I thank the witnesses for being here today and I acknowledge the fantastic work that is being done. The purpose of the committee's work is to identify the gaps that need to be filled. I will be frank, as always. Do the witnesses believe that we have made progress in this area in the past ten years?
Mr. Ryan mentioned consultant-led multidisciplinary teams. I have received information that indicates that no lead has yet been appointed to the HSE clinical programme announced in December 2015. As of September 2019, this clinical programme does not appear on the HSE website. I have been told that it is now a matter for the HSE service improvement board. In the four years from 2015 to 2019, nothing has been done in terms of dual diagnosis. In regard to the Kiwi model, the New Zealand Government established an inquiry into dual diagnosis, in respect of which six panel members surveyed people about what was needed. Following this, they produced a report and the Government accepted the majority of the recommendations made and agreed with the budget allocations. All of this was completed in 15 months. Are we plodding along here? I have only been a Member for a short time but my background has been in the mental health area for the past 15 or 16 years. It is like Groundhog Day in terms of what is being said and promised, including in regard to recruitment and retention. I have raised in the House with the Taoiseach and the Tánaiste the issue of nurses being trained but not being given a contract by the HSE. We are shovelling snow while it is still snowing. Why are we engaging locums and agency staff at huge expense rather than giving nurses contracts?
There are 700 vacancies within the mental health services. We are training people in mental health but we are not employing them. This does not make sense. A Vision for Change was produced almost 14 years ago and the review of it took almost as long. The Joint Committee on the Future of Mental Health Care also carried out a review of mental health services. Yet, we have not moved forward. There is much talk of a worldwide crisis in terms of mental health. Why is there no plan in place to train, recruit and retain mental health services staff? In the past ten years, only 68 posts in the mental health services have been filled. We face 500 possible vacancies within the next two to three years owing to retirements, which will mean a massive shortage of staff. Capacity was mentioned. We will not be able to do it. In a reply to a parliamentary question, I learned that we have a €19 million underspend on recruitment in the mental health budget. This is ludicrous.
My cousin recently emigrated to the UK because she was not offered a contract here. Many of our emigrants would have liked to have remained in Ireland. They want to work here and to pay their tax in Ireland, where they can remain close to their families. There is no positive news for them. This is not a personal attack on the witnesses. I need to put my views on the record in order that their managers will be made aware of the lack of drive in terms of recruitment. It seems to be a tick-box exercise. We have all heard about fake news. We do not need to go the USA or the UK for it. We sometimes have it in committees. An additional allocation of €55 million was not provided last year to the mental health service. The HSE report launched in the audiovisual room showed a €35 million allocation. Somebody is being spun lies. The witnesses are trying to do their bit but they do not seem to have the proper information, which I find frustrating. I have said that to bake a cake one needs the correct ingredients. There is no point using half the ingredients and expecting the cake to taste the same. It will not happen.
Returning to my original question and following on from my remarks, do the witnesses believe they are restricted?
They have spoken about models of care changing and I accept that service demand has increased, not only in the youth sector but also in the disability sector. There is a large ageing population and rural isolation and we are losing general practitioners. Everything seems to be centralised in accident and emergency services and the delegates' services are being overcrowded. We are listening to this time and again, yet nobody in the Government or at the top of the HSE is addressing it. The Government and the HSE should sit down and state they need to come up with a plan rapidly, whatever it takes, and acknowledge that whoever is trained within the service needs to be retained. Staff are retained by offering them a contract. I cannot understand what is happening.
Recently I asked a parliamentary question about CAMHS. I will put it to the delegates. Are they genuinely satisfied or dissatisfied with the direction CAMHS is taking? There is misinformation circulated on it. The delegates spoke about members of CAMHS teams. Let us say a premier league of ten teams was set up and each had 11 staff. We would not be able to run the league at present because team A has 11 staff, team B has five and team C has nine. Therefore, it would not work in the system.
