Maurice Quinlivan (Limerick City, Sinn Fein) | Oireachtas source

I first spoke on the issue of the community access support team in 2021, not long after it was announced that it was to be trialled in Limerick. I was told at the time that it was going to be operational in 2022. Unfortunately, this did not happen. My colleague Deputy Ward asked the Minister for Justice, Deputy McEntee, about it in 2022. He was also told that the community access support team would be up and running in 2022. I have raised this issue several times in this Chamber over the years, as well as in meetings of the Limerick joint policing committee. At one such meeting of the joint policing committee in January 2022, I was advised that the creation of the unit was progressing and it would be live in 2023. It did not happen. Again, in April 2023, I sought an update on the progress of the unit, this time via parliamentary question. Once more, I was advised that it was on the cusp of being launched, but it has yet to be launched. I have asked numerous parliamentary questions over the years about this matter, as outlined in the pages I have with me.

This is a pilot programme that is very much needed. It is very much welcome and is most definitely needed in Limerick. The pandemic period had a major impact on people's mental health and this is still being felt. The delay in commencing the community access support team is beyond disappointing. It is a further example of how this Government continually fails people in Limerick and the mid-west when it comes to accessing medical support. We have a trolley crisis that continues unabated, long waiting times in the major hospitals, including University Hospital Limerick, and we have a failure to urgently address the challenges in mental health, especially during out-of-office hours when such support is needed. The unit has been prioritised for nearly four years and for four years, the Government has failed to deliver it. Where does the fault lie? What is the impediment to establishing this proposed team?

I remind the Minister of State of the remit of the community access support team. Should it ever be implemented, this team will call to a person experiencing a mental health issue, with the idea being that this specially-trained team will meet the person, triage that person and refer or bring him or her to the appropriate service. The long-awaited de-escalation unit, which will combine staff from the HSE, the Garda and the National Ambulance Service, is set to serve those facing mental health challenges outside regular working hours. As it stands, in Limerick the vast majority of out-of-hours interventions for those needing mental health support are provided by volunteers. It is the volunteers from the Limerick Mental Health Association and other volunteers, such as those in the Haven Hub and other groups, who try to fill the gap. We then have the last line of defence, those groups that respond when there are no other services. These include Limerick Suicide Watch and Limerick Treaty Suicide Prevention, which both do regular riverside patrols in Limerick city. Without these people opting to give up their time to try to tackle the mental health challenges that exist, I am sure we would have had more people lost by suicide.

It is time for the Government to step up to the plate and implement that long-promised de-escalation team.

The launch of the team is not unprecedented and is not without an example to follow. A similar pilot was rolled out in Belfast some years ago. It operated between the hours of 7 p.m. to 7 a.m. on Friday and Saturday for one year. During that time, the team had 193 referrals, 94 of which were face-to-face. In this context, 131 people were diverted from attending an emergency department and were instead directed to more appropriate routes of treatment. It also diverted 61 people from the justice system - 61 people who would otherwise have been charged with an offence, despite being unwell. They met, treated, and triaged people within their own community, alleviating pressures on a strained hospital system.

The service and staff, when funded, can work. Now, if someone suffers a mental health challenge outside of office hours, it is incredibly difficult to get the support, or indeed any support whatsoever. If such results could be replicated in Limerick, it would have an immediate impact on the number of presentations at our accident and emergency department at UHL. As the Minister of State will be aware, UHL is always at full capacity. It always has a huge number of patients being treated on trolleys in hospital corridors. Any programmes, such as community access support teams, CASTs, or the pathfinder programme, that could stop presentations at the hospital while ensuring that appropriate care is received, must be enhanced, or indeed commenced. It makes sense from a capacity pressure point of view, and crucially, it makes sense from a treatment point of view.

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