Mr. David Walsh:

I thank the Chairman and members for the invitation to attend today's meeting. I am joined as a witness by Dr. Brendan McCormack, executive clinical director for mental health services. I am the chief officer of CHO area 7 and I am responsible for the management of Health Service Executive services, excluding acute hospital care, in this area. I report to the national director for community operations.

CHO area 7 includes County Kildare, west County Wicklow, most of south County Dublin and most of the Dublin City Council area south of the Liffey. The area had a population in 2016 of 697,000, an increase of 33,175 or 5% on the 2011 figure. A total of 43% of the population are below average on the deprivation indices.

The mental health service reports to me through the head of service. There is one executive clinical director and one area director of nursing. The mental health management team also includes allied health professionals and service user representation. A separate management structure is in place for the Kildare area, with a clinical director and director of nursing reporting directly to the head of mental health.

The mental health service in CHO area 7 operates across a number of specialist domains, including general adult, old age, child and adolescent, and mental health of intellectual disability. The general adult services are community oriented, with an emphasis on delivering secondary care in the community. The access team provides mental health services to the homeless population in south Dublin. In addition, a perinatal service is provided to the Coombe hospital. Rehabilitation teams are in place in Kildare and Tallaght, with recruitment under way for a team in the St. James’s sector.

The HSE national counselling service, NCS, provides counselling to adults who have experienced childhood abuse. The counselling in primary care service, CiPC, delivers short-term counselling to those with mild to moderate mental health issues who have been referred by their general practitioner. The service is currently available to general medical scheme, GMS, card holders only.

In total, there are 905 whole-time equivalent staff, WTEs, employed in mental health services in CHO 7. That is outlined in the appendix to our statement.

The mental health service in CHO 7 has a budget of €93 million in 2018. That has increased from a budget of €74.69 million in 2012. The budget is split between pay and non-pay expenditure by a ratio of approximately 70:30.

There are 12 general adult community mental health teams, which form the core of service delivery. These include three teams in the St. James’s sector, four in the Tallaght sector and five in the Kildare and west Wicklow sector. Referrals are mainly from primary care GPs and provide a range of interventions, often long term.

There are three psychiatry of later life, POLL, teams, and hospital liaison services are also provided. There is one rehabilitation team in each of the Tallaght and Kildare services, with a third to commence in the St. James's sector in 2018. A Vision for Change recommends that mental health services for people with an intellectual disability should be provided by a specialist team. Under the chairmanship of Dr. Brendan McCormack, a new management team, including the HSE and voluntary agencies, is in place to oversee this development. These will be catchment area-based services.

The HSE Linn Dara child and adolescent mental health service, CAMHS, has seven community mental health teams. They are supported by an adolescent day hospital team based at Cherry Orchard. However, services in Tallaght, Templeogue, Rathfarnham, Crumlin, Drimnagh and Walkinstown are provided through the Lucena Clinic service, which is under the governance of CHO 6.

There are 132 adult acute inpatient beds in CHO 7, with access to another ten beds in Midland Regional Hospital at Portlaoise. Some 52 beds serve the Tallaght sector, 51 beds serve the St. James’s sector and 29 are in Naas. There are eight hostels catering for 100 residents, and an additional 70 low support and medium support places are also provided. The 24-bed Linn Dara CAMHS inpatient unit is one of four inpatient units in the country. It also has an integrated school.

The CHO 7 mental health engagement area lead was appointed in 2017 and sits on the management team. There are local monthly forums in place across the CHO. These structures will be developed further in 2018. Learning from the views and experiences of service users, family members and carers ensures they are central to the design and delivery of services.

There are three resource officers for suicide prevention. Our Connecting for Life action plan will be launched next month. Work will continue to reduce the levels of self-harm and suicide in close collaboration with statutory and voluntary partners. Approval has been given for five additional posts in 2018 to develop a seven-day service in the St. James’s sector. That will mean that all sectors in CHO 7 have seven-day cover.

In addition, funding has been provided in 2018 for 16 assistant psychologists and four staff grade psychologists.

A regional specialist community eating disorder team for child and adolescent patients will commence this year. Work is also ongoing on a new attention deficit hyperactivity disorder, ADHD, clinical care pathway service in south-west Dublin. The new children’s hospital is located within CHO 7 and includes 20 mental health beds, eight of which will be for eating disorders. The operational arrangements for these beds are currently being worked through.

Recruitment and retention of staff is a significant challenge in CHO 7. Many staff members commute long distances. Shortages of medical staff have led to agency usage. Nursing recruitment particularly impacts on all services. The physical infrastructure for many of our services is poor. Capital planning to replace the Lakeview unit at Naas General Hospital is currently under way. St. James’s Hospital's acute mental health unit is currently being refurbished. A lack of long-term care options creates pressure on acute beds and the cost of private placements is significant for the service.

Other priority developments for the service include a home-based treatment team for Kildare and enhanced rehabilitation services in Dublin South-Central. I refer also to the need to further develop psychiatry of later life services. Bids have been submitted for additional funding in 2018 to address these areas.

That concludes my statement. I have also included some information in the appendix to my written remarks. I am grateful again to the committee for its consideration of these matters, and I am happy to assist further in any questions.