Mr. Paul Reid:

I thank the Chairperson and members for the invitation to attend today’s meeting to discuss expenditure on mental health services, including on CAMHS, in the context of the HSE financial statements for 2020. The Chair has introduced my colleagues so I will not repeat the names.

The range of mental health services delivered by or on behalf of the HSE is extensive and ranges from promotion of positive mental health, HSE-funded services provided by our partner organisations and mental health in primary care, to specialist inpatient and community-based mental health services.

As requested by the committee, I refer to the briefing notes submitted in advance of today’s meeting, which provide a detailed breakdown of all HSE expenditure on mental health services and associated governance and oversight arrangements, as well as expenditure and associated spending decisions with regard to the buildings at Owenacurra Centre in Midleton in County Cork.

Owenacurra Centre currently provides mental healthcare, rehabilitation services and accommodation for 11 service users. The building is, regrettably, no longer fit for purpose and it is not viable to bring it to a standard that will meet the needs of our service users and staff. Mental health services in Cork Kerry community healthcare organisation work in close collaboration with the affected service users and their families to find more appropriate accommodation. The process will be handled with sensitivity and with regard to the wishes and preferences of each resident.

The HSE’s annual financial statements for 2020 reported total expenditure of €20.2 billion for the provision of health and social care services while also dealing with the unprecedented Covid-19 pandemic. Mental health services expenditure in 2020 was more than €1 billion or more than 5% of total expenditure reported.

Over the past decade, mental health services have seen a significant budget increase. Since 2012, €325 million have been made available to support priority service enhancements. These targeted investments have been directed by national mental health policy in Vision for Change 2007, Connecting for Life 2015, and Sharing the Vision 2020, and in line with the Sláintecare reform programme.

Developments have, in broad terms, been aimed at modernising services that historically were centred on institutionalised care by building our workforce and investing in fit-for-purpose infrastructure; promoting positive mental health; intervening early when problems develop; and providing accessible, comprehensive and community-based services for those who need them and supporting the recovery journey of each individual, based on clinical advice and best practice, while recognising the importance of lived experience.

Funding for new developments has been invested in building our community teams for children and young people, for adults, and for older persons; expanding youth mental health services; developing specialist services and clinical programmes; driving forward our national suicide prevention strategy; strengthening mental health services in primary care; empowering service user involvement; and modernising forensic services.

The availability of skilled staff is a significant issue in mental health services where demand outstrips supply and where our workforce, particular younger staff, are availing of employment opportunities outside of Ireland. We continue to have a strong focus on mitigating these risks, among other things by building a service that is attractive to work in, by offering flexible working arrangements and by fully utilising opportunities offered by telehealth solutions.

Notwithstanding our recruitment challenges, this continued investment has enabled mental health services to progress the shift from institutional to community care and to improve the overall quality of services. Since 2012, mental health services have seen a net growth of 1,441 wholetime equivalent posts, while increases in agency staff and overtime equals an additional 789 wholetime equivalents into the workforce. In parallel, significant capacity has been built into primary care and community services to relieve pressures on specialist mental health services, including CAMHS.

The clear outcomes from this investment can be seen in the following: an additional 18 CAMHS teams since 2012, and generally enhanced capacity in CAMHS; between 2020 and 2021, the number of accepted CAMHS referrals increased by 21%; enhanced inpatient CAMHS capacity and reduction of young people admitted to adult acute units; enhanced capacity within our adult community mental health teams, which has significantly reduced admissions into acute inpatient units; an additional ten community-based teams for older persons; more developed upstream mental health services, including funding for partner organisations such as Jigsaw; greater access to talking therapies, including establishment of counselling in primary care, which has seen more than150,000 people referred for treatment since 2013; development of a new national forensic mental health service in Portrane, which will incorporate a new ten-bed forensic CAMHS unit; design and implementation of four national clinical programmes; establishment of a mental health engagement function nationally and within each community health organisation, as well as recruitment of peer support workers; and expansion of suicide prevention, mental health promotion and health.

An additional €24 million has been made available to enhance and build new mental health services in 2022. This will allow the HSE to continue our implementation of the national clinical programmes, build out-of-hours services, crisis response teams and crisis cafés, and bring forward a recovery approach into all services.

In collaboration with the Department of Health, next month we will launch a three-year implementation plan to drive forward delivery of Sharing the Vision, which will complement the Connecting for Life implementation plan already in place.

These detailed multi-annual plans will provide a clear roadmap for the continued development of mental health services in Ireland. Implementation will be driven by a strong outcomes focus and a shared commitment to report on progress against these plans in an open and transparent manner, among other things by making progress reports publicly available.

In delivering these work programmes, the HSE will work in partnership with staff, service users and families to achieve our goal of a modern and fit-for-purpose mental health service that meet the needs of those who require our services.

This concludes my opening statement.