Dr. John Hillery:

I thank all members of the Seanad committee for shining a light on a neglected area in the health service. I am the president of the College of Psychiatrists of Ireland, the body statutorily responsible for training all psychiatrists in Ireland and ensuring the ongoing training and professional development of fully trained psychiatrists up to retirement and beyond if they are working in some way after they practise.

As doctors, all psychiatrists have undergone six years of medical training. After this, they do at least four years of basic specialist training followed by four years of higher specialist training. They may do several more years of training before they are entitled to apply for specialist recognition and, subsequently, for consultant posts. They are, therefore, a group of highly trained individuals.

As previous speakers noted, psychiatrists are not applying for jobs in the Irish health service. The first question we must ask is what employer running a business would have vacant posts which highly trained persons, whom the employer will have often trained, do not want to take up. We must also ask whether the employer is asking why this is happening and I am not sure employers are asking those questions. I am aware, however, that representatives of the Health Service Executive will appear later.

The College of Psychiatrists of Ireland places a few regular messages in the public domain with varying degrees of resonance. The first is the total lack of funding for mental health services in general. Ireland falls far behind the countries to which Dr. Doody referred in this regard. Approximately 6% of the national health budget goes to mental health services in general, compared with figures of between 10% and 14% in some of the countries mentioned by Dr. Doody. The college has long called for the national budget given to mental health services to be increased progressively to 12%. My colleague from the Irish College of General Practitioners asked about the 5% figure. As I said to Dr. Doody, I am sure he would love to have 5% of the national health budget. Unfortunately, he probably has less than 5% of the 6% of the national health budget that is allocated to mental health. This is, as we keep saying, a scandal and I hope that message will go out from today's meeting. Child mental health services need much more funding, as do mental health services in general.

Recruitment and retention has been a major issue since I have been involved with the College of Psychiatrists of Ireland. The college has a manpower document, which lays out the needs for mental health services as regards consultant employment in 2020. The issue, however, is not only one of having somebody in post. I am the only person available in my current job, which means that if I want to take time off, there is a risk that the service will have to be closed down, which is not really possible, or we have to trawl around looking for someone to cover for me for a few days. That is not an uncommon scenario. Those of us in attendance who are in clinical practice are also stretching our time and our colleagues' patience because there would not be enough people in the system, even if every post were filled.

The College of Psychiatrists has stated there should be 180 child and adolescent psychiatrists in post by 2020 to allow people to do their clinical work, take the leave they are allowed, attend forums such as this to inform people as to what needs to be done, take part in personal professional development and train other psychiatrists. At the moment, we probably have between 80 and 90 posts and, as members will have heard, many of these are unfilled. One of the reasons is that people who train in the system see what happens to people like me who are losing our hair and getting wrinkles and decide there is a better world than this, one where they can practise as a psychiatrist in a team with other health professionals. They see their boss working alone without access to psychology and occupational therapy services and unable to take leave days when needed. They know there is a better environment elsewhere because they will have heard from friends in Australia and Canada about the systems there. This does not seem to be recognised. I was told recently, for example, that the HSE considers the time a consultant should have for non-clinical work, by which is meant activities such as supervising a junior doctor, is two hours per week. I have three junior doctors and I am meant to give them one hour of one-to-one supervision per week in addition to my supervision at clinics. I am already well ahead of what the HSE considers allowable and my attendance at this meeting is pushing me into unknown territory. We need people to act on the advice of the experts and we need to have more specialists in place.

There are simple issues around retention, some of which members will have heard. One of the basic issues I have raised recently is that I have junior doctors who are not paid at times because they have not been registered by their employer to pay them. Simple things are occurring in the public sector that no employer in the private sector would tolerate.

We heard also about waiting lists. The college has pointed out regularly that there are children with very serious mental health issues on waiting lists with children who need educational assessments, assessments for anxiety and, as my colleague from general practice stated, assessments for the autistic spectrum. These children do not need to be on waiting lists for psychiatry; they need primary care assessments. Those who need secondary or tertiary care should then be allowed through the system to get this care.

I will conclude and ask Dr. Doyle, a former chairperson of our faculty of child an adolescent psychiatry, to continue. As a practising psychiatrist in a rural area, Dr. Doyle will be able to give many examples of what is taking place. She is also our college representative on the European Society of Child and Adolescent Psychiatry.