Michael Harty (Clare, Independent) | Oireachtas source

I thank Mr. Kane and Mr. Murchan for coming in this morning. I will deal with two practicalities relating to the priorities of the oversight group. One relates to the integration of primary and secondary care, and the other relates to workforce planning and recruitment.

On the integration of primary and secondary care, mental health issues are quite difficult diagnostic issues. So much comes through the door of a GP that it is difficult to sift through what needs to be dealt with outside general practice and what can be dealt with within general practice. There is a quantum leap when moving from general practice to referring on to the psychiatric services, for want of a better word. There are many holistic issues relating to mental health. Is it a disease or just an issue somebody has? We do not want to label people unnecessarily.

There are many social determinants of health, including unemployment, social deprivation, housing, education and social exclusion. Many of the issues that present as mental health issues are not illnesses or diseases and should not be over-medicated. How should we integrate primary care and secondary care? In my local community I am on first-name terms with the staff that exist. Quite often there are many members of the community psychiatric team that do not exist.

I agree with what Deputy Brassil said about over-medication which often arises because other services are not available and it is the last port of call. However, I think there is over-prescription of medication.

Mr. Kane talked about forecasting and workforce planning. What is needed in a community psychiatric service is pretty obvious, namely, social workers, counsellors, psychologists and, of course, psychiatrists. Quite often we are missing the social workers, psychiatrists and counsellors who provide talk therapy and not medication. How can we address the issue of recruitment and retention? Either it is not possible to recruit or there is a rapid turnover from burnout.

I do not think it is salary. It could be workload, job satisfaction, or support from management. Maybe Mr. Kane would address those issues of integrating and recruiting staff and ensuring there is a full complement of staff in each area.