Maire Devine (Sinn Fein)
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I welcome the Minister of State, Deputy Jim Daly, to the House. I am delighted he is taking the matter. We have had issues every now and then with people not being in a position to give responses to supplementary contributions. I hope the Minister of State will respond to me today.

I have put in a question about the closure of day programme at Linn Dara at 4 p.m. last Friday. My Dáil colleagues, Deputies Aengus Ó Snodaigh and Pat Buckley, raised the matter as a Topical Issue last night and I hope the Minister of State is not going to read out what was read out to them. We need to move on and work to get this vital service restored for our young children and adolescents. The Minister of State knows about Linn Dara. Last year, half of the beds in the inpatient unit were closed down and on Friday that happened to the day programme servicing the inpatient unit and outpatients to keep people at home to be treated in the community as per A Vision for Change. In 2006, it was announced that there would be 15 of these units opened across the country. We had three and are now down to two. We cannot stand over that. We cannot stand over the chipping away, brick-by-brick, at child and adolescent mental health services. The Minister of State has been frequently involved with the Committee on the Future of Mental Health Care and he knows about the absolute crisis in services for children. Many services are not being provided.

The Minister of State should not listen to the management of the HSE, he should listen to me and those people who are on the ground regarding their experience of how this service was shut down. On 11 June, the consultant was told by the director of services of concerns regarding staffing in CAMHS at the Linn Dara day programme. The possibility arose because the supporting CAMHS in Clondalkin was in dire straits. The consultant was willing to support the services in Clondalkin and formulated a solution with staff to provide 50% of capacity to Clondalkin with 50% remaining in the afternoon. It was half and half. Staff would go to Clondalkin in the morning and return to Linn Dara to carry out the assessments, appointments and therapies in the diary to provide long-awaited services to adolescents and children. As such, two members of staff went to Clondalkin and nothing else happened between 11 June and 27 June. On 27 June, an email was circulated by senior management instructing and advising of the closure of the day hospital programme on 6 July, which was last Friday. The senior manager went on to say the service should not inform any of the families directly about the closure and should continue to make appointments at 3.55 p.m. on Friday for children who have been on those waiting lists for a long time. This order not to inform families was the entire concern of management. They refused to communicate directly with the families or the staff. They said they would not issue letters to cancel appointments because they did not want them to end up on the Joe Duffy show.The closure was kept quiet. Last Monday the team members were instructed to commence working in their new posts, but, again, they were not consulted. The closure has caused massive distress and led to significant consequences for the adults involved and their families. All of the adults were discharged prematurely from the day programme last Friday, 6 July. In the space of just one week the families were informed of the closure and that their loved ones would be discharged from the programme. The unit has ceased operations. We have been told that it will be reopened in September or October, but that is absolute balderdash, as I know that staff have been told that the issue will be reviewed in November. That does not mean, however, that the unit will be reopened. Consultants have been offered the opportunity to return, but the same courtesy has not been shown to any of the team.

I urge the Minister of State to show leadership. I want him to tell the HSE that enough is enough, that the people affected have had enough, that everything has changed and that it is the people of the nation and their children who are in dire straits. I plead with him to show leadership and provide assistance for the people concerned.

Jim Daly (Cork South West, Fine Gael)
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I thank the Senator. It is the policy of the HSE, as reflected in its annual service plans, to provide an age appropriate mental health service for those under the age of 18 years. I reiterate the Government's commitment, in view of the significant additional funding allocated in recent years for the development of all aspects of the mental health service, including services for young people. I will continue to make the case for the allocation of further resources annually in line with evolving demands and in accordance with the commitments given in A Programme for a Partnership Government.

The HSE service plan 2018 commits to further developing the child and adolescent mental health services, CAMHS. This is against a background where the demand for access to CAMHS increased by 26% between 2012 and 2017 and where various youth mental health initiatives, other than the specialist CAMHS service, are also being progressed.

We have 69 CAMHS teams and three paediatric liaison teams that are supported by around 75 CAMHS beds nationally. Further beds are planned to come onstream as quickly as possible. In addition, the Government has agreed to fund an extra 140 psychiatric nurse undergraduate places each year to help to improve the planning and delivery of services in the next few years.

A key difficulty being addressed on a steady basis by the HSE is staff recruitment and retention, particularly in the sphere of CAMHS. The recent appointment by the executive of 114 assistant psychologists and 20 psychologists will help to develop counselling services in primary care. It is anticipated that these posts will deal with the less complex child and adolescent cases and thereby reduce the demand on CAMHS. In addition, I recently approved ten new posts of advanced nurse practitioners, ANPs, that will be specifically directed at the CAMHS service nationally. The new ANPs will play a key role in delivering better service co-ordination where local service pressures are greatest.

The HSE Linn Dara CAMHS service covers a region comprising County Kildare, west Wicklow and south west Dublin and reflects a total population of around 420,000. There are seven multi-disciplinary community CAMHS teams for these areas. The HSE has indicated that a decision was taken by the Linn Dara management team to temporarily suspend its day programme from Friday, 6 July. This was to maintain essential community and inpatient services. It is expected that the day programme will reopen in September or October. The decision was taken owing to psychiatry and allied health professional temporary staffing shortages within the community sectors. To maintain essential provision of services, psychiatry and multi-disciplinary staff have been reassigned from the adolescent day programme to maintain other key community-based Linn Dara services and manage their overall capacity at this time. The small number of young people who were scheduled to attend the adolescent day programme will continue to attend their existing community CAMHS teams and receive appropriate individual and therapeutic programmes.

