Dr. Kieran Moore:

I thank the Deputy for the question, to which there are a number of elements. I shall answer it honestly. The simple answer is that it is absolutely devastating. The Deputy is correct in that regard. It is important when designing services that we try to examine the difference between mental health and mental illness. I say that because at any one time approximately 20% of children broadly have psychological difficulties which may extend from difficulties within the family and bullying at school to the other end. I am not saying one is different from the other, except where there is a very severe illness such as schizophrenia which is a long-term biological illness that, unfortunately, will require an input from the medical and other professions for the rest of the patient's life. It is about working out how we deliver the service. That is why we would very much welcome having psychologists in primary care services. In some parts of the country there is a waiting list of approximately four years, which is crazy.

To go back to our bit, it does not make sense that specialists end up seeing children who do not need to see them. Many of the children on the waiting list for the specialist service do not necessarily need a specialist service. However, they do need to see somebody, which is why we are very much promoting the idea that primary care psychology services and all of the other ancillary services should be resourced also. On our side, we really need help with the more specialist service.

To answer the Deputy's question, early intervention is key in anything about which we know. We know that 50% of mental illnesses which will require psychiatric intervention come on before the age of 14 years and 75% by 25. The earlier the intervention, the better, including in cases of autism and ADHD. Not only does it help the child, but it also helps society in order that people can work in the community and will not need to be in receipt of disability benefit for long periods. It is best to have intervention as early as possible. Expenditure is far lower than at the other end where one ends up treating people. Even with those with whom I deal, 17 and 18 year olds, it is almost too late. It is not too late, but it can be in some cases where people are already in trouble with the Garda or may not be able to work or go to school. It is not just about resources and early intervention, but they do have a huge influence.

To answer the questions on retention and recruitment, a large part is that people really enjoy working together when they are able to do so and when the resources required are in place. Colleagues of mine are frustrated across the spectrum. The psychological stress and burden in being overworked cause a lot of difficulties for people.

On the point about psychiatric nurses, there are really good, interested people who want to work and do work. However, the system does not work at times. Perhaps if we had more people and more support available, we could do better.