Pat Deering (Carlow-Kilkenny, Fine Gael)
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I apologise for not being here earlier. It was an oversight on my part. I thank the Minister of State for attending to take this Topical Issue on the lack of a consultant psychiatrist in Carlow for the last period. The position has been vacant in Carlow for a number of years at this stage. There was a mental hospital in Carlow for many years, but it closed following the policy changes of recent years. While the outreach service has, generally speaking, been good, the position of consultant psychiatrist has remained vacant with services being provided on a locum basis. The locum would come on a weekly basis to meet clients, but when a new locum attended, the client had to start from scratch all over again to explain his or her story. The lack of consistency has been a huge problem. As difficult as the locum situation was, there has been no service at all since 1 February 2018. There is no consultant psychiatrist at all, whether provided by a locum or otherwise. There is no service in Carlow at all to cover what is unfortunately a great level of need locally. Service users have now been told that their care plans will not be reviewed and that the medication they have been prescribed will have to continue to do them until a consultant psychiatrist is available or a similar service can be provided. This is totally unsatisfactory. At the very least, a locum service should be provided to meet the needs of people in Carlow. If those needs did not exist, the position would not have been created to meet them. While I appreciate that there is a huge difficulty in filling vacancies and that consultant psychiatrists are extremely hard to acquire, closing the service completely has been a regressive move. I ask the Minister of State two questions. When will the position be filled? What is the possibility of renewing the locum service in the short to medium term?

Jim Daly (Cork South West, Fine Gael)
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I thank Deputy Deering for providing me with the opportunity to address this issue. The lack of consultant psychiatry services in Carlow is an issue he has brought to my attention on numerous occasions in various fora. To refer to the broader picture first, the Deputy acknowledged the worldwide shortage of consultant psychiatrists. It affects us here in Ireland also. I note that the Acting Chairman, Deputy Connolly, has a great interest in this area too. We are currently short approximately 60 consultant psychiatrists in Ireland. No matter what action we take and no matter how much money we spend on advertisements in medical journals in Australia, New Zealand and other countries, we cannot get sufficient cover for the positions we have created in recent years. We are putting adequate resources in place. If it was a question of more money, I could solve the problem overnight. We have increased the mental health budget from the €700 million provision in place when the Deputy first came to the House in 2011.

It is now more than €1 billion. Having put an additional €300 million into the mental health budget over the past five years, we still face the same challenges.

I am a firm believer that if we always do what we always did, we will always get what we always got so we have to move away from the issue of more money and resources because that is not the problem. There is a shortage, we have an over-reliance on the consultant psychiatry and we have to look at new ways of delivering consultant psychiatry. What I have done since becoming Minister of State is increase the number of training places for psychiatric nurses by more than 130 every year and I have introduced 114 assistant psychologists in the past year and brought 20 psychologists into the mental health system. We have also introduced ten advanced nurse practitioners, which are effectively one step below a consultant, to try to do as much of the work that consultants do as possible and to make sure that consultant psychiatrists are only doing the work that they absolutely have to do. We are trying to reorientate the system to be more proactive, to get more people into the system earlier, to ensure earlier intervention in the system and to get people detected at an earlier stage before they get to a higher level input. That is an ambitious target and that is the journey we are on.

I have also engaged extensively with numerous partners to try to bring about telehealth because that is what they are doing in Australia and America where they have the same difficulties as us. Telehealth works through screen to screen delivery of mental health services. A consultant psychiatrist based in Dublin can assess, diagnose, prescribe, treat and admit patients, if necessary. Many of our consultants provide cover in areas where we have gaps and as soon as I announce that I have a consultant psychiatrist for Carlow, there will be somebody else in the Deputy's seat in a few more weeks saying that there is a consultant psychiatrist missing in their area.

