Professor Harry Kennedy:

It is interesting to compare my colleague Professor Brendan Kelly's assessment of the situation because he works in the very busy general adult service in Tallaght Hospital and he has previous experience of working in the north inner city as well. All parts of the service are having the same experience. All of the contributory experts - those of us who do this - are coming to the same view from different starting points. I would go a little further. I think the EUROSTAT figure for Ireland of 35 per 100,000 lumps in community hostels, old age intellectual disability and other things. The HSE number is 20 per 100,000. Comparing like with like with the EUROSTAT number, the situation is even worse.

The system, following A Vision for Change, was driven by ideology independent of expertise and independent of the research evidence at that time. A lot of new evidence has emerged since. For instance, the UK rate of admission under the Mental Health Act has increased in recent years. It was previously lower than the 120 per 100,000 that it is now. Forces of nature in the population cannot be blocked by ideology. There is a certain amount of severe mental illness in the community. People have genuine needs for levels of care and treatment, which bring us back to this position. The old asylums were impoverished and negative in every way for all kinds of very interesting reasons. There was a choice between reforming them or closing them and the choice was to close them. The obligation on us now is to find something better. The way to do this is through reawakening the concept of excellence in clinical services. Excellence is how we keep up with what is happening in the population that we serve. It will never be the same each decade and so the only way to keep up and ensure we are genuinely meeting the needs of people with severe mental illness and all the range of mental health problems is through the virtuous circle of research, leading to the development of better services; teaching so that we are constantly preparing new professionals in these newly-developed services and training for postgraduate work to provide the people who will do the next round of research, development and teaching. Other countries have centres of excellence funded continuously to keep up in this area. The Italians have an excellent centre of excellence in Brescia in northern Italy. The Dutch have an excellent centre for forensic expertise in Utrecht. Most other countries have these centres; we have nothing of the sort.