Dr. John Sheehan:

To reply to Deputy Kelleher's point about the extensive mental health problems of women travelling and whether some of those women present for help, it would clearly be a very good thing if that happened. One difficulty we have is that we may have a reasonable idea of the numbers of women who travel for terminations but we have no data on the extent of mental health problems in that group. We have no data on how many of those women are suicidal, so when people make comments about this group, they are entirely speculative because we have no data. Would anything that encourages women who travel for terminations to come for help be a good thing? Of course it would. One only has to look at people such as Bressie on the television last weekend or Alan Quinlan, the Lions and Ireland rugby player, talking about mental health issues and reducing stigma. Anything we can do to help people come forward and seek appropriate help is clearly a very good thing. If that happened, I would be delighted to see it.

Deputy Ó Caoláin raised the difficult question of the numbers - whether there should be two psychiatrists and an obstetrician, and the number of specialists that is required. The core of this question is whether anybody has the capacity to identify that one woman in 250,000 who will go on to commit suicide. Whether it is one, two or three doctors, the number does not improve one's ability to identify that woman in 250,000 to 500,000 because it is impossible to predict with any accuracy when one is looking at statistics as significant as that. The number issue is a difficult one because one is in an area of trying to predict something that is extremely rare.

It must also be said that when we look at the information from the confidential inquiries and the forensic examination of the case histories of women who died by suicide in pregnancy, we see that the very small number of women who die are women with major mental illness such as schizophrenia or bipolar disorder or with alcohol dependence or serious drug problems. This is the group we are dealing with. When one looks at psychiatric involvement, often the psychiatrist is looking at specific risk factors. As Dr. McCarthy mentioned earlier, when we see people with a mental disorder who are deemed to be an immediate risk to themselves or others, the current psychiatric practice is to detain that person is hospital. That, of course, is completely at variance with what is proposed in the heads because they propose that someone who is deemed to have suicidal intent is able to make a decision about having a termination of pregnancy. It is completely at odds with what one would call standard good practice in psychiatry.

Deputy McGrath's point tied in with the question of probability which I covered. In the case of probability, doctors assess risk all the time; I do it every day at work. We assess risk in order to reduce risk, to care for the person and to intervene - including even in certain situations as I mentioned - detaining the person in hospital. That is different from what we are being asked to do and what psychiatrists are being asked to do in this Bill. It is also complicated by the fact that with regard to evidence-based practice there is no evidence base to show that termination of pregnancy prevents suicide. There is no data available.

The question comes up too about whether to shorten or lengthen the duration of the assessments. I do not think that the time is the central factor of importance. The woman's mental state is the central factor. As I mentioned at the start of my submission, a person may be extremely distressed, agitated, perhaps feeling abandoned and hopeless. We see people almost every week in the emergency department who may have been bullied at work or there is a crisis at work; they have self-harmed and they come to the emergency department. They then say, "I am resigning". We say to them: "Don't make any decision now. Wait." Such people need time out and support. They need to consider carefully all their options and then, with the level of distress reduced, they can decide whether to resign or whatever. There seems to be this notion that because a person is expressing suicidal intent that the response has to be a rapid termination of pregnancy. That flies in the face of what we do at work every day of the week. It is exactly the opposite of what is regarded as good practice.