Tuesday 15 October 2019

Patricia Casey: 'Harris is latest prince to let 'Cinderella of Medicine' down'

Taking a stand: The Psychiatric Nursing Association held a strike yesterday over union recognition.
Taking a stand: The Psychiatric Nursing Association held a strike yesterday over union recognition.

Patricia Casey

Simon Harris, young, inexperienced and intoxicated by the adulation of the media, is no friend of psychiatry. But perhaps I am being unfair to him since government after government has shown a neglect of our mental health services that borders on being criminal.

We are out of recession, our economy is thriving and we are building the most expensive children's hospital ever constructed, albeit without meaning to, since the overspend seems to have happened by stealth. There is no question of scaling back on the project and according to reports during the week, the Government plans on redirecting finances from other projects to pay for this. This inevitably means that psychiatry will be a victim since it always is.

In 2016, then Health Minister Leo Varadkar was brutally honest when he indicated that he was diverting €12m from the mental health budget for that year to compensate for shortfalls in other areas of medicine. This money had been set aside to develop and enhance 24-hour psychiatric services around the country as part of the suicide prevention strategy. This was a repetition of what occurred in 2012.

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Whatever happened to the moneys accrued from the sale of psychiatric institutions that were supposed to sustain and develop modern services in the years ahead? To this day, nobody knows what this windfall was used for but it appears to have been "stolen" from its psychiatric source.

Known as the Cinderella of Medicine for some unfathomable reason, Ireland's spend on treating mental illness is now just 6.6pc of the total health budget. The budget allocation for psychiatry in 2018 is 10pc below that allocated in 2009. In the 1980s, the mental health budget was 13pc of the overall health allocation.

In terms of consultant psychiatrists, there are now 472 nationally, but in 2003 the Hanley Report recommended that by 2016 the number should be increased to 712 to ensure safe and effective psychiatric services. Of the current posts, more than 20pc are unfilled and of those that are, almost one-third are with locums.

How do we compare with the rest of Europe? Ireland has half the number of consultants per 100,000 of the population compared to the EU average. We are ranked below countries like Romania, Slovakia and Greece. Compared with Finland, a country with a similar sized population, we have less than a quarter of the number of consultants it employs. We have half the average number of inpatient psychiatric beds compared to the rest of the EU, which also adheres to a community model of psychiatric practice. In fact, at 34.8 beds per 100,000 of the population, we are the third lowest for in-patient bed numbers in the EU.

These deficiencies in our services lead to dangerous situations in the provision of treatment. In order to deliver services, the blueprint for psychiatry, 'A Vision for Change', made recommendations that, far from being realised, have shown staff shortfalls of up to 68pc in adult intellectual disability services, 47pc in child and adolescent mental health services, 42pc on psychiatry of old age, and 22pc in general adult teams. These lacunae should hardly be surprising with the diversions and reductions in our funding over the past three decades.

There are humanitarian reasons for being horrified at these deficiencies since they affect people's day-to-day lives, often culminating in life-and-death situations. But there are also economic reasons for lamenting them. As Mental Health Reform Ireland pointed out recently these gaping voids in the services contribute significantly to the €11bn lost to the Irish economy annually, secondary of the loss of productivity associated with mental illness.

The situation in child and adolescent psychiatry is now particularly grave and while this has received some publicity, its seriousness seems not to have sunk in as it might. The huge deficits in filling posts, including psychologists, social workers and occupational therapists, has placed an overwhelming strain on the service. This has culminated in ever-lengthening waiting lists for children and adolescents to see specialists trained in treating childhood psychiatric disorder. The most recent numbers that I have found calculate that almost 2,700 children and adolescents are awaiting appointments with psychiatrists, with almost 400 waiting over one year. The numbers waiting to see a psychologist amounted to more than 6,000 of whom more than 1,600 were on the list for more than a year.

These preposterous and inconceivable figures point to an unprecedented underspend on mental health services. Is there any possibility that some of these posts might be filled in the coming year? This would seem to be a vain aspiration since 25pc of consultant psychiatrist posts advertised in 2015 and 2016 had no applicants and 30pc had one.

The starting point to significantly improve the mental health services has to be an appreciation by the minister that these are at breaking point. Spin about the increase in funding last year mean nothing when all the other specialties also achieved pro-rata increases and psychiatry's proportion remained unchanged.

Do Mr Harris and other former health ministers, including the Taoiseach, not appreciate that the health and lives of all our citizens are important? Seemingly those with psychiatric illness are second to others. This is pertinent when considering the specific syphoning off of funding from psychiatry over the years when there are shortfalls. The door steps and the ballot box are the most potent tools we have in redressing this callous approach to those we psychiatrists treat and those your families love. We should make this abundantly clear the next time we are canvassed and above all when we grasp our pen in the ballot box.

Patricia Casey is consultant psychiatrist in the Mater Hospital and emeritus professor of psychiatry UCD

Irish Independent

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