Mattie McGrath (Tipperary, Independent)
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Ar an gcéad dul síos ba mhaith liom buíochas a ghabháil don Leas-Cheann Comhairle. I thank the Leas-Cheann Comhairle for allowing me the opportunity to raise this sad and desperate situation. An bhfuil aon Aire Stáit anseo?

Andrew Doyle (Wicklow, Fine Gael)
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Yes.

Mattie McGrath (Tipperary, Independent)
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I refuse to have it taken because this is a joke. No disrespect to the Minister of State but the Minister of State, Deputy Daly, should take this very serious issue for my county and its population given the tragic increase in mental health issues and suicide as a result-----

Andrew Doyle (Wicklow, Fine Gael)
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I was asked to take it.

Mattie McGrath (Tipperary, Independent)
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This just goes to show the interest the Government has in mental health and the people of Tipperary. It is an outrage. There are four Ministers of State and one Minister at the Department of Health and not one of them could be here to take this issue. Topical Issue matters are not selected easily and it is thanks to the Leas-Cheann Comhairle this has been selected. It beggars belief that the Government would send in the Minister of State with a script and fob us off. For a long time, I accepted the bona fides of the Minister of State, Deputy Daly, but they are quite useless now. Goodwill gestures and telling us he is interested are no good to us any more. He is doing nothing about the situation in Tipperary. We have not had one long-stay bed in Tipperary since the so-called A Vision for Change was ushered in by the former Minister of State, John Moloney, of Fianna Fáil. Then we had Kathleen Lynch and now it is three years out of date and we still have no places. It is just not funny any more.

Recently, I received a reply to a parliamentary question from the HSE's head of estates, Mr. Jim Curran, who confirmed to me that the new design for a proposed upgrade to the Grenville mental health crisis house in Clonmel is undergoing a review. This is not even happening because funding has yet to be confirmed under the HSE's capital plan for 2019. Are all the Ministers in hiding? We still do not have the 2019 HSE capital plan. The Ministers are hiding because they have made such a bags and unholy mess of the children's hospital that every other project is suffering as a result. This is confirmation of it. We badly need mental health support, crisis nurses and other staff to deal with people in Tipperary. Kilkenny is full to the brim. It cannot keep us there. The same is true for the people of north Tipperary who must go to Ennis or Limerick. This is a crisis of high proportions. Fr. Michael Twomey came here and met the Minister of State, Deputy Jim Daly. We had a committee in south Tipperary to save our hospital and now we are dealing with this also. There are groups such as C-saw, Taxi Watch and the River Suir Suicide Watch out night and day patrolling. There is an epidemic of drug dealing in Carrick-on-Suir, Clonmel, Tipperary town and many other towns. Every town and village has a crisis with drugs and there is nobody to deal with it.

CAMHS, with regard to children trying to access it, is in utter disarray. Recently, I received two separate calls from parents whose children are attending CAMHS with severe social anxiety and other mental health issues. These children have been referred to the early intervention and disability services team for assessment of needs but the families have been told not to expect one for 12 to 18 months. Imagine this. The Minister of State should be ashamed to be part of a Government that deals with vulnerable people in this way. These children were due to start secondary school in September but they have no services. Even the fact they have received urgent referrals from CAMHS should be sufficient to ensure the children are seen but that is not sufficient. What do we have to do? We have countless suicides and a mental health epidemic but nothing is happening with the Government. Its members should be ashamed of their lives to send back replies when no Minister would come in to deal with it. They can run but they cannot hide, and they cannot hide from the people of Tipperary. This is a crisis epidemic and people are being left vulnerable and sadly short of services for their loved ones.

Andrew Doyle (Wicklow, Fine Gael)
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The Minister of State, Deputy Daly, has asked me to convey his sincere apologies for not being able to take this Topical Issue debate as he is on official Government business in Finland.

The recent budget provided an additional €55 million to progress new developments in mental health this year, which brings overall HSE mental health funding to nearly €1 billion in 2019. This in turn will allow for continued improvements to all aspects of mental health care across the nine HSE Community Healthcare Organisations, including CHO3 and CHO5, which incorporate County Tipperary.

