Michael Harty (Clare, Independent) | Oireachtas source

I thank the witnesses for attending today's meeting as we commence our deliberations on mental health services. As a general practitioner, I will address this issue from a practical point of view and focus on primary care. The great difficulty faced by general practitioners is that while we can access community health teams, many of these teams are lacking certain professions. For example, many are experiencing serious difficulty recruiting psychologists and in many other teams psychologists, community health nurses, social workers and occupational therapists are also missing.

As the document submitted by the Health Service Executive states, 90% of mental health issues are dealt with in general practice and primary care.

For the 10% of people who are referred, there is a problem in accessing services because we do not have a psychologist and not everybody needs to see a psychiatrist. In fact, few people need to see a psychiatrist. General practitioners look after many patients themselves but when they refer patients, it is quite often for psychological assessment or else they are referred to CAMHS. The patients do not need medication. They need assessment and, probably, talk therapy or occupational therapy. Those services are not available, perhaps not because there is no funding but because there is a difficulty in recruiting. Perhaps the witness will address those issues.

The Sláintecare report, which was published last May, includes a reference to mental health reform. If we are to reform our health service, that would obviously include mental health services. The difficulty with Sláintecare is trying to get legislative backing and political buy-in in order that the HSE and the Department take responsibility and there is accountability and responsibility for delivering or not delivering health services. We should continue to refer to Sláintecare when considering our mental health services because it contains a roadmap for improving such services.

There are many social determinants for health issues, and particularly mental health issues. These cut across the Departments with responsibility for housing, education, transport, health and social protection. We must examine how those Departments are helping to deliver a mental health service to our patients.

As I said initially, talk therapy is the outstanding deficiency in our community mental health services. We just cannot get to people for talk therapy. A great deal of medication is prescribed, almost definitely unnecessarily, because we cannot get access to psychological services, cognitive behaviour therapy and so forth.

Finally, there are budgetary gymnastics every year whereby the allocation of extra money to mental health services is €35 million. However, €20 million is not spent either because the HSE cannot recruit people or for other reasons. It is unclear how that money flows into the following year. Perhaps Ms O'Connor will address that matter.