Mattie McGrath (Tipperary, Independent)
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Thank you, a Cheann Comhairle, for allowing us to raise this important issue. I am disappointed that neither the Minister for Health nor the Minister of State, Deputy Jim Daly, who has responsibility for mental health, is present. However, it would make no difference if they were.

County Tipperary does not have one psychiatric long-term or any other type of bed. We have a crisis house and great front-line staff, but there is a chronic situation in Tipperary. There are half a dozen children between 11 and 13 years of age, mostly girls, languishing in beds in the paediatric ward in St. Joseph's Hospital in Clonmel. One has been there for 11 weeks, with others there for ten, seven and eight weeks. Their parents are distraught because they have no services. I ask the Minister of State to do something because this is not good enough. The Minister of State, Deputy Jim Daly, told me last week that a worldwide shortage of psychiatrists is delaying the delivery of mental health services. He said recruitment, not funding, is the issue in the delays.

Last week I pointed out to the HSE that it spends €400 million every year on medication for the treatment of mental health but a mere €10 million on psychological and counselling services. That is the problem. We must spend money on counselling and psychological services and take money away from all the management and mismanagement.

Séamus Healy (Tipperary, Workers and Unemployed Action Group)
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Along with my two colleagues, Deputies Mattie McGrath and Cahill, I attended a powerful but heartbreaking public meeting last Thursday night in Clonmel, which called for the reopening of closed beds at St. Michael's unit in the town. It was shocking to hear many contributors say they were satisfied that their loved ones would be alive today if those beds had been open.

The closure of the acute psychiatric unit in St. Michael's in Clonmel in 2012 was wrong and should never have happened. It has turned out to be an absolute disaster, as we warned at the time. The closure was announced without any consultation by the HSE. It was opposed by service users, families, carers, medical consultants, GPs, psychiatric nurses, public representatives and the public. Everybody opposed it because it was wrong, but the then Minister, former Deputy Kathleen Lynch, declared that the closure was written in blood and bulldozed it through. Mental health services in Tipperary, despite the best efforts of the staff, are substandard and not fit for purpose.

I appeal to the Minister of State to approve the reopening of acute psychiatric beds in Clonmel.

Jackie Cahill (Tipperary, Fianna Fail)
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As Deputy Healy said, I was also at the public meeting in Clonmel on Thursday night, where the stories told by mothers, fathers, brothers and sisters were heart-rending, to say the least. They feel completely let down by the system. We have no psychiatric beds in our county. Even for people who do get access to a service, whether in Kilkenny or Ennis, it is completely inadequate to cater to their demands. The other point, which was made extremely forcibly by relatives of people suffering from mental health issues, was that when they are released from psychiatric care, the backup services are not there. The mental health clinics that are available are completely under-resourced. We have a complete lack of mental health resources in County Tipperary. We have no beds and we have completely under-resourced mental health clinics in the county. This situation is intolerable and must be addressed. The public anger was palpable in Clonmel last Thursday night. We need a psychiatric unit both in Clonmel and in Nenagh for north Tipperary, and it is essential that this commitment be given immediately. We also need extra resources put into counselling and other services in the mental health clinics in the county.

Finian McGrath (Dublin Bay North, Independent)
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I thank Deputies Mattie McGrath, Healy and Cahill for raising this very important issue of residential psychiatric care beds in County Tipperary. Mental health care remains a priority in the programme for Government. Since 2012, approximately €200 million, or 28%, has been added to the HSE mental health budget, which now totals more than €910 million. This is a significant investment by any standard. A Programme for a Partnership Government gives a clear commitment to increase our mental health budget annually, as resources allow, to expand and modernise all aspects of the services, including those in Tipperary. HSE mental health funding for Tipperary this year is in the region of €24 million. One of the strategic priorities for mental health in the HSE national service plan for 2018 is to deliver timely, clinically effective and standardised safe mental health services in adherence to statutory requirements. Acute inpatient care to the adult population of north Tipperary, which is in community healthcare organisation, CHO, area 3, is provided between the acute unit in University Hospital Limerick, which has 50 beds, and the acute psychiatric unit in Ennis, which has 39 beds. The 44-bed department of psychiatry based at St. Luke's General Hospital, Kilkenny, is the designated approved centre for acute inpatient services for south Tipperary, which is in CHO area 5. This enables all acute inpatient admissions for this CHO area to be managed at a single site. Referrals to St. Luke's are through a consultant psychiatrist, who makes the clinical decision to admit based on the level of acute presentation or need.

In addition to the department of psychiatry, a dedicated psychiatric liaison team operates from the emergency department in St. Luke's. All service users presenting to the emergency department who require psychiatric assessment will receive that assessment within agreed timeframes, in line with relevant guidelines. Onward referral pathways are agreed with all service users upon completion of psychiatric assessment in the emergency department. Pathways can include admission to an acute unit, referral to a relevant community mental health service team or referral back to a patient's own general practitioner, GP.

