Dr. Amanda Burke:

I thank the Senator for her questions and for being so supportive of our models.

I want to look at the use of e-mental health in supporting our rural areas. It is not about denuding - quite the opposite. I will talk about our own area for the purposes of illustration. We brought in a CAMHS connect model. Essentially, this is to do exactly what the Senator described, namely, connecting all of our different pieces of the model. Centres of excellence can be everywhere. They tend to be in our urban centres. It is important to recognise that most of the serious mental illness happens late in adolescence, and is now happening to young people into their early 20s. These young people tend to be in urban centres attached to universities. This is an important first point.

Consultants and consultant teams prefer to work in teams. It is much easier to recruit to our urban centres. As I said, the evidence base for treatments is around people who do treatments a lot. Sometimes we do not have patient cohorts. For example, if we take psychosis, one would only see a small number of those patients in a community mental health team in any particular year. To get the real expertise to look after these people one needs to have a centre of excellence. One can then provide to the spokes, and consultation into the spokes, via a combination of e-mental health and in person services. Nobody is saying that e-mental health is a complete solution. We are talking about an adjunct. Certainly, the feedback we have received from young people as regards relationships is that we might see them face-to-face for the first appointment in an urban centre and then continue the appointments with e-mental health solutions. They might also have a key worker in the local community supporting them.

We need to look at our clinical care programmes, for example, for deliberate self-harm, early intervention in psychosis and eating disorder programmes, in the context of a hub and spoke model going forward.

I would like to see more qualified advanced nurse practitioners and clinical nurse specialists working and supporting the network of teams there. That is key. I have a question for Ms O'Connor. She mentioned the role of the national director, which she held prior to 2017. She also mentioned the challenges between the way the systems were set up then and the way they are set up now. Is there a timeline for that role? If changes needed to be made to the remit of that role to accommodate the new changes within the HSE, what would those be?