Professor Kevin Malone:

I think the question about pathways to service was a good one. We are currently in Dublin 2. One would go straight to St. Vincent's University Hospital where there is a protocol under which one would be seen, assessed and triaged psychologically and psychiatrically within eight hours. If one was identified as having a treatable mental illness one would be referred on to a community psychiatric team in Baggot Street or Irishtown and one would hopefully be afforded the full complement of clinical services. I would like to think that would be the same around the country. Unfortunately, it is not, but it is really important in all this to have evidence of good clinical practice. It gives hope and leadership. It is a good question.

The question on involuntary admission and therapeutic alliances is a fantastic one. They are both fantastic questions, but that is a particularly good one because it is a real challenge to treat somebody under an involuntary certificate and working longitudinally with a therapeutic alliance. It is something we do all the time and it is part of what we do. I would point out that there is still no evidence that abortion is a treatment for a mental illness. While Dr. McCarthy's point about suicide in pregnancy being real is correct, there is still no evidence that in those cases where a suicide death has occurred in pregnancy and there was a treatable mental illness, abortion was the right treatment for that person. Again, I come back to the four clinicians from the perinatal psychiatry service over the last 20 years, and indeed all psychiatrists around the country. I have not heard one psychiatrist say he or she has found a case in which abortion was a treatment for mental illness.