One of the strategic priorities for mental health in the HSE's national service plan for 2019 is to deliver timely, clinically effective and standardised safe mental health services in adherence to statutory requirements. The provision of acute inpatient care to the adult population of north Tipperary, which is in CHO3, 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 in Kilkenny is the designated approved centre for acute inpatient services for south Tipperary, which is in CHO5. 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, there is a dedicated psychiatric liaison team operating 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 GP. There is a range of other mental health services for adults in Tipperary. These include 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.

In relation to those under 18, three CAMHS teams operate in Tipperary, with one in north Tipperary and two in south Tipperary. The CAMHS acute units at Éist Linn in Cork and Merlin Park University Hospital in Galway, which has a total of 42 beds, serve the Tipperary catchment area. The new permanent crisis house to replace Glenville House is included in the HSE’s capital programme for 2019 and is at the tendering phase. The Government is also funding a new Jigsaw service for the youth of Tipperary. A plan is now being put in place by Jigsaw with the aim of opening the new service in the early part of 2020. The Minister of State, Deputy Daly, is very aware of the challenges facing the mental health services in Tipperary. He has met Oireachtas members and various local representatives to discuss current and future provision of mental health services in Tipperary, on several occasions, most recently on 3 July 2019.

Mattie McGrath (Tipperary, Independent)
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It is bad enough to have the Minister of State come in and read out a reply but to read out untruths I will not accept. I have a reply to a parliamentary question from the head of procurement, Mr. Jim Curran, who confirmed to me that while the new design for a proposed upgrade is undergoing a review the tender process, the project cannot proceed because funding has yet to be confirmed under the HSE's capital plan for 2019. Is the Minister of State telling me that since this morning the capital plan has been approved?

It was not approved this afternoon during Leaders' Questions. I will not accept mistruths and baloney from any Minister of State but especially from someone who is reading a reply on behalf of someone else's Minister. What the Minister of State read as part of that reply would be a sick joke if it was not so serious. He stated: "One of the strategic priorities for mental health in the HSE national service plan for 2019 is to deliver" [wait for it] "timely, clinically effective and standardised safe mental health services in adherence to statutory requirements". It is not delivered, timely, clinical, effective or standardised.

We have nothing in south Tipperary. It is an appalling vista and there is nothing but a skeleton service. We could not even be given a room in South Tipperary General Hospital where people could go when they have a psychotic attack. Having such a facility would mean that people could be brought to a quieter place rather than be left in an overcrowded and overburdened emergency department. That is a disgrace. I want the Minister of State to withdraw his reply because the service plan was not agreed this afternoon during Leaders' Questions. Unless it was agreed and published over lunch today, he is telling mistruths.

I will not accept that from him or anybody else. I have a reply to a parliamentary question here. The Minister of State thinks that he can peddle as many untruths as he can get away. He will not, however, get away with that in Tipperary. He has no place to hide. It is disgusting and no wonder none of the five Ministers or Ministers of State with responsibility for health would come into the House. It is a downright disgrace on the second last day before the summer holidays for the Government to think that it will get away with treating the people of Tipperary, and especially those who have mental health issues, this way. It is a total abdication of responsibility and the Minister of State does not deserve to be in government. He deserves to be out milking the cows or someplace else on his farm but not giving that kind of diatribe to me and to sick people in Tipperary. I will not accept that. I want the Minister of State to withdraw what he stated. The HSE strategy has not been announced and part of the Minister of State's reply stated that it is.

Mattie McGrath (Tipperary, Independent)
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I thank the Acting Chairman and I accept that. I am so enraged with that diatribe.

Andrew Doyle (Wicklow, Fine Gael)
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I have nothing to say.

Mattie McGrath (Tipperary, Independent)
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There are two minutes left. Will the Minister of State withdraw his statement concerning the tenders for the HSE service plan having gone out? I have a reply from the head of procurement stating that tenders have not gone out. He is waiting on the service plan to be published.

Mattie McGrath (Tipperary, Independent)
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This is outrageous.

Mattie McGrath (Tipperary, Independent)
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What did I get? I got mistruths.

Mattie McGrath (Tipperary, Independent)
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Then he waves the white flag and runs away.

Andrew Doyle (Wicklow, Fine Gael)
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There is no white flag. There is a way to conduct oneself.

Mattie McGrath (Tipperary, Independent)
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I will conduct myself but I will not accept----

Mattie McGrath (Tipperary, Independent)
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-----mistruths and lies.