One of the country's leading psychiatrists has questioned how the Government can finance the Metro Link to Dublin Airport when people with mental health problems and their carers are having to put up with ‘shambolic' services.

Speaking at a conference for family carers, the president of the College of Psychiatrists, Dr John Hillery, explained that he had resigned from the HSE this year due to the lack of progress in this area.

"The fact that we are still discussing these issues as needs rather than as facts is a disgrace. It is one of the reasons I resigned my clinical post earlier this year after nearly 30 years in the mental health and intellectual disability services as a trainee and consultant.

"The inability for rapid change in systems and poor environments was always a frustration. The introduction of regulation of environments with HIQA provided great hope, but seemed to me to become somewhat of a box ticking exercise. Regulation in the services I mostly worked in was not interactive from my point of view, with reports written without a right to correction or other reply," he said.

He pointed out that a lot of his time was spent writing memos and making phone calls advocating for supports, such as respite, for individuals and carers ‘that should be taken for granted'.

"One example of this is the way young people with intellectual disabilities and challenging behaviour lose their respite and sometimes other services once they leave school. It continues to amaze me that this was an issue when I was first a consultant and is still an issue today," he commented.

Ho noted that while government ministers ‘regularly communicate their intention for reform', this continually fails to actually occur.

"Our structures lack governance. The HSE has no board and an acting CEO. The main policy on mental health services A Vision for Change recommended a leader in this area, but recently the last CEO absorbed the Mental Health Division into a bigger grouping, thus removing the focus at the necessary high administrative level from mental health.

"This is allied to the fact that the national budget for mental health services remains at 6% when A Vision for Change recommended a higher figure 10 years ago, and when that of equivalent countries is around 12%," Dr Hillery said.

He insisted that the lack of implementation of reports and legislation that would make life easier for patients, carers and those working in this area, such as the Carers Strategy, ‘is another sign of a lack of true commitment to change'.

"It may be that there is no money for these issues. However, if that is so why is there money for less important issues such as Metro Link? We need transparent, simple governance of our health service as regards financing, planning and delivery. The multiple layers and cross responsibilities, a diagram of which resembles a Jackson Pollock painting, have to be reduced into a simple, effective model with allocated decision making and accountability," he added.

Dr Hillery made his comments as part of his keynote address at the Family Carers Ireland conference, 'Life After Care', in the Hilton Hotel in Kilmainham, Dublin.