Mr. John Farrelly:

The Chairman mentioned teams not being staffed. He painted a picture with which we would be familiar. GPs tell the commission about being left with a dilemma about how to care for a patient, including the risk. That comes back to community services and planning. We seem to be stuck in accident and emergency in this country but other 24-hour wrap-around services are available to a GP. This was all being done 20 years ago in other countries but we seem to be consumed with inpatient beds as opposed to developing the community services where people want to be treated. We need to be clear. Nobody wants to go to a psychiatric inpatient unit. If care was available in his or her area, particularly in rural areas, he or she would access it. The State must be commended on Jigsaw. This is not the HSE but is funded through the HSE and the State. Many of these services, such as Pieta House, are born out of gaps because the services are not there, so we need to identify the gaps and see how we create the momentum around that in communities.

We do not have full visibility regarding overmedication. From working with various doctors and nurses, I think we are fairly clear in Ireland that medication is used appropriately. We have a fairly professional and good workforce.

I can understand it in an emergency, but generally that does not seem to be a major issue.

Some of the medications have side effects, particularly weight gain. We met Tusla recently to discuss the potential of a memorandum of understanding. We just put one in place with the HSE, which is a risk-based protocol.