Mr. Ger Reaney:

I thank the Chairman and members of the committee for the invitation to attend the committee today. I am the chief officer of Cork-Kerry community healthcare, which is referenced in the documentation provided by the national division as CHO 4. I am the principal responsible officer, responsible for all HSE-run or HSE-funded community-based services in the counties of Cork and Kerry. I am joined Ms Sinead Glennon, who is the head of mental health services in Cork-Kerry community healthcare. My colleague chief officers, Ms Colley and Ms Queally, will introduce those accompanying them. As with our colleagues who addressed the committee earlier, we have tried to ensure a mix of different roles in the teams attending today across the CHOs. All responsibility for mental health services in Cork and Kerry is under Ms Glennon as head of mental health services. There are separate management teams in Cork and Kerry for historical reasons each of which includes an executive clinical director and area director of nursing along with an area director of nursing for child and adolescent mental health services in Cork.

Specialist mental health services are developed in collaboration with the national mental health team and delivered in line with national policies, frameworks and priorities. As I am conscious of the committee's time, I do not propose to go through much detail on the make-up of services and the various teams. Suffice it to say that Cork-Kerry, as with other CHOs, has a mix of adult and CAMHS teams, psychiatry of later life teams and a mix of acute units and other residential units. They are set out in our statement and in the appendix. Mental health services in Cork and Kerry have a strong focus on recovery and co-production whereby initiatives are developed jointly by service users and staff. We have consistently sought to emphasise community-based services, including home treatment services, thereby reducing reliance on acute type services.

Referrals to specialist mental health services are usually through GPs. Specialist mental health services work closely with many other health and social care services. The introduction of community health care networks, as referenced in the Sláintecare report, will support stronger integration between specialist mental health services and other health and social care services in each local area.

Cork-Kerry community healthcare mental health services employs 1,468 staff across a range of disciplines set out in table 4a in the appendix which we forwarded to the committee. This represents an increase of 23% in overall staff numbers since 2012. The increase in staffing shows the impact of the programme for Government investment in mental health from 2012 onwards, which has impacted on the staffing in adult mental health teams and in CAMHS teams; additional staffing to open new acute units at Cork University Hospital, CUH, and Deer Lodge residential unit in Killarney; and also the development of specialist services for psychiatry of later life, mental health services, people with intellectual disability, suicide and self-harm prevention, as well as services for homelessness, rehabilitation and forensics.

Like many of our colleagues in other parts of the country, we experience recruitment challenges, particularly in child and adolescent psychiatry, non-consultant hospital doctors, nursing and psychology. We recently established a task force in our CHO comprising HR and medical personnel to focus on recruitment into child and adolescent mental health services. We can expand on that later. Notwithstanding these challenges, we recruited 170 new staff who started in Cork-Kerry mental health services in 2017. At the end of December, there were 28 vacancies, excluding a number of development posts which we have yet to fill. The budget for specialist mental health services in the area is €118.3 million, representing an increase of just under 15% since 2015.

One of the committee's headings is primary care. Obviously, the majority of mental illness is treated in primary care, in particular by GPs. We support that through the counselling in primary care service, which provides counselling for people with medical cards referred by GPs. We can give further details on the location and volume of that. We have also been developing a psychology service in primary care through recruiting seven additional psychologists and 16 additional assistant psychologists. Five of the seven psychologist posts have been filled, as have 13 of the assistant psychologist posts.

The next section outlines a number of achievements, and given time constraints I will not dwell on them. They refer to a number of acute units, the Jigsaw service in Kerry, which also commenced in Cork in 2017, a number of initiatives in suicide prevention and also mental health engagement.

In 2018 we will develop a liaison psychiatry team in University Hospital Kerry, a CAMHS liaison service in CUH in 2018; an additional CAMHS consultant in Kerry with a special interest in liaison and the mental health needs of children with intellectual disability, complete the refurbishment of the acute adult mental health unit in University Hospital Kerry, establish a specialist forensic team working with Cork prison, establish a child and adolescent mental health services eating disorders team, establish a specialist perinatal service in Cork University Maternity Hospital, and introduce advanced nurse practitioners.

As with other areas, we face a number of challenges in addition to the recruitment challenge. We experience waiting times for child and adolescent mental health services due primarily to recruitment issues and the absence of certain staffing levels. We are working through a detailed comprehensive enhancement project led by a clinician in our area, with a number of short-term and long-term measures to improve that. We are also prioritising that area for development funding which has been allocated to us at the end of 2017. Access to the CAMHS inpatient unit can be a challenge depending on demand. The unit has fluctuated between 14 and 18 beds depending on medical staffing. We are also conscious that suicide rates in Cork and Kerry are high, although they have reduced in recent years. They are a particular focus through our connecting-for-life plans. As with other CHOs we are experiencing high-cost external placements where we need to refer individuals to external agencies for services.

That concludes my opening statement and I would be happy to answer any questions members have later.