Professor Matthew Sadlier:

I thank the Deputy for those important points. Talk therapies are essential. However, the Deputy's last sentence is the one that I would rile up on. He said "replace the medical model". I think they work in conjunction with each other. Mental health services throughout this country and internationally have had an ongoing battle between two ideologies that are actually not in opposition with each other but are complementary. If one looks at all the evidence towards mental health, it is a combination of medicine and therapy that works best. Neither one should be alone. Too many different services either go down one road or the other, largely due to ideology, without accepting that there is a middle road. That would be like asking that if people broke their leg, should they go to a physiotherapist, or should they have their leg in a cast? The answer is that they have to have both. That is the way I always try to look at it. Yes, talk therapies are important.

We have in our submission, as the Deputy knows, asked about how community mental health services are structured. This is because, as they are currently done with strict sectorisations, postcode lotteries do arise. We can talk about that in more detail if the Deputy wishes. We have asked for an independent review of that. Ultimately, the services are under-resourced. This is core problem. However, we also know that they are poorly structured. We know that posts are vacant all over the country. There are posts that the HSE is very happy to fund. It is very happy to pay salaries for them. However, it cannot recruit people into those posts. Therefore, just throwing money at the problem to an extent is not helpful.

There is a deficit of funding so we need to increase the funding but we also need to look, in a structured way, at how we recruit and retain staff. The fact that we increase a budget in an area often does not result in any improved service because people cannot be got to work in those services. We need to look in-depth, with the various different professions, be it psychology, social work or medicine – and we represent doctors so that is our emphasis but I am sure the committee has met the other professional groups and I will not speak on their behalf – to see why certain posts are vacant. We must also look at why it is more difficult to recruit in certain areas of the country than others and at what can be done to recruit people in those areas.