Dr. Yolande Ferguson:

I thank the Chairman. I am a consultant general adult and community psychiatrist based in the Dublin south central psychiatric service and also in Tallaght Hospital. I am a member of the faculty of the adult executive of the Irish College of Psychiatry and a member of the Joint Forum on Mental Health between the Irish College of Psychiatrists and the Irish College of General Practitioners.

I thank the committee for this opportunity and I welcome this legislation. Psychiatrists are unique among medical practitioners in that we deal with legislation as part of our everyday routine clinical practice in the form of the Mental Health Act 2001. We have extensive experience in performing assessments to ascertain whether our patients meet the legal criteria set down in that Act. We also routinely defend those decisions in mental health tribunals. We bring that expertise and experience to the enactment of this legislation.

I will restrict my statement to heads 4, 6 and 8. I believe the constitution of the assessment group in heads 4 and 8 requires revision. These heads address an infrequent circumstance. For the most part, this represents a woman or child in the early stages of pregnancy who is distressed because she is pregnant and generally does not have a mental illness. They are most likely to present to their general practitioner in the first instance. If the doctor dealing with them is sufficiently concerned, he or she will then make a referral to the appropriate local psychiatric service. Psychiatric services in Ireland, like most other countries, are arranged on a geographical basis with community mental health teams addressing the needs of the local community. There are also specialist teams who provide for the needs of children, as Dr. Peadar O'Grady mentioned, and for those with intellectual disability. The psychiatrists who are the clinical leads for these teams are expert in assessing suicidal risk, whatever the circumstance. The general practitioner has been assigned a peripheral role in this legislation, a consultative one. They should have a central role, followed by an assessment by one psychiatrist, in line with the procedures under the Mental Health Act. This means that two doctors would be involved in the assessment process, which would thus not differentiate psychiatry from other medical specialties in this legislation.

The assessment group in both heads is made up of an obstetrician and two psychiatrists. First, as was mentioned by Dr. Peadar O'Grady, there is a requirement that both psychiatrists are attached to an institution registered with the Mental Health Commission. This does not reflect psychiatric practice. Child and adolescent psychiatrists are rarely attached to such an institution. Some general adult psychiatrists who provide community-based care are also not attached to an institution because their services divide the inpatient and the outpatient roles. I suggest that this be replaced by a psychiatrist who is entered on the specialist register with the Medical Council. The head also states that one psychiatrist must be attached to an obstetric unit, and again this was raised as an issue this morning. The head and the explanatory note contradict one another in that the head states attached to "anappropriate place" and the explanatory note states attached to "the appropriate place". While clarification is required as to whether the head specifically demands that the psychiatrist must be attached to the unit in which the procedure would take place, I recommend that this requirement be removed. These are women and children who cannot contemplate reaching the point of the booking appointment for an obstetric unit that is the usual entry to perinatal psychiatry. This requirement imposes an unnecessary restriction. Their needs can be accurately assessed by an appropriate specialist, such as a general adult or child and adolescent psychiatrist.

I propose that a panel be established by the Executive, much as the Mental Health Commission forms a panel for the workings of the Mental Health Act. Ideally, the psychiatrist who is involved in their care would be on the panel to provide the psychiatric opinion. I should add that an obstetrician should not be expected to perform assessments out of their area of expertise. It is also proposed that a consensus must be reached between all three doctors. Could we envisage where an obstetrician is placed in a position where they veto the assessment of two psychiatrists on the assessment of the risk of suicide? As the head is currently written, the woman or child could have seen up to four doctors, including her general practitioner, at the end of the assessment process. If the case proceeds to an appeal, she will have been seen by a total of seven doctors. The time period for the appeal process set out in heads 6 and 8 should be shortened to a maximum of 72 hours for each stage of the appeal.

This legislation must serve to alleviate rather than add to the distress of the women and children for whose needs it seeks to address.