Dr. John O'Brien:

I thank Senator Gabrielle McFadden for her contribution. There must be an awful lot of throat infections because it is all people seem to think I do. I wish it was the case, but it is a little more complicated than that.

We teach our registrars and trainees that general practice is holistic, encompassing the biological, psychological, social and existential problems people bring with them and they are multiple. They include loneliness, grief and financial problems, among many others that will not be found in a medical textbook. We have a continuous relationship with patients over many years. It is an iterative engagement that builds relationships and forms emotional capital which can be drawn down at the times people are in trouble. Psychology, counselling and psychotherapy are extremely important resources for us to have at our disposal, but it is not always the case that people are ready to attend those services at a given time. Very often there will be a "Will I? Won't I?" dilemma because it is painful for them as they are exposing themselves in attending a professional. We should not fragment general practice. One of its great strengths is as a central, holistic place into which everything feeds. Any problem can be heard or dealt with, although perhaps not concluded. Other agencies can also feed into it. If services are to be added to general practice in the form of psychologists and counsellors, they will be important.

A meta-analysis was conducted in the United Kingdom which demonstrated that psychological intervention soon after a self-harm episode reduced the risk of reharming by between 30% and 40%. We deal with and contain problems while the waiting lists are being worked through. That is not good as it leads to a deterioration in problems and a greater requirement for more expensive services that might be available in the secondary care system. If the problem can be tackled in the place of least complexity and the guns are brought to the front line, one is likely to have a greater impact. As a country, we spend the same as the OECD average, but we do not spend or divide it up well. Earlier people were harping on about the FEMPI legislation. If the State persists in investing 3.5% to 4% of national income in general practice, I am afraid we will end up with the same results. If someone has pyrite in his or her house, the basement should be fixed, not the attic. We are in the basement.