Dr. Gerry McCarney:

On what would help, I am not sure that splitting disability services off from CAMHS worked. I am not sure disability services had developed to a sufficient degree to offer a service that was sufficient. Previously, people went to mental health services, regardless of mental illness or disability, to be assessed, to identify what intervention might help and then to seek support. There is now a lot of confusion about which service people go to and whether it is there, which is not helpful.

On substance misuse and dual diagnosis, the national clinical programme for dual diagnosis is timely. It is great that there is some action at last. To be fair, we have had a lot of support, particularly from the Ministers of State, Deputies Butler and Naughton. The two new hubs are not new. They have been working for some time as substance misuse teams. They will continue to do so, as well as trying to do more on dual diagnosis. They will see people who do not have an illness, as well as those who do and have substance misuse issues. The plan is to have two more hub teams, one in Galway and one in Cork. Those teams would have this hub-and-spoke model, where the four hubs will cover their own catchment area but will also be in a position to offer more support virtually and some face to face. It will certainly be virtually to areas outside the catchment area so the expertise can travel more easily and be available. To do that, however, we need to have these spokes. That means we need to have a skeletal team at least. The skeletal teams that were envisaged consisted of a clinical nurse specialist and a counsellor in each CHO area. There were nine CHO areas and now, with regionalisation coming down the track, that will be six. We have to see how that will reconfigure but the plan was, regardless of where people lived, that there would be a person to refer a child, if he or she were using substances.

We are trying to expand that potentially into process addictions, which are essentially gaming and gambling. Gaming, particularly for younger people, is an issue. Gambling is probably an issue but we are not sure of the extent of it, especially if it takes place over the phone rather than through going to shops and so on. We are very conscious of that in trying to develop that service. In the strategic implementation group, SIG, for the drug and alcohol strategy, we put in eight new action points in the mid-term review, one of which was the development of a national substance misuse service for under-18s that would be cohesive, well governed and supported. We hope to develop that so there is a real service out there that will see young people regarding their drug and alcohol use, and their process or behavioural addictions, and be able to look at the dual diagnosis aspect so we can maybe take some of the pressure off CAMHS, depending on how well we are developed. One of the issues is recruiting people. It is great that funding is being made available to recruit but people are not always there. We have had difficulty in recruiting for certain disciplines. Having different disciplines offers a different skill mix. That is very important but if the people are not there, or they are not coming forward to join the service, then the posts cannot be filled. That is a challenge.

On making the service better, CAMHS has been under-resourced for a long time. It has improved over the past few years. There is a lot of frustration that it cannot do better but, when it has half-teams, it has been a challenge. I was chair of the Faculty of Child and Adolescent Psychiatry for three years and I heard a lot of that, even though I was not working in a CAMHS post as such. There is a lot of willingness to improve things. Recruitment is one way of doing that, but it is also about looking at how we work and how we co-work between different services. That will help, as will looking at referral criteria and services underneath the moderate to severe. Other services were developed, such as community psychology, and other agencies were supported, such as Jigsaw, etc. CAMHS then focused on moderate to severe illness, but there are a lot of people who are in distress who may not have a moderate to severe illness but could receive support. We need to look not just at CAMHS but the other funded organisations to see how they are fitting into the picture because they need to work cohesively to offer a proper service for people.