I welcome the opportunity to update the sub-committee on the subject of access to continuity of mental healthcare at primary care level through the community mental health teams and day care centres. A Vision for Change, published in 2006, was recognised as a progressive strategy for mental health in Ireland. Many of its recommendations are still considered relevant to the ongoing development of mental health services.
The mental health landscape has changed considerably since then, however, with much wider societal awareness of the issue, increased demand for services, advances in technology and a greater emphasis on recovery, all requiring a refresh of the policy and recommendations tailored to meet present day challenges. The refreshed policy, Sharing the Vision, was approved by the Government and published in June 2020. It is a ten-year plan which seeks to place mental health policy as central to the broader development of Irish healthcare. It recommends a whole-of-government, population-based approach, involving interdisciplinary working to meet the needs of the individual at the appropriate level over the whole of his or her life cycle. In line with Sláintecare, the policy advocates improved linkages between the community, primary and secondary sectors and ease of movement between each, as required. It also supports the further development of non-inpatient services to ensure that minor issues may be addressed as quickly as possible and that they do not become larger problems.
Under the subject of community mental health teams and child and adolescent mental health services, CAMHS, A Vision for Change recommended the development of multidisciplinary community mental health teams to facilitate a move away from institutions and to provide treatment in a community setting. This policy was prescriptive in the membership and numbers of each team, recommending that there be one community mental health team CMHT for every 50,000 people. In recent years, the demand for mental health services has increased substantially. This is illustrated in CAMHS, where between 2012 and 2019 demand increased by 24% and referrals accepted by the HSE increased from 10,700 to 13,200. It should be noted that waiting lists for CAMHS over this period increased by only 4%. As of September 2020, CAMHS waiting lists nationally total 2,137. While this is down from the December 2019 figure of 2,327, and the HSE has initiatives in place to address the waiting lists, it is accepted that more needs to be done in this area. With this in mind, the 2021 national service plan will provide funding for the expansion of CAMHS hubs, which have been piloted in Galway since 2019. This will involve the recruitment of 29 whole-time equivalents, WTEs, specifically for CAMHS. The hubs will complement rather than substitute face-to-face care and will help address improved access and reduce waiting lists by establishing closer links with other parts of the health services. In addition, funding was provided in 2018 for the recruitment of 114 assistant psychologists and 20 psychologists in primary care. This initiative has helped to reduce demand on the specialist services by dealing with issues at a local level before specialist intervention is required.
Sharing the Vision continues this work, making a number of recommendations to enhance the performance of CMHTs. Access to such teams is usually through GP referral or follows from attendance at an emergency department. Sharing the Vision proposes a new referral option to out-of-hours crisis cafes. These will be appropriately staffed and will reduce demands on emergency departments, providing an environment more suited to the needs of those who present. I will offer another example. To facilitate greater flow between the different sectors, the introduction of a key worker from the community mental health team for each individual is also proposed. This worker would help to facilitate improved integration, for the individual's benefit, between the various service strands. In addition, the new policy recommends greater flexibility around the formation of the teams. It proposes additional workers, such as peer support workers and job coaches and, rather than specifying absolute numbers of specific professionals per team, will determine the needs of each team by assessing the needs and social circumstances of each sectoral population. Crisis resolution is a key component of the CMHTs. Sharing the Vision recognises its importance in that it offers out-of-hours psychiatric assistance for those presenting with a mental health issue. Finally, the provision of information is important. The new policy recommends that directories of information on supports available in the community and voluntary sectors should be made available to CMHTs to ensure they are in a position to advise service users of such supports.
Funding of mental health services has increased from €711 million in 2012 to €1.076 billion for 2021, an increase of €365 million, or 51%, over this period. This increase includes the allocation of €23 million to begin the implementation of Sharing the Vision in 2021. This will fund an additional 123 posts in mental health, as well as an additional 30.5 individual placement scheme, IPS, workers. This funding will also help to further develop CMHTs generally, crisis resolution teams and peer support as part of the first phase of implementation of the new policy.
Regarding implementation of the new policy, a national implementation monitoring committee, NIMC, has been established by the Minister of State, Deputy Butler, to drive the new policy over the next ten years. The NIMC structure will comprise a steering committee and a specialist subgroup panel, which will provide a wide base of expertise to advance specialist areas of action in Sharing the Vision. The steering committee includes experts from the fields of psychiatry, counselling, social work, youth mental health and occupational therapy. There will be strong service user representation in the NIMC structure to ensure that the service is developed around the needs of both service users and their families. Specialist groups will be established in areas such as Travellers' mental health, the transition from CAMHS to adult mental health services and acute mental health beds. Membership of these groups will be drawn from those on the specialist group panel. Panel members include representatives from Traveller and LGBTI+ organisations among others. On 4 November the Minister of State, Deputy Butler, announced the appointment of Mr. John Saunders as independent chair of the NIMC. The selection of the membership of the NIMC has been completed and the steering committee will have its first meeting on Friday, 11 December.
Regarding Covid-19 and mental health, in March 2020, the Department of Health introduced emergency legislation for holding mental health tribunals that review involuntary detentions. The legislation permits one-person tribunals to be held. This allows for continuation of tribunals where there is pressure on clinical staff availability due to Covid-19 and to prevent the spread of infection. To date, no one-person tribunal has been held. The legislation has now been extended by resolution of both Houses of the Oireachtas until June 2021. At the Department's request, and in response to Covid-19, the Mental Health Commission developed a monitoring and reporting framework for residential mental health facilities. Under this framework, Covid data are collected and reports provided on issues arising regarding suitability of premises, preparedness, training and equipment levels. The commission reports weekly to the Department and the HSE, which greatly assists the overall sectoral outbreak response. The Department, along with the HSE and the commission, has also established an oversight group to monitor any developments in this area and to ensure a quick response is available in respect of any issues arising.
I thank the committee. My colleague, Mr. Maguire, and I look forward to answering any questions Members may have.