Ms Aileen Colley:

I thank the Chairman and members of the committee for the invitation to attend the committee today and the opportunity to provide them with information on the mental health services in the south east. I am the chief officer for CHO 5, and like my colleagues, I am responsible for the overall management of HSE services excluding the acute hospital services in the south east. I am accompanied by Dr. Stephen Browne, who is the executive clinical director for mental health services, and Mr. Michael Morrow, who is the head of finance for CHO 5.

CHO 5 covers Carlow, Kilkenny, south Tipperary, Waterford and Wexford, an area with a total population of 510,333, which has had a net increase of 2.6% since 2011.

The greatest increases were in the older age groups, particularly those aged 65 to 74 years, with the greatest decreases in the younger age groups, particularly those aged 25 to 34 years. There is a further breakdown in the appendices.

In health service analysis and planning, we are cognisant of many factors, including the age groups, gender, social determinants of health, deprivation indices, housing and so on. All these indicators have an impact on the demand for services in our area and a potential impact on expected outcomes for our population.

Nine CHOs are the delivery arm of the HSE national operation plan and the mental health plan, implementing care in alignment with key performance indicators, national policies, clinical standards and operating procedures.

Community health care organisation, CHO, 5 like the other CHOs are standardised as such in that we have a governance structure that devolves under four care groups, primary care, mental health, social care, and health and well-being. There is an alignment in both the governance, that is, to and from the national office to the CHO and then in the local clinical service delivery across the four care pillars. This is achieved by agreed key performance measures, across care group representation at senior management through to population alignment, where the clinical teams work in areas, averaging populations of 50,000 people.

The term mental health describes a health status that can range from positive mental health through to severe illness. Hence the requirement to provide services from a stepped care model from population health such as information through to specialist mental health services. The specialist mental health services are provided to a particular group in the population. Like my colleagues in the south east, we have seven child and adolescent mental health services, CAMHS, providing secondary care, specialist services for young people up to 18 years who have severe and complex mental health disorders.

We have 17 general adult mental health teams and five psychiatry of later life teams, servicing people in different settings, including outpatients, acute day services and in the individual's home.

The south east has six approved centres, including two acute adult units and four psychiatry of later life units. Community mental health services are delivered by a range of multidisciplinary teams and that is within a sectorised population based approach.

As the statutory service provider, we work with our voluntary partners to ensure the meaningful engagement and involvement of the service users in its design and delivery. Integration is achieved through collaborative working between and across primary care, acute services and mental health. The integration is further enhanced through co-location as appropriate.

The mental health teams with a total staff of 1,187 staff are organised to provide inpatient, residential and community services in centres as set out in the table in my presentation and also in appendix 3.

In line with the stepped care model we have roles and teams that provide prevention, early intervention and other supports, such as suicide prevention. The regional suicide resource office co-ordinates activities in suicide prevention, intervention and postvention in CHO 5. One of the key responsibilities of the office is the development and implementation of Connecting for Life - Ireland National Strategy to Reduce Suicide 2015-2020. The latest launch was in Carlow on 7 December 2017.

Under the national counselling services, the south east has three services: counselling in primary care, self-harm intervention programme and national counselling services south east. There is a further breakdown in the appendices.

The development of a recovery focused model in CHO 5 has been an ongoing priority. The recovery college in the south east was officially launched in 2017 and offers focused education which is designed to complement existing community mental health services by utilising an education approach which has a positive effect and impact on the mental health and well-being of people who utilise the services. The introduction of an area lead and five peer support workers to represent the views of service users, family members and carers was a significant step also in 2017.

The budget and actual spend on mental health services in CHO 5 is summarised and one can see there has been a 14.6% increase between 2012 and 2017. CHO 5 remains committed to the delivery of a high quality patient-focused service. However, as my other colleagues acknowledge, there are challenges to achieving this objective. There is an increasing demand for services for children and young people across the spectrum of promotion, prevention and early intervention right through to tertiary level inpatient care. We will be continuing a strong focus on this area throughout 2018 and beyond. Similar to all areas, recruitment and retention of staff, especially for medical and nursing staff remain a challenge. We continually assess, analyse and monitor our operational plan, key performance indicators and the feedback we receive to target change and address our challenges through resource management and best practice.

That concludes my opening statement. There is further information in the appendices. I thank the Chairman and members of the committee for the opportunity to make this presentation.