Professor Jim Lucey:

To respond to Deputy Barry, I will pick out the issue of the relationship with pharmaceuticals before taking on the questions from Deputies Madigan and Buckley on alcohol. The pharmaceuticals issue is something on which we welcome discussion. We also support entirely the position outlined by Dr. John Hillery and the College of Psychiatrists of Ireland. The committee may be interested to know that we introduced this policy more than ten years ago and we were the first in the nation to introduce a comprehensive policy with regard to the pharma industry that sets out very clearly the limits that need to be placed between prescribers and the industry. We did so in a policy we published and that was commended by the then inspector of mental hospitals from the Mental Health Commission, Dr. Pat Devitt. In his report in 2010, he indicated this should be the industry standard for health services as a whole and recommended that it should be adopted. We can give the committee that information.

The facts are that all human beings are influenced by a variety of inputs, including the market. We need to ensure that the highest possible standards determine how physicians and clinicians prescribe and determine care for patients. This is really the unifying theme of our presentation. It is about human beings and a holistic service that is centred around the patient, person, service user and citizen. That is where the issue about addiction comes in as we have a national problem with addiction. We cannot deny that are in many ways dominated and distracted by it all the time. Our service, historically, has been associated with a commitment to those with addictions. Many believe our service is primarily associated with that but of course addiction is not our only mental health agenda. We are leaders in the delivery of addiction services, with the understanding that addiction is part of a mental health problem. Most often a dual diagnosis, as has been described, is a better term. It is a part of a journey for many people. Very few people take their lives in this country without having alcohol involved with that process, which is so tragic. From the beginning to the end, recovery that denies the place of substance use is probably mistaking and misunderstanding the needs of people.

We have introduced dual diagnosis services and approximately 12% of inpatient services relates directly to alcohol and dual diagnosis. We have a consciousness of this right across the services. As the Chairman stated, we have over 700 staff but we have hundreds of highly qualified therapists and trained staff who are aware of the duality. We have a coherent delivery. We also recognise that the delivery of mental health services must be a population health system, community-based in the sense that it returns people to the community and to where they live, work and love. We were the first centre in Europe to introduce Alcoholics Anonymous in the 1950s and we have just celebrated the 70th anniversary of its arrival.

We have a long-standing commitment to supporting people struggling with addiction where it matters and where they are in the community. We are about delivering those services and returning people there. I hope our contribution can help the committee's vision, which should be about returning people to wellness where they are and providing them with excellent services. The question of cost is really important, and as Mr Gilligan has stated, cost can never be taken out of the issue. There are also questions about standards, commitment and vision, which need to be addressed as well. We believe in the provision of excellent services to people in the community.