Monday 18 December 2017

Mental health Cutbacks will eventually cost us

Leo Varadkar
Leo Varadkar

Patricia Casey

Health Minister Varadkar was brutally honest a few weeks ago when he indicated that he was planning to divert €12m from the mental health budget for 2016 to compensate for shortfalls in other areas of medicine. This money was set aside to develop and enhance 24-hour psychiatric services around the country, which included the appointment of 1,500 extra staff.

This incredible admission has drawn the ire of mental health professionals, mental health activists and, thankfully, some politicians. It is hard to identify a more cynical exercise than robbing an already poverty-stricken Peter to pay the more well-heeled Paul.

The increase in funding for mental health that was agreed in the 2016 Budget should not be regarded as a slush fund or a crock of gold. Money should not be stolen from it with the agreement of the sitting Minister.

Why are round-the-clock services for those with mental health problems less worthy than for those with surgical or medical problems? Why is the life of a person with depression, who is acutely suicidal, less worthy than the life of a person at risk of dying from an acute physical illness?

By the reckoning of some decision-maker in the Department of Health, some people's lives and health are more important than than others. By cutting the budget, Minister Varadkar is acquiescing with this despicable and dangerous view.

Dr John Hillery, spokesman for the College of Psychiatrists of Ireland, commented: "Talk of dispersion of funds from mental health to other areas reflects an ambivalent attitude to mental illness by some decision makers."

He is correct. Does Minister Varadkar believe that mental illness exists, that it can blight the lives of those who suffer with it and that in some instances it is fatal?

Death stops a beating heart and whether it is by suicide or from renal failure, the loss is irrevocable and heart-breaking for those left behind.

Illness, mental or physical, causes suffering to its victim and places a burden on families and on the wider society. And all long-term illness affects the realisation of the full potential of the individual. Yet Minister Varadkar seems to not subscribe to parity of esteem between psychiatry and other branches of medicine.

In the 1980s, 13pc of the health budget was devoted to mental health, now it is 6pc, while in Britain, it is currently 10pc. Yet, the Minister is willing to oversee a raid on the meagre funding we currently receive.

Psychiatry needs frontline staff to deal with a range of patients presenting with acute mental health problems. This might be suicidal behaviour, acute psychotic episodes or relapses of those already under the care of psychiatrists.

Mental health nurses, specifically employed to work in emergency departments with suicidal patients, have only been appointed in some hospitals, and others who were in these positions have been moved to fill more acute shortages.

In total, there are 600 vacancies for psychiatric nurses, both in hospitals and in the community. Their union has recently threatened strike action.

Consultant numbers have plummeted as newly trained psychiatrists leave to find work in countries offering more attractive conditions. We currently have eight consultants per 100,000, while 16 per 100,000 are recommended to match the numbers in other countries.

The same problems exist with regard to junior doctors training in psychiatry. Fifty percent emigrate to Australia, Canada and Britain for better terms and conditions.

There are 500 junior doctor posts in psychiatry, of which just 200 are filled from our national training scheme. The remainder are either filled by locums (who earn one-and-a-half times the salary of those in training), by doctors wanting a brief period of experience in psychiatry, or they are left vacant. This is not a safe way to staff a service under strain.

In the Mater Hospital where I work, on two occasions in the past year (about four days each time), we had to close the ward to acute admissions as we did not have enough nurses to staff it. On several occasions, we have discussed suspending our emergency services because of junior doctor shortages and we have to do this on one occasion about 18 months ago.

Maintaining a responsive, comprehensive and safe psychiatric service has been demanding and demoralising and we constantly teeter on the edge of a monumental catastrophe.

Now, the Health Minister has decided that none of this matters and cocks-a-snook at the concerns of mental health workers for our patients' treatment while we are left to manage on a shoestring.

The perverse, cold and callous decision to steal our funding is immoral. It should not be accepted without a battle. Our patients need and deserve no less.

Health & Living

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