Dr. Shari McDaid:

We have a mental health service which is psychiatry led. It is orientated in such a way that essentially all the decisions have to go through the psychiatrist. From managerial decisions in terms of planning the service and the way the service is run to all decisions on individual cases, everything must start and end with the psychiatrist. Patients are admitted and discharged by a psychiatrist. While that expertise is invaluable, there is scope for more flexibility in the service than what we are operating currently.

We do not have clinical expertise so we cannot speak on whether one clinical perspective is better than another but we can say we are aware of some other countries that do not organise the service in that way and their mental health services are functioning and they seem to offer more ways for clinicians from different backgrounds to be the first point of contact or to make decisions around an individual case at different stages and at different points of the pathway.

It seems to me in the current context that we must explore how it is possible to loosen up the roles, not in a way that diminishes the quality of the support that an individual, a child or an adult gets, but to ask whether it is possible that some individuals referred to the services, as an initial point of contact could see somebody who is not a psychiatrist and if there was proper training in terms of being able to recognise the individual who needed psychiatric input, to be able to draw on that input appropriately but not to leave it as psychiatrists being the only gateway into support.

I think there is scope for exploring that without wanting to come down firmly in terms of a particular model.