Dr. Shari McDaid:

I will respond to Deputy O'Connell's question on whether the problem in the lack of integration arises from the separation between acute hospitals and social care in our health structures.

In my view, that is not where the difficulty has arisen. Let us look back at the primary care strategy published in 2001. Unfortunately, it had described a rather limited role for mental health. Mental health is hardly mentioned in that strategy. Mental health workers were not described in that strategy as core to the primary care team. In the 20 years since then, whatever investment has gone into primary care has gone into the core primary care team roles. Mental health workers have literally slipped off the radar and off the agenda. Primary care is where most of us get our health care. If mental health care is not integrated in terms of designated mental health workers, the whole health system is neglecting that part of an individual's health at a structural level.

Reference was made to the counselling in primary care service being limited to eight sessions. It was rather insightful to suggest that there is no other part of the health service where we ration in this way or where we say a patient can only have eight sessions. In fairness to the counselling primary care service, I understand that there is some flexibility on a case-by-case basis. However, relying on a case-by-case basis can be somewhat risky. This is because if the message is put out from the start that an individual who takes up the service will only be assured of eight sessions, the patient may believe, even from the start, that the service will be unable to answer their needs and the person may not go near it.

That point was related to the question of the limitations of and what happens when private health insurance runs out for someone who is an inpatient. I do not have enough detail to say exactly what happens to a person in that situation. Theoretically, if a person still needed inpatient care, he or she could be transferred to an inpatient bed. It should be the case that if a person needs inpatient care, as with any other health condition for which a person needs such care, the person will get as much as is required. Having said that, we want to get to a point where far fewer people end up in inpatient care. If we had more developed community-based mental health services and a good relationship between primary care and specialist mental health services, we would expect that fewer people would end up needing to take up inpatient beds.

A comment was made about the prevalence of people who have depression going to a general practitioner and being given a prescription and then encouraged to go to private counselling services. That is simply not an adequate response. The fact that such a response is even considered adequate reflects the historical Cinderella position of mental health care and the way it has not been taken seriously. Certainly, that approach should play no part in the future vision of health care. We should see something different. Any health professional should have access to mental health supports for people and they should be publicly provided. We should ensure that financial cost is no barrier to someone receiving mental health care, especially when we consider the cost of having a mental health difficulty in the workplace, absenteeism, presenteeism as well as the numbers of people on disability benefit and invalidity benefits because of a mental health condition. Economically, it makes no sense to make it expensive for someone at the start of mental health treatment, especially when this barrier will lead to long-term higher costs.

A question was asked about the regulation of counsellors. There is an urgent need for regulating the counselling and psychotherapy professions in the country because it is difficult to boost capacity in an unregulated system. We would very much appreciate it if this were made a priority.

Reference was made to e-mental health. One of the leading countries in this area is Europe is Netherlands. We are in partnership with five other countries in a north western Europe e-mental health project. One of the partner countries is Netherlands. We would be glad to supply the committee with further information on developments on the project.

I thank Deputy Browne for his question on how other Departments needs to play a role. I will offer another example of what is needed. Currently, we are piloting the best practice approach to supportive employment to help people with mental health difficulties to get back to work. There are some key barriers to people getting back to work when they have a mental health difficulty. Let us suppose a person is not allowed to drive because of the medication he or she is receiving. Moreover, let us suppose he or she is living in a rural community and there is no transport option for that person. He or she will be literally trapped at home and unable to take up employment opportunities. That is a good example of how decisions about initiatives to provide transport in rural communities need to have a mental-health-in-all-policies approach. Such decisions need to have a mental health lens in which the mental health impact is considered, whether positive or negative, of an initiative to provide rural transport. Such an initiative is needed to help people of working age to get to places of work. It is not only a question of helping those outside the workforce to get to social activities. This is a very good reason that we need a mental-health-in-all-policies approach to be considered by every Department.

I was asked about common assessment tools. The question raised related to a child not being assessed for 18 months and remaining on a waiting list for 18 months to be assessed by the child and adolescent mental health services, only for the child to be deemed ineligible for support. I am sorry for being repetitive, but again this speaks to the point that if we had adequate assistance in primary care, that scenario might not have arisen. If we had skilled mental health workers like psychologists in primary care, they could provide the necessary assessment quickly. In that way, they should be in a position to say quickly whether the child needed to be referred to the child and adolescent mental health services. That would be far preferable to a child sitting on a list, a child whose whole life might be changed by that period of 18 months without getting the mental health addressed. I hope that helps to answer that question.