Pat Buckley (Cork East, Sinn Fein)
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I welcome the opportunity to speak on this important issue. We have been informed today by groups working on the front line that the specialist ACCES team for homeless people with severe mental health difficulties, located on Conyngham Road in Dublin, is now closed to new referrals due to staff shortages. This special community mental health team for homeless people is a vital service that liaises with homeless agencies to ensure that at least some people within homeless services who are very unwell can access appropriate mental healthcare. The absence of this service is likely to lead to people with acute psychosis not getting appropriate treatment. We know that homelessness is at an unprecedented level with over 10,000 people, many of them parents of young children, suffering because of the housing crisis. They are forced to couch surf, to sleep in hostels, on cots or in hotel rooms totally inadequate for anything other than the shortest of emergencies. Some feel they have no choice but to sleep on the streets. These people are under huge strain and the damage that this experience is doing to their mental health should be clear to anyone who cares enough to consider it.

We know that those who suffer homelessness are seriously vulnerable to mental health problems not just because that is common sense but because the statistics show it. Some 47% of people in homelessness last summer were found by Simon and Mental Health Reform to have at least one diagnosed mental health condition. Those are just the ones who can be diagnosed. We know that these strains lead to worsening or development of substance abuse problems which make recovery and rehousing even more difficult for individuals and services. A survey found that 17% of those surveyed had attempted suicide in the previous six months and 19% had engaged in self harm. Some 21% said they had experienced barriers to accessing mental healthcare.

It is difficult enough to access services. These are front-line people who provide a vital service and yet we are heading into the winter, with people who are in dire circumstances, homeless and have mental health difficulties which are often severe, and no more referrals will be taken in this centre. I cannot understand why this issue keeps coming up about staff shortages. Can we find out when this will be resolved? Was this flagged up beforehand? There are recurring staff shortages with no forward planning. I am very conscious that the Minister of State mentioned staff morale in an earlier Topical Issue debate. It is important to acknowledge that staff are doing their very best in extremely difficult circumstances. We as legislators, the Minister of State and the Government are letting these people down terribly. We are aware that things will worsen. Can anything be done to resolve this issue as soon as possible? Otherwise we will unfortunately face more deaths on the streets.

Finian McGrath (Dublin Bay North, Independent)
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I thank Deputy Buckley for raising this important issue. I take this opportunity to emphasise that mental health 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 is now €910 million. We have secured an additional €55 million for new developments in the recent budget. Despite serious financial pressures overall, 2019 will see a total HSE mental health budget of almost €1 billion, an increase of 40% on 2012. Dual diagnosis in particular has been given specific attention.

The HSE mental health division has recognised the need for a clinical programme for dual diagnosis to respond to people with substance misuse, both alcohol and-or drugs, together with mental illness. The aims of this programme are to develop a standardised evidence-based approach to the identification, assessment and treatment of comorbid mental illness and substance misuse. This includes increasing awareness of the frequent co-existence of mental illness and substance misuse; ensuring there is a clear pathway for management of people with such a dual diagnosis including when they present to emergency departments; ensuring a standardised service is provided throughout the country; and ensuring adolescents are also included within the scope of the clinical programme. An additional €2 million in funding was made available from the €35 million of new development funding for mental health in 2016 to address the specific needs of homeless persons in the Dublin region, with a particular focus on mental health needs.

A key requirement was that any mental health supports provided would be provided as part of an overall cohesive response to homelessness. This €2 million has helped to fund the expansion of in-reach services and supports for temporary accommodation for charities such as the Peter McVerry Trust, Crosscare, Sophia Housing Association and Dublin Simon Community. The additional funding has continued to be provided to fund these additional services for homeless people with mental health and addiction needs. As part of these services, the Assertive Community Care Evaluation Services, ACCES, team is based in Parkgate House, Conyngham Road, Dublin. This specialist community mental health team for homeless people is a service that liaises with homeless agencies to ensure that people within homeless services who are very unwell can access appropriate mental healthcare. I understand that ACCES is currently unable to take on new referrals. I take Deputy Buckley's earlier point. The HSE has informed me that there are vacancies at psychologist, social worker and occupational therapist levels. While the psychologist is on maternity leave and is due back in March 2019, the HSE is attempting to recruit the new social worker through the national recruitment service and the occupational therapist has been recently appointed and is awaiting a start date.

Pat Buckley (Cork East, Sinn Fein)
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I thank the Minister of State for his answer. I will revert to what I mentioned earlier about the problems with staff shortages and forward planning. It is not a personal attack on anybody but if somebody is going out on maternity leave, surely there is forward notice or somebody will cop on that if somebody is expecting to go on leave, which they are totally entitled to, something should be put in place where the HSE can plan ahead, so it can know that someone is due to go on maternity leave on a certain date and should be able to recruit and fill that gap temporarily.

March is five months away. October, November, December, January, February and March are very bad months here so I am not optimistic about the forward planning, as we call it. Vacancies for a psychologist, social worker and occupational therapy is a huge gap in services. How have people been coping with this? It goes back to the morale of the people on the front line. I am black and blue from coming in here and to committees and asking Ministers why the powers that be and the HSE cannot plan ahead. We have said it repeatedly. We will be facing a major issue in the next couple of years. We will possibly have 500 people in mental health services retiring and nobody is planning for it because the system works on a basis of having to wait first for the individual to retire, then it goes into a 12 month cycle and the crisis gets larger. I want to highlight it. It is not a personal attack on the Minister of State and I appreciate the answers he gave me. I am disappointed that we do not have forward planning. We have another emergency in Dublin with people who will be severely affected, not just with mental health difficulties and weather, but we are being told the best the Department can do is say that it will see them again in March.

Finian McGrath (Dublin Bay North, Independent)
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I thank Deputy Buckley for highlighting the issue. It is very important. I take his point about forward planning. It is a strong message which we will have to bring back to the HSE. I will bring it back to the Minister, Deputy Harris.

The Government is committed to ensuring all those in need of mental health services and supports will have access to them, in particular vulnerable groups such as the homeless and those to which the Deputy referred. It is not acceptable that somebody who is homeless, poor and marginalised cannot receive a service. A broad range of support initiatives are under way or planned across mental health services to cater for that group and I believe the initiatives will help us to achieve equity of access and support for those individuals in order that they can access care at the earliest possible stage.

I accept the Deputy's point about the ACCES team receiving ten to 15 calls per week inquiring about referrals. It amounts to approximately 150 to 200 calls per year. I agree with the Deputy that such persons could be facilitated with some forward planning. Money is not the issue; rather it is a case of planning to implement services and find people to fill the posts. There is a difficulty in filling posts, including in my area of responsibility, namely, the disability sector. In recent months we have had a steady stream of occupational therapists and speech and language therapists returning from England, in particular. That will help to address the issue. I agree with the Deputy that there is a need for more forward planning in order to resolve the issues. I will bring the message back to the Minister and the HSE.