Professor Veronica O'Keane:

The first issue of risk - Deputy Rabbitte has put her finger on the button there - is very difficult to evaluate. It is unpredictable because risk can change very quickly. I have outlined - I do not want to repeat too much - that women who are pregnant are vulnerable emotionally, because of what is happening to them but also because physiologically the gestational hormones alter the emotional centres in one's brain. Anxiety symptoms and depressive symptoms are much more common, even from women who do not suffer from depression, when women are pregnant. There is this vulnerable background. In such situations, what might not be something tremendously challenging can become something tremendously challenging. Amplification can occur in terms of emotional responses. Psychiatric presentations can be unpredictable and unforeseeable and that is because of the nature of the pregnant female brain. We need to allow for that. That is why I really liked the recommendations of the Citizens' Assembly. Although almost 100% - it was 95% - recommended that abortion be available for women who are at risk of suicide, almost 80% stated that abortion should be available for women whose health was at risk so that the range between the highest risk and the lowest risk was only 20%. That is a narrow range. That reflects the unforeseeable fluctuations that can occur. Risk cannot be gauged rigidly. It cannot be fixed. That is important for the legislators to understand in terms of mental health problems that might arise.

The second issue Deputy Rabbitte asked about was maternal mental health. I guess it is broader than maternal mental health services. It is women's mental health because if women choose to have abortions then it is not really maternal mental health. We need to see women's mental health. The National Women's Council of Ireland has been lobbying for this for quite a long time. Its phrase is gender-sensitive mental health services or health services. That is a very good way of looking at it because there are some issues that are very sensitive to one's gender. Of course, reproductive health care is one of those areas. The services are bad at present but clinicians and the leaders within the health care systems are all working hard to improve services and to improve the delivery of services. I suppose the national maternity strategy has had a sluggish start with a little bit of remonstrating, but the mental health services are very much an intrinsic part of the services that will be developed now.

In psychiatry as well, there is the area of perinatal psychiatry. I do not want to go into Dr. Anthony McCarthy's territory. He will be talking about that and I do not want to duplicate any information that the committee might be given. Dr. McCarthy will address that for the committee in a fuller sense. Is that okay?