Mr. Martin Rogan:

It is of critical importance to understand the role of primary care. As the Deputy has pointed out very well, a GP's practice can be a very busy place at the best of times, even without Covid-19. It has been suggested that a GP visit can take seven minutes. That is composed of two minutes of meeting, greeting and seating, two minutes of formal diagnosis, two minutes of prescribing treatment and a minute in which to ask the patient to move forward. That time constraint should be reduced somewhat with the implementation of Sláintecare and better access to primary care.

GPs have been very creative and responsive. Their viewpoint is really important because they do not just see patients at one moment in time. A GP sees a patient in the context of his or her family and knows the individual over a period of time. He or she can recognise if things are different. On average, about three GP visits by either an individual or a family member can elapse before the difficult topic is raised and a patient expresses concern about his or her mood, anxiety, drinking patterns etc. Mental Health Ireland works with the Irish College of General Practitioners, and Professor Tom O'Dowd to understand the tools and skills of GPs. They play a really important role in early recognition and sometimes in watchful waiting. They have an array of options. As Ms Mitchell has mentioned, this includes access to psychology, the counselling in primary care service and other initiatives. They are not limited to their prescription pads.

People are sometimes reluctant to avail of mental health services. That can arise from historical stigma or a sense of hopelessness. Sometimes it comes from a fear of losing control or a sense that the service will somehow take over a patient's life. We need a much better understanding of this. People are increasingly availing of peer-led services such as recovery colleges, where people can equip themselves with new understandings of mental health and manage their own care in a much more effective way. People who have used the service often bring a unique insight that we as professionals do not have through our training. They also carry a great sense of hope. While acknowledging that things are difficult and a patient's story will not necessarily be the same as their own, they can point to things that were helpful and unhelpful in their own lives. Those are really powerful messages for a person who is feeling deflated, frightened about the future, alienated or disconnected. This is about having an array of options that are acceptable to the patient.

When we are supporting a person with his or her mental health or promoting positive mental health, we approach things on three levels. We aim to strengthen the individual, strengthen the community and reduce barriers. Covid-19 has become an additional barrier that we must find creative ways to address. We have seen some really strong examples of that in recent months. Services that routinely go the extra mile have now gone the extra kilometre. That does not just apply to front-line services. Support teams and managers working the system have had to move heaven and earth to ensure that people can access quality services in a timely way. Waiting lists are not really helpful when a person is in acute distress or considering self-harm. That situation must be addressed immediately. GPs are at the front line of that in many instances.