Maurice Quinlivan (Limerick City, Sinn Fein)
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I first spoke on the issue of the community access support team in 2021, not long after it was announced that it was to be trialled in Limerick. I was told at the time that it was going to be operational in 2022. Unfortunately, this did not happen. My colleague Deputy Ward asked the Minister for Justice, Deputy McEntee, about it in 2022. He was also told that the community access support team would be up and running in 2022. I have raised this issue several times in this Chamber over the years, as well as in meetings of the Limerick joint policing committee. At one such meeting of the joint policing committee in January 2022, I was advised that the creation of the unit was progressing and it would be live in 2023. It did not happen. Again, in April 2023, I sought an update on the progress of the unit, this time via parliamentary question. Once more, I was advised that it was on the cusp of being launched, but it has yet to be launched. I have asked numerous parliamentary questions over the years about this matter, as outlined in the pages I have with me.

This is a pilot programme that is very much needed. It is very much welcome and is most definitely needed in Limerick. The pandemic period had a major impact on people's mental health and this is still being felt. The delay in commencing the community access support team is beyond disappointing. It is a further example of how this Government continually fails people in Limerick and the mid-west when it comes to accessing medical support. We have a trolley crisis that continues unabated, long waiting times in the major hospitals, including University Hospital Limerick, and we have a failure to urgently address the challenges in mental health, especially during out-of-office hours when such support is needed. The unit has been prioritised for nearly four years and for four years, the Government has failed to deliver it. Where does the fault lie? What is the impediment to establishing this proposed team?

I remind the Minister of State of the remit of the community access support team. Should it ever be implemented, this team will call to a person experiencing a mental health issue, with the idea being that this specially-trained team will meet the person, triage that person and refer or bring him or her to the appropriate service. The long-awaited de-escalation unit, which will combine staff from the HSE, the Garda and the National Ambulance Service, is set to serve those facing mental health challenges outside regular working hours. As it stands, in Limerick the vast majority of out-of-hours interventions for those needing mental health support are provided by volunteers. It is the volunteers from the Limerick Mental Health Association and other volunteers, such as those in the Haven Hub and other groups, who try to fill the gap. We then have the last line of defence, those groups that respond when there are no other services. These include Limerick Suicide Watch and Limerick Treaty Suicide Prevention, which both do regular riverside patrols in Limerick city. Without these people opting to give up their time to try to tackle the mental health challenges that exist, I am sure we would have had more people lost by suicide.

It is time for the Government to step up to the plate and implement that long-promised de-escalation team.

The launch of the team is not unprecedented and is not without an example to follow. A similar pilot was rolled out in Belfast some years ago. It operated between the hours of 7 p.m. to 7 a.m. on Friday and Saturday for one year. During that time, the team had 193 referrals, 94 of which were face-to-face. In this context, 131 people were diverted from attending an emergency department and were instead directed to more appropriate routes of treatment. It also diverted 61 people from the justice system - 61 people who would otherwise have been charged with an offence, despite being unwell. They met, treated, and triaged people within their own community, alleviating pressures on a strained hospital system.

The service and staff, when funded, can work. Now, if someone suffers a mental health challenge outside of office hours, it is incredibly difficult to get the support, or indeed any support whatsoever. If such results could be replicated in Limerick, it would have an immediate impact on the number of presentations at our accident and emergency department at UHL. As the Minister of State will be aware, UHL is always at full capacity. It always has a huge number of patients being treated on trolleys in hospital corridors. Any programmes, such as community access support teams, CASTs, or the pathfinder programme, that could stop presentations at the hospital while ensuring that appropriate care is received, must be enhanced, or indeed commenced. It makes sense from a capacity pressure point of view, and crucially, it makes sense from a treatment point of view.

Emer Higgins (Dublin Mid West, Fine Gael)
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I am taking this Topical Issue on behalf of the Minister for Health. I thank the Deputy for his support for this Government initiative. The development of a CAST, a multiagency initiative proposed for Limerick city, was a recommendation of the final report of the high-level task force, HLTF, on mental health and addiction challenges of those who come into contact with the criminal justice sector.

As the Deputy will be aware, this report was published on 30 September 2022. It was always envisaged that significant planning would be required to progress this recommendation. The purpose of the CAST project, as he outlined, is to create a specialist uniform unit in which gardaí will work together with mental health professionals to provide a rapid and integrated 24-7 response to persons with mental health difficulties or those experiencing situational trauma. This will be a one-of-its-kind, first-of-its-kind team of its kind to be created in Ireland comprising two modes of delivery, namely, a crisis response service and a community support forum.

A specialist uniform unit will respond to relevant 999 calls that have been triaged. The on-scene crisis response will involve trained members of An Garda Síochána working with their existing operational unit and supported by an assigned clinical nurse specialist and other members of the team. As the Deputy will be aware, the community access support team will be based in Limerick’s Henry Street Garda station during working hours and will follow up with individuals based on needs identified during coresponse. When not responding to calls, these staff will be completing work associated with the project, such as linking in with external agencies, outreach to homeless and addiction services, following up on previous call outs and providing ongoing intervention based on need.

