Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
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I do not know if the Minister of State, Deputy Finian McGrath, was here earlier when the Taoiseach was boasting about living up to the commitments made in the programme for Government about expanding capacity in child and adolescent mental health services, CAMHS. I do not know how he or the Minister of State could square that boast with the decision made two weeks ago by the HSE to close one of the most successful child and adolescent day care centres, the Linn Dara CAMHS unit in Cherry Orchard Hospital. It was closed on 6 July for possibly five or six months. It has played a vital and highly positive role in the lives of many young people who have availed of its services since it opened. The decision to close it is ridiculous and follows on from a decision made last year to close half of the inpatient services for the months of June, July, August, September and October last year.

Every parent I know who had a child attend the Linn Dara CAMHS unit in Cherry Orchard Hospital has had very positive experiences and praised the service and the staff, in particular, and acknowledged the benefits for his or her child. Closing the service is a retrograde step which will add huge pressure on inpatient services not only in the future but also now, as those who cannot access the day service will try to get their children into the inpatient service. It will also put pressure on the local adult mental health services because the parents of children will have to reach out somehow to get some help or seek relief for their children, as well as some access to psychiatry, social workers, nurses, occupational therapists, dieticians, social care workers, speech and language therapists and educationists who are available in the day services provided in the CAMHS centre. It is a multi-disciplinary service which has worked well. I commend the Mental Health Warriors who have protested against the closure and will arrange another this Thursday.

I ask the Minister of State to intervene to ensure the centre will reopen as quickly as possible, which means tomorrow or this week.

Pat Buckley (Cork East, Sinn Fein)
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I echo what my party colleague said. It is a bit like "Groundhog Day". I raised the closure of 11 beds last year. Approximately 12 months to the day - there may be a couple of days in it - I am raising the decision to close the outpatient clinic at Linn Dara at a time when the 22 inpatient beds are full. According to the staff members to whom we have been listening, the HSE is not putting a sufficient focus on this. We had the same situation last year and - lo and behold - we are back with the same old thing this year. There is no such thing as forward planning. Things are breaking down. The Minister admitted earlier this year that those closure of the Linn Dara beds has put pressure on adult admissions into mental health services. For two years, this House has been debating the need to keep children out of adult services. This is another example of the failure to engage in forward planning.

I am aggrieved about the reply I received to a parliamentary question I tabled in respect of Linn Dara services, which asked "the Minister for Health the estimated annual cost of reopening the closed CAMHS" beds at the centre. It is ironic that I received the reply in question on 5 July, which was the day before the closure of the outpatient clinic. Even though I had asked about the annual cost of reopening the beds, I was told in the reply I received that it had been decided to reduce temporarily from 22 to 11 the number of inpatient beds available at Linn Dara. I was advised that this temporary reduction was applied from June 2017 to October 2017 and was necessary because of ongoing nursing staff shortages. I was further advised that funding was maintained throughout the year to assist with the reopening of these beds. It is like saying, "We gave them a bucket with no ass in it and sent them to the river to empty it". Twelve months on, we are in the exact same situation. All we are getting is absolute waffle from the Department. It cannot even answer a question. I asked for costs. There is no forward planning. If we keep going down this road, we will lose more people and more staff. Individuals and their family members and friends are suffering, unfortunately,

Finian McGrath (Dublin Bay North, Independent)
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I thank Deputies Ó Snodaigh and Buckley for raising this important issue. I know they are genuinely interested in mental health services. The policy of the HSE, as reflected in its annual service plans, is to provide age-appropriate mental health services to people under the age of 18. In view of the significant additional funding that has been provided over recent years, I reiterate this Government’s commitment to the development of all aspects of mental health, including that relating to young people. The Minister of State, Deputy Jim Daly, is continuing to make the case for further resources annually, in line with evolving demands and in accordance with the commitments set out in A Programme for a Partnership Government.

The HSE service plan for 2018 commits to further developing child and adolescent mental health services, known as CAMHS. This is happening against a background where the demand for CAMHS increased by 26% between 2012 and 2017. Various youth mental health initiatives other than the specialist CAMHS service are also being progressed. We have 69 CAMHS teams and three paediatric liaison teams supported by approximately 75 CAMHS beds nationally. Further beds are planned to come on stream as quickly as possible. The Government has funded an additional 140 psychiatric nurse undergraduates places each year to help to improve the planning and delivery of services over the coming years.

