Mr. John Saunders:

There are various pathways. The commission, through its inspectorate, obviously speaks to each of the services it inspects. There is a constant conversation about changes and improvements. To be fair to the mental healthcare services, where a need is pointed out and where it is possible for them to do so, they will make changes and improvements. The problem, as I suggested, is that the changes and improvements are often beyond the scope of a local service. There may be resource or policy issues that are national.

The mental healthcare services are unique in the sense that a mental health division was created in 2013. This was a highly visible structure through which the commission or anybody else could communicate on a national or corporate level with the mental healthcare services at what is called national director level, which is a very high level. That was quite effective for trying to push change within the system. However, that system has collapsed and there is no longer a mental health division because it was dismantled within the HSE structure at the end of last year. As we speak, we are not very clear about the overall corporate responsibility of mental health in the context of all the healthcare programmes that are in place. It is a constantly changing situation.