The demographic issues are known about. Cork is a black spot and there are many others. I will use Cork as an example because I am from there. The demographic data imply that the rate of suicide and self-harm is high. Let us have a pilot project and resource and staff it fully, thus facilitating all those concerned because they all have to work as a team and start to reduce the figures, thus showing that this model works. When one invests in a model that works, it can be replicated throughout the country, thus improving everything. At present, however, the strategy is to try to do everything together, with no plan A. Plan A has been shelved for the past four years and is to be transferred to somebody else's department to talk about it. In the meantime, we are losing nurses and people to suicide, unfortunately. The information we have shows that there are 76 beds and that 23 or 27 were vacant in July. I received that information in the response to a parliamentary question. While the number of beds has increased, the number is only at 75% of the level recommended in A Vision for Change 13 years ago. In reality, if one removes the 23 beds, or the 27, we are only at a rate of 50% under the CAMHS plan. If one stops putting out all of these figures, it makes no difference to those who are trying to gain access to the service. It is a matter of access, as I know from experience.
I was late yesterday because I had to meet an individual in my office about a crisis case during the so-called break. Four times I had to have a young man arrested for his own safety. I will give credit where credit is due in that when I contacted the crisis team in Cork, its response was above and beyond the call of duty and absolutely brilliant. However, it is just one section.
I need an honest answer that management and the Government can hear to the question of what the delegates genuinely believe, 13 years on and having had a children's committee, a health committee, a committee on the future of mental health care and the Sláintecare report which in fairness was produced in very short time. CAMHS is only at a figure of 50% of what is needed. There are 700 vacancies in the mental health service and we face losing another 500 staff in the next two to three years. There is under-expenditure of €19 million on recruitment because we cannot pay, yet we have money available. There is misinformation every year. The original figure was €84 million, of which some €29 million was spent the year before. There was a total of €55 million and the HSE's report refers to €35 million. We are trying to do our best, yet we are back again to phase 1. What is planned for next year? That is my spiel. I am not saying this to pick on the delegates, but I need their management and top brass to ask the Government to stop trying to fix everything in one go and try to proceed properly, giving each service the maximum resources, be they for Linn Dara, Éist Linn or the Jigsaw project in Galway. Squashy Couch was in Galway when I started 12 or 14 years ago. Do the delegates believe services are under-resourced? Is the plan plodding along? Is there genuine drive, bearing in mind that in New Zealand something could be done in 15 months? It came up with a ten-point plan. There is a video which shows what is being done in New Zealand. It is patient centred.
I am here three and a half years. I am sitting in front of some of the same delegates hearing the same thing time and again. We flagged the issue of recruitment three years ago. If the nurses who were trained in the past three years had been retained, we could have 400 vacancies in the mental health service, rather than 700. There have been 700 vacancies for the past three and a half years and nothing has happened. As an old lady said to me one time, it is like a penance where one gets a bucket with no arse in it and is told to empty the Red Sea with it. One will have a bucket, but one will not be able to do anything with it. We seem to have budgets and nothing seems to be done with them.
What is happening is being misconstrued. This is not to reflect on the delegates. They will take responsibility, but it is their managers with whom I want to deal. I would love to sit down with them to ask them to tell us the truth and whether mistakes are being made. There are mistakes being made, but this is not the platform for addressing them. It will emerge that there are many parts of the mental health service that are not fit for purpose. Deputy Sherlock touched on this issue. Staff are not being disciplined for X, Y and Z, but that is a different story. My priority is to implement a preventive measure. There does not seem to be any joined-up thinking. There is misinformation and we are hearing the same stories. We are hearing them today and will do so again tomorrow. We are told that services are short a few bob. If the delegates outline their position in black and white, we will tell the Government on their behalf. I have no doubt that they would not be in their current positions if they were not passionate about their work. They want to make changes, but they cannot be managers of football teams if there are six on one team and 11 on the next. This puts one team at a disadvantage straightaway. If the disadvantaged team does not receive funding, it will be relegated. Once it is gone, it is gone. It feels the same with mental health services. Even with the best will in the world and everything that takes place, there is no access and people are being turned away. The services are oversubscribed and understaffed and those who require them are told by the staff that they are sorry. This is not a reflection on the delegates. The front-line staff do their best, but my point is that this should go back to head management. The Minister for Health, the Minister of State responsible for mental health services and all of the others should be told the truth, even by text, and that the time for talking is long gone. There is now a different class of politicians who actually give a damn. We are not talking about statistics and percentages but people. The delegates are saying - we have heard from other delegates - that when one person dies, 42 to 45 others are affected directly, fluttering out to 220 odd people. That could be a rural community devastated in just one go and it is happening every day. The WHO's report states somebody dies by or contemplates suicide every 40 seconds in the world. There is a crisis and something is going wrong. Do the delegates genuinely believe we have moved forward in the past ten years?
