Mr. Bernard Gloster:

On the CAMHS overview, I will not repeat everything in the appendices, but the Deputy pointed to the six teams we have. The VFC column shows the percentage of the team that is filled measured against what A Vision for Change indicated would be the optimal for the population at the time.

Members can see that they are quite variable. That is consistent with CAMHS teams generally across the country because of recruitment challenges and so forth. However, they are quite variable, running from 41% of the A Vision for Change recommendation up to above 81%. That is a general overview of the teams. The CAMHS across the mid-west have approximately 50 whole-time equivalent positions occupied out of a total workforce of 786 in the mental health service. There has been quite an amount of focused attention on the service in the past couple of years.

With regard to managing age-related issues and pressures, I will let Dr. O'Mahoney comment on that momentarily. However, a very significant concern for us at any point is when children are waiting, particularly for over 12 months. On the balance side, I tend to emphasise to people that the mid-west area, since it had its first CAMHS, has moved to operating a 24-hour service through the emergency department at University Hospital Limerick. There is a CAMHS consultant on call every night. That mitigates the concern in what one might call the milder categories of referrals and shows that the focus is on the crisis and emergency. Ideally, we would get to a much better position of early intervention that would avoid children having to go on a waiting list and waiting for 12 months to be seen. That is probably the biggest concern we have, and we do not shy away from it being a factor for us.

The age-related factor is a particular issue. People who are familiar with mental health legislation and policy will understand that there was a point in time when children were seen up to 16 years of age, after which they were seen in the adult service. The trajectory now must be to ensure there is a CAMHS sub-speciality for people under 18 years of age. Dr. O'Mahoney can comment on progress in achieving that.