Crisis in mental health services blamed on underfunding and consultant shortages

Underfunding and a shortage of consultants have lead to a crisis in mental health services, according to the Irish Medical Organisation. Picture: Gareth Fuller/PA Wire

Mental health services are in crisis due to long-term underfunding and a decade-long battle to recruit enough consultants to meet soaring demand, with the situation in Camhs services in Co Kerry an example, according to the Irish Medical Organisation (IMO).

Professor Matthew Sadlier, consultant psychiatrist and former president of the IMO, told the Oireachtas Sub-Committee on Mental Health on Tuesday morning that new legislation was required to underpin services for those who need them and to ensure there wasn't a further fall in the standard of care.

Prof Sadlier said funding for mental health in Ireland now stands at just 5.5% of healthcare funding, compared to 10% in the UK and Canada, 13.5% in Norway and 15% in France.

"We have a consultant recruitment and retention crisis," he said, adding that 136 out of 485 consultant psychiatry posts are unfilled or are filled on a temporary locum basis. "That is almost one-third of posts and the highest for any speciality.

"Particular deficits arise in our Camhs services, where in excess of 3,300 children are waiting for a consultant appointment — 6% of these are waiting in excess of a year.

"We have an over-reliance on non-training NCHDs [non-consultant hospital doctors] to deliver services when services should be delivered by consultants and NCHDS in training."

He said the National Doctors Training and Planning (NDTP) service estimates that 628 additional consultants are required over the next 10 years to cope with additional demand and to replace those retiring or leaving the service.

Prof Sadlier said there were also significant shortages of key support staff including psychiatric nurses, counsellors, psychotherapists, occupational therapists and social workers, at a time when there was also a shortage of in-patient psychiatric beds and when acute adult psychiatric units were operating at almost 90% occupancy, well above the 85% safe occupancy levels.

"There is no dedicated or resourced time within general practice to deal with mental health issues and in many cases, the only option is to refer," he said.

"We must be sure that in amending our legislation we are not further lowering the standard of care provided in our health services nor creating additional barriers to access."

The committee is hearing pre-legislative scrutiny of the Mental Health (Amendment) Bill 2022 and the IMO raised a concern about the draft bill over a proposal that a consultant would have to consult with at least one other mental health professional before certifying an admission order.

It also said any plans to have authorised officers as the only people allowed to make an application to a medical practitioner for involuntary detention would have to ensure those people were available 24 hours a day.

It also argued that children needed to be defined as anyone under the age of 18, given how some services are currently only available to those aged 16 and under.

The IMO comments came as the Irish Association of Social Workers issued a strongly worded statement on the recent Maskey Report into the situation in South Kerry Camhs.

It said it was concerned at the findings and IASW chairman Vivian Geiran said: “The report on Kerry Camhs is a worrying example of systemic failure. It highlights the need for clear oversight and governance structures to be in place in Camhs services around the country."

The IASW said at present Camhs was sometimes seen as a sub-set of adult mental health services rather than an equal partner, and was clearly understaffed.