Mr. Tony Canavan:

I apologise. I shall briefly outline some of the general direction that we hope our services will take over the coming years.

CHO 2 covers a population of just over 453,000 based on the census from 2016. As outlined by my colleague, the CHO 2 is an administrative structure within the HSE through which all social care, primary care, health and well-being and mental health services are delivered. Essentially, this includes all health services in counties Galway, Mayo and Roscommon outside of the hospital services, which in our area are provided by the Saolta group.

CHO 2 is one of nine community health care organisations. There is a direct line of governance between me as the chief officer and the national director for mental health services. In this way, our mental health services in Galway, Mayo and Roscommon are integrated as part of a larger, national governance structure. The total budget for CHO 2, incorporating all services, in 2017 was €457 million and we employed approximately 4,500 staff across all services.

The mental health services are a very important element of the services that we provide. In total, 1,296 staff were employed in our mental health services last year across a range of grades. The breakdown of this information has been provided to the committee in table 1 of my written submission.

Last year, approximately 20% of all expenditure from CHO 2 related to mental health services, some €99 million for the year. The allocation to our mental health services has increased steadily over the past three years from €92.5 million in 2015, to an increase in 2016 and the spend as I have just outlined for 2017.

Mental health services are provided across a range of settings including inpatient facilities located in all three counties with a total of 125 beds, community-based residences, day hospitals and day centres. In addition to these services, we also have the child and adolescent mental health services, CAMHS, inpatient facility located in Galway city which meets the needs of the population from Donegal and down through the western seaboard as far as North Tipperary. This unit is located in Merlin Park in County Galway. Details of the types and numbers of centres are provided in table 2 of my written submission.

Over the past ten years, in particular, 25 community-based teams have been established across CHO 2 delivering services in the areas of general adult psychiatry, child and adolescent mental health, psychiatry of later life and mental health intellectual disability, MHID. As such the mental health services in CHO 2 can be said to be largely community based with the support of required inpatient facilities. This reflects a change of approach over the past 30 years from one which was previously heavily reliant on inpatient care that focused on illness and centring around large institutions such as St. Mary’s in Castlebar and St. Brigid’s in Ballinasloe, to an approach now focused on community-based delivery and is steadily working towards a wellness model as provided for in A Vision for Change. Table 3 in my written submission provides an outline of each of the community mental health teams we have across the four service areas.

There are opportunities arising for us. In 2016, we completed the development of a primary care centre in Castlebar, which will become a base for one of our community mental health teams. We will shortly complete a similar centre in Westport, County Mayo and we have planning permission to develop a community health team base in Tuam, County Galway. We are also in the process of completing the development of a new 50 bed inpatient unit on the grounds of Galway University Hospital and minor capital works are taking place across a range of facilities in Castlebar and in Roscommon. All of these investments are designed to create further opportunities for us to develop our community-based services that integrate well with other more general health services. This is an important factor of the services we are trying to develop.

We are, however, facing challenges. Recruitment of qualified nursing and medical staff continues to be a significant issue for CHO 2. Subsequently, these difficulties lead to a reliance on services provided through agency staff and the cost and other issues associated with this approach to employment.

While great progress has been made in developing our services along the strategic direction outlined for us in A Vision for Change, there is still a lot of work to do in this regard. We have a highly skilled and motivated workforce that is receptive to the process of continuous improvement, but there are cultural impediments within our services and the communities we serve that we need to overcome if we are to continue to modernise our mental health services. In recent years, the mental health services have led the way in involving service users in the design and delivery of services. I say this in the context of the health services generally. We expect this to develop even further and are very optimistic about the outcomes this involvement will have for our services overall. The importance of integrating our mental health services with other vital services such as primary care and social care cannot be over emphasised.

I thank the Chairman and the committee for their time today.