Dr. Shari McDaid:

I will take the questions the Deputy has raised around governance and accountability and link that to the question she asked on the experience of gaps in services.

We have been clear that we believe the absence of a mental health information system and the dissolution of the post of national director in the office of mental health within the HSE are negative for adequate accountability. A good example of this is the statement the HSE made in the service plan this year. The plan stated clearly that the HSE will have to essentially make choices about providing services to some people and not providing services to others because mental health services did not get the full funding that they needed. The HSE is essentially saying that it has to ration services. That is how the statement translates. It means the HSE will have to make choices that some people with get mental health treatment while others will not because the mental health services will not have adequate funding for the year based on what those responsible know the demand will be. The real tragedy, as has been pointed out, is that when people do not get mental health treatment their mental health deteriorates and they get worse, sometimes with the worst of outcomes.

Moreover, we do not know, and we have no way of knowing as far as I can tell, how much this is going on or who is being helped and who is not or what those decisions are. A good example is in emergency departments. We have a self-harm liaison service and admissions through accident and emergency departments. We know people who are admitted through accident and emergency departments get help but we do not know how many people are turned away from accident and emergency departments. That information is not kept, so we have no idea how many people have showed up at accident and emergency in distress but who have not gotten any service.

That runs throughout the mental health services. We do not know how many people are helped. We do not know how many people go into mental health services who feel they need a holistic range of supports but maybe only get one type of support but not the others they need. We have some indications from our survey of people who have used mental health services. They say they have got talking therapies. The findings were encouraging in that more people said they were getting talk therapy than we had expected. However, it is still the case that many people say they only saw one mental health professional. Many say that within the mental health services their experience is of medication being the predominant mode of treatment.

We really do not have robust consistent regular transparent information about what is going on in our mental health services and of course that is concerning. We have hundreds of people living in high-support accommodation and medium and low-support HSE accommodation but we do not know the quality of the service they are getting apart from the inspection reports that have been done on an informal basis, so to speak. We do not have those services regulated.

I will say what I have said to the committee in the past. It is an urgent priority to get better quality more transparent information about what is happening in the delivery of our mental health services so that we can then attest to whether people are getting the services they need.

There was a question on the separation of addiction and mental health.