Professor Brendan Kelly:

I thank the Deputy for the questions. She asked about consultant recruitment. It is an enormous issue. It is common for there to be no applicant for a consultant job, or sometimes one applicant, leaving very little choice in what occurs. It is part of a broader difficulty with recruitment across the health service in other grades of doctors, nursing and other professions. Doctors are particularly mobile. Consultants are offered jobs elsewhere and we get emails every day about jobs in Australia, New Zealand and other largely English-speaking jurisdictions, where these jobs are embedded in health services that offer more support, more multidisciplinary working and therefore more opportunities for professional flourishing. A great majority of the graduates and people leaving medical school go directly to Australia. It then becomes a task not of retaining them but enticing them back, which is something to which we devote an enormous amount of time. A broader resourcing of the health service, particularly in mental health, would help with that.

The Deputy asked about the distinction between mental health services and addiction services. She correctly pointed out that many people have both problems. For example, the vast majority of the young men I see with psychosis or severe mental illness involving a significant break with reality use cannabis pretty much every day. It is very unusual for me to encounter a case of psychosis or severe mental illness in a young man who is not misusing cannabis. The misuse of cocaine is also very widespread and results in mental health problems. The 2006 policy, A Vision for Change, stated that mental health services were to be focused on people whose mental health problem was primary and that addiction services would be a separate entity. This does not make much sense, certainly in my day-to-day practice. The revised 2020 policy, Sharing the Vision, says:

[A Vision for Change] recommended that specialist mental health services should support only individuals ‘whose primary difficulty is mental health’. This recommendation is now reversed.

In practice, two services cannot simply be united by saying it is so. A great deal needs to happen to connect things up a little more and that has not happened yet, even though it clearly needs to.

The Deputy also asked about the unique health identifier number and whether the PPS number would serve that purpose. Yes, one would imagine it would. However, Ireland has gone down a slightly different path. According to the HSE website:

[Everyone is] given an Individual Health Identifier (IHI) number the first time you use health or social care services in Ireland.

It is used to identify each person that has used, is using or may use a health or social care service.

The [number] lasts for your lifetime.

These numbers appear to exist for almost everybody in the country. However, for reasons I do not understand, they are not used in clinical or day-to-day practice. There appears to be a structure there.

This brings me to the final point, about legislation. I am interested in initiatives that have been started but maybe not completed. These seem like low-hanging fruit for us to make improvements. If these individual health identifier numbers exist, it would seem useful to introduce them, even though they do not appear to be the same as PPS numbers, for some reason. It is the same with legislation. We have the Mental Health Act 2001 and proposals are being scrutinised for revision. These could be revised a little and advanced. The College of Psychiatrists of Ireland has made this point elsewhere about the need for revision. The Assisted Decision-Making (Capacity) Act 2015 is about to be commenced, pretty much in full, and that requires support after commencement. It will introduce possibilities for supported decision-making and advance healthcare directives but these things will not happen overnight. They require education programmes, encouragement and roll-out and hopefully we can reap the benefits of that. There is also a need for dedicated safeguarding legislation but I am pointing to the two initiatives that are very much under way and appear to be near the finish line. They would help enormously.