Dr. Shari McDaid:

I started to answer the question on how we know we need an increase. Even if we do not necessarily have enough detail about particular community mental health team support, and how much it costs, we do know the kind of supports people want when they are in severe distress. We know they want holistic support and want the option of psychological therapy, occupational therapies or social work support, such as with housing and other things. We know that there are not enough people in those roles to provide those things for everyone who is currently being seen in the specialist mental health services.

Often we hear anecdotally - we do not have the statistics because we do not have the information system - that a person's team referred him or her to a psychologist but the team said it would take six months or a year, and he or she has been waiting for that length of time. We would hear people talk about gaps in their occupational therapy support because their occupational therapist, OT, may depart or may go on maternity leave. The view was take at a certain point that we only need one of each of these professionals, for instance, there is one OT per team and one psychologist per team. That is not what A Vision for Change says but there was a strategic view taken early on in the implementation of A Vision for Change that it was better to have one in each team than to have a bunch in one team and not in another. That is a fair enough growth strategy but we never got to the multiples of these other disciplines that were supposed to be in the mental health teams. That means, simply speaking, that the 30,000 individuals each year who are referred in to the specialist mental health services are not getting the holistic support they should get. We would benefit from an in-depth evaluation of what happens in community mental health teams when someone is referred to them, what kinds of supports the person is offered, how well do those work, does the person recover and where does he or she end up in life. We do not have such evaluation and it would be useful to get that done. That does not necessarily mean that we should not ensure that those professionals are in place. That is just the mental health services, and then what I have been talking about is in primary care.

The WRC report is telling us that we are so low in our investment in giving people access to counselling and psychotherapy that there is a vast unmet need. We can confidently say that if we made that investment in greater access to counselling and psychotherapy for people with common conditions such as anxiety and depression, it would reap rewards. It would be a good investment and good value for money. That is the basis upon which I would say it is worthwhile making the investments.

Similarly, as we have argued on out-of-hours access to services, we have good evidence that where one provides out-of-hours access the referrals to accident and emergency departments drop. It is expensive to have people going into accident and emergency, and then some of them will be referred into hospital. We have good evidence that if one has good out-of-hours access to community-based mental health supports, one will have fewer people both referred to accident and emergency and in need of hospitalisation and it is value for money to make those kinds of investments. Those are the kinds of recommendations that we have made through the years. It is not pie-in-the-sky stuff. It is stuff that we know works.

The €35 million-----