Mr. Jim Ryan:

I am the head of operations of mental health in the HSE. I thank the members for the invitation to meet with the joint sub-committee to provide an update on the Linn Dara CAMHS service. I am joined by my colleagues, Brendan Doody, Mary O'Kelly and Kevin Brady.

I will provide an overview of the HSE Linn Dara service. CAMHS provides specialist mental health service to those aged up to 18 years, who have reached the threshold for a diagnosis of moderate to severe mental health disorder that requires the input of a consultant-led multidisciplinary mental health team. CAMHS inpatient units offer assessment and treatment to children and adolescents up to the age of 18, with severe and often complex mental health difficulties. For those aged over 18, general adult community teams and inpatient units provide these services. Approximately 2% of the under-18 population will require a CAMHS intervention at any given time.

Linn Dara CAMHS in Dublin south, Kildare and west Wicklow provides the following services: community mental health teams; a community eating disorder service; Linn Dara approved centre, inpatient unit; ADMiRE-ADHD pathway; consultation and liaison psychiatry at the National Children's Hospital, Tallaght; and two mental health intellectual disability teams for mental health of intellectual disability services.

In line with the HSE CAMHS operational guide 2019, the Linn Dara approved centre provides acute, emergency and specialist inpatient child and adolescent mental health services and treatment on a tertiary basis for children and adolescents with severe and complex mental illness. The approved centre is registered, regulated and inspected by the Mental Health Commission and subject to regulatory inspection in relation to care and treatment, facilities and premises, staffing and governance.

The Linn Dara approved centre is a 24-bedded unit, which is configured into three wards - Rowan, Oak and Hazel. The Rowan and Hazel wards both consist of 11 individual beds and the Oak ward has two beds, which provide high dependency and care. The Linn Dara approved centre provides services on a regional and national remit. Our primary catchment area is community healthcare organisations 6, 7 and 8. Linn Dara also works with the other specialist inpatient mental health services to provide services on a national basis as the need arises and where clinically appropriate. The 24 beds in the Linn Dara approved centre are as follows: two high-dependency CAMHS beds, eight specialist eating disorder CAMHS beds and 14 acute or emergency CAMHS beds.

The Linn Dara approved centre provides eight specialist eating disorder beds, SEDBs, to level 4 care and treatment for children and adolescents with severe and complex eating disorders. Level 4 in the HSE model of care for eating disorders is classified as the most intensive treatment setting.

I will outline the service developments at Linn Dara CAMHS. The Linn Dara community eating disorder service was officially launched in September 2019.

It was the first Irish community-based dedicated eating disorder service for children and young people under the age of 18. The team operates at levels 2, 3 and 4 of the stepped model of care, providing specialised outpatient, day patient care and support to people with eating disorders with an enhanced range of treatment options.

The ADMiRE ADHD pathway, which stands for assessment, diagnosis, management initiation, research and education, is the first public specialist service for children and adolescents with ADHD in Ireland. Set up in September 2018 in south Dublin Linn Dara CAMHS, the primary goal was to reduce waiting times and provide early access to evidence-based assessment and management for young people with ADHD.

On the Kildare and west Wicklow community CAMHS team, in 2021 Linn Dara established a new community CAMHS team based in the Athy primary care centre serving south Kildare and south-west Wicklow, bringing the number of community CAMHS teams in Kildare and west Wicklow to a total of five. Linn Dara has also established two specialist teams to deliver specialist mental health service to the mental health intellectual disability, MHID, community across the CHO and continues to develop this service through the national clinical programme.

Regarding new development posts, building on existing services and investments in CAMHS, in 2022 Linn Dara was allocated an additional €950,000 to recruit nine new additional posts across the service, with recruitment currently ongoing. These posts were targeted at the further development of the ADMiRE ADHD team and the community teams in Kildare and west Wicklow.

There are challenges in this area. The Linn Dara approved centre treats complex and high-dependency cases that require intensive input from experienced and specialist staff. Nursing posts account for more than 75% of the multidisciplinary staffing complement of an inpatient service. The ability of the service to provide the necessary standards of quality care on a sustainable basis for patients over a 24-7 cycle depends on the necessary nursing staffing being in place. Unfortunately, due to the level of current and projected core HSE nursing staff vacancies, the service was left with no choice but to reduce the number of operational beds on a temporary basis. Extensive efforts continue, both nationally and internationally, to recruit nurses to these vacant posts. This temporary reduction in bed capacity is being done strictly on the basis that the beds that will remain operational are available with a safe and sustainable staffing ratio, on a 24-7 basis.

Post Covid, there has been an increase in referrals to both to community and inpatient services within CAMHS. Such an increase in referrals will have an impact on the level of service delivery, with the likelihood of increased waiting lists. The response of CAMHS to the public health emergency has brought about some benefits, such as a rapid adoption and effective use of telehealth and video-enabled care. It also created a public discourse about the importance of mental health to personal and societal well-being, thereby strengthening the case for continued investment in CAMHS and service developments to meet these increasing demands.

Since opening in December 2015, Linn Dara has continued to develop a number of services, as I have outlined, using models of care supported by clinical evidence through the national clinical programmes. Notwithstanding the improvements, we are very aware of the continued need to further develop services and deal with identified challenges, including staffing vacancies, which impact on service delivery. We will continue to work with all stakeholders in this regard.