Wednesday 21 February 2018

Psychiatric services suffering due to chronic lack of funds

At a time when mental health problems are escalating, staff numbers have fallen to almost crisis point

Psychiatric services suffering due to chronic lack of funds.
Psychiatric services suffering due to chronic lack of funds.

Patricia Casey

Recent reports in the media have disclosed that government funding of up to €35m ring-fenced for the recruitment of almost 500 personnel to the mental health services in 2013 may now not be available due to the overspend by the HSE in other areas.

So psychologists, occupational therapists, community nurses and other essential staff may now not be recruited to complete the range of disciplines required by multidisciplinary teams.

In January of this year, the public was informed that suicide prevention services were also being cut. So money earmarked for psychiatry, already struggling due to decades of underfunding, is being further depleted.

The posts affected by this include social workers, psychologists, occupational therapists and a range of other specialist posts recommended by the Department of Health's own blueprint for modern psychiatric services entitled 'A Vision for Change'.

The failure to fill these necessary posts is history repeating itself and is replicating what occurred in 2012 when a similar sum of money, set aside for the mental health services, was diverted to other areas of the health services that had overrun on their budget.

Some of the vacant posts from 2012 are currently being filled with funding released in the last quarter of last year. The specifics of what happened to the remainder of this money, apparently acquired from the sale of land and the attached old mental hospitals, is unknown.

Thus there is an accumulating shortfall of these new posts, extending back to 2012 and continuing into 2013. The reports in our press show that even now, heading into the third quarter of 2013, the recruitment levels planned for 2012 have not been maintained.

Aside from these new posts, older pre-existing posts are not being filled when they are vacated due to retirement, because of the embargo on recruitment, in the absence of savings in other areas. These vacancies are generally for nursing posts in in-patient psychiatric units, most of which are located in general hospitals throughout the country.

The thinking behind this is that bed numbers should be reduced and these traditional nursing posts should be moved into the community or used in the emergency departments as part of the suicide prevention strategy.

The problem with this thinking is that it is ignoring the reality that not all mental illness, especially when it is very acute or severe or when the person is suicidal, can be safely managed in the community.

Many of those who present to the emergency departments in a suicidal state require a period of in-patient assessment and treatment for their own protection. Those who are psychotic or severely depressed likewise need to be thoroughly assessed and closely monitored at least in the early stages of treatment.

Local managers appreciate this and so instead of placing the newly appointed staff in the community or in the emergency department, they have recalled them back to the in-patient wards in order to ensure safe staffing levels.

One could be forgiven for considering that the Titanic analogy is appropriate and that this is moving the deckchairs while the ship sinks. If proof were needed that the psychiatric ship is sinking then we need look no further than the overall numbers for mental health service employees.

These show that in 2013 there are more than 1,000 fewer mental health service employees than there were in 2009. Some areas have haemorrhaged mental health staff – for example, earlier this year the mental health services in Kerry reported that they had lost 30pc of their staff, with a drop from 429 whole-time equivalents in 2007 to 308 in 2012.

In some areas of the country the psychiatric teams have less than 50pc of the personnel recommended by 'A Vision for Change'.

This deplorable situation arises at a time when we learn that our suicide rate, which seemed to have been in decline as in much of the rest of Europe, may be increasing again.

Farmers and young people face numerous stressors and are increasingly reported to be on the brink of suicide and in some high-profile instances have acted on their despair.

Contrast the Government's seeming disinterest in mental health services and suicide prevention with its statements when it took office in 2011.

In its Faircare Policy it promised that in the first phase (to be implemented in years one and two) money from the sale of psychiatric institutions and lands would be ring-fenced and used to improve mental health services. It stated "psychiatric illness must be treated like any other illness, and resourced accordingly".

Everybody knows that the country is in dire financial straits and that pre-election promises will have to be broken. The Government, or rather the Health Ministers, should level with us psychiatrists and with our patients and tell us what has happened to the millions said to have been earmarked for improvements in our creaking psychiatric services. This is the least we and our patients deserve.

Perhaps the Government, cynically, doesn't care, since psychiatric services are seldom raised on the doorsteps.

Irish Independent

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