Kate O'Connell (Dublin Bay South, Fine Gael) | Oireachtas source

I thought that was the first matter for discussion. My target is to conclude by 12.30 p.m.

I hope I will not go over ground that has been covered. Reading the opening statement last night, governance and accountability in the health service stood out. I sit on the Joint Committee on Health and the Committee of Public Accounts which have discussed CervicalCheck and the national children's hospital project. Key to fixing all this a change in governance structure, which is a magic wand that is waved at us when something goes wrong. Overspends in hospitals are one issue but if the witnesses have a serious concern about governance and accountability in mental health services, the net effect of poor governance are the catastrophic instances of people dying prematurely. Will the witnesses outline their experience of how bad governance or weakness in governance can have catastrophic impacts on patient outcomes?

On the devolution of powers to regional bodies, Deputy Durkan, the Chairman, Deputy Harty, and I sat on the Sláintecare committee at which we discussed community health organisations and having proper boundaries among the hospital groups.

Are the witnesses saying to us that we need a national director of mental health steering this from the top and then filtering down that direction to the organisations? Coming out of this committee, we want to make it clear what the witnesses want because if bad outcomes have catastrophic impacts on families and on people's lives then we have to act because it is not an accident. This is an emergency as far as I am concerned.

For the doctors and the medics present, when there are gaps in funding or staffing, how does it affect their approach to treatment and their approach as professionals? I cannot outline every permutation of a situation but are consultant psychiatrists and teams ending up in situations where, for example, they see person A at 14 years of age and they want to carry out a considered pathway of care for this particular individual but because the resources are not there, they have to go to the tier 2 or the tier 3 of the treatment where they decide that they do not have cognitive behavioural therapy, social services, clinical nurses or psychiatrists so they will just medicate in a holding situation? I am a pharmacist by profession although I do not practise anymore. Is it a case that people, young or old, are getting suboptimum treatment to keep them in a holding position? To what extent is that happening?

The increased demand was mentioned and I find that concerning. In some ways it is good because people are recognising that there is an issue and perhaps openness towards mental health is the reason for that. Maybe it is just that there are more conditions or there are more presentations but it is very concerning if there is an increased demand. Although I can see that the budget has increased, it has not increased at the same rate.

Dr. McDaid or Dr. Finnerty spoke about the threshold and how that makes treating medical professionals feel they literally have to nearly triage the level of emergency. I do not want to get into the witnesses' personal lives, but in terms of going home and sleeping at night when they are looking at that threshold and that funding, are they lying there in bed wondering if that person should have got over the threshold and if they have made the wrong decision? Are they being forced to make suboptimum decisions because they just have to prioritise the services to those who are most at risk?

I refer to the institutionalisation in residential care reference mentioned by Dr. Finnerty in response to Deputy Durkan's question about homelessness. Trinity College Dublin has a longitudinal study on growing up in Ireland and I read some findings that were brought out at the start of the year. There were negative effects from the recession on children and families and their mental health. I cannot remember the detail but I am sure that is the case because it is a well constructed study. I mention the people living in direct provision; 13 years ago I was working in Athlone with the Lissywollen site as a pharmacist and I cannot believe those people are still there as I was telling them it would be over soon. Can anyone quantify the long-term effects on those people's mental health? In this scenario 13 years have been taken out of people's lives - they have been deskilled, the ability to have a home has been taken from them and there are other issues affecting women with children who are particularly vulnerable. Is this the inquiry of the future? That is what I am getting at here.

I want to finish off my questions and then I will take the answers. The next bit I want to speak about is the separation of addiction and mental health and international best practice. I have heard anecdotally in the real world that people cannot see a psychiatrist until they stop taking drugs. Is it normal in other jurisdictions to stream these two illnesses or conditions? It does not seem in any way logical. If a person is taking drugs because he or she is self-medicating for an underlying mental health issue and then he or she comes off the legal or illegal drugs, he or she is in limbo and his or her mental health needs are still not met. Perhaps the witnesses could expand on that and maybe outline what the best way is of sorting this out.

Another issue that came to me as I have been sitting here this morning is that I have a bit of legislation going through the Dáil, and we will be looking at it here in the committee, about the regulation of the advertising of fake cures and treatments for people with cancer. On the influence of social media on vulnerable people who have mental health issues, some people are so bad that they will target people who have stage 4 cancer and tell them that by standing on their head and rubbing cat's urine into their hair, for example, it will cure it. Is this happening across mental health and psychiatric units? Is there any market out there that the witnesses know of or that they have come across? That is just an aside I thought of this morning out of personal interest. Is there a notable social media influence, a negative impact and a targeting of people with mental health illnesses with rogue treatments or suggestions that big pharma is out to get them? Is that prevalent these days and is it an issue in providing care? Do people drop out of the services because somebody on the Internet is going to fix them and not the professionals?