Marcella Corcoran Kennedy (Offaly, Fine Gael)
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I welcome the opportunity to raise this important issue with the Minister of State. As a member of the Joint Committee on the Future of Mental Health Care, I recently paid a visit to my local Offaly-Laois child and adult mental health service, CAHMS, located at St. Fintan's Hospital in Portlaoise. Built in 1832, it was formerly known as St. Fintan's Asylum. It is an intimidating building and much of it is in a poor state of repair. Even the main entrance steps are damaged, with grey timber panels on either side attached to the railing. The first impressions are not great. Internally, however, the Laois CAMHS facility has been upgraded and is modem and bright. The Offaly service is also run out of this old building. It has not been refurbished but I was delighted to learn on the day of my visit that there are plans to move to a modern premises in Tullamore, which will result in a better experience for young people. The new premises will be more accessible to them and their parents.

While on my visit, I was extremely concerned to learn of plans to reduce the staffing levels in the young adult mental health service, YAMHS, in Offaly and Laois. This service is specifically targeted at those between 16 and 18 and has a fully functioning team and no waiting lists. I was dismayed to learn during my visit that, at a time when the Government's stated objective is to prioritise mental health services and increase the resources for youth mental health services, the HSE management team in CHO area 8 is planning to cut three full-time equivalent posts in the YAMHS. This means that one psychotherapist position, two nursing posts and an administrator are due to be cut by the HSE. This proposal flies in the face of a cross-sectoral commitment to improving mental health services for children and young adults. We are all aware of the vital importance of access to services and treatment in a timely manner for young people who find themselves distressed or in an emergency. I know from my dealings with local families who have engaged with the YAMHS in Offaly and Laois that they are highly complimentary of the quality of the service and the dedication and commitment of the multidisciplinary teams working there.

I am informed that the service is currently meeting targets for all its performance indicators but the proposed cut to staffing levels would inevitably damage the capacity of the service to cope with the ever-increasing number of referrals it is receiving. Over five years, the service has dealt with 1,000 referrals. What plans has the HSE to deal with the young people from 16 to 18 who may be referred over the next five years? Reducing the staffing levels in the YAMHS is just going to place increased pressure on the CAMHS, which is trying to manage significant waiting lists in Offaly and Laois. Is it intended to put those patients back into the CAMHS where there are existing waiting lists? How will emergency cases be dealt with?

I understand that, year on year, the number of children and young people engaging with the service for diagnosis and treatment for conditions such as attention deficit hyperactivity disorder is increasing. It is important that our children and young people have access to early intervention and that the necessary professional supports and services be provided at the appropriate time.

Psychotherapists play a pivotal role in the delivery of the youth mental health services, as do the specialist nurses. The operation of the service requires skilled administrators. All play a vital role in the lives of the young people who need to access the service. I am perplexed as to why staff numbers are being reduced at a time when anxiety among young people is at an unprecedented level. There are myriad reasons for this but there is emerging evidence that social media have a large role in this.

We must ensure that the proposed cutback in this area does not happen. Can the Minister of State confirm the accuracy of the reports that one of the psychotherapists working in the YAMHS in Laois and Offaly will be leaving their position at the end of July and that two nurses and an administrator will have to leave their posts? What is the reason for this? Does the HSE intend to get rid of the YAMHS altogether? It seems to be providing a service that we all aspire to. Should the HSE not be trying to replicate this model across the country instead of trying to get rid of it?

Finian McGrath (Dublin Bay North, Independent)
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I thank Deputy Marcella Corcoran Kennedy for raising this important issue. I am well aware of the great work of the Oireachtas committee, particularly on this issue.

There are six CAMHS teams in the midlands mental health services. The staffing levels of these teams are currently at or above the national average. The staff allocation for the two young adult mental health service, YAMHS, teams in the midlands is also above the national average. The level of staff in Laois-Offaly YAMHS is at 222.6% of the figure in A Vision for Change and that for Longford-Westmeath YAMHS is at 182.4% of the figure in A Vision for Change. As such, the Minister of State, Deputy Jim Daly, has been informed that the HSE intends to reconfigure the staffing levels by removing any unfunded posts, which do not form part of the sanctioned allocation. This is necessary to provide a service within the allocated resources available and to comply with the policy in A Vision for Change.

