I thank our guests for their presentations. It is important that we acknowledge the work, dedication and commitment of everyone working in the mental health services, which is a very demanding area.

I wish to raise a few issues, some of which have already been touched on. I will first address CAMHS and my experience from dealing with parents who have come to me about the issue of medical practitioners. I know of a case where someone would have had access to a consultant within a short time if he had just lived a half mile up the road, but there was no medical consultant in his own area. I do not understand the geographical boundaries that are being used to determine who a person sees. If someone is in the wrong area at the wrong time and there is no consultant, that person might have to wait anything up to 18 months to see someone. I have had to deal with such a situation. The parents of a 16 year old had to monitor their son non-stop for those 18 months. CAMHS would not get involved until he was assessed. If there is not a consultant, I do not understand why some other process is not in place to ensure that a case is handled. The parents ended up taking their son to an accident and emergency department, but he was sent back home without an additional care plan being put in place. This issue needs to be addressed. Why are there geographical boundaries? We do not have that type of boundary in maternity services.

Why do we have it with adolescent mental health?

The second issue is the growing challenge that we will now have to deal with of people who are non-Irish and who have come to Ireland without the kind of traditional family support that one might see in Ireland. I had a case recently, for example, where a non-Irish girl had been in Ireland for approximately 12 years and had no family in Ireland. She was in rented accommodation and had serious mental difficulties. The landlord got her GP to see the girl because she would not go to the GP herself. The GP's response was to contact me as a public representative for the area but four weeks later she was still not getting help. I got on to the public health nurse, who told me she could not attend the girl unless she is requested to do so by the GP or somebody else in the HSE. There were four weeks during which there was no action but eventually the landlord took a recording of the person because she was going downhill very fast. Only when played the recording did the GP go to see the person. The person in question was admitted to psychiatric services for eight weeks but is now back in the community and in the same residential accommodation. The landlord has told me the person must leave by 30 June but I cannot source a back-up service. This is one of many problems where we have many non-Irish people who, unfortunately, will end up in a position without backup from a family. We will end up with people like this on the street. What do we need to bring about forward planning with this matter?

The third issue relates to balancing of cost. I had a case of mid-30s person and, in fairness, the HSE was doing its best. It had to apply two care assistants to the person in question because assistants working on their own had been assaulted. A package was done to provide care for the person in the community and the cost was €130,000 per annum. There must be a way of dealing with a case like that, where a person has good and bad days but the assessment is the person should be out in the community as opposed to being in a more definitive care position.

The fourth issue concerns the lack of information. I know a guy for a long number of years and I spoke to his family recently as I received ten or 20 emails per day from the person. The person is now under the care of mental health services. The family has distanced itself from the person because of difficulties, and the family is convinced that the use of illegal drugs over a long period caused a long-term mental health problem. We are not getting the information out there that the use of illegal drugs can lead to mental health issues. There is not enough information out there for young people in particular. I have come across a number of cases where people have been in perfect health before getting into drugs and they now have long-term mental health problems, with no road back. How is it proposed to deal with this? Must we put much more information out there? Where do we start with such a process?