Stretched to the limit: Ireland is lacking in specialist doctors to treat children’s mental health

Mental health services based on assesment see long waiting times. Credit: Orla Dwyer

The Covid-19 pandemic has drawn public and political attention to the Irish health system and the courageous work of health workers on the front line. Before the pandemic struck, reporters from The College View identified and examined some of the major pre-coronavirus challenges faced by the Irish healthcare system, including waiting lists for some chronic conditions, the dependence on locums (doctors in temporary positions) in short-staffed hospitals, and the difficulty some parts of the population – Travellers, the homeless – have in accessing healthcare. These stories present facts and context to understand the Irish health system has been stretched to its limit as it deals with the effects of Covid-19.

Ireland cannot hire enough specialists to treat children and adolescents with mental health problems because poor working conditions and low domestic salaries drive consultants to work abroad, experts say.

Health authorities assess the country’s child and adolescent mental health services (CAMHS) units, which is a free service that helps young people aged up to 18 with mental health difficulties.

Figures gathered from these assessments found that recruitment of mental health specialists failed to meet targets set out in a 2006 government strategy called Vision for Change, a plan for providing sufficient services for people with mental illness.

The assessments are carried out nationwide within nine specific Community Health Care Organisation (CHO) areas.

Figures from October 2019 show that the South-West were the worst off, meeting only 39.9% of the Vision for Change employment target.

The Irish Medical Organisation (IMO), which represents Irish doctors, stated in a 2018 report that poor working conditions, as well as uncertain career progression, were barriers that have resulted in a declining Irish medical workforce, with particular impacts on consultants.

The IMO said that failure to improve consultant contracts has led to the decline in the successful recruitment of Irish consultants. It said that in recent years there has been a 30 percent salary reduction for new entry consultants.

Paediatric consultant, Dr Kieran Moore, said that among other issues within the services, there is the problem of doctors working as consultant paediatric or child and adolescent psychiatrists who are not trained in the specialty.

As a result of this, he said: “Many consultants think what is the point in training for so many years when someone who is not trained can get the same money and pay.”

A further push-factor clarified by the IMO was that Irish trainee doctors often spend longer periods of time training for their consultancy posts than those in countries such as Australia, New Zealand, and England. In addition to this, they remain on lower pay scales and earn significantly less compared to their peers internationally.

Of the five doctors in specialist training with Dr. Moore, only one remains “reluctantly”  in Ireland.

In 2018, Ireland ranked 17th out of 26 European countries with consultant psychiatrist numbers amounting to eight per 100,000.

The College of Psychiatrists of Ireland said there is an  “increasing clinical demand for services” annually and believes this number needs to be doubled to 800 posts across Ireland.

The president of the college, Dr Hillery said that the Vision for Change model was not being followed, as the national budget for mental health services remains at six per cent when a Vision for Change recommended a higher figure a decade ago.

Dr Hillery, said “It is hard to work out why many of the simple recommendations in these reports remain unimplemented as they have been well enunciated for many years…”

Dr Hillery said that he resigned from the HSE due to a lack of progress in mental health services.

Due to staff shortages in the North-West, CAMHS waiting times for emergency cases from referral to first assessment ranged from 48 hours to three months, with follow-up appointments usually taking one to two weeks. Some children in this area were also admitted to adult mental health units.

Linda Hederman is an art therapist who has worked in schools for 12 years with six  to 18 year-olds, including those with special needs and in disadvantaged areas. She said there is a “huge lack of services unless children [are] suicidal”.

She said: “[There is] mostly a very short time frame kids will be seen for. We need three times the amount of CAMHS services to what there is presently.” She also said that CAMHS can refuse children with mental health issues who have significant absences from school.

Dr Moore resigned from his position as a paediatric mental health consultant in Wexford after 16 years as a result of the poor conditions he experienced.

Following his resignation, the position was left vacant for over 18 months. The main cause of this was the conditions of Slaney House, where he worked, which was described as a “serious obstacle” in recruitment of consultants by Fianna Fail TD James Browne.

Moore now works in Our Lady’s Children’s Hospital in Crumlin, where he believes treating patients is made far easier by “the fact that patients are there all the time in front of you”.

He said: “Even if anyone, including management, wanted to try and ignore them, they couldn’t.”

Moore said that “in a hospital environment the only thing that matters is patients and they are seen based only on clinical need 24 hours a day, not the length of the waiting list.”

“Everybody prioritises the children,” said Moore.

Moore stated in a letter published in The Irish Times on 25 August, 2017, that “the unpalatable truth is that working conditions and salaries in other countries are far superior.”

In order to resolve current issues within the system, he believes “the government should end the unfair and self-defeating two-tier salary for new consultants”.

Should this happen, it would improve funding for training colleges and incentivise trained consultants specialists to be trainers, according to Moore.

He said: “If this does not change, the potential for significant clinical risk opens up more and more.”

Rachel Power, Shauna Power, Beibhinn Thorsch

Image Credit: Orla Dwyer