Dr. Elisabetta Petitbon:

I thank the committee for inviting me here today. It is important. It is an honour and a privilege to be here. Over the last ten years of working in primary care in Ireland as a clinical psychologist and psychotherapist in private practice, there is one thing which I have consistently seen. It seems that we are not able to listen to our clients. Our clients come to us but we are not able to listen. That means that we are unable to provide an adequate service according to the needs of our population. I am saying that because I am trying to be brief. I want to get straight to the point and to the reason I am here today.

I am here today not really as a clinical psychologist but as a psychotherapist. Psychotherapy is a profession which I think is not looked upon and considered properly here in Ireland. Psychotherapists make up a fantastic workforce which is being overlooked. We have the resources. We have the people to employ as psychotherapists but it seems that we do not consider it as a good enough profession for the HSE to employ. In my experience working in primary care in Ireland, the things that I could see include a very long waiting list and that CAMHS works only on an emergency basis.

They are not able to provide treatment.

Families go away with CAMHS with a label but they have absolutely no idea what to do with that, as after there is no support. There is no social inclusion or education in the school. Primary care has a model with six sessions. In six sessions it is very rare to address the issue or the problems of families that come to us. When we speak about children, we talk about families and children in those families. We must provide a service for the children and families. Another issue is a lack of clarity. Working in primary care as a clinical psychologist, sometimes I do not know who I can refer and for what reason. There is not general clarity in Ireland for all services, such as CAMHS and primary care. It changes according to regions. That leads to much confusion for GPs, the population, social workers and everybody who works in the health service.

I am going to try to go straight to the point. There is one thing for we have the resources, which is to try to better address the needs of our population and listen to what they need. An idea could be to create a walk-in clinic, as we do not have a 24/7 service for mental health emergencies. We do not provide prevention or social inclusion like many countries have done in the past ten years. They are trying to ensure people are involved with prevention and education when it comes to mental health issues. If I am not mistaken, a couple of years ago the Health Service Executive, HSE, produced a very catchy advertisement stating that if a person had any issue, he or she should speak with somebody. We did not follow up on that. Adolescents may be in quite a difficult time in their lives and emotions may go to the roof and back down. If they want to speak with somebody, there is a very long waiting list.

I want to bring an example to the committee's attention today relating to the resources we have. It is the Luxembourg example. It is a very small country and of course it is different from Ireland. Between 2000 and 2004, Luxembourg, had a very difficult time with abuse of drugs and alcohol and the rate of suicide was 15 per 100,000 people. They injected much money into the health service, so much so that in 2016, it was ranked as the best European health service. They created many resources for mental health, including services that started to employ psychotherapists. Psychotherapy is a long-term treatment and it is cost-effective. This is not just my opinion and there is much research, especially lately, proving that if we want to stop the abuse of psychoactive drugs or self-medication, such as alcohol, abuse, one must provide psychotherapy. It is exactly what they did in Luxembourg, providing psychotherapy everywhere, so much so that in 2013, a new report indicates that the suicide rate was 7.3 per 100,000 people, or half of what it had been. That is amazing.

Why am I using the Luxembourg example? With mental health, the only action it took was to provide psychotherapy and ensure that psychiatrists and psychologists, a fantastic work force for the public, worked together and agreed a template of what services would provide. That is exactly what Ireland can do. We have the Irish Council of Psychotherapy, which is the body guaranteeing a high standard for all the five modalities included in psychotherapy. We are not looking at that. In the HSE, unless the head of department has a special interest in psychotherapy, there are only clinical psychologists on staff. Some issues can be addressed with psychologists and screening but also with a trained psychotherapist.

I want Senators to remember one point. We are not looking at other professions that could be very useful for the population. One of those is psychotherapy.