Mr. Bernard Gloster:

I thank the Senator and, lest I forget, before I bow my head, I thank Deputy Durkan for his kind comments on the sincerity of the issue of mental health. It is an enormous challenge. We tend to be consumed in our public discourse with trolleys and acute hospitals, and rightly so, because our citizens experience such difficulty. There is, however, absolutely no doubt but that the two areas we are most challenged in, and in respect of which we have to reflect seriously on how we approach from start to finish the delivery of service, are services for people with a disability and services for people who experience mental health issues, be that acute episodes or enduring mental illness.

I was very struck by the Mental Health Commission report last week. The commission points out to us the repeated challenge of, on the one hand, trying to progress new inpatient facilities and, on the other, trying to pursue international best practice, which is to reduce dependency on inpatient facilities. The reality is that in mental health services across Ireland today our second greatest consultant vacancy challenge is in psychiatry. We have 75 vacancies that Ms Hoey's team are hoping to address at least some of in the international campaign.

To take the question of how this will be addressed in the RHA structure, first, there is a national lead for mental health in the centre of the HSE at the moment. I intend to keep that role and to add to it with a second role that will be filled in September with a specialist national lead for child and adolescent mental health. Both those national people have a clinical lead with them. We have just appointed a clinical lead for CAMHS; we already have one for adult mental health. Their job will be to ensure that right across the six RHA regions there is not only a focus on but also a consistent improvement in progressing towards achieving the two primary strategies we are pursuing in that area, which are Sharing the Vision, which the Senator has pointed out, and Connecting for Life, which is the strategy directly associated with suicide. The same as in enhanced community care and in every other part of the health service now, the approach involves multidisciplinary teams. It is a challenge filling those position when you are trying to fill so many teams. I met the Minister of State, Deputy Butler, recently and had very productive discussions with her, but we have to address the serious question: are we better to continue to pursue, for example, 70 CAMHS teams that we know repeatedly cannot come up to the fully staffed mark or are we better to have something like 50 or 52 with a wider geographic remit but which are guaranteed to be fully staffed? That is a serious question. To be fair, the Minister of State, Deputy Butler, is open to that. In the RHA structure, each CHO at the moment has a head of mental health services. That head of mental health services will continue in the RHA structure but will now also cut across acute hospitals as well as community services. That is aimed at driving integration. It is a serious challenge.

The Mental Health Commission is due to report at the end of this month, I think, or in July in the next report from Dr. Susan Finnerty on CAMHS. Obviously, I am not in a position to divulge the commission's report, but I can say that that will point out to us challenges not for the first time, but they are challenges we are responding to and going after step by step. We cannot allow the mental health service or the need the public have for it to go out of visibility when we talk about the delivery of healthcare, and that has to go right out to counselling psychology and counselling in primary care. In respect of mental wellbeing, we should start from the premise that the majority of people at some point in their lives will need some level of support, even at an indicative primary care counselling level, whether that is because of trauma in their lives or whatever else, right up to the progression of people who experience psychotic and other mental illness challenges.