Dr. Anne Doherty:

If we take it outside that issue, all these things are interrelated. Many people have psychosocial issues that impact on how they see the world and how they feel at a given time, and influence how they feel about the future. It is not easy to separate it in the general population. It becomes even more complicated if we look at people who have a physical health condition on top of that because there are additional stresses built into having a condition. The rates of things like depression and anxiety go up in those populations. That is why we have the national clinical programme for psycho-oncology. It is an acknowledgement that people who have a range of cancers, for example - cancer is only one part of the bigger picture - are at higher risk of having depression and anxiety. We get referrals all the time after people say to their oncologists: "I want to die. Can you send me to Dignitas?". The oncologists cannot do so but they can say they are worried about the patients' mood and ask them if they would like to see the mental health team. We assess people on that basis and we have had quite a few referrals like that over the years. In most cases I have seen, the people have been depressed and have responded well to treatment. There is a treatable piece.

These are complex interrelated problems and it is hard to separate them. Cancer now has the national clinical programme for psycho-oncology which is wonderful, but many other conditions also need integrated mental and physical healthcare. For example, let us look at the area of neurological conditions as it was brought up. There are no dedicated mental health services for people with neuro-psychiatric conditions; that is, people who develop neurological problems and have comorbid mental health problems.

None of the hospices have integrated mental health care either. There are many gaps that we need to close. Speaking from a clinical background, I am worried that, if we do not close them, there may be people choosing assisted dying in a semblance of voluntariness, if that is a word, and autonomy when the reality is that they may have conditions that are not being treated. The Deputy spoke about going to the home of someone who had been unable to access mainstream mental health services. We see that all of the time. There are significant delays and gaps in services. “Mental illness” can mean different things to different people, but even at the more mild-to-moderate end of it, for example, depressive illness, most people who are mild to moderately depressive will never see a psychiatrist. They will be managed very well through primary care. However, we need to ensure that such conditions are being picked up and that people are getting the specialist care they need and not necessarily being shunted down a path from which there is no return.