Eugene Murphy (Roscommon-Galway, Fianna Fail)
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I understand Deputy Buckley wants to accommodate Deputy Ó Laoghaire and that Deputy Kelleher has no difficulty with that.

Pat Buckley (Cork East, Sinn Fein)
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Last Monday, it was reported in the press that there were no child and adolescent mental health services, CAMHS, available in emergency departments in Cork. The HSE said that the recruitment difficulties had affected the CAMHS service in Cork, particularly since the start of the year. Since January, it has been particularly difficult to maintain the non-consultant hospital doctors' on-call rota for the two Cork city emergency departments due to a combination of vacancies, sick leave and other factors. However, further resignations - I stress, resignations - and sick leave have compounded the service difficulties. The HSE said that, since 25 March, it has not been possible to guarantee as responsive a service to the emergency departments as it would like. To put the question simply, why is this happening?

Donnchadh Ó Laoghaire (Cork South Central, Sinn Fein)
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The news that broke on Tuesday was of extreme concern to the people of Cork. There was nobody available from the CAMHS teams to see anyone who presented in Cork city last Monday. If a child presented as self-harming or suicidal at the accident and emergency departments of either the Mercy Hospital or Cork University Hospital, there was no psychiatrist there to see them. That situation beggars belief.

I know the Minister of State visited Cork a number of months ago and heard about the situation and the services that were available. While there is credit due to her for coming down, it also means she is familiar with the situation. At that time, responding in Leaders' Questions in respect of the issue, the Taoiseach led us to believe that no stone would be left unturned and that every effort would be made to ensure that all resources would be provided to resolve the crisis. Nonetheless, we see a situation in which one of the most fundamental and crucial mental health services for children and adolescents in Cork has been found wanting and left short.

Billy Kelleher (Cork North Central, Fianna Fail)
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I will read an extract from a letter that was circulated to general practitioners from the mental health Cork and Kerry HSE offices:

In recent weeks, it has been increasingly difficult to maintain out-of-hours, on-call services at the two Cork city emergency departments along with the out-of-hours service to Éist Linn, the CAMHS in-patient unit. The difficult decision has now been taken to prioritise out-of-hours cover to Éist Linn and to postpone out-of-hours on-call cover in the emergency departments until staffing levels improve.

That information was circulated to general practitioners on 7 April in the Cork-Kerry area. Some of the replies I have got back to recent parliamentary questions are quite alarming in terms of the length of time people are waiting for services from CAMHS in the region. Beyond that, it is also a major national problem. I know there is extreme difficulty in recruiting at non-consultant hospital doctor and consultant level. I accept that. However, this has been on the cards for some time. We have been raising the matter for a number of years. We knew there were going to be huge difficulties because of the slow recruitment process. Now that is evidenced on a daily basis in Cork and Kerry and throughout the country.

A general practitioner said he had an extremely vulnerable 14 year old and a 15 year old whom he could not refer to the emergency department as there was no CAMHS support available. While I acknowledge the Minister of State's commitment to this area, we do need to expedite the recruitment of clinical personnel to ensure we do not have a situation in which vulnerable children are waiting up to a year for assessment and supports. It simply is not good enough.

Helen McEntee (Meath East, Fine Gael)
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I thank the Deputies for raising this issue. I share their concerns, as do the people who are providing the service. They understand the difficulty they are facing and the impact it is having on the young people in the area.

It is the policy of the HSE, under its annual service plan, to provide an age-appropriate mental health service for those under the age of 18. Mental health remains a key care programme priority for this Government, reflected by the fact that the HSE mental health budget increased from around €826 million in 2016 to approximately €853 million this year. The HSE service plan for 2017 commits to further development of child and adolescent mental health services, including better out-of-hours liaison and seven-day response services. This is a strategic priority action in the plan, against a background where the population of children is expected to increase by over 8,500 in the period 2016 to 2017, thereby creating additional demand on CAMHS. Approximately 18,500 referrals are expected to HSE CAMHS services this year alone.

