Professor Jim Lucey:

I would like to add to Mr. Maher's response to Deputy Browne's question about physical ill health. The figures are striking in the mental health agenda for the nation. People with enduring mental health disorder have a life expectancy that is significantly shorter than their neighbours by more than a decade, and perhaps two decades in terms of some of the enduring mental health difficulties. This is a significant shock. What people may not realise is that the deficit in life expectancy arises from physical ill health. It is remarkable that the theme throughout all of what we said today is about removing barriers. One of the barriers that has existed for centuries is the barrier between mind and body. The Deputy asked how should we look at things, we need to look at our services in order that we cease to divide mind and body in this way in our structure. We could do that. In many ways presentation at an emergency department is probably an end event.

It is obviously an emergency but it is not where we want to be in terms of prevention, health of population and well-being. We need to address these at an earlier stage. However, we need to do it with a mindset that already integrates mental health with physical health and does so where it really matters. In the case of 70% of adults with mental health difficulties the issues emerge before the age of 25 years. One of the key things the committee needs to be aware of is the need to get in early and young and to target the part of the population where it matters, in other words, young people. Physical and mental health problems co-exist but overwhelmingly it is mental health problems that matter until the age of 50 years. That is the truth in terms of actual outcomes.

The barrier idea unifies the three areas I wish to comment on in response to the questions from Deputy O'Reilly and the Chairman. It is important for the committee to examine ways of reducing the barriers between allied professionals, the independent sector and the public sector. It is important to place the burden at standard levels. The idea is to set standards. We should relish the opportunity to meet the standards set by the Mental Health Commission. It corresponds to standard setting as set by the body politic of the State, and everyone must rise to it. This is how we unify the service. Such a change would mean the committee could do exactly what it has sought to do, that is to say, to ensure no barriers between the professionals.

Reference was made to general practice. Less than a quarter of general practitioners have postgraduate medical health training of any description. This is extraordinarily important. This is a seriously burdened group and yet they do not have the skill set. When it comes to training and education, the body of staff who work in mental health are not motivated primarily by a desire to get higher earnings - I am saying this carefully. They need decent, sustainable and respectable returns, of course. However, they are motivated by many other things that can be captured by a culture and a commitment to their development throughout their careers. They also have to overcome the tremendous challenge of burnout. Education is a factor. This is one of the reasons for the deep commitment in St Patrick's Hospital to education. One of the problems with other providers of mental health is that they do not provide training in the way we do. We have an extraordinary dedication with a dependent department in terms of research and training. This fosters the development of staff in all our disciplines, including psychologists, social workers, occupational health staff and mental health and psychiatry staff. We will end up eating our seed corn unless we train and deliver the people who can flourish and deliver the integrated services of the future. That is what people need. There is not necessarily one particular barrier to take down. We need to take down all the barriers by recognising that allied staff, so-called professionals, patients and their issues can no longer be divided by the various sectional groups.