We need to look at the bigger picture, and recognise that we have a challenge here and that we need to look at how we do what we do, and that is why I have been championing telepsychiatry. We have made good progress and we will roll out a number of pilots this year in this area. I would love to hear from the Deputy's community health organisation, CHO, area and it is something that he might take up with HSE management in his area because we will make money available for people to apply to participate in a pilot project so that a neighbouring consultant psychiatrist can provide governance to the team that is working locally and cover without having to make a four or six-hour return journey by car. We can eliminate the travel and do it in a clinical, supervised setting.

Thanks to the Deputy continually raising this issue, he will be pleased to hear that we secured an adult psychiatrist in his area who started work the day before yesterday. It is a locum position and it is not the silver bullet that I wish it would be but it ensures that there is a service there as of this week for the short term and, hopefully, the medium term.

Pat Deering (Carlow-Kilkenny, Fine Gael)
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I thank the Minister of State again for this result, for his comprehensive understanding of the situation and for his engagement in recent times. I welcome the fact that the position has been filled on a locum basis in the past week. I tabled this Topical Issue matter two weeks ago but the slot was not available so I am delighted the position has been filled. It is important that there is a service, albeit it is not the silver bullet service that we might want, as the Minister of State mentioned. It is important that people in an area who require that service can access it when they want.

I also welcome the Minister of State's initiative of a teleservice. No matter what the area of difficulty, I have always felt that we needed to look beyond the normal and traditional ways of doing things and a teleservice is definitely something to consider for the future. The Carlow area could be considered and I will definitely take that issue up with my CHO area. It is something that could be piloted in as many areas around the country as possible so that people will have access to that service. My genuine initial concern was that service users would not have their service plan reviewed and they might have to deal with the same medication for months without being reviewed which I would consider to be dangerous. I am delighted that has changed and that there is a little bit more certainty for the service users that they will have a system available to them. Going forward, there needs to be something more definite and better planned so that they will be able to go in whenever they have an appointment and see the same face. Continuity is important from a mental health point of view so that a patient is not starting from scratch with a clean slate every time a new issue arises.

I thank the Minister of State for his response and his interest in the matter and I will continuously engage with him on it over the next period and I will take up the initiative with my CHO area as we progress.

Jim Daly (Cork South West, Fine Gael)
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I thank the Deputy and I acknowledge that he has consistently raised this issue of a chronic shortage in his area with me for many months and acutely so in recent weeks. I am glad it has been resolved and I look forward to working with him and the CHO management team if the Deputy will instigate same to try to develop a pilot.

I will give an example to the House of telepsychiatry and what I am referring to because I have visited New York and other places looking at how it works. My ambition is to see a hub established in, say Dublin, where there would be a consultant psychiatrist on duty 24 hours a day and consultant psychiatry can be beamed into six or seven emergency departments, so that if a child or a young person in psychosis presents to an emergency department, a trolley or a cart with a screen on it will be brought up and a consultant psychiatrist will be there live and will diagnose, treat, prescribe and admit, if necessary, and that consultant psychiatrist in the hub can cover six or seven emergency departments as opposed to us trying to have a consultant psychiatrist in each one of those emergency departments 24 hours a day, seven days a week, to cover the two or three cases that might present in any given 24-hour period. This is how they are tackling the shortage in other countries and in Ireland we have to be forward thinking and brave in this as well and embrace that new technology and new thinking. It has been done elsewhere and we do not need to reinvent the wheel. We just need to take up the challenge as opposed to trying to do what we always did because we will always get what we always got, which is not satisfactory and is not good enough as far as I am concerned.

I look forward to working with the Deputy to roll out some of these initiatives in Carlow and wish the new consultant who took up a post in adult psychiatry in Carlow on Monday the best of luck.

Catherine Connolly (Galway West, Independent)
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Bogfaimid ar aghaidh go dtí an Saincheist Tráthúla dheireanach ón Teachta O'Rourke. Fan nóiméad don Aire Stáit.

Brendan Howlin (Wexford, Labour)
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Tá an tAire Stáit ag teacht.