Maire Devine (Sinn Fein)
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Is the Minister of State taking the second matter?

Finian McGrath (Dublin Bay North, Independent)
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Yes, I am taking the matter on behalf of the Minister of State, Deputy McEntee?

Maire Devine (Sinn Fein)
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This is happening quite frequently. This matter relates to the closure over the last couple of weeks of 50% of the beds at the Linn Dara unit in Cherry Orchard. The engagement, thus far, by the Minister of State, Deputy McEntee, in this regard has been poor. Owing to the closure of these beds children who would have been inpatients at Linn Dara were left queuing last weekend at accident and emergency departments, some of them for 24 hours and at great risk. While some of these children are being released to the loving embrace of their families, other children are not. There are 20 children on the waiting list, which has also been culled.We also have been left with half of the staff. It has been alleged that staffing issues caused the closure and there have been warnings about staffing shortages for a long time, particularly the shortage of psychiatric nurses.

I am outraged by the closure of the facility. The parents and children are desperate for help. We know the reality due to the publication yesterday of a report on the services available to children, the publication this morning of a report on children's mental health services by the Seanad Public Consultation Committee and from the public writing to us beseeching us to do something about access for children. We have failed them miserably and we continue to fail them every day. Numerous reports have been published and some action has been taken but what we need has been ignored. We need a robust 24-7 service for children in need.

I want the Minister of State, Deputy McEntee, to up the ante and engage with the Psychiatric Nurses Association, PNA. The association, of which I am a member, has solutions that it gave to the Minister of State but they have been completely ignored and not acted upon. Action is much more than kicking something into touch, undertaking reviews and waiting for recommendations to be implemented, which has gone on forever. We just need some action. I urge the Minister of State present to convey my comments to the Minister of State, Deputy McEntee, and ask her to re-engage with the PNA.

Finian McGrath (Dublin Bay North, Independent)
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I thank Senator Máire Devine for raising this important issue, along with the staffing issue and her call for the Minister of State, Deputy McEntee, to engage with the PNA. I shall respond to the latter issues at the end of my response.

The Linn Dara facility is a state-of-the-art child and adolescent mental health services, CAMHS, inpatient unit. It provides support and services to young people who struggle with their mental health and find it hard to cope with everyday life. Linn Dara consists of two 11-bed units called Hazel and Rowan and a two-bed high observation unit called Oak.

Over the past few weeks, as is normal practice, a number of patients were discharged from Linn Dara's CAMHS unit for clinical reasons. The decision was taken not to refill those beds due to staff shortages. Unfortunately, the decision has left Linn Dara with just half of its 22 beds occupied, and that is the core of the issue. I can assure the Senator that the Government is taking the issue very seriously. The Minister of State with responsibility for mental health, Deputy McEntee, met the HSE last week specifically about this matter and she also visited Linn Dara so the process has started.

I want to assure the Senator that the HSE has confirmed that no young person is discharged from Linn Dara unless deemed clinically appropriate by his or her mental health team. It should be clearly understood that nobody is discharged to allow for a bed to be closed. For those discharged for clinical reasons, dedicated follow-on supports from the community-based CAMH service will be provided, if deemed necessary. The HSE will also make available the CAMH day service, as appropriate in individual cases, to enhance supports for young people and their families.

The core issue that faces Linn Dara, which we must face, relates specifically to staff recruitment and retention difficulties for mental health professionals. Unfortunately, this matter reflects wider health system issues. The problem in this case does not relate to funding availability. Staffing cover has been augmented in recent times through methods such as staff working additional hours, overtime and engaging the services of agency staff.

I assure the Senator that the HSE is exploring every option to maximise the operation of this service, keeping quality and safety to the fore. The HSE has intensified its recruitment efforts. A number of staff have been identified to join the Linn Dara service in the near future but realistically, such recruitment will take some time.

The Minister of State, Deputy McEntee, has told me that she will remain in close contact with the HSE and the management at Linn Dara on this issue. The Senator may rest assured that all efforts will continue to be made to address ongoing service difficulties at Linn Dara. In this context, I urge all relevant health professionals, including those represented by the Psychiatric Nurses Association, to consider working in a modern high-quality CAMHS unit, such as Linn Dara, or other CAMHS units nationally.

I will briefly address the wider issues around mental health services for children and adolescents. It is the policy of the HSE, as reflected in its annual service plans, to provide an age-appropriate mental health service for people under 18 years.Mental health remains a key priority for the Government, underscored by the fact the HSE mental health budget increased from €826 million in 2016 to €853 million this year. That is a substantial increase. The HSE service plan for 2017 commits to further development of child and adolescent mental health services, CAMHS, including more acute bed provision, better out of hours liaison and seven day a week response services. This is the strategic priority action in the plan against a background where the population of children is expected to increased by around 8,500 over 2016 and 2017, inevitably creating additional demands in CAMHS. Around 18,500 young people under 18 years are expected to attend a CAMHS service this year. That is a great many children. Additional resources and facilities means there are 67 CAMHS teams and three paediatric liaison teams, until recently supported by 66 operational CAMHS beds nationally. Further beds were planned to come on stream as approved staffing posts materialised at local level. However, I acknowledge that difficulties have clearly arisen in recent times in the HSE securing adequate staffing to maintain approved CAMHS capacity, including the Linn Dara unit in Cherry Orchard. I assure Senator Devine that all efforts will be made to continue to address the ongoing service difficulties at Linn Dara.

Maire Devine (Sinn Fein)
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Linn Dara is a modern unit and it is a shame to see it half empty. The 20 or more children on the waiting lists to all intents and purposes have been culled.

Ireland's overall suicide rate has stabilised in the past two years, but among young boys and young men it is increasing alarmingly. Our country shouts out in despair to remind us to look after, embrace and make sure our children are safe. This is what every parent wants to do and what every State should be doing for our children. The Minister of State, Deputy Helen McEntee, needs to be really proactive now. She has been told to re-employ the bank of retired nurses. I have spoken to retired nurses who have just left the health services and they are willing to come back and keep this unit open. Where is the bespoke recruitment campaign that was to happen for Linn Dara in particular? There are many things that can be done.

The Minister of State needs to understand how heavy a burden is placed on the medical teams when staff are told to find a bed by discharging a person right now. The burden is placed on a medic to tell a person that he or she is being prepared for discharge. The risk the medic is taking is enormous. That risk has to be taken by the Government and it should act now.

Finian McGrath (Dublin Bay North, Independent)
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I totally accept there is a major issue with mental health issues, particularly among our adolescent and younger population. I mentioned that 18,500 persons used the services last year. These are people under 18 years, which is a very high number for those using CAMHS.

I will bring Senator Devine's suggestion of using the bank of retired nurses to the attention of the Minister of State, Deputy McEntee. However, the Minister of State assures me that she is working very closely with the hospital and the HSE to try to resolve this issue. We have a major problem with retaining nurses, which sadly is a reality. We have many vacant posts across services which we are unable to fill. I will bring Senator Devine's strong message that we have to ensure we do not lose people or put human life at risk. We have to ensure an adequate mental health service for young people. That is the message I will bring back to the Minister of State, Deputy McEntee.