Mental health services at ‘tipping point’, say psychiatrists

CPI president Dr William Flannery said: 'We are at a tipping point. If this continues, as is, we will end up at a full-blown crisis.'

Mental health services at a “tipping point” will require additional resources, including beds, staffing, and funding, to meet a “significant increase” in demand since the Covid-19 pandemic took hold.

That’s according to a new survey of 180 consultant psychiatrists, who reported significant increases in patients relapsing, new referrals, and emergency presentations in the second half of last year.

The survey, carried out by the College of Psychiatrists of Ireland (CPI), shows the impact of Covid-19 on services has worsened since an earlier survey in the initial phase of the pandemic.

About one third of those surveyed reported a “significant increase” in referrals, emergency interventions, and patients relapsing, as well as a rise in self-harm and suicidal ideation and general anxiety.

There is also a rising trend in people presenting with eating disorders.

Burnout

For psychiatrists, the pandemic has also led to increased workloads, an inability to take leave, and burnout.

“Toxic combination of increase in workload and unable to take annual leave due to lack of cover,” one psychiatrist told the anonymous survey.

“Mental health in Ireland needs significant investment but who is listening or acting on what we are calling for?” another said.

CPI president Dr William Flannery said social isolation due to Covid-19 restrictions was a key contributor to the increased demand and that current workloads were unsustainable without additional investment.

“We are at a tipping point. If this continues, as is, we will end up at a full-blown crisis,” Dr Flannery said.

Mental health budget has fallen

The proportion of the overall health budget spent on mental health has fallen from 6% to 5% in the past year and should be more than doubled to 12-14% in line with international norms, he said, adding that the number of psychiatrists will need to be doubled from an existing complement of fewer than 400 filled positions to 800 by 2030.

The service needs more acute mental health beds immediately, while more funding is injected into community services and existing national clinical programmes for eating disorders, self-harm and other needs.

“The more immediate need is beds. In the greater Dublin area, on an average night there may be no beds or only one or two acute beds available,” he said.

The recent cyberattack on the HSE’s IT system is also taking its toll and has put telepsychiatry initiatives “on hold” for the moment, he said: “It makes the situation even more challenging.”

Dr Flannery said the Government must deliver on commitments to appoint a chief psychiatrist in the Department of Health and a director for mental health in the HSE, who could sit at board level, and must also be more transparent around how funding is spent.