Pat Buckley (Cork East, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

I wish the Minister of State, Deputy Jim Daly, the best of luck in his new role, which will not be an easy one. I will try not to be difficult with him just for today.

A main principle of A Vision for Change is that people seeking mental health care should, where possible, be treated at the earliest opportunity in their own communities on an outpatient basis.

This is about providing the best care while avoiding hospitalisation and repeated admissions in the absence of community structures. It is also a much more efficient and cost-effective model of care for the State. Unfortunately, those community services have not materialised to the level recommended in A Vision for Change and hospital services, which remain far too necessary, have been scaled back for those seeking care and they have been forced to travel across the country. This can be seen in places such as Wexford in particular, where the closure of local beds has led to people having to travel to Waterford for inpatient care. In some cases, this may not be a major journey but for those on the northern edge of the county, it is at least a 90-minute drive and possibly 150 minutes by bus. This is very hard on the families of patients and it also discourages those who need care from seeking it. Consider how, in the midst of suicidal thoughts and a severely low mood, many may feel unworthy of the assistance needed to get them there for care. I have heard countless stories from family members who have had to drive their loved ones up and down the country, particularly in the south east, in order to find somewhere they could receive inpatient care.

In terms of child and adolescent care, only 63 of the minimum 100 beds needed in the State are in place. Children are being turned away from child and adolescent mental health services, CAMHS, in Cork and across the State because waiting lists are far too long. The inability to provide community care inevitably puts more pressure on the hopelessly inadequate inpatient services. According to the HSE, only 53% of CAMHS whole-time positions are filled at present. Eleven beds at Cherry Orchard Hospital are currently at threat.

While I am on the subject, I also wish to raise the serious concerns for funding for Youth Work Ireland's counselling services in Galway. This is an essential service for young people beginning to experience mental health issues. The service could provide 31 hours of counselling, which is almost double the current hours, to 12 to 21 year olds in local communities such as those in Galway, Ballinasloe, Tuam and Loughrea at an annual cost of just €62,000. However, funding is not stable - not even now. These are the kind of local early intervention services we need investment in.

Eugene Murphy (Roscommon-Galway, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I take this opportunity to wish the Minister of State well in his new role. I think this is his first performance here.

Jim Daly (Cork South West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

It is my first Topical Issue debate.

Eugene Murphy (Roscommon-Galway, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

We wish him well.

Jim Daly (Cork South West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I thank the Acting Chairman for his good wishes, which are very much appreciated, and I thank Deputy Buckley for his good wishes also. I sincerely look forward to doing the role justice. I hope I will; I certainly will try my very best.

First and foremost, health care is about the individual and individual well-being. In January 2006, the Government adopted the report, as referred to by the Deputy, of the expert group on mental health policy, A Vision for Change, as the basis for the future development of mental health services in Ireland. It advocated a move away from traditional institutionalised care to a patient-centred, flexible and community-based mental health service. It also recommended the organisation of mental health services nationally in catchment areas for populations of between 250,000 and 400,000, with specialist expertise provided by community mental health teams, that is, expanded multidisciplinary teams of clinicians who work together to service the needs of service users across the lifespan.

More than 90% of mental health needs can be successfully treated within a primary care setting, with less than 10% of patients being referred to specialist community-based mental health services. Of this number, approximately 10% are offered inpatient care, with 92% of all admissions being of a voluntary nature.

The spectrum of services provided by the HSE extends from promoting positive mental health through to supporting those experiencing severe and disabling mental illness. These services include specialised secondary care services for children, adolescents and adults. Services are provided in a number of different settings, including the service users' own homes. The service is integrated with primary care, acute hospitals, services for older people and services for people with disabilities and with a wide range of non-health sector partners.

Specialist mental health services provided include acute inpatient units, community-based mental health teams, day hospitals, outpatient clinics, community residential settings, continuing care settings and the national forensic mental health service. Primary care services are usually the first point of contact for individuals presenting with mental health problems directly through their GPs or other health service professionals.

