Dr. Mark Murphy:

I will move on to the issue of mental health. It might surprise the committee to hear that we see 30 or 40 patients per day. We spend on average ten minutes per patient. Every patient typically brings two issues on average. Sometimes there is a list of eight. One of those issues is identified by the GP, so the evidence for continuity of care is crucial. We know patients and recognise patterns. We may meet a wife in the street or in the local supermarket and she will say something. That issue may bring up a mental health issue. A GP may ask, "How are you getting on? You're looking quite stressed."

Approximately one fifth of all presentations have a mental health component. When we say that we manage the majority of mental health complaints in the State, we are talking about stress, anxiety, panic attacks, obsessive compulsive disorder and all the anxiety disorders. We are talking about mild depression and sometimes severe depression with suicidal ideology. We are talking about addictions. We treat methadone and gambling. The problem of alcohol use is everywhere. We manage these conditions effectively by ourselves. In effect, we are a counselling service. We are trusted and patients are well managed.

The next step is if someone needs treatment. The NICE guidelines all state that patients should receive psychological therapy as the first-line treatment after holistic social treatments. We do not have meaningful access to primary care psychology services - no cognitive behavioural therapy. We are talking about a patient who is in distress, has severe crippling anxiety, is not working and is taken out of society and yet we must say, "There is no CBT. I'm really sorry, there's none." That is what we are dealing with and it is absolutely crazy. That is at the primary care level.