Dr. Brendan O'Shea:

I thank the Chair. Senator Freeman asked about changes from the perspective of general practice and what would we do if we had a magic wand. We are looking at this as a clinical pyramid. Much of the conversation is focused at the top end of the pyramid. Extreme cases involve suicidality and the suicide of young male adolescents. These are really important aspects of it. If we want to impact the health of the community and the nation, we will target resources into the middle and the bottom part of the pyramid into the less severe spectrum and at an earlier stage in the process of complex histories. If we had a magic wand in general practice, we would have some more general practitioners in the system and a lot more practiced nurses in the system. These are the health care professionals who are the most accessible for children, adolescents and their stressed parents. These are the health care professionals who live in closest proximity to the community. We think we are very skilled in terms of generalisms and provide generalist care. We are confident, based on best international research, in particular from the United States, Canada and the Commonwealth countries, that investment in primary care and community medicine pays huge dividends in the long term. There are analogies in education. Every €1 spent on children under five years of age gives a €15 or €20 return in the long term. If that €1 is spent on children between ten and 15 years of age, we get less of a return. We need to put the resources into the communities.

A second observation in response to Senator Freeman's question is that, again, when we are looking at resources based on small area research, whether secondary care, primary care or CAMHS, we need deprivation weighting. We know that our colleagues in the HSE have an expertise in small area health research. We would recommend that this is reflected in whatever it is decided to do. We also recommend the onset of smart medicine. It is a curious society we live in. Adolescents are perfectly at home with electronic media. Health care professionals, the health services and, in particular, secondary care services are seriously uncomfortable with it. All over our society we do very clever things with smart media, social media and so on. We need electronic medical records and better interfaces with the demographic we are trying to serve. This is not now expensive. It has become far more reliable and has become accepted in more advanced health care systems than our own.

Senator Ó Céidigh asked about primary care teams and centres. The ICGP has a very well thought out position on this. We have been talking about them since 2001 when Deputy Micheál Martin launched the health strategy. Our colleagues in the HSE have a perspective on it and the ICGP has a different perspective on it. It is a fact that the composition of the primary care team has no mental health professional on it. That is incredible. The ICGP regards primary care teams with some degree of hope, but they are not functional. We have similar feelings towards primary care centres. In effect, in the whole body of general practitioners, we have not been able to effectively engage with primary care centres. We will go back to the drawing board in the interest of the well-being of this demographic. In the interest of all our patients, we will talk until the cows come home. They are not working. That is the message of the ICGP on primary care teams and centres. We reiterate some of our other recommendations that a strand of child and adolescent mental health services should be integrated into GP co-operatives. I will stop now because we are well into injury time.