Dr. Anthony McCarthy:

There were a few questions, but I will start by talking about having a sense of humour. I am sorry that Deputy Mattie McGrath has left. Having a sense of humour is very important in my job. After talking about a very distressing matter, being able to share a joke and a laugh is sometimes one of the best things we can do. Even laughing and joking after some painful losses, including pregnancy loss, is part of the process. It is a little like being at a funeral; people will laugh and joke. That is part of the human response in situations such as this. It is healthy rather than something about which to be offended, I hope.

Obviously, the legislation was enacted at the time with the best of intentions to try to deal with all of the results of the directions of the European Court of Justice. It was trying to address some of the issues involved. Mental health issues had to be involved and, in those circumstances, suicide was the most controversial aspect of the legislation, as the Deputy knows. I remember being on radio at one stage when there was a suggestion there should be 12 professionals involved. One of my children says it was a relatively proud moment to see my name on an Evening Heraldposter on Pearse Street. It read: "Psychiatrist calls this idea a joke." I believed originally that the figure of 12 was a joke. The number was eventually reduced to three. All along I said there were simply not enough people available to do the work. I questioned how it would work and how it would be appropriate.

There is an acknowledgement that there are not enough psychiatrists in the country. Of course, there are psychiatrists. The three Dublin maternity hospitals have part-time psychiatrists. The major unit in Cork has a liaison psychiatrist who does a lot of work in this area. Throughout the country, however, there are very few. The requirement is that a psychiatrist must have treated a woman with mental health problems in pregnancy to be allowed to do this work. He or she has to be a consultant and to have treated a woman. That is the pragmatism of the legislation based on the problem of having enough people. Of course, there are not enough people available with the required training. A requirement was included afterwards that they be trained. One of the key issues is the nature of the training provided. There is none working in maternity hospitals. I might see a woman who wishes to terminate a pregnancy but who will have no idea of gestation or the difference between an emergency caesarean section at 24 weeks and the scar that will be on her body and a different procedure altogether if she waits a few more weeks. She will have no idea of various things. Equally, the assessing doctor will not either. The amount of experience and time it takes to deal with that issue is considerable. There is simply not enough training provided and not enough people used to doing this work. For all of the theoretical training, it is actually a matter of practice. I learn every day from the patients I am seeing. That is how we learn. Unequivocally, the system really does not work. Since it is so clumsy, the vast majority of women will come nowhere near us, appropriately so. It is just an unnecessary and unhelpful procedure. Therefore, women have to travel.

I do not have a breakdown of the very small number of women who find themseles in the circumstances to which the Deputy referred. Some of the cases that were very much highlighted have some involved younger people and at least one refugee. I have not seen a breakdown of the numbers involved simply because I have not been involved.