Dr. Lorcan Martin:

It would certainly deal with one of the issues, but there are a number of issues involved.

You can throw money at something and provide financial resources but if you want people to work in a job, it has to be attractive. That is one of the big problems. From speaking to junior colleagues in training and people who have just qualified to become consultants, I know they are finding the current situation quite difficult already. If something like this were to be added in, they will start thinking about the fact there are other places they can work. That is going to be a problem. We could suddenly wind up with a shortage, regardless of how many millions of euro are put into the system. We are aware that the mental health portion of the health budget is way lower in Ireland than in most other places and we would look for an increase in funding. However, it is not just about funding. It is about providing the wherewithal to make jobs attractive. It can be very difficult to fill posts. Many of our consultant posts are already vacant and if we are looking to double the number between now and 2028, difficulties are likely to arise.

I mentioned that the threshold for admission will be immediate and serious risk. The problem with somebody who becomes unwell and does not display an immediate and serious risk is that that person can easily become a very serious risk. I do not want to dwell on any individual instances but we all know of some very tragic cases over the last number of years where people might have had a sense that somebody was unwell but would not necessarily have been aware of the severity of that risk. That is where the difficulty arises. As Dr. Rafiq said, raising the threshold to that extent is going to cause big problems. I can almost guarantee that tragedies will happen because it is very easy to go from being unwell but not at risk to suddenly being at risk, or to go from being unwell and the risk not being identifiable to something tragic happening. That is one of the biggest concerns we have about that change in threshold. Not only will people who require treatment and have a right to it not get it, but also there is that added risk. Ironically, the risk threshold has been set as the key to admission but risk can change. That is important. Anyone who does risk assessments will be able to say what a risk is now but I could see somebody today and something awful could happen tomorrow because I do not know what will happen between today and tomorrow.

We can talk all we want about putting more resources in, such as more psychiatrists and so on, but fundamentally this comes back to seriously ill people. The Bill primarily revolves around people who are going to be involuntarily admitted. By definition, these people are very unwell. No psychiatrist, from a moral or ethical standpoint, will admit somebody involuntarily unless the person really needs it. That is partly for practical reasons because it involves more paperwork, but also we have a massive duty of care to our patients and the doctor-patient relationship is something fundamental that goes back millennia. First, do no harm. If we are going to bring somebody in and deprive them of their liberty, we want to be really certain there will be a significant benefit to that in getting that person back into their life, functioning, living with their loved ones and getting back to work or to college. That is the core of it. It is about providing the best possible service in the fastest possible way to the people who most need it.