Professor Kevin Malone:

I thank members of the committee for inviting me to make a submission, as I did earlier this year. In the interest of brevity, focus and, hopefully, clarity, I sent a more brief submission, which I will present now and which I believe relates to the heads of the Bill.

I made a previous submission to the Oireachtas earlier this year. The legislation, which is based on the outcome of a 20-year-old risk assessment of suicidality, excludes 50% of the population - males. Such a focus in excluding men when dealing with legislation on suicidality further eclipses the problem of male suicide in Ireland. This morning I published a research report on suicide at the Royal College of Physicians of Ireland - I have only three copies left, but the Chairman may have the three - wherein the question of marginalisation and normalisation of suicide among young males is analysed. Members should note that suicidality is already a significant problem in Ireland, accounting for more than 12,000 emergency department presentations annually and more than 2,500 presentations to voluntary organisations. The rates for males attempting suicide are climbing all the time.

Based on the research evidence from my studies on this problem in Ireland for the past ten years - Ireland is unique and somewhat different from other countries with regard to this type of research - it is possible that this legislation could inadvertently accelerate suicide rates in younger men, where the real problem lies. Members should note that the problem of male suicide in Ireland is at least sixfold that of the theoretical problem of female suicide, which is rare.

Contrary to the notion of it saving the lives of an extremely small number of females it may be placing a greater number of young male lives at risk. In terms of legislating for the whole of society, I bring this to the committee's attention. Overall, at a macro level the effect of legislation may be a greater loss of life in Ireland than life saving. Surely, that would be a law of unintended consequences. I wonder how mental health literacy will be taught in schools, in terms of explaining that suicidality is legitimised for women in certain circumstances, in respect of which the rate for pregnant females is 2 per million, but not for young men in respect of which the rate is 350 per million, or 150-fold.

My second point is whether abortion is an evidence-based treatment for mental illness in Ireland. My understanding - again I highlight this problem not from the point of view of either side of the debate but based on my clinical research experience - is that four psychiatrists in Ireland have been looking after perinatal psychiatry in Dublin for the past 30 years, including Dr. McCarthy, Dr. Joanne Fenton, Dr. John Sheehan and my late father, Professor Sean Malone who cumulatively have been in clinical perinatal practice in Dublin for close to 30 years. My father was consultant psychiatrist for 40 years at two maternity hospitals, the Coombe Hospital and Holles Street hospital. They are all on record as saying that they have not observed one clinical case where abortion was the recommended psychiatric treatment. As a clinician, I wonder how then it can overnight become a recommended psychiatric treatment in Ireland.

My third point is more for the profession but I will bring it to the committee's attention, namely, therapeutic alliance, which is the cornerstone of our clinical practice with regard to our "relationship" - I use that word in the professional sense - with patients. If the therapeutic alliance is to be preserved for psychiatrists and their patients becoming clinically involved in a decision on abortion one way or the other - again I stress "one way or the other" - in my clinical professional point of view, that comprises the therapeutic alliance and is therefore clinically contraindicated. Any kind of fee in such a situation further compromises this position.

While my submission runs to another page I will pause at this point in the interests of clarity and brevity.