GP Dr Eleanor Fitzgerald, who is coroner for North Mayo, told the last day of the MacGill Summer School that the impact of the recession had wreaked havoc — with suicide a problem among young people in particular, amid growing referrals for mental health problems and excess alcohol consumption. She said cutbacks were also damaging the health service.
“In my area, the impact of rising rates of suicide over the past five years is that — based on the figures from inquests held between 2007 and 2012 — suicides have doubled,” Dr Fitzgerald said.
Mayo has the third highest incidence of suicide in the country per 100,000 population, she said, a statistic she found “alarming”.
“Mental health problems and related illness makes up about 40% of our workload in general practice,” she said. “How then do we predict, with limited time and resources, which patients are at risk?”
She said alcohol was “overconsumed by the majority of drinkers” and was associated with 40% of suicides.
Dr Fitzgerald said the stigma of mental ill-health was still very prevalent and that loneliness, isolation, rejection by friends, unemployment, relationship problems or serious financial problems were well recognised as associated factors in suicides.
“There certainly seems to be a connection with the effects of austerity [and] recession, especially felt in our own rural North West Mayo — I’m sure it is the same in Donegal, but also in urban deprived socioeconomic groups. I feel we are losing the close-knit support in communities, because of families being broken up, mistrust among people, lack of faith in religion and church, and a reduction in social interaction etc: as people are using Facebook, Twitter, mobile phones, the internet to communicate, especially our young generation, which is no substitute for good old fashioned one-on-one interaction by way of conversation face-to- face.”
She said work had been carried out locally to co-ordinate services in the aftermath of a suicide and that there was a “clear pathway for families and sufferers to be referred to mental health professional, in a team framework, by their own GP and gardaí [and] this could be replicated nationally”.
“As a GP and as coroner, It is clearly apparent to me personally, the vital importance of the personal contact we have with our patients, how crisis intervention in the consultation can make a difference to a person’s life, [and] prevent potential death. The doctor with a finger on the pulse can make a difference; anything that interferes with that autonomy — be it pressure of time, a lack of resources — will have a negative impact on patient care, now and in the future.”
She also had harsh words for the Minister of Health James Reilly.
“By further cutting funding to general practice, the HSE and the Minister for Health are fundamentally dismantling the fabric of community medicine in this country. General practice only receives 4% of the total HSE spend on an annual basis, yet 92% of all clinical cases are seen in the primary care setting, therefore, is it not good economic sense to invest more at community level at point of delivery of this care?”
She added that more and more layers of administration were being added and there were examples of “cart before horse” reform without basic services put in place, while the primary care strategy had “altered and changed the role of the GP and interfered with the most important relationship known to be effective in delivering care to the patient, ie the doctor-patient relationship”.