Mr. Jim Ryan:

The Deputy mentioned the primary care services. Child and adolescent mental health services are delivered to primary care services around the country. We are trying to provide services for young people in locations they will actually attend. Young men in particular do not tend to go into HSE-delivered services. We struggle with that. It is a phenomenon all over the world and certainly in this country. I was a youth worker in Tallaght for ten years and there was a group called "the non-joiners". We needed to have a very particular way of working with some young men because they had significant difficulty attending GP practices or anywhere else. That is one of the reasons we partner with NGOs to be able to provide services in a more appropriate youth-friendly way. We do not want a big sign on the road saying "HSE this" or "HSE that" because for some people that is a turn-off.

The HSE provides 94% of funding to Jigsaw. The other funding it has received recently is for very specific purposes, but all the counselling and the 13 sites are funded by the HSE. That has been a significant development in recent years.

We will certainly have a secondary-care mental health service. The waiting list for primary-care psychology is very long in some areas. We have employed over 100 assistant psychologists across the nine CHOs to try to address that issue. We recognise that if we have waiting lists at primary care, sometimes GPs and others will refer to the next available service which will tend to be CAMHS. That means we end up with young people who should not be on our waiting list and who could be dealt with at a lower level.

Dual diagnosis has been an issue for many years. It goes back to the drug task forces of the late 1970s. Is addiction a mental illness or where does it fit? In the drug task force policy and the mental health policy, addiction is not seen as a mental illness. In this city, we have Trinity Court, which deals with people who have both an addiction and a mental illness. We are trying to get to a point where we have a "no wrong door" policy which means that nobody looking for help is turned away because they have an addiction or a mental illness. We try to treat both. That is taking much longer than I expected. Internationally it is also an issue. In most other parts of the world addiction and mental illness are treated the same. In some parts of the country that is the case here. We still have considerable work to do to integrate our services so that the person who asks for help is not turned away because they do not meet particular criteria.

We fund hundreds of groups across the country in the context of both early intervention and suicide. We have to try to manage that because we need to ensure the quality of the services being delivered and the clinical governance behind them is appropriate. That is one of the reasons that in some respects we need a smaller number of larger organisations. When an issue happens in the community, many people will come together, as is the Irish way, and form a group which is very well meaning. However, unfortunately in today's world we need to ensure that is done in an appropriate manner.

The Deputy mentioned schools. While our care is secondary care, some of the stuff we have done includes the Mind Monster campaign, which is aimed at second level school students. We provide posters and people go into schools to support it. It focuses on examination stress, sleep, digital issues and feelings because the feedback we have got from young people, similar to what Jigsaw would have found, is that those are the areas that cause the most stress. Studies show that our inpatient units tend to have less demand in summer when young people are out of school.

School is a stressor. I am not suggesting it is stressor for all students, but for some young people it is a serious stressor in their lives. We also have a recharge programme for third level students. We fund interventions in the Union of Students in Ireland, USI. Members may be aware of its report earlier this week that examinations, sleep and alcohol are the three key issues that we have addressed in our programme for third level. We are conscious of the need to do this in schools, but there are many young people who are not in school and we have to try to help them remain connected as well.

On suicide clusters, this has been a feature of the past. We work with community groups to ensure that the way in which a young person's life is celebrated when there is a suicide is appropriate and does not create a circus of issues that some other young people buy into. We have tried to analyse that and to ensure that the support provided is done through Pieta and in an evidence way that does not create a drama, which sometimes can happen. Priests officiating at funerals have been trying to ensure that they are not another drama for young people to buy into.