Mr. Michael Walsh:

Nationally, we have a standard operating procedure, SOPs, manual which guides us in what we see, where we go and what we do. As part of that, every child in the country is supposed to be seen up to his or her 18th birthday. From that point, it is recommended that they are referred on and there should be a six month lead in to being referred on to adult psychiatry. That does not happen because many adult psychiatrists will not accept referrals from CAMHS.

On Carlow-Kilkenny and someone struggling emotionally, unless that child has a working diagnosis of a mental condition they cannot be contained in any particular psychiatric unit. To my knowledge there is no psychiatric unit in Carlow Kilkenny that looks after children. The only one is Cork.

As I said in my submission, sometimes a child who has received a diagnosis and is acting out and is difficult to maintain can be sent to the department of psychiatry which is an adult facility. That is fundamentally wrong.

The question of referral by a GP and what meets a threshold is one that arises every day of the week.

We have a problem insofar as we do not have a primary care psychology service. There is a two year waiting list, and in some cases it is a four year waiting list across the country. The psychology service has been under-resourced for years. They do not have the psychologists. I know there is talk of perhaps 200 assistant psychologists coming on line, but that is a long line. We will be a long time waiting. We have heard of buildings and staff coming, but that will not happen. When there are no primary care psychology services, we end up as the gatekeepers, taking all the referrals from GPs. The GPs are very frustrated, they do 90% of all the referrals for every condition across the country, working on 4% of the budget. It is difficult.

What meets criteria? We are the end of the line as regards mental health. We are looking at early onset schizophrenia, depression, anorexia nervosa and severe anxiety. We are not talking about what some people would refer to as "soft psychiatry" where somebody needs to discuss things and would benefit from counselling. If a child had a substance misuse, they would go to somebody dealing with substance abuse. In doing a referral, the GP would have to do a mental state assessment and see how big a risk the child was. If that is the risk, one makes a phone call and there is a discussion on it.