CAMHS has been prioritised in new funding made available by the Government since 2012. Additional resources and facilities mean there are now 67 CAMHS teams and three paediatric liaison teams, supported by 66 operational CAMHS beds nationally with further beds planned to come on stream in the near future. CAMHS services in Cork have eight community-based teams. Two of the teams have consultant vacancies, namely team C - Western Road, and North Lee North. Team C has had a vacant psychology post since Christmas 2016, but the executive recently secured a person to fill this post. There have been widely acknowledged difficulties in recruiting and retaining specialist CAMHS staff, particularly consultant psychiatrists, which all of the Deputies have recognised. Recruitment efforts have been ongoing including local and international advertising for a locum consultant in Cork, which have not yielded any success. Unfortunately, there is currently a serious shortage of suitably qualified CAMHS consultants at both national and European level.

The HSE is working to provide the best possible service within available staffing resources. A key focus is on managing clinical risks and prioritising referrals accordingly. All efforts are being made to support teams with additional therapy and administrative resources, notwithstanding the consultant vacancy, to ensure that the best possible service is provided. The rest of the multi-disciplinary team associated with team C continues to provide a service to those deemed within their scope of practice. Unfortunately, however, those requiring consultant or psychologist review are currently on a waiting list. The HSE acknowledges that the lack of consultant cover is having a considerable impact on access to the service locally. It is working to explore all avenues for the recruitment of qualified staff to fill vacancies and to replace staff retiring or resigning, particularly in areas such as consultant, psychologist and nursing posts.

4 o’clock

I have spoken to Sinead Glennon, head of mental health services in the Cork-Kerry area. I absolutely believe that every stone is being turned and every possible avenue is being looked at to try to fill these posts and cover weekends or various parts of the day. Bearing in mind all of the circumstances, I am satisfied the HSE is making every effort to address this, including the prioritising of cases based on assessed professional need. In other words, I am assured that urgent cases are being prioritised and seen within the recommended level of time. I will continue to monitor this closely in conjunction with the HSE.

Eugene Murphy (Roscommon-Galway, Fianna Fail)
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Two minutes is 120 seconds. If we divide it by three, speakers have 40 seconds each. You each have time for a supplementary question.

Pat Buckley (Cork East, Sinn Fein)
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I thank the Minister of State for her reply. I am also satisfied that the HSE is making every effort to address this important issue. This is not a personal attack on the Minster of State but I am somewhat aggrieved. I have some experience of working within the system. I listen to people on a daily basis who are qualified for these jobs. It seems to me that there is no will to hire these people. I urge the Minister of State to approach the HSE and stress this point. The Minister of State stated the HSE is experiencing significant shortages in child and adolescent mental health services personnel. I do not believe that.

Donnchadh Ó Laoghaire (Cork South Central, Sinn Fein)
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I recognise it is likely that every effort is being made to ensure that priorities are being well managed. However, the reality is that we are dealing with an inadequately resourced service. Consequently, as much as the HSE can try to manage priorities, the position is that staff are being stretched too thin. I am particularly concerned about the implications if this arises in an accident and emergency department. Again, children could end up in the accident and emergency department of Cork University Hospital or Mercy University Hospital and not have any psychiatrist available to see them.

Billy Kelleher (Cork North Central, Fianna Fail)
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I urge the Minister of State to ensure that she keeps on top of this and liaises with the local office and with Sinead Glennon to ensure that recruitment is expedited. If we have to be imaginative in how we recruit, then so be it. We have to bring forward solutions to the problems in the emergency departments where we simply have no resources available for vulnerable children and adolescents, as explained in the letter circulated to GPs. Moreover, in letters GPs have forwarded to local Deputies, GPs have expressed legitimate concerns about their patients being put at risk because of the dearth of supports.

Helen McEntee (Meath East, Fine Gael)
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It is absolutely unacceptable that a young person would not be able to receive the level of support needed. Again, we are doing everything we can and not only through the recruitment process. We are trying to improve the environment, facilities and technology to make our mental health services facilities places in which people want to come and work. The fact of the matter is that within the CAMHS teams and services, a high level of intensity is involved in the work. It means there is a high level of turnover and burnout, especially given the difficult in recruiting consultant psychiatrists. In cases where they leave after a short period, we have to try to recruit again.

I believe every effort is being made. Let us consider the teams and how they can be utilised best. I note we are introducing the new well-being programme in our schools. Before the summer is out, the task force will make known its actions and recommendations to the committee and the Dáil. Many other things are being done to try to stop the number of young people needing services in the first place. This is and will continue to be a priority for me. I will keep the House updated with any developments in these areas.

Eugene Murphy (Roscommon-Galway, Fianna Fail)
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I thank the Deputies and the Minister of State sincerely for their co-operation.