Professor Veronica O'Keane:

Senator Ruane has brought up a number of points. The point about the woman with dual diagnosis should not arise. If somebody is suicidal somebody is suicidal, and if they are suicidal because they are pregnant then the analysis does not have to go below that unless there is a treatable mental disorder which is making them suicidal and is not related to the pregnancy.

Situations are very complicated so I guess third hand information is very difficult to comment on, so I will talk perhaps about my own experience instead of addressing that directly. Some people have very complicated lives. They have complicated lives because they were born into situations of deprivation that are unimaginable to a lot of us. Children are neglected. They are left in dirty nappies. They are not spoken to. Nobody gets them up in the morning or puts them to bed. I have a lot of contact with Tusla because a lot of my patients were brought up like that. Of course they need psychiatric services in adulthood and of course they have difficulties parenting. It begets a cycle. If one does not have control over one's reproductive fertility or whether or not one has children, if one cannot practise responsible parenthood this situation of deprivation is going to continue. I think it is a very important societal point. If one has somebody with dual diagnosis I would say that increases rather than diminishes the risk. On the other hand, if a woman changes her mind during a pregnancy, if she initially has an unwanted pregnancy and then decides it is wanted then that wish should be respected. The same choice that pertains to choosing whether or not to continue with a pregnancy also pertains to whether or not one wants to be a parent, if one continues with a pregnancy, even if one is being forced to continue with the pregnancy. Choice is terribly important. If a woman does want to continue with a pregnancy and she is in dire circumstances, what we need to do as a society and as a medical service is to intervene with all the supports we can muster to help her.

We really try to break the transgenerational transmission of deprivation by targeting young mothers who have children and who want help. It is very satisfying work, because the children benefit from it and the mothers develop great confidence in their own lives and in their abilities to mother. When we are talking about abortion, we are talking about parental care as well, and all those other services. This debate allows us to talk about issues that we could not talk about previously, such as very difficult parenting, children who were perhaps not wanted and became wanted, or children who are simply not wanted whom the State may have to provide for or for whom alternative parents may have to be found. It is a very complex area, but in my experience it is tremendously satisfying, and intervening when families are young to try to help women parents, regardless of whether those children where even considered or ever wanted, can be done. We need that as much as we need abortion services.

Senator O'Connell asked a question about how we treat younger women and girls and whether it would be appropriate to detain them in psychiatric hospitals if they are suicidal because of unwanted pregnancies. I believe that is absolutely and utterly unacceptable. The case of the 15 year old who was detained is unacceptable. I am not talking as a psychiatrist who knows anything about the case. I am talking as a citizen who is observing what has happened. Pregnant women who are suicidal because of their pregnancy should never be locked up and detained, ever. If we are stooping to that level of abandonment and putting girls in captivity who are in desperately complicated and distressing situations emotionally, we really need to look deep into our hearts. We need to move this legislation forward because it is absolutely the wrong way of doing it.