There are a range of other mental health services for adults in Tipperary. These include, for example, psychiatry-of-old-age teams, non-acute beds, day hospitals and day centres. In addition, there are community mental health teams and high, medium and low-support community residences. For those under the age of 18, there are three child and adolescent mental health services, CAMHS, teams operating in Tipperary, one in north Tipperary and two in south Tipperary. The CAMHS acute units at Éist Linn in Cork and Merlin Park in Galway, which has a total of 42 beds, serve the Tipperary catchment area.

The Minister of State, Deputy Jim Daly, met Members from Tipperary last week to discuss current and future provision of mental health services in the county, including reviewing bed capacity.

Mattie McGrath (Tipperary, Independent)
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It is a pity the Minister of State, some of his officials or the people who wrote his reply were not at the meeting. The Minister of State talked about pathways. There are no pathways. These people have nowhere to go. We had to hear all the hopelessness and helplessness of the parents and siblings who spoke at the meeting, although we knew it anyway. There are no beds. There is no space in Kilkenny for us and there is no room in Ennis or Limerick because they are full already. As far as CAMHS is concerned, we heard from the Minister of State, Deputy Jim Daly, last week that the youth and adolescent centre in Cork is shockingly only half occupied because the beds cannot be opened as there is difficulty getting and retaining consultants. If one divides up the figures I read out into the regions, so much money is being presented on mental health but it is all for drugs, treatments and so on. As I said, so little of it is to help people, on aftercare or on psychologists and various therapists to talk to those affected. There is no aftercare. Prevention is better than cure. The money is being mismanaged at an alarming rate. It is a shame for the Minister of State to read out such a report because it is not factual, not right and is insulting to the people who are suffering and our loved ones we have lost.

Séamus Healy (Tipperary, Workers and Unemployed Action Group)
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I agree that the response shows a shocking ignorance of the situation in Tipperary, north and south. Patients from south Tipperary have to travel to Kilkenny for inpatient care. North Tipperary patients have to go to Ennis. Neither unit is fit for purpose. The Kilkenny unit is continually overcrowded, there are delayed admissions as a result, there are inappropriate early discharges and there are huge problems with travel for family members to support the patients there. There are huge industrial relations problems with staff; there have already been protests there. Patients are being admitted to the unit in Kilkenny to chairs and couches and some of them sleep on mattresses on the floor. It is simply not good enough. We need beds in Tipperary and we will insist that we get them.

Jackie Cahill (Tipperary, Fianna Fail)
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There is a song called "Any Tipperary Town". If the Minister of State stopped in any street in any town in Tipperary, from Borrisokane to Carrick-on-Suir, and asked about mental health facilities, he would be told by anyone he stopped on the street that there are none there. He said €24 million was spent on mental health services in Tipperary in 2017. I honestly find it hard to know where it has been spent because the services are just not there. We have a crisis.

I was elected to the Dáil in February 2016 and this is the topic on which I have spoken most since then. One of the most potent images I saw last Thursday night was pairs of shoes left at the front of the hall, which represented the people in our county who have committed suicide since 2012. The number of shoes there was frightening in the extreme. As I said already, we listened to family members say that if there was any kind of adequate service, their family members would still be alive. We are getting meetings with Ministers, and the Minister of State, Deputy Jim Daly, has met us on a number of occasions but we need money and services put in place. Shortly after I was elected to this House, we were promised a Jigsaw project by the Minister of State, Deputy McEntee. That is over two years ago and that still has not happened. We do not want Ministers agreeing with us; we need money put in place and we need beds now in both north and south Tipperary.

Finian McGrath (Dublin Bay North, Independent)
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I thank colleagues for their representations and take their point about the bed capacity issue in Tipperary. I take their word for it as they were at the recent public meeting. I got the message very loud and clear and I will bring it back to the Minister, Deputy Harris, and the Minister of State, Deputy Jim Daly, because it is very important we have a debate on money and services on the ground. It is a regular debate.

The 2018 mental health budget for south Tipperary is €20.12 million, and for north Tipperary €3.5 million. It is legitimate to ask what we are doing with our money and whether we are getting value for money with these developments, particularly in Tipperary. What I am told and what I see here is that a number of matters are being taken on board including the community mental health teams, the acute day services and day hospitals, the south Tipperary home-based services, the high-support services in Garryshane House in south Tipperary and the crisis respite house.

I believe that a permanent crisis respite house building will be developed in Clonmel on the Glenconnor Road, with planning resolved and approved. This has gone for tender and confirmation of funding received.

The other very important matter is that the Minister of State, Deputy Jim Daly, has committed to review the bed capacity in the Tipperary area.