Mental health remains a priority for the Government. This is reflected by the allocation in budget 2018 of an additional €35 million for new service developments, bringing total HSE mental health funding to around €910 million this year. Since 2012, around €200 million in additional funding has been provided for this care programme, and some 2,000 new posts were approved. The HSE continues to enhance various aspects of its CAMHS, including improved access at local level for areas such as Laois and Offaly. There has been increased funding for CAMHS for Laois-Offaly, rising from €1.387 million in 2011 to €2.528 million in 2018. The overall staff number for the service increased from approximately 16 in 2011 to 34 in 2018. It should be noted that there has been a significant increase in activity levels for the respective years. For example, the number of referrals received increasing from 167 to 1,044. New appointments offered increased from 146 to 797, and the number of new clients seen increased from 107 to 484.

The HSE service plan for 2018 will further develop all aspects of CAMHS, including inpatient or community-based care. This is a strategic priority action in the plan, against a background where the population of children is increasing and where demand for CAMHS has seen a 26% increase since 2012. Approximately 18,800 referrals are expected for HSE CAMHS nationally this year, with in the region of 14,300 being seen by this specialist service.

Among the other CAMHS-specific measures included in the HSE service plan for 2018 are: an initiative to increase the number of CAMHS referrals to be seen this year by 27% over the number in 2017; provision for a seven-day-week service for CAMHS to ensure supports for young people, in line with Connecting for Life; and improvement of the day-hospital services within CAMHS. The HSE is also focusing on enhanced access for older adolescents to specialist mental health services, along with continued appropriate placement and care in CAMHS-specific settings.

I must also mention the broader menial health activity in this area. The HSE midlands, Louth and Meath community health care organisation, in partnership with community, voluntary and statutory organisations, is developing a regional suicide prevention action plan for the counties of Laois, Offaly, Longford, Westmeath, Louth and Meath. This local strategy is aligned with the national strategy to reduce suicide, Connecting for Life, in which young people have been identified as a priority group for support and prevention.

Marcella Corcoran Kennedy (Offaly, Fine Gael)
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I just cannot accept this diminution in the service when the Government is increasing budgets to the mental health services every year and, crucially, when the demand for the service is also increasing. That staffing levels are above the national average, that there are no waiting lists at this point and that the services are dealing with the emergencies when they come to them point to the success of the YAMHS team. I would not be penalising it by suggesting it is overstaffed, wishing it luck and stating that its staffing number will be reduced to that of others that are not able to deal with those they need to deal with when they need to do so.

The HSE has no grade for art therapist. Art therapy is widely accepted as an important aspect of therapy and treatment for young and old alike. Now it seems that position is to be dispensed with. That the HSE does not even have a grade goes to show how little it emphasises something of such importance to young and old alike.

The HSE's stated position in its mission statement on mental health is to "Promote and protect the mental health of the population, to provide effective services to those who need them making the best use of existing resources and to seek to continuously improve those services making best use of the resources available". How can the HSE stand over this decision given the negative consequences for the remaining staff and young patients who are and will be accessing the service? This development is completely avoidable. I really resent what the Minister of State said about the service being overstaffed. The 2016 census indicates Ireland's population of people aged between ten and 24 years is expected to increase to over 1 million in the next seven years.

There are still far too many young people dying by suicide across this country, especially young men, so we have a duty to maintain and expand our mental health services in the years ahead. The services that are succeeding and capable of delivering to young people and young adults should be maintained, not reduced.

Finian McGrath (Dublin Bay North, Independent)
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The figure for overall spending in 2018 is €910 million. That is a huge increase in spending on mental health services over the past number of years. The second point, which is important, is that in April there were 10,008 people employed in mental health services in this country. That is an increase of approximately 193 compared with 2017. Another important point is that the staffing levels in CAMHS teams in the midlands mental health services - there are six teams - is at or above the national average for CAMHS services. The staff allocation for the YAMHS in the midlands is significantly above the average of 58% of A Vision for Change. The HSE has informed the Department that it is necessary to reconfigure its staffing levels by removing any unfunded posts which do not form part of its sanctioned allocation.

On the specific issue the Deputy raised, I will convey her concern to the Minister of State, Deputy Jim Daly, that he look again at this issue. The locally based multi-agency response to self-harm and suicide is in final development and when launched will support local communities to respond to suicidal behaviour. The Minister of State, Deputy Jim Daly, has also asked his officials to continue to monitor the ongoing delivery of services in Laois and Offaly in conjunction with the HSE. Finally, I will refer all the issues and concerns Deputy Corcoran Kennedy raised to the Minister of State, Deputy Jim Daly.