The issue of staff recruitment and retention, particularly in the sphere of CAMHS, is a key difficulty that is being addressed on a steady basis by the HSE. These are two key issues in this debate. The recent appointment by the HSE of 114 assistant psychologists and 20 psychologists will help to develop counselling services in primary care. It is anticipated that these posts will deal with less complex child and adolescent cases, thereby reducing the demand on CAMHS. The Minister of State recently approved ten new posts for advance nurse practitioners that will be specifically directed to the CAMHS service nationally. These new practitioners will play a key role in delivering better service co-ordination where local service pressures are greatest.

The HSE Linn Dara CAMHS service covers a population of approximately 420,000 across County Kildare, west Wicklow and south-west Dublin. There are seven multidisciplinary community CAMHS teams for these areas. The HSE has indicated that a decision was taken by the Linn Dara management team to temporarily suspend its day programme from Friday, 6 July 2018 to maintain essential community and inpatient services. It is expected that the day programme will reopen in September or October. This decision was taken due to psychiatry and allied health professional temporary staffing shortages in the community sectors.

To maintain essential provision of services, psychiatry and multidisciplinary staff have been reassigned from the adolescent day programme to maintain other key community-based Linn Dara services and manage their overall capacity at this time. The small number of young people who were scheduled to attend the adolescent day programme will continue to attend their existing community CAMHS teams and to receive appropriate individual and therapeutic programmes. The HSE has a statutory responsibility to ensure safe, adequate and sufficient service provision to all areas of the CAMHS service. The Linn Dara inpatient unit will remain fully operational as normal, with 22 beds and functioning community teams available. I assure the Deputies that the Minister of State will keep this matter under close review. All efforts will continue to be made by the HSE to address the ongoing service difficulties at Linn Dara.

Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
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This closure is unacceptable and inexcusable. I agree with Deputy Buckley that this is a question of forward planning. As the Minister of State said, the Linn Dara CAMHS unit in Cherry Orchard hospital covers a population of nearly 500,000 people. This means that more than 200,000 young people no longer have access to day programmes. The Minister of State has said they have access to local CAMHS services, but that is not what many of those involved need at this stage. Most of them have been through the CAMHS service and have been referred to the day service for a particular reason. If they are unable to access those day services for a number of months, it could be detrimental to their health and future well-being. I urge the Minister of State to get the HSE to look at this again now, rather than waiting until September or October before deciding when this service will be reopened. It needs to be reopened now.

Pat Buckley (Cork East, Sinn Fein)
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I thank the Minister of State for his answer. He mentioned HSE policy. The HSE is unable to plan. I question the Government's commitment. We do not have enough time to go through these issues. The Minister of State referred to 69 CAMHS teams. How many of them are fully staffed? I would not like to see a CAMHS premier league because there would not be too many teams playing against each other. It is not good enough to say this is a staffing problem. Surely we should have moved on over the past 12 months. It is a HSE problem and a Department of Health problem. It appears that the cost of getting staff to work in providing these services is too high a target for the Government. It seems to be afraid to spend money. The problem is that we are putting children at risk. When we, as legislators, put children at risk, it is not just their problem - it is our problem and the Government's problem as well. I reiterate that we should not try to fix something that has not been broken.

Finian McGrath (Dublin Bay North, Independent)
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I thank the Deputies for raising this important issue. I commend them for mentioning that there are some positive experiences in child and adolescent mental health services. Of course I will bring the views they have set out during this debate to the attention of the Minister of State, Deputy Jim Daly. They have raised some important issues. As I have mentioned, some 69 CAMHS teams and three paediatric liaison teams are supported by 75 CAMHS beds. It is planned that further beds will come on stream as soon as possible. We have to face the reality that staff recruitment and retention is a particular issue for the CAMHS service. I take on board the strong points that have been made about the failure to engage in future or forward planning. We have to look at that issue and address it strongly. We must ensure we get value for money for patients from the 26% increase in spending. In the context of this debate, I am referring particularly to young people with mental health issues. I will bring back the Deputies' concerns to the Minister of State to see whether they can be responded to positively.