I thank the committee for the invitation to attend today. I am joined by the head of mental health services at CHO 8, Ms Siobhán McArdle. Ms Anne Kenny, the head of finance, is also in attendance. I am the chief officer of the HSE midlands, Louth, Meath community health care organisation, referred to in documents submitted to the committee as CHO 8. I am responsible for the overall management of all HSE services in the area, excluding acute hospital care.
The HSE midlands, Louth, Meath CHO area covers six counties, namely, Louth, Meath, Longford, Westmeath, Offaly and Laois. The region has a total population of 619,281 per 2016 census figures, which represents a 4.5% increase on 2011 figures. While the CHO has the fourth largest population when compared to other CHOs, it has the highest number of children and young people.
The CHO was established in 2015 and comprises two previously separate health service areas, the midlands and Louth-Meath. The mental health service of the CHO is one of four divisions which make up the community health care portfolio. The other divisions are primary care, social care, including for older people and those with a disability, and health and well-being. Acute hospital services in the CHO region are provided by three different hospital groups, namely, the RCSI Hospitals Group, the Ireland East Hospital Group and the Dublin Midlands Hospital Group. Those hospitals are referred to in the appendices attached to the documentation submitted.
The mental health service in the midlands, Louth, Meath, CHO operates as two service entities, with shared governance for the overall service operating through the office of the head of service, Ms Siobhán McArdle, who reports to me as chief officer. There are two executive clinical directors, Dr. Maurice Gervan in the midlands and Dr. Emir Niyazi in Louth-Meath. There are also two area directors of nursing. All mental health management teams in the region are multidisciplinary in membership and include occupational therapy, psychology, social work, speech and language therapy, dietetics and most importantly, service-user representation. This reflects the multidisciplinary nature of modern mental health services. A broad range of services support the mental health and well-being of the population of this CHO. Specialist mental health services are provided through child and adolescent mental health services, CAMHS, general adult mental health teams and psychiatry of old age teams across the region.
The mental health service in our CHO has made a strategic commitment to embed recovery within everything we do. This vision will be achieved collaboratively using the expertise of people with lived experience, HSE staff, non-governmental organisations, NGOs, local authorities and other stakeholders relevant to the experience of the recovery journey.
There is a total of 1,081 staff employed in the midlands, Louth, Meath CHO mental health service. Services are provided through multidisciplinary teams. This is consistent with best practice and in line with government policy as detailed in A Vision for Change.
The mental health service in the CHO has a budget exclusive to mental health services. In 2018 this is set as €95.517 million, which represents an increase of 21.3% from the 2015 budget of €78.735 million. I know that the Chair was anxious to get figures on CAMHS that I had not included in the report. I have them now and can provide them. The CHO's budget for CAMHS is €11.6 million. That represents 12% of the mental health budget for the region. The mental health budget represents 18% of the overall CHO budget.
The programme for Government development funding has been provided to the CHO to develop the new acute mental health facility adjacent to Our Lady of Lourdes Hospital in Drogheda and to develop child and adolescent community mental health teams across the CHO along with general adult community mental health teams.
There are 17 community mental health teams providing services to the general adult population with moderate to severe mental health disorders. Five of the teams are fully staffed per A Vision for Change. The remainder are operating with approximately 70% of recommended staffing levels. Again, I have included this information in the appendices. Recently opened primary care centres in Mullingar and Kells provide accommodation for community mental health teams alongside their primary care colleagues.
There are five psychiatry of old age teams in the CHO providing community-based and residential services to older people with mental health difficulties. In this service, only one of the teams is operating with less than the recommended staffing levels. Specifically, that is the service in Meath. There are 11 child and adolescent mental health teams in the CHO providing community-based services to children, young people and their families. The service currently operates with only 60% of the recommended members of the multidisciplinary team. The development of the CAMHS teams is ongoing.
Specialist mental health services are provided through a range of specialist teams, including teams for mental health intellectual disability, rehabilitation and recovery and liaison services. It is important to note that the developments in this area have been slow, and there is a need for further investment and development of these services.
Community teams are supported by day hospitals and inpatient units where necessary. There are 116 acute beds provided in three inpatient units in the midlands, Louth and Meath. Ten of these beds are used to provide services to people from Kildare, as Mr. David Walsh mentioned. There are 108 continuing care beds in three approved centres in the region, including services provided by psychiatry of old age. In addition, the service supports people with high, moderate and low-support needs to live in the community. Services work closely with local authorities and housing agencies to support those with housing needs.
The mental health service is responsible for the provision of counselling in primary care, CIPC, and the national counselling service, NCS. The CHO funds a number of agencies to provide supports to the population in the area, for example, Mental Health Ireland. There are three resource officers for suicide prevention in the CHO who co-ordinate activities in respect of suicide prevention. This office is the first point of contact for those affected by issues associated with suicide and self-harm.
I will now speak on some of the specific initiatives we have been working on and our achievements in recent years. The mental health service appointed an area lead for mental health engagement in 2017. It is important to acknowledge that this individual has been the leader in encouraging user engagement with services. We are committed to ensuring that service users, family members and carers are central to the co-production, design and delivery of mental health services. This builds on the foundations laid by the mental health services consumer panel in Louth-Meath.
Our CHO has been successful in securing moneys from the service reform fund in order to refocus existing services to a recovery-based model. Our three-year plan will facilitate the advancement of recovery initiatives and the enhancement of employment opportunities and will allow support service users to transition from accommodation by the HSE.
The CHO is committed to the full implementation of Connecting for Life, Ireland’s national strategy to reduce suicide. The launch of our CHO Connecting for Life plan will take place in March 2018. This multi-agency plan has been developed in partnership with service users, family members and carers across the region during 2017. The plan was informed by a public consultation process involving staff, members of the public and key priority groups.
The CHO has been allocated additional funding to develop and enhance community-based seven-day mental health services for existing users of the services provided by general adult community mental health teams. This is a positive development through which service users can access appropriate services at the weekend instead of presenting at accident and emergency departments.
One of the challenges we face relates to the difficulty of securing sufficient recurring funding for a number of services in our CHO. The programme for Government funding is used to develop and implement A Vision for Change. Given that the policy A Vision for Change is now over ten years in existence, it does not reflect changes that have occurred in HSE community health care in recent years. There is a challenge in funding services not described in A Vision for Change. Funding does not cover the additional cost of employing agency staff while waiting for permanent staff to be recruited. Non-recurring funding for 2018 is €5 million or 5.2% of the budget.
The three areas that are being discussed today have experienced the highest increases in population due to being in or on the commuter belt. There has been significant and consistent population growth in the CHO in recent years. This has created a corresponding increase in demand for all services, particularly CAMHS, across the region. All teams are working to ensure that targets relating to waiting times for services meet national key performance indicators.
My colleague, Mr. Walsh, has already discussed recruitment, so I will address clinical accommodation. The rate of capital investment in permanent clinical accommodation has not kept pace with staffing increases in our mental health teams across the region. Delays in the development of primary care centres in key urban areas have resulted in an over-reliance on leased or shared accommodation. This gap impacts on productivity and staff retention.
Specialist mental health services for adults and children with an intellectual disability are underdeveloped in our CHO. The service welcomes any additional investment in these teams to ensure equitable access to mental health services for children and adults with an intellectual disability.
I thank the Chairman and members for their attention and for their interest in the mental health services in CHO 8. I acknowledge the strong commitment of all staff working in the mental health services and in the national division who support us. Through them, we are committed to providing safe, high-quality, recovery focused person-centred services. My colleagues and I are happy to assist with any questions or clarifications members may wish to raise.