Community mental health teams are the first line of acute secondary mental health care provision. They support individuals in their recovery in their own communities. The community mental health team co-ordinates a range of interventions for individuals in a variety of locations, including home care treatment, day hospital outpatient facilities and inpatient units, and interacts and liaises with specialist catchment or regional services to co-ordinate the care of individuals who require special consideration.

There are 51 HSE approved centres for adults spread across the nine community health care organisations, CHOs. In addition, there are six private approved centres for adults. There are also five CAMHS approved inpatient centres, four in the HSE and one private, that is, Willow Grove at St Patrick’s Hospital.

As well as a primary care GP network, which is often the first point of contact for someone who is experiencing mental health problems, there is a community team network of 119 HSE adult community mental health teams, 64 community CAMHS teams and 29 community teams responsible for older age psychiatry who deliver specialist community-based mental health treatments.

Since 2012, we have provided an additional €140 million for mental health services. This has helped to ensure that patients have access to community services and, in most cases, are not required to travel distances to access these services.

Pat Buckley (Cork East, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

I thank the Minister of State for his reply. He referred to 64 community CAMHS teams. I wonder how many of them are fully staffed. That is one issue I would have. The Sláintecare report was recently debated in the Dáil and while the work involved in producing it was difficult, it was a very good learning experience. We had cross-party agreement on a lot of it. There is a strong emphasis in the report on funding for mental health services as well.

We had raised the €37.5 million extra to be put into mental health services early last year but we did not get the full support. Could we even get a commitment? I know the Minister of State is new to the job. However, we need to 24-7 crisis services and across the country. The Minister of State has seen it. One of the Wexford county mayors said that it is disgraceful that people have to travel so far when they need immediate help. I do not wish to put the Minister of State in a position but we have to ask the question. Could he make a commitment to go so far as bringing out a pilot system of 24-7 services. We know that it is not a Monday to Friday job; it is the weekends and the out-of-hours. Families are suffering as well as the patients. As I said, if they have to travel from one county to another to access help, we will lose a lot more people in this country. Will the Minister of State please make a commitment to invest in mental health services? I ask him not to let families suffer.

Jim Daly (Cork South West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I again thank the Deputy for raising this important issue. The more times this issue is raised in this House and on any other platform where he gets the opportunity to raise it, the more it assists me, the Department and all of us in driving the focus that is necessary in this area. If we went out and asked anyone in our community what is the single most important issue, I think there would be unanimous agreement across the board that mental health is the challenge of our generation. We happen to be the politicians who are populating this space at this point and this is our greatest responsibility. As Minister of State, I have been given the task to see what I can do. However, we all have a role to play.

Deputy Buckley has a lot of experience, passion and commitment in this area. He has already asked me for an early meeting and I hope that we can have one in order that we might discuss some of these matters in more detail and that he can share his wisdom with me and try to guide and direct my efforts within the Department. As we are both Corkmen, I look forward to working collaboratively to ensure that we can try to bring some achievements, not just for Cork but for the country. We have an understanding which, perhaps, some other fellow county men might not have.

I also agree with the Deputy, and share the view strongly, that people have the right to be treated in their own communities. That is the least we should do. We are trying to retain and build communities and ensure that they prosper. People should be treated there and we should be making effort in that regard.

I am not fullyau faitwith the issue in the south east. However, there was a request to meet all the elected Members from the south east, particularly those from the Wexford area. We are trying to make that happen this week. I am not sure that it will but it will certainly happen next week. I will get my head around the issues involved in order that we might move forward with the meeting. I know that some of the Members here now are from Wexford.

On the waiting list for CAMHS, the Deputy is right that there is a staffing issue, but I do not accept that it is just about staffing. Nor is it just about resources; it is about a combination of effort and focus and we have to address both.

I do not have a solution for that right now. I will certainly take on board what the Deputy said with regard to Youth Work Ireland. We will mention all of these issues at our upcoming meeting. I will come back to the Deputy with the figures for CAMHS staffing levels.

I cannot give the Deputy a commitment today, as I am sure he will understand, other than to do my very best. I have to get my head around too many issues but I will certainly give the Deputy a commitment to do everything I can. I look forward to working further with the Deputy and I hope he will continue to raise this important issue.