Dr. Matthew Sadlier:

There is a model out there involving agencies. Jigsaw, which works in my area, is the one I am most familiar with. I give the caveat that I am not a specialist child psychiatrist. I am an adult psychiatrist. Our statutory mental health services were designed at a time when mental health services dealt with what we would now call severe and enduring mental health problems, specifically issues of schizophrenia, learning disabilities and severe levels of illness. We are now dealing with issues of mental health as opposed to mental illness, if we can make that distinction. Issues of distress and anxiety have moved into the realm of the treatment zone as psychotherapies in these sorts of things have advanced and have been found to be beneficial in these areas.

Is there a middle ground between primary care and specialist secondary psychiatric care? There can be and there are models that have worked elsewhere in the world. However, for that to happen we would need to have very well-defined referral pathways. We would need to have very well-defined middle-ground services with staff with adequate qualifications and adequate definitions of roles, which can be a problem in areas of non-statutorily defined roles such as nurse and doctor. That is the difficulty with that middle-ground area.

At the moment people are generally seen by the specialist services initially. This is certainly the case with adults. Where we would see those over 18, these are in the teenage years, but the later teenage years. We would divert some patients to wards if we felt they were not suitable for secondary services. We have two choices. We can run a service where patients get screened at the highest level of expertise first. Then the specialist services will, for want of a better word, and I apologise, keep some people within their services and divert some people to services of a lower level of complexity or whatever terminology one wishes to use. Alternatively, we can run a service at the lower level of complexity, as the Chairman is intimating, whereby they see the people first and then pass on. The concern about that is when somebody has a serious problem, are we putting in another stage before the people with the most serious illnesses get the treatment they most require?