Dr. Shari McDaid:

I am not qualified to give a good answer on that and I hesitate to speak about things I have not really considered. The Deputy is right to say there is a link between substance misuse and mental health difficulties that is not discussed enough in the public domain, in both directions. We could do much more in that regard.

As for the question on the sufficient use of psychotherapists, earlier I stated we should vastly increase people's access to counselling and psychotherapy. We should not underestimate the potential for psychotherapy within the specialist mental health services as well. Some clinicians used to have the view that people with certain diagnoses were not appropriate for counselling and psychotherapy. I hope that we have moved beyond that view. Even if one has been diagnosed with schizophrenia, a schizo-affective disorder or a psychotic disorder, there might be real reasons one could also benefit from counselling and psychotherapy because one will likely have gone through real losses in one's life that one might need to explore. There are issues of having become more isolated and all kinds of emotional issues that might benefit from being explored. I say that as a layperson and not as a clinician.

I am really glad the Deputy mentioned a role for creative arts therapists because it is something about which we have not always been vocal. We would be very supportive of ensuring that a future mental health system incorporates and embeds the role of creative art therapists as part of the options available for people. The area was neglected in A Vision for Change and that situation should be rectified in any future mental health policy.

In terms of the facilities for mental healthcare, we know that there are problems with the facilities at all levels. I refer to community residences around the country that are not accessible for people although they have been people's homes for years. I agree with the Deputy when she mentioned day facilities and clinics that are not located in welcoming environments. Many people have told us that many inpatient settings in acute facilities need to be upgraded. My organisation would really support investment in that area and in ensuring there are respectful and welcoming environments for people in distress who seek assistance.

I agree with the Deputy that we should explore the upskilling of clinical nurse specialists as one of the options. We must consider all of the options and, therefore, should be open-minded. I ask all clinicians to be open-minded about considering a range of ways that we will need to adapt to higher demand. There is enough need to oblige us to call upon everyone who is able to provide different types of support and we must also be creative about drawing on their expertise.