Dr. Roisín Plunkett:

It is a fundamental cultural problem. There is the lack of clarity on the distinction and delineation between primary mental health care and psychiatric services and secondary care services. Part of the problem is that psychiatry is actually housed within community health care organisations, CHOs. It is housed within the primary care CHO structure rather than within the acute medical division as such. There are cultural and historical reasons for this. In the old asylum culture the asylums provided social, psychiatric and institutional forensic care, with all kinds of function rolled into very messy and difficult arrangements. Now that this has changed and deinstitutionalisation has happened, there has, unfortunately, not been a delineation between primary and secondary psychiatric and mental health care services.

Primary care services have large resource needs because of the number of users. In primary care services there are always more people with a lower acuity of illness. They require resources because there are so many of them. Within secondary care services there are smaller numbers but higher levels of complexity. Therefore, these services have different needs which also require resources. When resources for both are drawn from the same pool, there is a very clear problem. That is why primary care and secondary care services have different budgets in order that the amount that can be drawn from either is limited and both are ultimately protected. Without that structure within mental health and psychiatric care services, there is a real risk that nobody would be well served.