John Lahart (Dublin South West, Fianna Fail) | Oireachtas source

I was not present earlier but I followed the discussion remotely. I will make some comments because many of the questions have been answered. If there is something the witnesses want to take up in that regard, I am happy to hear it. I found both presentations had different emphases and were quite evocative. Sometimes you think you have processed losses and suddenly you get ambushed when people start discussing some of the issues. I found myself very moved and touched by that.

A point I have made at meetings of the Joint Committee on Health and the Joint Sub-Committee on Mental Health is that I am very struck by the difference in approaches in Scotland and in Ireland to healthcare generally. The Scots seem to adopt, ever since the foundation of the National Health Service, this concept of having an embracing health service. We have a health service that to some degree likes to keep things at arm's length, which is a pity and that is a necessary step change. I am thinking about immigrants, towards whom Dr. Doyle gestured, who do not have granny and grandad or the aunts and uncles and that support network that translates into childcare, and it translates into so many aspects of their lives. For example, it translates, as we know, into the ability to go back into study or to take on work etc. In this particular area, it is an especially acute loss.

I am a psychotherapist by training and some of my favourite clients were pregnant women or women who had lost their pregnancies or miscarried. One of the things that would have caused me to reflect was the awesomeness of the whole pregnancy piece. To me, depression, as opposed to clinical depression, is quite understandable and a logical conclusion when a woman has carried by herself a growing baby and the awesome responsibility of that. Then there is the great birth event, but the baby is no longer part of the mother, and that represents a loss, I imagine. The idea of being depressed and feeling a sense of loss and dislocation makes an awful lot of sense to me but can be news to a mum. About 20 years ago I spent two weeks in hospital, and I remember on the journey back home feeling this sense of complete isolation because I had become very used very quickly to the institutionalisation and the care of nurses, and now I was on my own to care for myself and what if something happened? Multiply that by an infinite amount with a mother who is coming home with such a fragile delicate piece of life. Perhaps the witnesses would like to comment. Maybe somebody can note it and come back on that issue of the speed of the turnaround of pregnancy in hospital. It seems to be really quick in terms of delivery and then home. I do not know what the witnesses' views are on that. If I was a mum I think I would find it quite scary being in care and surrounded by professional care, even for a very short period, and then I am back home. A lot of this comes back to the rights of the child, and maybe that should be the point from which we start, once they are born. Obviously, there are the rights of the child in the womb in terms of being a caring environment and reflecting that, but it is just that turnaround period I am thinking of.

I am probably one of few politicians who have read John Bowlby's books on attachment, separation and loss. I know when we talk about attachment, people often think of that clinging behaviour.

One of my favourite images is of the baby crawling out of the room and exploring, and then going back in to check. The certainty that the parent and caregiver is there allows the baby to explore further. It is one of my favourite images of attachment. I ask the witnesses to address the issue of the turnaround time.

When I hear our guest use the words "mental health", there is a voice screaming in my head that we would be better to use the term "well-being". There is still a stigma attached to it. I would welcome their views in that regard.

I was interested in the witnesses' remarks on facilities. I visited the new children's hospital satellite in Tallaght, which is in my constituency. The health committee was fortunate enough to go there to see the developments in the new children's hospital. I was struck by the lengths that have been gone to, even in the satellite hospital, in terms of things such as the scent. The place does not have the classic hospital scent. Quite a bit of work has been done in that regard. Children had a significant input into the environment, art, colour scheme and all those kinds of things.

My next point is for Professor McCarthy of the National Maternity Hospital. Breast-feeding is a significant issue when it is encountered by professionals in terms of the lack of support and the sense of guilt or failure that some women may feel. They find it quite difficult to overcome that.

I refer to the mother's environment or the environment in the room. I ask Professor McCarthy to develop that theme as well. I refer to housing or the lack thereof. Anxiety and distress are experienced by women who are living in cramped conditions or on a housing list while pregnant. In some cases, they are coming home from hospital not to their own home but to a shared home environment. Some women are not lucky enough to even have that. I liked the fact that Professor McCarthy outlined that the National Maternity Hospital is clear about the functions of specialist perinatal mental services. The witnesses will all have a chance to respond when I have finished my questions.

Moving on to the PSI, I refer to the first year of care. We know the damage that is caused by separating infants from their primary caregivers. Do we still not do that well?

Going back to the needs of the child, the PSI in its written submission states: "We must learn from our history of separation and move towards combined care that supports early relationships between caregiver and baby." Where are we in that regard? That sentence arrested me. It made me wonder whether we are not a million miles away from the awful stuff that we read about.

There are one or two new primary care centres in my constituency. I like the idea of it being the model but the staffing issue in that regard is quite tricky, even in terms of GPs, never mind any of the specialist pieces.

Dads do not get a big mention. There is a gesture towards dads. It is like there is a picture of a helpless onlooker. There could have been more emphasis on moving from that to a really supportive role. What is the PSI's view in that regard?

There is the piece in respect of being out of control. Professor McCarthy made the point that suicide is the highest cause of maternal death. He referred to maternal death rather than women's death. I ask him to develop that point as I did not understand it fully.

I will finish on the point relating to the health system in Scotland. Dr. Ní Longphuirt urged the committee "to invite in the infant, the mother and the family". What do our guests think we actually do? What is the chasm? That is food for thought.