James Cox
Mental health professionals have warned that Ireland is on the cusp of a mental health “emergency” that could last for a decade post-Covid.
Mental health services in the State are under constant pressure and these issues have been exacerbated by the Covid-19 pandemic.
Dr Anne Doherty, liaison psychiatrist at the Mater Hospital in Dublin, and Dr Gillian Moore-Groarke, the psychologist attached to the Bon Secours Hospital in Cork, spoke to breakingnews.ie about the impact the pandemic is having on mental health services.
Dr Doherty was involved in an Irish Hospital Consultants Association (IHCA) report published this week which outlined a lack of resources and “chronic inefficiencies” in Irish mental health services.
One of the stark findings in the report was that 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.
“The volume of people being referred to us in the emergency department has gone up 160 per cent on the last few years,” said Dr Doherty. “Obviously people who turn up to the emergency department are in crisis, these aren't people experiencing mild to moderate problems, they're having severe difficulties.”
“We're seeing the impact already which is unfortunate because you can predict there will be an increased need, and we desperately need the resources to be put in place, so people can get the care that they deserve,” she added.
She described the lack of mental health beds as the “tip of the iceberg”.
“The vast majority of mental health care is delivered on a day basis by community mental health teams, day hospitals etc. They are stretched too, the problem is when community services are under pressure, or not built up to the degree they should be, what happens is we end up relying more on patient care because people get sicker and when people get to a point where there is no other alternative, obviously we have to admit them. Sometimes if you got people a little earlier, you might be able to avoid that.”
Long Covid
While long Covid is an area that is still being researched, specialists have already identified many of the issues associated with people who have recovered from the virus but are still struggling, including brain fog.
Dr Doherty explained that a lot of the symptoms patients are suffering with in the aftermath of Covid are consistent with people suffering with conditions such as depression and anxiety.
“A lot of work has been done on the brain effects of Covid and certainly people do become quite confused, depressed, in the initial aftermath of an acute case of Covid.
“A lot of the symptoms of long Covid are things like low energy, low mood, difficulty with sleep and eating. There's a big crossover between some of those symptoms and what we see in things like depression and anxiety.
“If people are living for prolonged periods of time without enough energy to get back to their normal lives, you can see how that's going to have secondary knock on effects on top of that.”
The Health Service Executive currently spends six per cent of its budget on mental health services, compared to 12-13 per cent in most European countries.
Waiting lists
Both Dr Doherty and Dr Moore-Groarke feel the HSE need to invest more money to deal with the demand for services and long waiting lists.
“Compared to treatments in other areas of medicine, treatment for mental health problems isn't that expensive. It's time heavy, you need the personnel in place, but you get a good return on investment if you can invest those funds in people's well-being," said Dr Doherty.
“We see people on the worst day of their lives in many case and spending hours searching the country for a bed for them, and sometimes there just isn't one. We try to avoid having people waiting in the emergency department because that's the last place you want to be if you're having a relapse of a major mental illness.
“Having adequate bed capacity is a no-brainer, but the second part is staffing. Before we go down the route of looking at extra staffing, the first step needs to be filling the gaps we already have. 30 per cent of consultant posts are not filled. There are similar gaps across mental health nursing and psychology so if all of those gaps were filled that would be a great start and then after that we can start developing things better.”
One person in every five since the start of the pandemic has increased psychological distress
Dr Moore-Groarke has a private practice in Harley Court, Wilton, Cork along with her work at Bon Secours Hospital, and she said the Covid-19 pandemic has contributed to mental health problems across all age groups, however, waiting lists for child and adolescent services are particularly long.
“When you look at mental health, one person in every five since the start of the pandemic has increased psychological distress. What we find in clinic is an increased presentation of anxiety and depression.
“These presentations are not typical to Ireland, the growth and presentation among people with mental health illness is increasing all over the world, that's frightening really.
“Mental health services were already in crisis, with huge waiting lists. What we're finding now is the waiting list for child and adolescent mental health services is growing daily, parents are in the interim trying to access private services while on the waiting list.
