Professor Patricia Casey:

On the role of psychiatrists vis-à-vis the proposed legislation, psychiatrists are people who treat mental illness. If somebody is depressed, anxious, has schizophrenia or whatever we offer them treatments. We have already heard from Professor O'Keane at the outset that not everybody who is suicidal has a mental illness. They are suicidal simply because they do not want to be pregnant. At least, that was my understanding of what Professor O'Keane said. If I understand her correctly, I wonder about the role psychiatrists have if somebody does not have a mental illness. If somebody is not mentally ill, what are we doing? That is a very important issue. Are psychiatrists being used in this debate simply to get the Government off the hook and to find an easy way out for some of these cases? I do not know, but it is something on which the members need to reflect.

Deputy Fitzpatrick asked if abortion increases the risk of mental illness. There is debate about that within psychiatry. A big study from the Royal College of Psychiatrists - a systematic review - showed there was no increase generally and that whether a woman had an abortion or gave birth to an unwanted child the outcome was the same, but for a sub-group of women - those with prior mental health problems, those who were being coerced and adolescents - there was an increased risk. A psychiatrist by the name of Ferguson who is a pro-choice person has done a lot of research on this and he believes that abortion increases overall the risk of mental illness post-abortion by about 30%. There is disagreement on it but everybody agrees that certain groups are vulnerable to an increased risk of mental illness after abortion, particularly people with prior mental illness.

On the question of whether abortion increases suicide, there is an association between higher suicide rates and having had an abortion from a series of studies in Finland to which one can refer. On the question of whether motherhood reduces the risk of suicide, there is a body of evidence showing that parenthood and motherhood is protective against suicide.

Deputy Doherty asked about the X case and said that we had lost sight of that person. I would agree. Unfortunately, when Miss X presented she did not have a psychiatrist. She was not receiving any treatment and in the judgment the judges mentioned that no treatment suggestions were offered. If she had had input at a psychological level who knows how she might have felt?

We do know about Ms C, who was another young woman in very similar circumstances. She was the same age, had been raped and was taken to England for an abortion because she was acutely suicidal. She came back here and went public. She said that she was not fully informed about what was happening but, more significantly, she was suicidal and was in hospital for a considerable period.

On the floodgates phenomenon and criticism in this regard, I do not believe psychiatrists will be responsible for the floodgates opening because psychiatrists are people of integrity who will act within the law and in good faith, but there will be many people coming forward for these assessments. Our colleague Dr. Siobhán Barry commented on that recently. She believes there will be huge pressure on services and that assessments will not be able to happen quickly enough. There will be an attempt to dismantle the current restrictions and extend them.