Leading psychiatrists at the Oireachtas Health Committee Hearings have been expressing opposing views about the inclusion of suicide risk in the planned abortion legislation.

Consultant child psychiatrist Dr Peadar O'Grady of the Doctors for Choice group said the opinion of many psychiatrists and other doctors internationally was that the risk of suicide was increased by having access to abortion restricted.

He said Doctors for Choice were particularly concerned that the abortion Bill contained elements that would cause unnecessary delay to access to abortion services, causing an unnecessary prolonging of an emergency level of risk and requiring more complicated procedures, eg surgical instead of medical abortions.

Dr O'Grady said in the case of eligibility for abortion on the basis of a risk of suicide, imposing a requirement for three doctors to certify this would cause unnecessary delay.

He said women and children in situations of rape, child sexual abuse and fatal fetal anomalies would have to wait for further legislation to allow for the option of abortion in those cases. "That this Bill does not provide for this is a serious limitation."

Consultant psychiatrist Dr Bernie McCabe told the Committee, on behalf of Prof Patricia Casey, that there was no evidence available suggesting that abortion was a treatment for those who are mentally ill and suicidal.

"Claims have been made that some women are suicidal simply because of the pregnancy only and not because of any underlying illness. There is no scientific data on this group to assist in predicting suicide. Psychiatry has little to offer this group beyond saying that mental illness is absent."

Dr McCabe said the planned legislation should be replaced by a clinical care pathway for suicidal women that does not include abortion, so that they can readily access treatment.

Dr Veronica O'Keane, Professor of Psychiatry at TCD and Tallaght Hospital, told the Committee that the sole purpose of the legislation was to provide clarification on the narrow terms of the law as established in the Supreme Court ruling on the X Case, namely to provide a service for women who, unless they had an abortion, were in danger of dying.

Dr O'Keane said a national panel of those prepared to lawfully engage with this process should be established and an efficient executive put in place to administer requests for termination.

She said a GP should make the recommendation for an abortion and one psychiatrist could assess suicide risk. Under the draft legislation, two psychiatrists and one obstetrician must do this.

Dr O'Keane said a consistent argument had been that allowing suicide risk as part of the abortion legislation would remove the only effective barrier to 'abortion on demand', that women who were not genuinely suicidal would be able to get abortions, and that abortion was not a treatment for suicidal intent.

"Underlying all these arguments are deeply problematic assumptions about the credibility of women, the reliability of psychiatry as a medical discipline, the meaning and management of expressed suicidal intent and the concept that doctors have the power to control women's reproductive autonomy."

Dr O'Keane said the difficulty with evaluating suicidal ideation had been exaggerated and the message that it was difficult to assess and manage was untrue.

President of the College of Psychiatrists Dr Anthony McCarthy said that any pregnant women with suicidal ideation should have access to proper services, but there was a lack of such services.

He stressed that suicide in pregnancy was real and the Bill was about legislating for the very small but real possibility that sometimes a woman's life could be saved by termination of her pregnancy.

Consultant psychiatrist at St Vincent's Hospital, Dublin, Prof Kevin Malone, who ha carried out extensive research on suicide, said including suicide ideation in the legislation could place a greater number of young male lives at suicide risk than currently.

He asked how would mental health literacy be taught in schools explaining that suicidality was legitimised in the legislation for women in certain circumstances when the pregnant woman suicide rate was two per 1,000,000, but not for young men, where the suicide rate was 350 per 1,000,000.

Prof Malone said abortion was not a treatment for mental illness in any psychiatry textbook.

"Four Irish psychiatrists...in the Dublin Maternity Hospitals for over 20 years have not observed one clinical case where abortion was the recommended psychiatric treatment - how can it suddenly become a recommended psychiatric treatment overnight in Ireland upon this legislation?"

Dr Jacqueline Montwill of Mayo Mental Health Services said there was no evidence to support the view that abortion had any mental health benefits, but there was evidence to support that in some women abortion may be associated with small to moderate increases in risk of mental health problems including suicidality.

"There is an ethical problem in offering a procedure as a life saving treatment to a suicidal woman, where that intervention also poses risks of suicidality as an outcome," she told the Committee.

Dr Montwill said it was most important to stress that a psychiatric emergency or crisis was fundamentally different to any other medical or surgical emergency.

"This is because of the nature of the disorder. In a true psychiatric emergency, the patient's judgement is frequently impaired. Our role at that time is to administer the most appropriate psychiatric treatment and support. It would be highly inappropriate to impose an irrevocable intervention at that time, when the patient may not have sufficient mental capacity to give a valid consent to that intervention."

Dr Montwill said it was her view that if a termination was prescribed and given at that time, the patient would be in a strong position to accuse their treating team of failure in their duty of care .

The hearings will conclude tomorrow.

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