Mr. Bernard Gloster:

I thank the Senator for her good wishes. I am very familiar with her work in this area. I will ask Dr. Henry to talk about the focus on clinical improvement in mental health. Last week, we both did a very important engagement with the Department, HSE and the mental health sector across the country on the end of the first year of the implementation plan for Sharing the Vision. It might be a sign of my age, but I made the point there that I can go back to the policies of Planning for the Future and Vision for the Future and so on. All of them were excellent policies in the area of mental health and all of them were a serious challenge when it came to implementation. Last week we were prepared to hold up a mirror to ourselves and ask: what is it we said we would do; what have we actually done; and what are we going to do about what we did not get done? That is fundamentally it when you get down to it. There have been serious advances in psychiatry of later life. There have been some very good developments in the connections between mental health and maternity care, which is very significant, the prevalence of post-natal depression and so on. In reality, it is our adult mental-health services where we remain most challenged with the demands and complexities of what people present with because of the prevalence of many things in their lives including addition and their social circumstances. The whole system around them means their presentation is very complex.

The other area where we have a serious problem, on which I do not have to educate this committee, is child and adolescent mental health. That is not just in terms of access but in the totality of the response. We have to start from a place of accepting that many good things are happening in the mental health service, but the service is seriously challenged and if we do not get on top of that, the consequences for the public for the future are quite dramatic and significant and they are often not talked about.

Dr. Henry, as chief clinical officer, might talk a little about Sharing the Vision specifically in the clinical space. His leadership and that of his team is significant. We come from a very historic model in mental health in Ireland as with many of our services. It was very paternalistic and very much a rescue and recovery model. We need to get to the recovery place that is well evidenced but not well implemented.