Suicidal women struggle to get second opinion when seeking an abortion
Expert teams are not always available when assessment needed
Concerns have emerged at senior HSE levels about the failure to always secure a psychiatrist to give a second opinion in cases where a pregnant woman is seeking an abortion on the grounds she is suicidal.
An internal document said in some cases it has meant the two psychiatrists and obstetrician, who are required under law to make an assessment in such cases, cannot be found.
Abortion is allowed in cases of suicide risk under the Protection of Life During Pregnancy Act of 2013, which came into effect in 2014.
The abortion can only be allowed if the doctors agree she is suicidal. If she is turned down, the woman then can apply for a review before another panel.
However, in an internal report authorised by Dr Philip Crowley, HSE national director for quality improvement, the lack of availability of a "second opinion" psychiatrist at the initial assessment means that in some cases the woman's application is going straight to review.
Some consultants "are referring to the review process before exhausting all opportunities to get the required second opinion locally", the document obtained by the 'Medical Independent' revealed.
It said this may be due to conscientious objection issues which are allowed for in the legislation.
However, the report also said "it appears that sometimes it is seen as an easier option for a consultant psychiatrist/executive clinical director to refer to a review panel".
It also highlights the difficulty women who have been assessed as suicidal can face if they want to have the abortion in a hospital outside their local area. This can happen within hospital groups or when the woman wants to go to another region.
It said that "further clarity is required regarding responsibility for accepting transfer of care protocols in this regard".
It also pointed to the issues which arise for obstetricians if the pregnancy is advanced and the mother's life is at substantial risk.
There have been few abortions carried out on grounds of suicide risk since the legislation came into effect.
Last year, one abortion went ahead according to the law.
There were three such terminations in 2015 and the same number in 2014.
Dr John Hillery of the College of Psychiatrists said yesterday the issue had not been brought to the attention of the body.
He said a training day had been held for psychiatrists where various aspects of the legislation and doctors' obligations and professional practice were covered.
It is the intention of the college to hold another training day on the issues this year.
The operation of the act, which may come under review if the upcoming referendum leads to widening of abortion laws, has been criticised by some psychiatrists who have described it as a "lottery" in cases of suicide risk.
It means a woman who is in psychiatric distress may end up having to see four psychiatrists before getting an opinion.
This is a disincentive to a woman who does not feel able to undergo that level of medical assessment at a time when she is vulnerable.