Kate O'Connell (Dublin Bay South, Fine Gael) | Oireachtas source

I thank Dr. McDaid for her presentation. Regarding the integration of services for mental and physical health, would it be Dr. McDaid's considered or informed opinion that there is segregation; that acute hospital care is one service, with social care and mental health care being dealt with by a separate wing of the health services? Does she believe that the root of the problem probably comes from the old model where people with mental health issues were put into institutions? For the purpose of the work of this committee, does she believe that whole structure must be changed in order to get the services for mental health and physical health working together as she referenced in her statement?

In regard to a limit of eight sessions on the GMS medical card scheme, I am not sure of any other aspect of health care where barriers and limitations to the amount of treatment are put in place. One often sees barriers in the treatment of end-stage disease, where the treatment is expensive. Very rarely in my experience, and I have worked as a pharmacist in the NHS and as a community pharmacist in Ireland, does one see limitations being put on the prescriptions that one can get filled. Something that was not raised during the proceedings but I have seen it happen in community pharmacy, is where private health insurers put a time limit on inpatient care in a psychiatric hospital. It is one of the issues that nobody ever speaks about. A consultant psychiatrist may prescribe that one stays in hospital but once a patient has reached his or her limit, one is turfed out or somebody has to pay to allow the patient to remain in hospital. I do not know of any other aspect of health care, where that sort of discrimination is practised. Has work been done on dealing with that issue?

With the rise in the rate of acute depression in the community during the recession, there is an onus on the patient to get better themselves. If one is not a medical card patient and one presents with depression in the GP surgery, my experience is that the onus is on the patient to source a psychotherapist or a psychologist. I have heard that six months of counselling for people with a treatable depression could cost about €5,000 in professional fees. I think that is an enormous barrier to getting oneself well.

Has Dr. McDaid any views on the regulation of rogue counsellors or people offering counselling services online to vulnerable patients? It seem to be fairly widespread. In regard to Dr. McDaid's reference to e-mental health, will she elaborate on it now or send me some data on it later? Is it operating in other countries and what is the level of success with it?