Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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92. To ask the Minister for Health the reason, despite commitments to do so, returning the year on year budgetary provision for the roll-out of community mental health services to that promised in the 2011 programme for Government, did not seek the add-on of the 2014 shortfall of €15 million to the €35 million ring-fenced for 2015 for further advances in the delivery of A Vision for Change; if he will make a commitment to have the 2014 shortfall secured for the 2016 budget provision; and if he will make a statement on the matter. [42757/14]

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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My question has been somewhat played around with. It should state:

To ask the Minister for Health to explain why his Minister of State, Kathleen Lynch TD, despite her repeated commitments to do so, did not, in fact, at the end of the day, seek the add-on of the €15 million unsecured in the current year to the €35 million to be ring fenced in 2015.

Kathleen Lynch (Cork North Central, Labour)
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I can read out for the Deputy the exact same answer I gave Deputy Colm Keaveney earlier. I know it is identical because I have read it. I understand what the Deputy is saying and why he is saying it. However, I must say the experience I have gathered over the past year or two has shown me very clearly that trying to put in place the posts for a new service in mental health is quite difficult. The bulk of the posts are in place. Recruitment for the posts approved in 2012 and 2013 is continuing. At the end of September, of the 416 posts approved in 2012, 397.5 have been recruited.

Regarding the 2013 posts, the recruitment process is completed for 370 of these posts and the majority of the remaining posts are expected to be filled by the end of this year or early next year.

In the interests of debate and in order that we all know exactly where we stand, I received a note last week from the national office. We now have a national office for mental health. We have a difficulty in some areas relating to being unable to recruit child and adolescent psychiatrists. Not alone did we go to the market in this country, we also went to England because we heard of an agency there that was having some success in recruiting this very specialised consultant. Having gone and looked, however, we had no success. Not alone did we not have success, a private provider that was offering a salary of €200,000 for an equivalent post did not have success. We have a difficulty in terms of the type of specialist post we are trying to recruit and in terms of changing the service in the dramatic and quick way we are trying to do it. I am very determined that this should happen quickly. We are having a difficulty regarding the posts and that has changed my view over the past year. It is better to try to operate in terms of what we have available and get in as quickly as possible those whom we can recruit.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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The only interpretation that can be put on the failure of the Minister of State to seek €15 million that was not provided for this year is that we had nowhere to spend it. We are talking about the implementation of A Vision for Change and we still do not have the model of 24-7 crisis intervention within the specialist mental health services in all parts of the country. Not all services are providing home treatment and there are very few crisis houses to provide alternatives to inpatient beds.

There has also been a large increase in the number of homeless people being admitted to inpatient units. In 2013, 245 people of no fixed abode were admitted to inpatient units, an increase of 40% on 2012. Mental health services in primary care, representing a core aspect of all entailed in A Vision for Change, are simply not able to cope with current demand. The Minister of State in an earlier response referred to the new counselling and primary care service. The HSE has advised us that the waiting list for this new counselling and primary care service is already building up. This service was only initiated nationally in July 2013. As of August, 211 people were waiting between three and six months for an appointment and 70 people had waited more than six months.

Michael Kitt (Galway East, Fianna Fail)
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I will come back to the Deputy. I call the Minister of State to reply.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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A considerable amount could be done with these moneys.

Kathleen Lynch (Cork North Central, Labour)
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In response to the request that the Government should have made up the €15 million it held back in 2014, my position is that in the circumstances and given the logistical and phasing issues arising from recruitment and properly planned service reconfiguration, it was considered more efficient to restore the annual programme for Government allocation to 2012 and 2013 levels. Coupled with unspent 2014 moneys, this represents a considerable commitment to an increase.

Regarding counselling in primary care, CIPC, because we did not know what the demand or uptake would be or how successful it would be, a waiting list built up. That is why the €35 million in this year's service plan will be directed very clearly towards the primary care setting. I will get the Deputy an entire list of what we have done and what is available in mental health and primary care. There are constant complaints about what we do not have, whereas we have a considerable amount done.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I do not argue there have not been improvements. I am highlighting, as is my role and responsibility, what needs to be done. There is so much in the mental health area and I know the Minister of State is as aware of it as I am.

There can be no way we could fail to utilise that €15 million in the coming year.

I refer to the waiting list for CAMHS. Children continue to be admitted to adult wards with 158 admissions up to the end of June, 53 of whom were placed in adult wards, while in July more than 2,700 children and adolescents were waiting to be seen by CAMHS.

These moneys were pushed into other areas of the health budget in previous years and they could be pushed into other mental health services. If the Minister of State is not adding this money in 2015, whatever value her commitment may have, will she seek and secure it and add it for 2016?

Kathleen Lynch (Cork North Central, Labour)
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With regard to children being placed in inappropriate places, my research tells me that they are usually aged 16 or 17. I was worried that this involved a younger cohort but, nevertheless, when young people are placed in inappropriate beds on adults wards and beds are available within the CAMHS unit, a question needs to be asked. I have asked that question of those charged with both delivering the service and inspecting it. We need to have a conversation about what is causing the delay and why there are such waiting lists.

We are looking for a child and adolescent psychiatrist but we cannot get one. We have tried not only on these shores, but also abroad. A private service offering much more than we are offering cannot recruit such a psychiatrist. There are difficulties in some areas and we have to recognise this difficulty. I am not certain how to resolve it but we are working on a solution.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Will the Minister of State secure the missing €15 million?