Ms Aileen Colley:

I will start with the forum. It is a new matter in the 2018 plan. In the opening statement we referred to the area lead, the six peer workers and the Recovery College. That is linked into ensuring that the people who utilise our services, who we provide care and support to, have a voice in determining how our services are developed and how they would like to see them delivered. I take the Senator's point that an awareness campaign is very important. It is essential, because we want this engagement. It was the first meeting of the year, and it is a brand new programme. There was a meeting in Carlow, and then another in Kilkenny this week. I am very happy to take the Senator's comments and suggestions back. She will see the forum developing over the course of the year. I note that it uses social media and radio, but we need to make sure that we are getting the contact points out and encouraging people to turn up and have that voice. Sometimes that is about permission. People have to feel that it is a safe environment to come to and add their voices to. We received €1.6 million in service reform funds, which will specifically look at supporting people under the headings of housing, employment and training, and that is linked to the Recovery College, which will also be linked to the forum.

In terms of the Senator's other questions, it is much the same as has already been said about Cork and Kerry. Recruitment and retention is one of our priorities. We have all of the data - we have provided it to the Senator - which we look through and ensure that we can allocate appropriately. For example, 33% of the development posts we had were targeted towards child and youth mental health services. There is a recognition that child and youth mental health services need to grow and must be supported. In my opening statement I referred to a step-care model, which is really what we have been discussing today. The importance of primary care, GPs and the voluntary organisations was alluded to, in terms of the regional youth service. We have provided money for that. We have also worked with Tusla and the local council to decide how that support can be given. For us it is about trying to provide wrap-around services, making sure that people get the service at the level they require. The Child and Adult Mental Health Services, CAMHS, is a specialised service. It is trying to ensure that the people it is involved with get what they need as quickly as possible and that they can get it easily.

The Senator asked about the self-harm intervention programme, SHIP. There are three people on the list for SHIP in Carlow, and we take that very seriously, given the type of service that it is. We have a director of counselling services that works closely with both primary care and the mental health team. That team spans both services. When a person comes through SHIP their care can be returned to the GP, or if multi-disciplinary care is needed, hand in hand with the specialist services, those referrals are made. We are piloting that in the south-east. An evaluation study is available, if the Senator would like to read it. It has already been published. We are now in the next round, and SHIP is now available in all counties in the south-east.

St. Luke's was mentioned. The events of last weekend were very unfortunate, when there were 52 patients and only 44 beds. We do have an emergency protocol which is used to bring a situation like that under control as quickly as possible. Nobody wants people on extendable couches or chairs. It is very difficult for the patient and their families but also the staff involved. We recognise that. I am happy to say that by 6 p.m. that evening there were 44 beds occupied, through emergency measures implemented throughout that day. Since then we have had ongoing management plans and have sought to address that. It is difficult to always keep the number to 44, because there will be times where it is under 44, times when we have exactly 44 and of course times when there are more than 44. The Mental Health Commission is one of the regulatory bodies, and we are very conscious of that. Most important, we work for the comfort and safety of the patients. A management plan is in place there.

In terms of beds, 44 beds are available in both Kilkenny and Waterford. We use some beds from CHO6 as well, which I believe was referenced in the statement. Vision for Change is something of an indicator. We must take cognisance of the fact that we have had a 2.6% growth in our population. A Vision for Change was published ten years ago. We must also look at the indices in terms of social determinants of health, etc, and what that means for our area. Dr. Browne might speak on this as well.

However, our team takes it very seriously and it is looking at it analytically as well as from the care perspective, that is, in terms of clinical pathways of care, what is the most informed best practice, so that we can plan ahead.

At this point in time we do not have any commitment on the capital plan for new acute units in the south east. We do have it for other things. For example, in Waterford, we will have 20 beds as part of the rebuild of St. Patrick's and we will have beds coming into Clonmel but not for an acute department of psychiatry.

I will hand over to Dr. Browne.