Dr John Hillery discusses the states failure to meet staffing targets in the mental health sector on Clare FM.

President of the College of Psychiatrists of Ireland, Dr John Hillery, speaks with Gavin Grace of Clare FM, about the states failure to meet staffing targets and how this has affected service provision in the mental health sector.

Dr Hillery highlighted the need to increase the mental health budget which currently rests at just 6% of the overall health budget, which, compared to other country’s budgets averaging at 12%, has been reflected in the shortfall of service provision.

“We have to stick beside that 12% figure, it’s disappointing that it’s half of what other countries equivalent put into their mental health services. If we can’t afford it the government has to say that but they’re not saying it so we have to keep demanding that the same amount of investment be put into mental health services in Ireland as it is in other countries.”

Mental health seems to be the ‘poor relation’ says Dr Hillery, who cites the historic lack of parity given to the funding of the mental services in Ireland;

“It’s interesting when you look historically, a lot of money was being spent on the old asylums, which none of us would want back again, but when those closed down the money doesn’t seem to have gone into the community it seems to have gone elsewhere.”

Funding efforts by government usually favour tangible health solutions such as infrastructure, operating machines and scanners which are considered a one-time purchase. However the problem with mental health services in Ireland, according to Dr Hillery, is staffing rather than objects. Consistent spending on staff, including training and having a variety of staff is key. This is not a once-off payment. In the long run this may be more expensive but it is necessary to ensure people have access to services in the community. If you ask locally, he says, teams will say they would like to have more doctors and allied health professionals help to provide a more community based service for when people turn up in ED.;

“We are looking to create support in the community where people won’t have to go to hospital; they can probably stay at work and be getting on with their lives rather than having to be admitted to hospital in crisis. The ideal is if people are feeling unwell they get immediate support at home. The reality is that it is happening in some areas but not consistent across the country. “

In order to deliver patient focused services we have to look at the different philosophies, for example recovery, and how they are delivered across the country. Recovery is where the patient, working with the MDT, takes the lead on how they get better and how they live their lives. Around the country in each health area they are setting up a situation where there will be a patient and carer representative at the very top of the local mental health services helping the organisation, which is very progressive and not about money. However in order to deliver recovery based care you need a full team to deliver it.

“There is a need for full investment, but there is also an aspect of delivering on the philosophies and asking what are the blocks that stop that from happening where they are not happening.”

Recruitment and retention

Recruitment and retention is one of the main barriers to maintaining adequate staffing levels. Health services in general are finding it difficult to recruit staff, and some of that is due to the economic problems a few years ago which caused a lot of young people to leave the country. Dr Hillery noted that consultants are highly sought after internationally so many young people who qualify from medicine do look to leave the country for a while, where services may be better funded and offer them a better quality of life. Doctor and consultant pay has also been reduced in recent years’ which is also a disincentive to stay in Ireland. He says we need to look at ways at drawing these doctors back;

“The prime way to do that is to have affective services where they want to work…The young psychiatrists who train with me aren’t looking for huge amounts of money, they’re looking for a situation where they can work in the type of teams they’ve trained to work in, so they can work with colleagues who aren’t doctors, for example psychologists, speech therapists, occupational therapists, and social workers…and also have cover when they need to go off and upskill themselves, when they need to do research or further education and not be worried…It’s very hard to get time off, e.g. maternity leave, because there is no cover there. There isn’t a stretch in the system that allows people time off to develop more skills – and we find services very much affected because we don’t have enough staff in place to cover them.”

This is why a lot of consultant posts go unfilled for a long time, the posts aren’t attractive. The College of Psychiatrists of Ireland holds a lot of training for consultants and for junior doctors and, according to Dr Hillery, you regularly see people leave the room to answer their phone because they are actually on-call for their service while they are also trying to upskill themselves which isn’t acceptable.

A Vision for Change

Dr Hillery also highlighted the need to implement a Vision for Change, which was welcomed by everyone in the mental health services and carers in 2006. It is now 11 years on and what should have been a 10 year plan with a revision at the end will now going be superseded by a new document according to government plans. Dr Hillery stressed that we should be implementing the old document and then move on from there.

When a Vision for Change was written the country was in a very different place and it put Ireland on a plan that some say derailed economically. Dr Hillery pointed out that the state of economics at the time shouldn’t have derailed the implementation of the document because it was about a change in the approach to services and recruiting new staff:

“Obviously financial circumstances have impacted the approach of moving services into the community and supporting people in the community but that shouldn’t be the case now.”

Dr Hillery also credited mental health charities and community psychiatric nursing staff who go the extra mile to fill in the gaps in the services, who know families, and are going beyond the bounds of their contracts to help people.