Michael Harty (Clare, Independent)
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In respect of the commission's remit regarding the inspection of inpatient services, it has come to my attention on a number of occasions that there is substantial overcrowding in acute services, which has resulted in a loss of dignity and privacy and a very unsatisfactory perception of the treatment people have received in acute services. Will the witnesses comment on that because some services have been amalgamated? For example, mental health services in south Tipperary have been amalgamated with mental health services in Ennis. I understand that this has led to substantial pressure on beds and admitting patients and led to subsequent overcrowding.

My second point concerns presentations to general practice and, going back to Deputy Durkan, who is the source of referrals. In general practice, one is left trying to filter things that need to go to CAMHS, namely, serious mental health issues and those that can be dealt with counselling or other services. Unfortunately, the number of team members missing from CAMHS teams is substantial. For example, there may not be a psychologist or a team may only have half a social worker, as it were, or lose a community psychiatric nurse, who may be on holidays or maternity leave and may not be replaced. In many cases, CAMHS teams other than the psychiatrist - the backup personnel - are not there because the teams are understaffed. It then falls to the GP to decide if an issue is a serious one, in which case he or she will send it to the psychiatrist in CAMHS, or whether it can be medicated by himself or herself. There is pressure on GPs to medicate themselves because the backup talk therapy and support services are not there. In some cases, there may be unnecessary medication because the alternative talk therapies are not there. Is there a sense that there is overmedication because of a lack of the other supports that should be there within community psychiatric services?

Regarding recruitment and retention of staff, one of the findings of the report of the Oireachtas Committee on Future of Mental Health Care was that there was a disconnect between the HSE centrally and front-line needs at ground level. A total of 25 steps needed to be taken before a staff member could be recruited. It is to be hoped, with the new Sláintecare proposals, there will be a regionalisation of services so the number of those steps will be reduced substantially so that a staff member can be recruited in a relatively short time. Will the witnesses address this point? What engagement does the commission have with Tusla regarding children's problems and child services?