Jim Daly (Cork South West, Fine Gael) | Oireachtas source

I thank the Deputy for raising the issue of mental health services in his area. As he knows, this is a priority. It is not just about money. Money will not solve the problems in the service but €105 million has been provided in new development funding over the next three years, very specifically to extend mental health services to a seven-day week. This is our first priority.

Sligo Leitrim mental health services provide a broad range of mental health services to the populations of Sligo, Leitrim, south Donegal and west Cavan. Services provided encompass general adult psychiatry, psychiatry of old age, rehabilitation and recovery, mental health of intellectual disability and child and adolescent mental health services. Services are provided directly in the community and in clinical and residential settings. Sligo Leitrim mental health services operate a seven day a week, out-of-hours service based in the primary care centre in Ballymote. This provides acute mental health treatment and support to individuals from the hours of 9 a.m. to 5.30 p.m. seven days a week. The services also provide a rehabilitation and recovery service that includes home-based treatment and assertive outreach models of care to clients known to the mental health services. These are also co-located in the Ballymote primary care centre and operate from 8 a.m. to 8 p.m. seven days a week. In addition, our emergency departments provide national coverage through a 24-7 service from which members of the public receive acute mental health care and treatment. In Sligo, the emergency department of Sligo University Hospital provides this out-of-hours service.

I acknowledge the case raised by the Deputy. I will not comment on a specific case and I know the Deputy is not asking me to do so but is using it as an illustration. He will understand and appreciate, therefore, that I cannot respond. However, I will say that I recognise and acknowledge that one of the greatest causes of distress for parents and other family members is to be with somebody who has, as the Deputy described, a meltdown or an episode of psychosis. Having to deal with this is very traumatic. The reality is that the out-of-hours service available at 1 a.m. or 2 a.m. is based in the emergency department of the local hospital. The Deputy referred to somebody being turned away from the service. This is something I will not be able to comment on or deal with because it is a clinical decision made by a medical person and I am not here to judge the decision made by a qualified medical practitioner.

To give the Deputy some idea of the thinking on this, the challenge we will have far into the future, and what I am trying to do in this area, is to provide for online psychiatry. We will never be able to staff a 24-hour, seven day a week service led by a consultant psychiatrist in every county. It will never be possible and that is the reality. There is a real shortage of consultant psychiatrists worldwide. We will look at how we provide that cover a bit better. The worst place for anybody to be having an episode of psychosis or a meltdown is inside in an emergency department while waiting for two or three hours to be seen by a consultant psychiatrist. What they do in other parts of the world is deal with this through online psychiatry, whereby people can be assessed by a consultant psychiatrist immediately through online televisual conferencing. People can be assessed, diagnosed, prescribed and admitted, if necessary, there and then by wheeling up a cart similar to a blood pressure or BP cart, turning on a screen and having a psychiatric consultation. We will never be in a position of having a consultant psychiatrist sitting in Sligo waiting for the one presentation that might occur in a 24-hour period.

Today, I looked at the figures for another part of the country and the number of presentations in a busy city area. There were 14 out-of-hours presentations there in the entire year. We have to look at how we do what we do, and the plan I am trying to develop is having available online psychiatry. It works throughout the world and would cover a number of different sites and provide immediate access to that key decision capacity. It would be done in an emergency department with doctors and nurses but the consultant psychiatrist providing the clinical governance would cover a number of different sites with online availability. This is my hope for the future.

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