Dr. John O'Brien:

There was a great deal in that contribution. To start with the funding for mental health services in primary care, we do not see a great deal of evidence of it. We see a great deal of under-provision and extraordinarily long waiting lists. Primary care counselling has a waiting list of four to six months and the waiting list for primary care psychology in my area would be 18 months. It varies around the country depending, much of the time, on social deprivation.

On the affordability of general practice, I take the point that being faced with having to pay for the service is a deterrent. There is no question about that. This is a historical matter and not of our choosing. We would prefer it to be different. However, patients who have a medical card will consult twice as frequently as people without a medical card. If one has a system that is groaning in terms of its capacity to deliver by virtue of the numbers of GPs for 60% of the population, which is the amount without a medical card, and if one increases the consultation rate there by two there will be serious capacity problems. While we are in favour of this type of thing, it must be phased in. One cannot just magic it out of the air.

The Senator also raised the issue of suicide. Suicide is a major concern. Some 500 people commit suicide per annum and it is just awful. In fact, I was speaking to a GP during the week who works in a very deprived area. She told me about the case of a 20 year old whom she had attended. She had been looking for services for this person since the person was in third class.

The person never met the criteria for CAMHS or Tusla and when the family was ready to engage with family therapy, there was a waiting list for that so it never happened. All these deficiencies are within the system. We are failing people, most particularly vulnerable and poor people. The FEMPI legislation measures took their greatest toll among the section of the community that is paid for by the State, that is, the urban deprived and rural communities. It is not an accident that it is where the choke points are now. I was asked if GPs will come walking into practice if we fix FEMPI. The answer is they will not. It is much harder to fix something than to prevent it from breaking. The fixing will take some time. We would want to get on with it fairly sharpish because we are looking at a situation that is destabilising.