limerick and North Tipperary with a population of 384,998 according to the 2016 census, representing a 1.5% increase on 2011. The mental health service in the mid-west operates as one service with single governance for the service.

The service has one head of service reporting to me as chief officer, one executive clinical director and one area director of nursing. They are supported by an expanded management team in the disciplines of psychology, occupational therapy, social work and management, reflective of the multidisciplinary nature of modern-day mental health services. While there are some county-based aspects for logistical reasons, all operational parts point to one mid-west system with some services shared. The mental health service in the mid-west operates mainly across three specialist domains of general adult, psychiatry of later life, and child and adolescent mental health services, CAMHS. It would perhaps assist the committee to summarise these services, and I have expanded the detailed metrics in the appendices provided.

There were 786 whole-time equivalents employed in mid-west mental health care at the end of November 2017. The mental health service in the mid-west has a dedicated budget, and in 2018, this is set at €66.988 million, having grown from €58.923 million since January 2015. The general profile divide is in the order of 80:20 pay and non-pay. Thirteen community mental health teams form the core of service delivery for the majority of service users. Working in a multidisciplinary approach, these teams receive referrals, mainly from primary care general practitioners, GPs. The 13 teams are in 11 locations. There are two teams in north Tipperary, four in Clare and seven in Limerick. There are three psychiatry of later life teams, of which one is based in Clare, supporting also north Tipperary pending the further development of a fourth team specific to north Tipperary. Two are based together in Limerick. There are six CAMHS teams, of which one is based in north Tipperary, two in Clare and three in Limerick. There are two rehabilitation teams, one of which is based in Limerick and one in Clare, increasingly providing a mid-west focus. Small, discrete teams provide other supports, with one liaison team based at University Hospital Limerick, one forensic team and one mental health intellectual disability service.

The HSE mid-west hospital group has inpatient and residential supports for people according to their need and notes that the desired outcome is to have the least possible dependency on beds and the greatest possible support for people in their own communities. The former large institutions of the old psychiatric hospital era are now out of use for residential services in the mid-west. The mid-west has 81 acute beds with a plan for a further eight which are already built as high observation beds. There are 49 beds for psychiatry of later life, providing some element of intermediate but predominantly long-stay care. A further eight houses are staffed on a 24-hour basis. These provide a high level of support to people with particular needs associated with enduring mental illness, while another 16 houses are not staffed on a 24-hour basis, consistent with the level of independence and self-sufficiency of the residents.

On specific initiatives, in 2017, the HSE mid-west mental health service led and produced a detailed action plan, Connecting For Life, which is inclusive of the three counties and involves 41 key stakeholder interests. The service has developed the advancing recovery policy and secured a specific service reform fund to support and embed the approach across all teams. Strong progress is being made in the area of service user engagement, particularly in the design of services, since the appointment of a full-time lead for engagement.

The HSE mid-west hospital group's mental health service, like other areas, has challenges, many of which arise from the transition of historical models of the institutional era to the modern-day best practice approaches. The rapid expansion of multidisciplinary teams, coupled with economic factors, has presented a challenge in the areas of recruitment and retention, reflective of the wider international health service arena. The demographic pressures in some instances add to the demand, either in volume or complexity, reflected in various ways, perhaps most recently commented on in respect of CAMHS. These pressures lead in some cases to waiting times which would not be desirable. The services are operating to a comprehensive operational plan each year which strives for incremental improvements in response to those challenges.

That concludes my statement and I have included information in the appendices. I am grateful to the committee for its consideration of these matters.