Mr. Paul Gilligan:

There is the issue of the legal requirement. A rights-based model of mental health care would have four key components, namely, availability, accessibility, acceptability and quality. The issue of payment is very much a decision that would need to be made by the Government around what services it believes should be available free to any individual at any given time. We should remember that there is no such thing as a free service. In the view of St. Patrick's mental health services, people pay for their health care through their taxes. The question is what services should be made available to people as a result of them paying those taxes.

The issue of a national service is very important. St. Patrick's mental health services believes that all the key players need to form partnerships and there must be a partnership approach. For too long we have debated the role of the private, voluntary, independent and statutory sectors. Any future health strategy must include a role for all those people. That, combined with a rights-based approach, will effectively help us shape the financial model that will fund such an approach. There are inconsistencies in the system now. Where mental health care is concerned, it is difficult to argue against people being entitled to basic, high-quality care because it has such an impact on all the rest of their lives, not just their physical well-being but that of their families, as well as employment and schooling. It would be hard for any strategy to not consider making an extensive, high-quality mental health care service available to people. The State should effectively be paying for that, regardless of how it is structured.

Mr. Maher will speak about spending and Professor Lucey will comment on the pharmaceutical aspect. I will pick up on A Vision for Change. We believe the strategy is good and robust, although there are some shortfalls. When the strategy was put together, perhaps the role of the independent sector was not envisaged. Any development of that strategy should include an active role for the voluntary and independent sectors. The key principles of A Vision for Change are nonetheless robust. There are some difficulties around the interpretation of A Vision for Change and at times it is interpreted as amounting to the closing of all inpatient care and the opening community services. A Vision for Change discusses a comprehensive care model that involves all those key components. If we delivered A Vision for Change, there is no doubt we would have the highest quality mental health service. I will come back to staffing and salaries.