Ms Jean Manahan:

I thank the committee for the opportunity to make this presentation on prevention, early intervention and talk therapy. I thank Dr. Barry for his comments as well. I will focus on the psychotherapeutic input that is possible, the fact of how little talk therapy is available and accessing talk therapy.

One issue I have seen in reports from the joint committee and which has been identified by the HSE as a major barrier to effective service delivery is the difficulty in recruiting professionals, yet there is a significant cohort of highly trained psychotherapists on the Irish Council for Psychotherapy, ICP, register who are under-utilised in the State’s response to early intervention and crisis intervention. The ICP represents more than 1,500 psychotherapists who are trained to the highest European standard. Psychotherapy is the most in-depth talk therapy available and requires intensive preparation and training. This includes an undergraduate degree followed by four years of academic and clinical preparation. In all, ICP psychotherapists complete a minimum seven year preparation, comparable to a medical doctor. In addition, the ongoing continuing professional development, CPD, and personal care requirements continue for as long as a psychotherapist practises.

I emphasise this point of intensive preparation to underline what is often missed by service planners. There is a lack of recognition of what this highly trained cohort can add in terms of additional professional capacity both in quality and quantity. A skilled psychotherapist can treat challenging conditions, including serious psychological disorders. Psychotherapy does not merely aim to ameliorate symptoms, but can bring about significant change and the resumption of psychological growth where, for example, development has been suspended as a result of trauma. However, as a profession, psychotherapy is, in the main, excluded from the health system, depriving patients of the option of in-depth talk therapy. The general public, including health administrators, assume that many mental health professionals such as psychiatrists and psychologists have specific training in psychotherapy. This is not the case. A very small number of psychiatrists may do a specific psychotherapy training and psychologists are trained in a range of techniques but they are not trained in intensive psychotherapy unless they undertake additional training. It is interesting that patients hospitalised for depression, anxiety and so forth can spend months in a psychiatric hospital without having even one session of psychotherapy. In spite of so much talk about suicide and prevention, people who present to accident and emergency departments with suicidal thoughts or suicide attempts are generally sent home with a psychiatric follow-up, but are not offered psychotherapy.

A Vision for Change recommended that community mental health teams should offer multi-disciplinaryoutreach care and a comprehensive range of medical, psychological and social therapies across the lifespan. Psychotherapy needs to be instated as a crucial part of the multi-disciplinary approach to prevention and treatment of mental illness and psychological distress. In addition to lack of recognition by service planners, another major challenge to access psychotherapy is affordability and availability. It is expensive for a client on an average income to pay for private short-term or long-term therapy as may be required. While direct service provision may be part of service configuration, as it is at present, consideration should be given to other funding models which put the client or the patient at the centre in terms of need and not ability to pay.

Psychotherapy may be practised in a variety of settings – medical, private practices, voluntary organisations, State agencies and so forth. If we are to be truly person-centred then one of the ways of making psychotherapy more accessible is to allow clients or patients in the community to choose their therapist with financial support from the HSE rather than only providing institutional services which create a funnel effect leading to logjams and long waiting lists. This funding model of money following the client or patient directly, bypassing overburdened organisations, is practised successfully in other countries and it is something the former Minister for Health, Senator Reilly, considered in respect of hospital care. It could work in the community setting.

It has been a major concern for ICP that the title "psychotherapist" has been and still can be used by anyone, regardless of length, depth or breadth of training or, indeed, without any training at all. The need for quality training, stringent ethical guidelines and a robust complaints mechanism is clear. For this reason the ICP has long advocated for statutory regulation to safeguard the public. We have sent the committee our submission on statutory regulation, and we are pleased that the Minister for Health, Deputy Harris, has designated two separate titles of "psychotherapist" and "counsellor" to be safeguarded and regulated by CORU, the Health and Social Care Professionals Council. This is in process as we speak.

Finally, ICP is ready to contribute ideas and suggestions as to how we can work collaboratively to improve service delivery and to make talk therapy more accessible. Such collaboration would take into account the additional significant resource which psychotherapy offers, other funding models which would facilitate a more responsive referral system and inter-disciplinary co-operation which uses all the resources available in a coherent manner. I look forward to the members' questions.