Dr. John Hillery:

Regarding the Mental Health Commission, it is important to note that we are not dealing with out-of-hours placements. We are dealing with children who present in distress and in mental health conditions and where they are managed. We discussed the issue of people having to go to accident and emergency departments earlier. There is a problem with a lack of inpatient beds or supports in the community to deal with crises. As a result, people do end up in accident and emergency departments, including parents with a young child or an adolescent. They can then be admitted to the wrong places just for safety. It might be a paediatric ward or an adult psychiatric unit, even though we have brought these down a great deal.

Once again, it comes back to this issue that we do not have a national strategy for CAMHS and we do not have a national regulator for CAMHS either. We have a regulator of mental health services, which deals with inpatient mental health services, including childrens and adolescents, but not as regards the community services. If we had this type of regulator in place, with standards that had to be adhered to, these would be among the things that would be dealt with. I say this because Dr. Finnerty did point out in her report how in some areas of the country there was no psychiatric on-call service for children and adolescents. Adult psychiatrists then end up filling the gap. Some of this issue has to do with industrial relations, IR, some with the culture and some with traditions that have developed over the years. Once again, if we have national standards, there should be uniformity across the country. This is how things stand with this issue.