Dr. Anthony McCarthy:

I will try to be as quick as possible. Deputy Mitchell O'Connor asked a question about people setting up in a town. The recommendation would be that anyone doing this should be on the specialist register and approved by the College of Psychiatry of Ireland and by the Medical Council to do this sort of work. The idea that all of us who are working so hard, and overworked, would be going around in caravans is wrong. As long as this is not being done by a private external service I would have no concerns about that.

On Deputy Doherty's question, children are a key issue in all of this and there are detailed issues in that regard on which the committee would need our support and advice.

With regard to legislation and guidelines on, for example, children in care, there are particular circumstances. For a 17 year old or any child under the age of 17 to have a psychiatric assessment, her parents must consent, but she can have a termination and medical treatment without consent. There are many similar issues with regard to the Mental Treatment Act that must be addressed and worked through, and we would be very happy to work with the committee on that.

On whether abortion is bad for women's mental health, Professor Casey has mentioned that a few times. This is the area in which every one of us working in this field would highlight the importance of appropriate assessment and not seeing people as statistics but as individuals. Every one of us working in the perinatal service will have seen women who had terminations of pregnancy and who will feel profoundly guilty about that during a subsequent pregnancy, and it will have a negative effect on them. We have also seen many on whom it has not had a negative effect but instead was something positive. When we ask them how it affected them they reply that it was right for them at the time. We must look at the individual in the circumstances and not generalise. Overall, it is neutral in terms of statistics but for individuals it is hugely important. It is vitally important that they are assessed properly at that time and if they are mentally ill and do not have the capacity, with treatment we help them. If not, we do not label them as mentally ill.

Professor Casey mentioned that if these people are not mentally ill, there is a question with regard to what we are doing with them. I trained as a psychiatrist but I also trained as a psychoanalytical psychotherapist; I got a master's degree in that area. I do not just treat mental illness. I treat people with psychological distress that is not necessarily illness but overlaps with it, or it is part of the picture. Those of us in psychiatry should not be just tablet prescribers. We should be providing psychotherapy, support counselling and many other services as well.

As to whether we are supposed to have an advisory or signing-off role, it is clear that our role is advisory in this regard. We will be the key advisers on the mental health issue and suicidality.