Dr. Anne Jeffers:

I am Dr. Anne Jeffers. I am the director of external affairs and policy at the College of Psychiatrists of Ireland. I am also a general adult psychiatrist. I work with adults between the ages of 18 and 65 and I work in a community based service in east Galway. In an adequately resourced mental health service, general adult psychiatrists work with a multidisciplinary team made up of nurses, social workers, psychologists and occupational therapists. We receive referrals from general practitioners or the emergency departments of general hospitals. I will describe the issues as I see them in this legislation as they are likely to be seen by a general adult psychiatrist.

When a woman finds that she has a crisis pregnancy and feels suicidal, she may follow a number of choices. She may decide to have a termination and may travel outside the State to have that. She may visit her GP who will complete a full assessment, including an assessment of her mental state and the risk of suicide. The GP will offer her counselling and may advise that she seek the advice of a crisis pregnancy counselling service. If he or she has concerns that the woman is at risk of suicide and requires a specialist psychiatric assessment, he or she will refer her to a general adult psychiatrist. The woman may alternatively present directly to an accident and emergency department, especially if she has attempted suicide or has self-harmed. In this case, she will be assessed by a liaison psychiatrist where one exists or be referred to the general adult psychiatrist in the area. Only in Dublin will there be the option of a referral to a perinatal psychiatrist.

A psychiatric assessment involves a private one-to-one consultation where the woman has an opportunity to describe her distress. The psychiatrist identifies the issues contributing to the suicidal risk. These issues include any symptoms of mental illness and the psychosocial stresses affecting the woman. Each woman's presentation and circumstance is unique and the psychiatrist will provide a comprehensive and non-judgmental assessment. A psychiatric assessment is therapeutic in itself where a woman is given an opportunity to discuss her concerns and stress in a confidential setting and a safe and supportive environment. For many women, the outcome of this assessment will reduce her fears and she may decide to continue with the pregnancy. Where the woman and the assessing psychiatrist and team believe the termination of the pregnancy is the only way to avert self-destruction, a second opinion would be requested. Ideally, a psychiatric social worker or other key team member would also be involved in this assessment and in the provision of ongoing support for the woman. It is important to be aware that not all teams have social workers. It is anticipated that in all except rare cases, the psychiatrist will recommend interventions other than termination of the pregnancy. The legislation is extremely restrictive and it will not apply to the majority of women. In these cases, the psychiatrist will ensure the woman has access to non-directive counselling around the options, and these options include adoption, parenting or information about travelling outside the State for termination.

As psychiatrists, we are used to working within a legal framework in using the Mental Health Acts. We are used to the importance of wording within the law. Head 4 of this legislation clearly states that it would not be an offence to terminate the pregnancy only if the psychiatrists jointly certify in good faith that there is a real and substantial risk of loss of the pregnant woman's life by way of self-destruction and, in their reasonable opinion, that this risk can be averted only by that medical procedure. Reasonable opinion is defined to mean an opinion formed in good faith which has regard to the need to preserve unborn life where practicable. The emphasis is on the risk only being averted by termination and the regard to the need to preserve unborn life. This wording will restrict the use of this legislation to extremely rare cases.