Ms Mary Walshe:

Good afternoon. I thank the Chair and members for the invitation to attend. I am joined by Ms Angela Walsh, head of service for mental health in CHO 9.

I am the chief officer in CHO Dublin north city and county, which is the best description of the area, rather than a number. Similar to my colleagues, I am the accountable officer for the provision of community services. I am committed to integration between primary and secondary care. We work closely with acute hospital services in a co-ordinated way around the assessed needs of the client. This is done in conjunction with Beaumont Hospital, Connolly Hospital Blanchardstown, the Mater Hospital and the Children’s University Hospital, Temple Street.

CHO Dublin north city and county is one of nine community health care organisations in Ireland and is responsible for providing care services to a population of 621,405 within the geographical district of Dublin north city and county. I have included details of the area in appendix 1. There are high levels of need within the inner city as a result of socioeconomic and ethnicity reasons. The population of CHO Dublin north city and county has seen an increase from the last census of approximately 6.9%. One of the fastest-growing constituencies in Ireland is Dublin Fingal and the Dublin City Council area has experienced a population increase of 4.8%. Population growth has been a considerable factor in increasing demand for services in recent years and presents a significant challenge in the context of service planning and delivery in Dublin north city and county.

From a governance perspective, as chief officer, I work closely with the national director of community services, Ms Anne O'Connor, and her team in implementing the national priorities. This is managed through a series of performance meetings with the national divisions. As head of service for mental health, Ms Angela Walsh, chairs the CHO mental health management committee, which has representatives from all disciplines to ensure there is a wide range of expertise who can represent the views of service users, carers and family members. The governance structure is in appendix 3.

I will expand further on service provision for CAMHS. In CHO Dublin north city and county, there are eight child and adolescent mental health teams providing mental health services through assessment and treatment at outpatient clinics and in the day hospital. These teams are operating, as set out in A Vision for Change, staffing levels at an average of 66.5%. The CAMHS inpatient 12-bed unit, St. Joseph’s, is operated by St. Vincent’s Psychiatric Hospital in Fairview. The CAMHS consultants provide 24-7 cover to the inpatient unit of the latter and to the emergency department at the Children’s University Hospital, Temple Street.

There are 20 general adult mental health teams providing mental health services to the population. Four of the 20 adult teams are fully staffed as set out in the policy A Vision for Changeand the remainder are operating at an average staffing level of 65%. General adult acute inpatient care is provided in four locations, with a total of 125 beds.

There are two psychiatry of old age teams in CHO Dublin north city and county. These teams are operating at 53.3%, as set out in A Vision for Change. There are 12 acute assessment beds - six in the Aishlin centre at Beaumont Hospital and six in St. Vincent’s Psychiatric Hospital, Fairview.

There are a number of day hospitals, eight general adult, one CAMHS and three psychiatry of old age day hospitals with service user led recovery-based hubs within CHO Dublin north city and county. In addition to the day hospitals there are sub-specialist services including four rehabilitation psychiatry teams and three liaison psychiatry teams reaching into Beaumont, Connolly and the Mater and one homeless community mental health team.

We have one a mental health intellectual disability service, which is operated by the HSE's St. Joseph’s service in Portrane in partnership with two section 38 agencies, providing assessment and treatment to clients attending their services. It is important to note that St. Joseph’s intellectual disability service, although providing mental health and intellectual disability, MHID, services is funded through national social care. I have given significant detail on the totality of the bed capacity for continuing care in appendix 4.

The overall staffing for CHO Dublin north city and county mental health service is 1,232 whole time equivalent as at November 2017 census. The single biggest challenge for mental health services in terms of recruitment is mental health nursing. Since 2013 there has been an average of between 35 to 45 whole time equivalent on-going vacancies that remain unfilled in mental health nursing across all services.

The overall budget for CHO Dublin north city and county mental health services in 2017 was €114.458 million, which included an allocation of €14.233 million for St. Vincent's Psychiatric Hospital, Fairview, the section 38 service provider. The allocation for 2018 has been increased by €2.6 million, or 2.35%. The budget for the mental health is provided in appendix 6. I am aware the committee wish to have some level of details on funding and this is the best breakdown we can give in terms of CAMHS, general adult community mental health and psychiatry of old age. I can discuss that further if they so wish.

CHO Dublin north city and county received programme for Government funding of more than €2 million since 2013 for recruitment to posts under A Vision for Change and new developments in line with the HSE clinical programmes for mental health.

These additional posts have been welcomed in enhancing service delivery with a focus on recovery.

I will address the challenges and opportunities for a moment. The population growth within my and my colleague's area has resulted in an ongoing increase in referral rates to child and adolescent mental health services, CAMHS, which brings a significant challenge in terms of our ability to meet the resultant timelines. In response to this, a robust quality improvement plan commenced in CAMHS in my area in 2017 to focus on children who were on the "greater than 12 months waiting list". That list has been eradicated and we are now focusing on further lists. This remains a continuing focus in 2018.

As Mr. Bennett alluded to, capital development is critical. Having appropriate infrastructure to support the effective delivery of service is paramount. A detailed capital plan has been devised to meet the growing demand on services over the next five years in my area. A significant number of our mental health teams are co-located or are due to relocate to primary care centres, which leads to a better interface with GPs and our other colleagues in primary care.

We have been awarded €230,000 from the service reform fund. It is intended to utilise these funds to assist service users to maximise their recovery and support them in seeking employment. This fund will also support service users to articulate their views and fully participate in mental health management teams.

A strong focus for us in 2018 will be on the Connecting for Life strategy. The implementation plan for our area is in its final draft stage and is due to be formally launched in the first quarter of this year. There are two resource officers for suicide prevention who provide information and support, as well as co-ordinating suicide prevention initiatives in the community. I am happy to say there has been a reduction of 50% in the number of suicides in my area between 2006 and 2015.

CHO Dublin north city and county is committed to providing a high-quality, standardised, patient-focused service that best meets the needs of the population we serve. We support integrated health services that meet the diverse health and social care needs of the community and treat each person according to his or her needs. We work with all stakeholders in our area, both statutory and non-statutory, to achieve high-quality health and social care services to ensure that our service users are supported to recover from their mental health illnesses and are treated with dignity and respect. A key focus for our area is positive engagement with service users, families and carers, who can assist us in planning and developing services into the future.

I thank the committee for the invitation to address it. I have included some information in the appendices. My colleague and I are happy to assist with any question or clarification members may wish to discuss.