HSE mental health centres can't provide therapy to patients due to understaffing

Cork East TD Liam Quaide said in-patient mental health settings should be 'places of therapeutic care and recovery' and not 'reduced to beds, medication, and observation.' Picture: iStock

Mental health centres around the country are having to offer beds and medication only to distressed extremely vulnerable patients due to chronic understaffing levels.

Those impacted include people potentially experiencing severe depression, psychosis, mania, suicidal distress, or extreme anxiety.

Multiple approved centres currently have just nursing and psychiatric staff available to care for vulnerable patients, with essential multidisciplinary services such as psychology, occupational therapy, and social work left either vacant or dealing with recruitment issues.

The issue is particularly acute in the Midlands, where no psychologist, occupational therapist, or social worker has ever been assigned to any of the region’s three centres.

Approved mental health centres are registered psychiatric in-patient units or hospitals. There are roughly 60 of them nationwide, with upwards of 2,000 patients resident at any one time, plus a further 50 in child mental health services and close to 16,000 admissions a year.

The median length of stay for an in-patient in these centres is just over three months.

The Mental Health Commission's code of practice for approved centres says multi-disciplinary teams at each centre should include psychiatry, nursing, social work, clinical psychology and occupational therapy.

Psychology, social care, and occupational therapy each provide therapeutics for different facets of need for each patient — from assessing difficulties or trauma, to negotiating family housing and welfare challenges, to delivering the practical skills for a patient to leave a centre safely.

Cork East TD Liam Quaide, a clinical psychologist who received the information on staffing from the HSE via parliamentary question, said: “An in-patient mental health setting should not be reduced to beds, medication, and observation.”

He said people admitted to such units “are often at one of the lowest and most frightening points in their lives”. Mr Quaide added: 

These services cannot just be places of supervision and risk management. They have to be places of therapeutic care and recovery. 

The legal regulations for approved centres stress the importance of such multidisciplinary care, with each resident required to have an individual care plan to be regularly reviewed and updated by their multidisciplinary team.

However, the parliamentary responses to Mr Quaide suggest few approved centres are operating with fully functional multidisciplinary supports.

HSE staffing a nationwide issue 

In the Midlands — including Laois, Offaly, Longford, and Westmeath — the HSE said historically and currently there are no assigned therapists for psychology, occupational therapy, or social work.

In two Mayo centres, there is no dedicated full-time psychology position, while social work postings in both were lost as a result of a series of HSE recruitment embargoes.

At the acute mental health care unit in St James’s Hospital in Dublin, there is no funded or approved psychology post for adult support and no social worker.

The acute mental health unit at Cork University Hospital has no approved psychologist, with support instead provided by community in-reach services — the community unit which sees a client may continue to treat them when admitted to hospital.

Clinical psychologist and Social Democrats Cork East TD Liam Quaide: 'People in acute mental distress throughout the country are being denied the full therapeutic support they need.' Picture: Gareth Chaney

Éist Linn, Cork’s child and adolescent inpatient unit, has had no psychologist for the past 18 months, and no social worker for more than two years, though a candidate was recently accepted for the post.

Mr Quaide said the overall pattern is one of dedicated multidisciplinary care repeatedly being substituted by lesser services such as in-reach, adding that in many cases the gaps seen “are not vacancies at all — the post was never funded, never approved, or was simply removed during a recruitment embargo”.

“People in acute mental distress throughout the country are being denied the full therapeutic support they need,” he said.

A HSE spokesperson said it “regrets any impact” on people using its services caused by the vacancies.

“Where posts become vacant, local management has a responsibility to ensure that the associated whole time equivalent and funding are utilised in a way that best meets service priorities,” they said, including redeployment of resources in order to “better address population needs”.