The issue of access to mental health services, specifically the total lack of access to residential psychiatric beds in Tipperary, is creating an appalling crisis in our county. Almost all of those who suffer psychological distress are forced to use the services of the 44-bed unit at St. Luke's General Hospital in Kilkenny. I remind the Taoiseach that on 21 December 2018, the Mental Health Commission issued summonses against the HSE as the registered proprietor of the department of psychiatry at St. Luke's hospital. On 19 February, Kilkenny District Court found against the HSE on a number of charges relating to breaches of the Mental Health Act 2001. St. Luke's General Hospital pleaded guilty to four charges, including poor maintenance of seclusion facilities and failure to comply with the rules governing the signing of the seclusion register by consultant psychiatrists responsible as required by law. The Mental Health Commission inspectors reported - and I apologise for this - that they were almost physically sick from the smell of a discarded colostomy bag that had been left in a clinical waste bin inside the room where electric shock treatment is administered. It is appalling. This is deeply offensive to the dignity of all patients, from wherever they come. Was anyone held accountable? Of course not. Judge Brian O'Shea fined the HSE a paltry €5,200. What signal does this send out to the families of the service users? More important, what does it do to meet the overwhelming need for residential psychiatric beds in County Tipperary? Each year since the closure of St. Michael's unit in Clonmel, the situation has continued to deteriorate rapidly. I accept the bona fides of the Minister of State, Deputy Jim Daly, and sincerely accept what he is trying to do but something is blocking the return of psychiatric beds to County Tipperary and it needs to be addressed urgently. It is way beyond time.

If this is the crisis in the provision of adult mental health services, the crisis in child and adolescent mental health services, CAMHS, is even more alarming. There is not a single senior registrar for community healthcare organisation, CHO, area 3 covering north Tipperary or CHO area 5 covering south Tipperary. There is not one full-time CAMHS speech and language therapist or CAMHS social worker assigned to south Tipperary. It is appalling. When we put all of this together it is clear we are beyond breaking point in Tipperary. The HSE indicates the south east community healthcare area has the second lowest rate of acute psychiatric bed provision. If this area were to be provided with the national average rate of bed provision, an additional 18 acute psychiatric care beds would be required.

I acknowledge the announcement by the National Centre for Youth Mental Health, Jigsaw, that it plans to add to its growing network, with new services in Tipperary earmarked for 2019 or early 2020. We are waiting for these. In the meantime, however, the provision of additional professional psychiatric services in the county is at an all-time low. What steps are the Taoiseach and the Government taking to address this very urgent matter?

I thank Deputy Mattie McGrath for raising this important issue. I am afraid I do not have an up-to-date note in front of me on the particular issues he has raised with regard to Tipperary but I read the coverage at the time of the events he mentioned and I share his revulsion at the fact that basic things such as patient care and hygiene were not attended to properly in that unit, which is relatively new. There is no excuse for treating patients poorly or poor hygiene. These things do not require massive resources; they just require people to do their jobs properly. I am sure the HSE will respond to the Mental Health Commission's report and make sure remedial action is taken and changes made.

The focus in mental health over the past ten or 15 years has been the right one. It is moving away from inpatient services to outpatient and community services and moving away from the traditional model of mental hospitals and psychiatric institutions to care in the community. This is much more appropriate and is the right way to go. The Deputy knows that in Tipperary, for example, a new Jigsaw service is being established to improve the services available in the community to people with mental health issues. There is also increased capacity in primary care, with 114 new assistant psychologists and 20 psychologists recruited by the HSE primary care unit. Most of them are now in place. There is an increased supply of psychiatric nurses, with funding for an additional 130 undergraduates per year. Ten advanced nurse practitioners in CAMHS are in training. The Minister of State, Deputy Jim Daly, has developed a mental health telephone line, which helps to signpost people to the support they need, particularly out of hours. The Deputy is aware the budget for mental health this year will approach €1 billion, the biggest budget for mental health ever, with €55 million set aside for improvements in services alone. While there has been much focus on the national children's hospital, and I know the Deputy is particularly interested in it, we should not lose sight of the fact that three new hospitals are now under construction, one of these being the national forensic mental health campus in Portrane, which will replace the very outdated Victorian facilities in Dundrum.

I do not believe the people of Tipperary and their families will take much solace from the Taoiseach's answer. More than ten months ago, on 11 May 2018, the Taoiseach's colleague, the Minister of State, Deputy Jim Daly, wrote to the chief officer of CHO area 5 outlining the need to restore some acute bed provision for adults in Tipperary following the closure of St. Michael's unit. We cannot manage without these beds. The Taoiseach said A Vision for Change is working but it is not and it is three years past its report date of ten years. It has been a disaster for Tipperary. It is a black hole instead of a vision. The Taoiseach can mention the children's hospital all he likes but we will see where it ends up. People do not have the services. They cannot get access to Kilkenny. It is not that they are not wanted there but there is not enough room there to deal with the Kilkenny and Carlow situation, not to mention the appalling vista I mentioned. There are clearly no services in south Tipperary and very few in north Tipperary. To be sent to Kilkenny or Ennis from north Tipperary is an appalling vista. The Taoiseach cannot allow it to go on. Long-stay beds will have to be reinstated in St. Michael's unit or somewhere else.

We do not want every building, such as St. Luke's and St. Michael's former psychiatric unit in Clonmel, to be used for offices and storage. We want facilities that people can attend. Nurses and clinical advisers working in this area are burnt out. Psychologists are now trying to deal with this issue. Unfortunately, many patients are ending up in their graves. It is a terrible indictment of the Government and of A Vision for Change and anything to do with it.

On the case and facility referred to by the Deputy, I am advised that the HSE has accepted the report of the Mental Health Commission and put a plan in place to deal with it and funding has been allocated to implement it.

Is responsibility being taken?

Once again, I must emphasise that patient dignity and basic hygiene do not require much resources and that there should be no excuse for treating patients------

Accountability.

-----with a lack of dignity or for basic hygiene standards not being followed. I cannot comment on the specific request made by the Deputy for additional inpatient beds in Tipperary.

How many additional beds?

As I previously stated, the model of care towards which we are moving in mental health is away from mental hospitals and psychiatric institutions and towards community care. By and large, that has been the right policy direction.

A certain number of beds are always required.

The Minister of State with responsibly for mental health, Deputy Jim Daly, has committed to meet Tipperary Deputies in the coming weeks to discuss this matter. I am sure the Deputy will use that as an opportunity to put across his suggestions.