At the heart of the CAST project is the establishment of a multiagency community support forum in Limerick. This case management forum comprises identified statutory agencies and approved support services. The aim is to reduce future presentations and interactions with gardaí or other blue light emergency services through community follow-ups and the case management of complex cases. An independent person from the local authority will chair the forum, which will meet on a monthly basis. The aim of the forum is to provide an integrated approach to working with people during a crisis. A study of the project with academic partners in the University of Limerick will inform further roll-out of similar teams in Ireland.

Mr. Bernard Gloster, CEO of the HSE, recently confirmed that the new mid-west regional executive officer has been given appropriate directions for the CAST project to proceed without delay. The staffing requirement for the pilot from a HSE perspective is one clinical nurse specialist, one social worker and one social care worker. These posts have recently been approved. The gardaí will support the pilot with two gardaí, both of which are vulnerability navigators, and one clerical officer member of garda staff. In addition to significant progress at a local level, a meeting was held in Limerick yesterday, 8 July, between representatives of local HSE and An Garda Síochána to progress and commence the pilot project. Representatives of the interdepartmental steering group to monitor the implementation of the high-level task force recommendations also attended this meeting. It is hoped to commence the pilot project in the fourth quarter of 2024.

Maurice Quinlivan (Limerick City, Sinn Fein)
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I thank the Minister of State. I appreciate her response, but it seems that we do not have a cast-iron guarantee about when the unit will launch. She will excuse me for having concerns about the date of quarter 4 of 2024, because we have been told different dates on numerous occasions, but we will wait.

I do understand that progress has been made. For the first time, there are definite numbers and figures. There were meetings yesterday in Limerick, as the Minister of State has said. I have been speaking with the HSE, An Garda Síochána and the National Ambulance Service about this issue for a number of years.

Four years since it was announced, it is yet to be delivered. Much of the patience and space that have been afforded to the requisite Ministers and State agencies to allow for the training and launch of this unit have really run out. Yet, we need to get this right. Will it be launched before the end of the government cycle of quarter 4 of 2024? I doubt it.

When it comes to Limerick city, which is a city with three Government Deputies, there has never been any urgency. That is also demonstrated by the fact that there is nobody from Department of Health present here tonight, although that is no disrespect to the Minister of State. The people in Moyross campaigned for a decade to have the Coonagh to Knockalisheen road constructed, but it is yet to be completed. The people of Limerick voted in 2019 to have a directly elected mayor, but it took the Government five years to finalise the legislation. Those of us from Limerick have had years of waiting for improvements in capacity at UHL but rather than tackling that issue, it was allowed to worsen and worsen with trolley numbers rising every single year. Last year, for instance, more than 21,000 people were treated on trolleys, which was the highest number ever recorded in any hospital. That was an increase from 18,000 in 2022, and this year there will unfortunately be more than that. It will probably be 24,000, going by the figures we have at the moment. Why does the Government fail to deliver for Limerick? Why do the people of Limerick always have to fight, campaign and lobby to receive what has been previously committed to? I ask myself if the Limerick Deputies from the Government parties ever question this.

There remain extraordinary pressures on mental health services, services that have suffered from years of underinvestment, particularly in Limerick. Mental health services were under pressure before the pandemic, but the mental impact of that period, as I said earlier, has overwhelmed them.

Now more than ever, we need to assist those with mental health needs. I refer to the issue of delay again. Why has this unit not been launched yet? When will it be launched? How many people will be trained to operate in it? What are the stumbling blocks? What do we need to do to get movement on it?

Emer Higgins (Dublin Mid West, Fine Gael)
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The Deputy referenced 2022 in his opening contribution and the report of the high-level task force was published in 2022. Progress is happening. Posts have been approved. Additional progress happened just yesterday. That underscores this Government's commitment to make this pilot happen. I have given him the target date of the fourth quarter of 2024.

From a HSE mid-west perspective, mental health needs across the population are addressed through community and primary care supports and services. People who require specialist mental health services are referred to one of the 13 adult community mental health teams across the regional health authority. Those who are experiencing acute mental health crisis can access support through the 24-7 mental health crisis team, which is based in the emergency department at UHL. In the mid-west, there are also out-of-hours mental health services available in Clare, north Tipperary and Limerick seven days per week.

While in many cases it is appropriate for people to be seen at an emergency department, the HSE is progressing as envisaged under our mental health policy, Sharing the Vision. The development of alternative treatments, such as a crisis resolution team, CRT, is being developed in Limerick under the national clinical programme for CRTs nationally.

The team's model of care in Limerick includes a community café that could become a key contact point when working with people in crisis. A city centre location in Limerick for the café and a partner agency to staff the café have been identified. Integration with this team will be central to CAST in the future. The CAST project is well placed also to develop an integrated diversion model incorporating the use of the adult caution scheme, diversionary interventions, non-prosecutorial practices and a support hub to facilitate appropriate, therapeutic and-or personal supports.

This partnership approach to calls relating to mental health and situational trauma between An Garda Síochána and local mental health services is to support those in distress. The CAST pilot project and the establishment of the new crisis resolution team are welcome developments for the mid-west and they are exactly part of what the Government sets out to achieve in terms of delivering for people in the mid-west, as the Deputy has said, where our Ministers are working.