“Kids are struggling since school returned. There's a high level of school refusal for both primary and secondary students, we're seeing a lot of that at the moment.
“We're also seeing an increased risk in teenagers in terms of self harm and poor motivation.”
The Covid-19 pandemic has put additional strain on already overstretched mental health waiting lists.
Dr Moore-Groarke feels private clinicians should be utilised by the HSE to help in dealing with long waiting lists, similar to how private hospitals have been used for public patients during the pandemic.
“There are a lot of clinicians working independently and privately. Private hospitals are now being used to reduce waiting lists and I cannot see why this has not been considered to date within mental health services.
“I understand the importance of providing mental health teams, we need psychiatrists, psychologists, occupational therapists and social workers. The work we do as private clinicians kept a lot of people out of hospital prior to Covid and since Covid.
“People with mental health problems often do not present at a time like this and then by the time you reach them they're in an emergency state.”
Dr Moore-Groarke said a huge number of healthcare workers have been suffering with mental health problems since the beginning of the pandemic.
In terms of the 20s age group, the isolation of working remotely has been difficult for a lot of people
“We're seeing presentations increasing right across all age groups. This is huge across healthcare workers, double that of the general population.
“People living alone who have been isolated from families are also suffering.”
She added: “In terms of the 20s age group, the isolation of working remotely has been difficult for a lot of people. A lot of people are presenting with fatigue which is maybe representative of pre-Covid anxiety and depression.”
Both Dr Doherty and Dr Moore-Groarke highlighted unfilled mental health positions as a big issue, increasing the work load for those who are struggling to keep up with long waiting lists.
Dr Moore-Groarke said conditions need to be improved to prevent graduates from seeking work abroad.
We've gone from a crisis to an emergency, and I don't say that lightly
“A very important thing to stress is the mental health professionals and teams we have are doing a fantastic job, but they're very overworked. The case loads for psychology, social work, occupational therapy, speech and language therapy, they're all growing exponentially.
“There's very little time to catch up on the paper work, which is very important because good clinical records are needed.
“Really what we need is a person-centre approach. You can only provide that when you have a full team.
“All over the country, there are so many unfilled psychiatrist positions especially in the area of child psychology. We need to make it attractive, put full teams in place and reduce case loads. We've been talking about this since I was an undergrad in the 80s.
“We need our Irish graduates abroad to come back, we need to make it attractive for them and for them to see they would have a manageable case load, and they won't be overwhelmed by paper work.”
Private practitioners
She reiterated her call for the HSE to work with private mental health practitioners, pointing out that they are often contracted to do public work.
“There are an awful lot of good clinicians working independently, we're all chartered members of the Psychological Society of Ireland, we all adhere to monthly supervision, regular professional development, we network among ourselves and continuously support each other.
“That is something that I would advise the Government to look at to take people off waiting lists and put them into our clinics where we can help and are more than willing to do so.
“Most of us spent time training in the public system, many took the private option because it was conducive to personal lives and allowed us to specialise in certain areas.
The impact of this is going to last for at least a decade
“I speak for all of my colleagues when I say we have invested hugely in ongoing learning, we're required to do so many days of professional development which we fund ourselves, there are a lot of courses we would be interested in doing through the HSE, but we're not allowed to even though occasionally the HSE will call upon us to do work for them.
“We need to look at how everybody within the system can make a contribution and I feel that's how we're going to lower the numbers waiting for mental health services.”
Dr Moore-Groarke described the current mental health situation in the country as an “emergency”.
“We've gone from a crisis to an emergency, and I don't say that lightly, there was already a crisis pre-Covid within the mental health services and it's now an emergency.
“The impact of this is going to last for at least a decade, six per cent of the HSE budget is not enough we have to invest more in mental health, we have to put more staff in place, we have to reduce case loads.
“There's a perception that everyone is working 9-5, that's ridiculous, my colleagues are regularly travelling to meet service users and patients, working 12-hour days.”
