Resource-scarce Ireland an “outlier” in psychiatric care, but increased beds and fully staffed mental healthcare teams will improve patient outcomes
Ireland’s mental health services are struggling with 30% of permanent consultant psychiatrist posts vacant and just 1,000 acute adult mental health beds
- 22 adult acute mental health beds per 100,000 population in Ireland compared to EU mean of 70 per 100,000, leading to difficult choices for doctors
- Dr Anne Doherty, consultant liaison psychiatrist, says inpatient psychiatric care is now reserved only for “seriously ill”
- Chronic service inefficiencies, combined with Covid impact, will mean longer recovery time for patients with mental illness
- Ireland must become a “more attractive place to work” if HSE is to bring specialists working abroad home and to meet EU standards.
A leading consultant psychiatrist has described Ireland's resource-scarce mental health services as an “outlier” and “very much behind” the rest of Europe, an issue that has been compounded by the Covid-19 pandemic.
Dr Anne Doherty, a consultant liaison psychiatrist at the Mater Hospital in Dublin, speaking on behalf of the Irish Hospital Consultants Association (IHCA), said that Ireland has only 22 adult mental health beds per 100,000 population compared to a mean of 70 per 100,000 across the EU.
“When I graduated from medical school in 2005, there were 4,000 acute mental health beds in Ireland. That number has now decreased to 1,000. In real terms, what that means is that for every four patients we would have admitted to hospital in 2005, we would only admit one today.
“That means hospital consultants regularly have to make very tough choices about who gets a bed and who doesn’t. Inpatient care now is only reserved for the most seriously ill patients.”
Poor consultant recruitment and retention is also limiting the provision and effectiveness of mental healthcare in Ireland, says Dr Doherty. Currently, 30% of permanent consultant psychiatrist posts remain vacant, one of the highest vacancy rates for any medical specialty.
“We train enough doctors in the specialty every year, but the problem is, like with every other area of medicine in Ireland, psychiatrists are leaving for or remaining in other English-speaking countries, where they are not being treated in an inequitable manner and their working conditions are better,” said Dr Doherty.
“Because these countries’ health services are functioning better than ours, it’s very difficult for Irish doctors to decide to come home and, for example, make those very difficult choices of who gets that single mental health bed when you have four people who need it.”
The impact of the pandemic
As with all areas of the health service, the Covid pandemic has impacted the delivery of timely psychiatric care. Dr Doherty described restrictions on in-person appointments as necessary, particularly as poor mental health, after age, is a leading contributor to severe cases of Covid. However, the impact of such delayed treatment will lead to longer stays in hospital for patients with severe mental illnesses, in hospitals that are already stretched beyond capacity.
Growing waiting lists for diagnosis and treatment in other areas of medicine will also have knock-on effects for psychiatric care as patients develop secondary mental health symptoms, according to Dr Doherty.
“People with chronic pain have had to wait a very long time to access care because of the shortage of consultants. We know that a significant majority of people with chronic pain will develop problems with anxiety and depression.”
What can be done?
Dr Doherty believes that Ireland’s outlier status in psychiatric care in Europe can be improved by focusing on three key areas: consultant recruitment, mental health teams, and bed capacity.
“We need to attract and recruit highly trained specialists to fill the large proportion of vacant consultant positions. They’re staying in Australia, Canada, and the United States. We need to make Ireland a more attractive place to work.
“Ending the inequity imposed on consultants taking up contracts from 2012 is essential to attract and retain the number of psychiatrists we need. This is a long-standing issue that needs urgent Government action. Failure to address this barrier to recruitment and retention has led to the current situation where 30% of our consultant psychiatry posts remain unfilled and one in five consultant posts across all specialties are vacant.
“We must also prioritise investment in beds. Until we are further in line with our EU peers, we’re going to struggle to provide adequate mental health care in Ireland post-Covid.”
Commenting, IHCA President, Professor Alan Irvine, said:
“We simply do not have the resources and the number of consultant psychiatrists required to provide high quality, timely care and treatment to patients who need it.
“The appointment of additional consultants is the key enabler required to tackle the unacceptable waiting lists in our hospitals and mental health services.
“The Government’s latest mental health strategy, published last year, provided no clear plan to address the significant deficits in our mental health services – the new policy kicked the problem down the road with a suggestion of a further review of acute inpatient capacity. This is simply not good enough.
“As Ireland moves towards a plan for reopening our economy and society, we must start to focus decision-makers’ minds on addressing the fallout from Covid on healthcare. Action must be taken now by Government and the health authorities to prevent another crisis in our hospitals.”