Dr. Shari McDaid:

Not at all, Deputy. I will answer the questions in the order in which they were asked.

Deputy Madigan asked how addiction fits into the area of mental health. We have a structural problem in the health system in that we have separated addiction services from mental health services in a way that does not reflect the experience of individuals who have addiction difficulties. Many people who have an addiction issue also have a mental health difficultly. Sadly, many people with a mental health difficulty sometimes reach out in inappropriate ways by supporting their mental health through addiction.

One thing that we need is a much more integrated service approach to supporting individuals with both issues at play - mental health difficulties and addiction issues. In the worst case scenario we have seen people who have an addiction being turned away from mental health services and we have had some tragic situations in that regard.

The idea that has been put out is what one might call a no wrong door policy. That means that if one arrives at the door of a health service, be it a mental health service or addiction service, the service should work with a mental health service adequately to provide the holistic approach to care that a person needs. We need to address addiction and substance misuse and the whole area of the inappropriate use of alcohol in this country. I hope that the alcohol Bill, in the form proposed by the Government, will make its way through the full process. We also need to be prepared when people struggle with these issues to recognise that they might need mental health care and to make sure that the mental health care is provided to them.

In terms of mental health counsellors in schools, I am intrigued that a member made the suggestion because it was suggested to me by a young person recently when we visited the Galway child and adolescent mental health services. One of the messages we came away with very clearly from that visit is that young people do not feel that there is anyone within schools who they can turn to for support even if there is a guidance counsellor. The message that was given to me was that a guidance counsellor might talk to them about their future career but might not make it clear that he or she can support the child's mental health. We probably need some kind of identified individual in schools that students or the children themselves will have confidence in going to for help. We must also realise that we are going to need other options because it would be very easy for one person in a school to quite quickly become overloaded. Jigsaw services are important. Other innovative solutions for children and young people, like online, should be explored.

Deputies Madigan and Buckley asked about the cut in funding for family resource centres. A Vision for Change set out that the broadest area of contribution to the mental health population would be in the community and yet in some ways that is the area that has been least developed and resourced. We cannot pay lip service to community involvement in mental health care. We cannot just say we want everyone to talk about mental health in the community and be open to doing so without resourcing the initiative.

We know that people who live in disadvantaged communities are at much higher risk of developing a mental health difficulty. It would be very appropriate to provide dedicated resources in centres that have open access, where one can start building the confidence of disadvantaged communities in particular to support each other in looking after their mental health and to have better direct access to care where needed.

Deputy O'Reilly asked the important question of what does physical and mental health care look like. One of the reasons it is hard for us to conceive of that here in Ireland is that it is so unavailable that we are really just starting the conversation. About a year ago someone talked to me about how they had a particular health treatment or an occasion for surgery that was followed by rehabilitation. The person told me that no one, after that process, asked about his or her mental health needs even though it was a difficult time.

Similarly, in regard to cancer treatment and to a whole range of other conditions, having mental health raised as part of a conversation in a coherent way and making sure there is access in primary care to mental health workers who are ready and prepared to support individuals with their mental health, whatever their health issue is what we really need. It comes back to the issue of significantly boosting the capacity of our primary care mental health system, probably through something such as psychologists in primary care who are available to conduct assessments and early intervention support, but also much greater capacity in our counselling and primary care service and directing people to other options such as e-mental health once those are developed.

Deputy Buckley also raised the issue of the education system and asked about making mental health part of what every child learns as a normal skill so that every child learns to look after their mental health as they are growing up. It calls to mind the fact that mental health guidelines were published by the Department of Education and Skills for primary and post-primary education, but no resources whatsoever were attached to the publication of those guidelines. Clearly we can talk about mental health and the need for every area to be involved but we have to start to invest in the mental health of Ireland's population if we want to see the fruits of those aspirations in terms of Irish people having better mental health care.

Deputy Buckley also raised the issue of crisis care in the context of the numbers of people we have lost to suicide in Ireland. This is an area that mental health reform has been very concerned about in recent years, particularly because so many people who use mental health services and their family members have come to us expressing their frustration that when the person knew he or she needed urgent help, never mind the people who are afraid to seek help, he or she ended up having to go to an accident and emergency department, waiting for hours and hours and not getting an appropriate response to their urgent distress. We have called for direct access to a 24-7 specialist mental health services across the country in every community in Ireland. We think that is possible to implement. We think it is possible to implement at a minimum a seven-days-a-week service, provided by the mental health services with outside telephone support outside of hours that would reach much of that need and ease much of that distress for people who struggle with their mental health on an ongoing basis. We are calling for an implementation plan for that 24-7 service within three months and full implementation of the service within two years.