John Crown (Independent)

I thank the Minister of State. Without sounding like a broken record, it is very welcome to have a person in her position with such a commitment to the cause of reform in this area where reform is greatly needed. I was moved by Senator Moran's contribution. As she was speaking, I did a very sad mental inventory and I could think immediately of eight medical students, doctors or nurses I knew over the years who had taken their own lives. I knew many other patients and acquaintances who, when confronted with very bad news, had made similar decisions. These are the dramatic cases but at its most extreme, mental illness and disabilities of various kinds are a great burden for the individuals concerned, for their families and for society in general.

At the risk of sounding like a slightly different broken record, I ask the Minister of State a few questions. I do not expect her to answer them because I suspect she does not have the information at her fingertips, but these are numbers with which she will need to arm herself in analysing the situation regarding the psychiatric component of the health system. As anyone who has heard me speaking here will guess, the first question I will ask is the number of trained career-level psychiatrists available in the country. I ask how many psychiatrists are in Northern Ireland considering the population there is one third the size of ours. I ask how many psychiatrists are in the United Kingdom and in Europe. I ask what is the approximate number of trained career-level psychiatrists per head of population in our jurisdiction compared with other comparable jurisdictions. I do not know the numbers and these are not trick questions.

As a good rule of thumb, for any specialty one cares to mention, we tend to be way below the international averages. I was thinking of this when I heard Senator Moran's stories about particular hardships which people had encountered. It made my blood boil a little but I was also thinking how many patients had those doctors seen that day compared with a doctor working in a leading psychiatric institution in London or in Louvain.

I am delighted to see that an issue I have raised in a few contexts is now getting some attention. It is the question of the structures of medical education in this country. I would like to know the number of full-time academic psychiatrists attached to our six medical schools. I am guessing that with an average number of full-time faculty members, according to international guidelines, there would probably be between three and ten per medical school. I suspect the number is closer to zero. Without wishing to be provocative, I ask the number of grade eight officers in health administration whose work is entirely directed to the administration and supervision of the rather small number of full-time psychiatry professionals in the country.

The move to outpatient care is obviously an excellent decision. I do not wish to sound judgmental because we inherited them but anyone who has visited some of the truly Dickensian facilities in which patients received treatment over the years will be fully appreciative of the humanity shown in moving people from an inpatient setting to an outpatient setting. This is also a change taking place in other areas of medicine. Most oncological work is carried out in an outpatient setting and this is true for surgery where ambulatory care has also moved to such a setting. The closure of inpatient facilities without simultaneously developing the necessary outpatient facilities is a cutback by other means. It is crucial to ensure a match between what is developed in the outpatient setting and what is closed in the inpatient setting. The Minister of State and other Members will be aware of the awful financial situation and the pressure there will be to try to find means of curtailing spending at all times. I ask that we try to ensure a match between what facilities are closed and what facilities are opened.

I will probably be seen off the premises by security for being in breach of the orders of the House because we are not supposed to talk about money and raising taxes but perhaps I could suggest to the Minister of State in a friendly fashion that we might consider a ring-fenced vice tax on alcohol which could be used for nothing other than alcohol related health issues and perhaps greater issues of support for mental health services.

I thank the Minister of State for her attention to these matters. I would welcome the opportunity to have a systematic analysis of the person power available at senior specialist and other support levels within the health service. The Joint Committee on Health and Children may be the best forum for this information. I wish the Minister of State the very best with her endeavours.