Mr. Jim Ryan:

I have worked in mental health services for over 15 years amd genuinely believe circumstances are getting better. Where is the evidence for this? There were six beds in 2006 for CAMHS and now we have 74. I accept that there are only 48 open.

We have 70 teams. While I could trot out any of those statistics, it is much more about how much the way we look at mental health has changed in the past 15 years. We now have a regulator in charge in the Mental Health Commission; we have the Mental Health Act that was implemented in 2006 and reviewed in 2011, and we have A Vision for Change, a policy document that is recognised as one of the most far-seeing in the western world. There are a lot of basic building blocks, but the mental health service was at a very low ebb. Anyone who saw the television programme "Behind the Walls" will have seen what was happening in this country. While things have changed dramatically, we are obviously still on a journey. I am in contact with people elsewhere in Europe who look at what we are doing with service users and cannot believe it. We have a service user on my management team whose sole responsibility is to represent the role and views of service users at national level. No other division has this. We have nine area leads for mental health who are service users, carers and family members. No other division has this. We have forums and peer support workers, while a lot of the things which are needed from a carer's perspective or the point of view of recovery are in place.

On the issues raised by the Deputy, I will try to give some context on the figure of €55 million. Last year there was a figure of €35 million. One will receive €15 million of it in the year and €20 million the following year. That is the reason the figure of €55 million can be confusing at times. I assure the Deputy that it confuses me at times too because I am saying "I thought we got this." The other figure is €89 million which ones gets when one adds items like consultant back pay and annual increases. It is not money that is going into a service. The sum of €35 million is to go into the service. I told Deputy Neville that all of that money was spent on mental health services. I acknowlege that it may not all be spent in the areas for which it was given.

Issues were raised about nursing contracts. In virtually every area of the country there are nursing deficits. We have a process whereby if someone leaves, the head of area informs me and it goes to the national director to be signed off on. If a nurse leaves, we have never prevented that nurse from being replaced. We try to provide contracts for nurses who are graduating. We will have an extra 60 graduating in 2020 with mental health service money that we have spent, not education money. That gives a figure of 350 which will go up to 420 in the following year. We hope it will address some of the gaps. I am conscious that we have new developments every year and we try to fill them. They can sometimes create gaps in the services in which they arise. It is a churn and can be a question of catch-up, but I assure the committee that that is the rationale behind the figure of €55 million. I am involved with the Central Mental Hospital and we are offering permanent contracts to graduates as we will need them to open the new hospital in 2020. If a person wants a nursing contract, he or she will get one.

Our difficulty at times is with allied health professionals, AHPs. When we try to balance our budget and activities, we have to be cognisant of the resources allocated to us. While the Deputy is right about it being above my pay grade, it is to be open about it. I have to be straight and say each year we advocate on behalf of mental health services. We put together a business case for additional funding which has been allocated. At times, we have struggled to spend the money in the areas for which it has been allocated. Dual diagnosis is one such area, while early intervention, psychosis, perinatal, mental health and intellectual disability are other niche areas where it can be difficult at times to recruit specialist staff. Sometimes the staff who take on those posts come from our core services, which means that a deficit is created back at base. It becomes one of the circular difficulties.

There are a lot of things about which we do not talk in circumstances like this and it can become demoralising for people who work within the system because they hear a great deal of negativity. However, when we speaks to many service users, they will tell us that things are improving. While, as Deputy Lisa Chambers said, facilities nationally are still not as good as they should be, we have made some progress. In order to keep going one must believe things are improving. For example, over €10 million has been invested with our NGO colleagues in Jigsaw each year from HSE funds. We do not make a big deal out of it because that is how it is, but sometimes people say we are not doing anything. The fact is we fund organisations without having our name hugely up in lights. People can then become confused, but they do not need to. It is about delivering the service. It may be our service on which we are working with our partners, but it does not matter as long as people benefit from it.