The HSE has a statutory responsibility to ensure safe, adequate and sufficient service provision in all areas of the CAMHS service. The Linn Dara inpatient unit will remain fully operational as normal, with 22 beds available, as well as functioning community teams. The Senator may rest assured that I will keep this matter under close review and that all efforts will continue to be made by the HSE to address ongoing service difficulties at Linn Dara.

Maire Devine (Sinn Fein)
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The Minister of State has given the same reply as that given by his colleague, the Minister of State at the Department of Health, Deputy Finian McGrath, the last evening. I implore the Minister of State to, please, change his script and find a way to resolve the matter. He has mentioned that a "small number" of young people are involved. The CAMHS service covers a region with a population of 420,000, yet only 45 young people are treated annually, while waiting times, as we know, are off the Richter scale.

I welcome the recent announcement of ten new posts of advanced nurse practitioners. I plead with the Minister of State to listen to me. The unit's team provided a solution. Superficially, it was accepted by the senior management team, but, sadly, a week later it reneged on the offer and the unit's team was told not to ask questions, to close the doors within a week and not tell the parents. Management did not consult the staff. We need to change that script in that regard. A solution was provided this year, just as it was last year, but it was not taken on board. As legislators, we cannot stand by as children's health is at risk. Therefore, we need to show leadership by saying to the HSE senior management team that the closure will not happen and asking why it did not talk to us beforehand.

The Joint Committee on Future of Mental Health Care will continue to pursue this matter. The HSE turned down an invitation to appear before the committee today after initially accepting it to give its version of events which is the same as that of the Minister of State. I urge him to find out more about the matter and not accept the HSE's bland excuses about staff shortages because they fly in the face of the evidence that I have in my possession.

Jim Daly (Cork South West, Fine Gael)
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I note with interest that most of the Senator's references in this debate are staff-oriented, staff-related and staff-connected. They originated from staff.

Maire Devine (Sinn Fein)
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I have-----

Jim Daly (Cork South West, Fine Gael)
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No. The Senator only mentioned families once in her initial contribution.

Maire Devine (Sinn Fein)
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No, I mentioned them three times. I mentioned parents and children.

Jim Daly (Cork South West, Fine Gael)
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I urge the Senator to be honest on the matter.

Maire Devine (Sinn Fein)
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If need be, we can check the transcript.

Paul Coghlan (Fine Gael)
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I cannot allow a debate on the matter at this time. The Minister of State to continue, without interruption.

Jim Daly (Cork South West, Fine Gael)
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I did not interrupt the Senator when she commented and I am allowed to say my piece.

Paul Coghlan (Fine Gael)
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Yes.

Jim Daly (Cork South West, Fine Gael)
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This is a two-way process but not if the Senator chooses to make dramatic statements and label things as balderdash. She loves to use the word "chaos" and the phrase "dismantling things brick by brick." She wants to have her moment in the sun.

Maire Devine (Sinn Fein)
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The Minister of State does not need to get personal.

Jim Daly (Cork South West, Fine Gael)
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I have not personalised the matter.

Maire Devine (Sinn Fein)
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I referred to the Joint Committee on Future of Mental Health Care. I urge the Minister of State not to get personal, as it just shows that he has a defeatist attitude. I implore the Leas-Chathaoirleach to ask the Minister of State to desist from making personal attacks.

Paul Coghlan (Fine Gael)
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The Senator and the Minister of State have had their say. I cannot allow the Senator to comment again. Under the rules, unfortunately, a Senator is only allocated four minutes in which to contribute. The Senator ran over time and, as normal, I showed latitude by giving her an extra minute.

Maire Devine (Sinn Fein)
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For which I thank the Leas-Chathaoirleach.

Paul Coghlan (Fine Gael)
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The Minister of State is making his response, to which we must listen, without interruption.

Jim Daly (Cork South West, Fine Gael)
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I thank the Leas-Chathaoirleach. There is an issue that affects staffing and it is cross-sectoral. I am sure the Senator is well aware of the staffing issues, as she is very close to the staff. Therefore, she understands the issues and the challenges. However, I must view the issue at a policy level and identify the challenges at a national level.

The day programme has been suspended temporarily for the summer months in order to accommodate and ensure continuity of inpatient and community services. It is very important that best use be made of the available resources. I support the HSE in its efforts to widen the scope of the service and ensure it will continue. I understand the number of children impacted on by the change to the day programme is fewer than three. When I say impacted on, I use the them carefully because the children concerned continue to avail of services in their communities. The community CAMHS teams are delivering the services as opposed to the day programme run by Linn Dara.

CAMHS has grown exponentially in the past few years. The amount of money the State and the Government have put into developing it is astounding. We have moved from a situation where 20,000 people were in institutional residential care during the 1960s to one where the number is just 1,000 people. We have done so by building community teams and developing and growing CAMHS. I, therefore, ask the Senator to withdraw her remark that attempts are being made to dismantle the service brick by brick because nothing could be further from the truth.

Maire Devine (Sinn Fein)
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No, I will not withdraw my comment. I thank the Minister of State for his reply.

Paul Coghlan (Fine Gael)
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I thank the Senator and the Minister of State.

Jim Daly (Cork South West, Fine Gael)
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I thank the Leas-Chathaoirleach.