Mr. Jim Ryan:

I was going to ask the members what they thought the answer was. We have done a few things over recent years. There is an increasing demand for health services generally, and our ability to meet that demand has to be met in different ways. One of the things we have done in mental health is around e-health and e-mental health, and that is a way in which we can reduce the number of young people or adults who need to go up the line.

Under the tiered model of care, we are trying to have as many people as possible seen at the lower level. Taking youth mental health as an example, we have a service agreement with the likes of Jigsaw, Turn To Me, MyMind, SpunOut, etc. All these organisations are able to pivot very quickly. They can upscale their operations. That is an attractive way for young people to access services when traditionally they might have come to mental health services. We have attempted to take that approach over recent years, and mental health was one of the initiators of that approach. It has made a big difference. The numbers attending Jigsaw are increasing significantly. It has the same issues that we have about providing bricks and mortar services but it is able to upscale its online service much quicker because people can work from home and work more flexible hours, as we mentioned earlier. We must do a combination of things. We must ensure our secondary and tertiary care services are delivered by professionally qualified and appropriate staff. We must reduce the numbers moving up the system through our services and by working with non-governmental organisations, NGOs, which have a significant role to play.

I worked for an NGO in Tallaght as a youth worker years ago. Treatment from an NGO makes a considerable difference because young people are in their own communities and within their own settings. We are trying to reduce the numbers of people moving up the system. On the point Ms O'Kelly made earlier, we will have to look at some way of trying to incentivise some services. Other people will come in here and say we are not prioritising their area. We are in competition with the likes of enhanced community care. "Competition" is not the right word. Citizens need more services and we are trying to deliver them. The way in which we provide services must include face-to-face consultations but the other ways of doing it online will make a difference. Rather than seeing those alternatives as less positive, we should instead be saying how much more positive they are. We have many examples of that. Some young people much prefer texting and online consultations to face-to-face consultations. Rather than seeing that as a problem, we should see it as a benefit and take advantage of social media and different ways to try to deliver services. We are not going to be able to deliver services for everybody in every part of the country in the manner people might have thought we could. Consultants in more peripheral areas of the country find it difficult. South Kerry was mentioned earlier in that regard. It is more difficult to get consultants in such areas. However, remote consultation works quite well.

A combination of approaches is required. There is no silver bullet. We need to prioritise certain of our services and that is why we have found the need to prioritise the 2% of young people who require secondary care and those types of services. Those are the sickest young people we have from a mental health perspective. I do not believe there is any one solution because if there were, somebody else would have thought of it before me. We must continue to do those type of things. It is about trying to broaden the way in which we deliver services.