Colette Kelleher (Independent) | Oireachtas source

Mr. Reaney and myself worked together around disability issues in a previous life. It is nice to meet Ms Gleeson. The briefing was really clear - the main document and its appendices - so I thank the witnesses for that. I also welcome the ethos around recovery and co-production which they have outlined. It is important to have principles and values guiding decisions.

I live in CHO area 4. I have worked in that area with Cork Simon Community, where were big issues with addition and dual diagnosis, in the Cope Foundation where there was a focus on disability but also a significant interface with people who had mental health issues, and then in Alzheimer's, which is another area that takes us into mental health issues.

I was informed by the hearings that Senator Freeman chaired on child mental health and some of the questions I ask will reflect that. In preparation for this meeting, I have also made contact with teams on the ground. Dr. Karen O'Connor gave a very good presentation on the home-based team. This is an excellent service to prevent people being admitted and it also plays a role in respect of early discharge. I am also due to meet people from Arbour House. Some of my questions will reflect these things.

When I met Dr. O'Connor, she spoke of how access to counselling at primary care level would prevent over-medication and inappropriate referral to secondary care and that recruitment and retention of staff in other parts of the mental health service - including cover for maternity leave and sick leave - have a huge impact even on teams that are working well because they pick up the slack for problems in other parts of the system. Dr. O'Connor also commented on the out-of-hours service or the lack thereof and the postcode lottery.

The home-base team is working well but it does not cover all areas. The boundaries and silos were also an issue which came up all the time in the child and adolescent mental health hearings. People are falling through the cracks. I have some specific questions on these issues. In their experience, do the witnesses believe that the CHOs have the right mix of skills? We have spoken about vacancies but do the CHOs have the right kinds of people? With regard to the waiting lists, as of October 2017 there are 748 children waiting with 222 of those children waiting for 12 months. Where does Mr. Reaney expect to be this time next year in terms of those very unacceptable waiting lists? Does CHO 4 have proposals around family therapy as a core part of the CAMHS teams? This would seem to be something well worth considering. What are the CHO 4 plans for this? How is the CHO 4 helping to prevent people falling through the cracks? For example, if a person in COPE has a disability as a primary diagnosis but also has mental health issues, which often happens with people who have Asperger's or autism, how do people on the ground work to look after this person? It is the same with silos. If a person with dementia is under the age of 65 where does he or she get access to psychiatry services? How does CHO 4 make sure that people do not fall through the cracks of dual diagnosis?

With regard to the suicide rates of 14.7% in Cork city and 17.1% in Kerry, do the witnesses know the reasons the rates are so high in these areas and where does Mr. Reaney expect to be this time next year in this regard? Obviously, he is not in control of all the factors around suicide but where would he see the efforts to reduce those rates in Cork and Kerry?