Mr. Paul Gilligan:

The structure and nature of St. Patrick's Mental Health Services is quite tricky. We are eager to ensure people do not have any misunderstanding about the nature of our organisation. We are a not-for-profit organisation, so there are no shareholders and nobody is taking money out of the organisation. In that sense, one could describe us as a voluntary institution per se. There is a group of organisations that provide health care where money is paid to investors. All of the money we generate is reinvested into the organisation and those who serve on the board do so voluntarily. To describe St. Patrick's Mental Health Services as voluntary raises difficulties because 90% of the people who use our services have health insurance. That is something we have tried to address in the past ten years. We want our services to be available to everybody. It is quite simply that if the HSE does service level agreements with us, we are then in a position to provide care to people through the HSE system. Without that we cannot provide care. We have a small philanthropic fund whereby we try to ensure people who could not otherwise access help can access it.

In the past eight years, we have developed our community clinics, our dean clinics, and as part of our philanthropic purpose we have introduced the concept of free assessment. The difficulty is that it needs to be linked to a care pathway and it can be perceived as cynical. We have done it as a genuine gesture. This initiative has been protected by our board in order that people can get a free assessment in our dean clinics, but we need to generate a care pathway from that because otherwise we are providing something that is irrelevant. This is something we grapple with all the time. We want our services to be available to more people and we want to provide our services to everybody.

In response to some of the other questions that have been raised, the key issue is staffing. We strongly believe that salary is an issue. There is a problem with the salary levels in the health services. Nobody can dispute that. At our salary levels, we have to try to compete with the jobs on offer in Australia, the UK and so on. Job satisfaction and support are equally important. We find ourselves going into a downward spiral. When there the required number of staff is not on a particular team, the staff on the team lose heart as they feel they are carrying responsibility at weekends and on evenings when there is no backup. That causes burnout. It is not just about salaries.

There are also difficulties around the number of staff available. We are not training sufficient numbers. As part of the cutback measures, we reduced the number of training places and this is having a significant impact on professionals such as nurses and doctors. In St. Patrick's Mental Health Services, our approach is to have a multidisciplinary team service. One of our core aims is to meet the Mental Health Commission's regulations and standards and we therefore employ multidisciplinary teams. The team comprises consultant psychiatrists, psychologists, social workers, occupational therapists, dietitians in some cases, depending on the service we are talking about, and numerous different types of counsellors, addiction counsellors and cognitive behavioural therapists. We pride ourselves on ensuring we take a multidisciplinary team approach because that is best practice.