Ms Kate Mitchell:

I will pick up on the Deputy's question about staffing in mental health services. He is correct that there are massive challenges with recruitment and retention in mental health services. In general adult services, we only have about 75% of what is required, and the situation is much more dire in child and adolescent mental health services, with only about 51% of the required staff in post. That has massive implications for staff and for people and families accessing services, with waiting times, quality of services and so on. Pay and conditions are an issue. It is difficult for Ireland to keep pace and to compete with other jurisdictions such as Canada, Australia and even the UK. We see many of our graduates moving to other jurisdictions to work in the mental health space. The conditions are also an issue. We regularly hear from professionals that they do not want to commit to work in a service where they know they will not have the full complement of staffing. There are also issues relating to promotional opportunities. It is an issue that extends beyond the HSE and Department of Health to the Department of Public Expenditure and Reform. We need to look at pay and conditions in mental health services. Mental Health Reform has advocated for a new way of thinking and a new way of looking at service delivery for quite some time. There has been a strong emphasis for a long time on the recruitment of medical staff, nurses and psychiatrists. There needs to be more of an emphasis on recruitment for other disciplines such as occupational therapists, psychologists and social care workers. There is also an emphasis on the community and voluntary sector. They play a fundamental role and there is space for investment in that area and for peer-led community mental health services.