Dr. Niall Muldoon:

I think we have to do a bit of both, to be honest. Ms Brennan spoke earlier about the fact that some parts of the country have very good CAMHS and very good mental health services generally. Galway has been highlighted as one of the best in that regard. It can be done but it is generally done because of individual personalities who make things work. It is down to good decisions on who to bring in, what the contracts look like and making it work for an area. As a system, it is dependent on the individuals within it. That is why I am seeking a new A Vision for Change specifically for children. We keep referring to the original document but that was drafted in utopia, when we expected to be able to sell all of our old psychiatric hospitals for hundreds of millions of euro and reinvest that money in services. We are now in very different circumstances and the Minister of State at the Department of Health with responsibility for mental health has told me that at least 15 psychiatric consultant posts have been unfilled for the past five years.

We are not producing enough psychiatrists to fill them. That is where we need to start thinking in a new way, such as how else we can fill those posts and whether there are other posts that could do the same job for a period of time. There is a bit of both. The system when it is fully resourced with the right people will work perfectly, but when one has a situation where only one type of professional can fill it and one cannot get that professional one needs to start thinking about who else can fill the post. That is one part of it, but it is also necessary to resource properly the earlier stage, which is the primary care, the early intervention, the GPs and the stages where young people are identified as quickly as possible. I would love to see people without their professional hats on discussing how one would set this up as new. It would be a conversation worth having if we put everyone in a room and asked: "What do we want for our children and grandchildren regardless of what our profession is and what would be the best way forward?" There are examples of good practice around the country that are not supported by the system but by individuals with real passion and emotion. That is where we need to get a mix.