IT In The News Podcast: What does South Kerry CAMHS report reveal about Irish mental health services?

It used to be the case that the majority of junior doctors in Ireland were in training posts, were training to become consultants. They were under the supervision of the consultant in whatever the field was. And that has shifted now, where we have more non-training doctors. But in any case, a non-training doctor could still be working under the supervision of a consultant, but in this particular case in South Kerry it was a junior doctor with, as far as we know, no training at all in psychiatry, who was working without a consultant supervisor.

Asked whether the individual doctor is to blame or whether it is down to a more national and systemic issue, Dr Kelleher said:

This service allowed a junior doctor to work unsupervised, and we know that that’s not safe. There’s a reason why we train people for seven years to become specialists in different areas. It’s not simply a case that you can replace them with a junior doctor who hasn’t done specialty training. So I think that is a systems issue. Why was a junior doctor allowed to work unsupervised? It’s not safe for patients, and it’s also not safe for the junior doctor.

Speaking on the shortage of CAMHS teams in Ireland — around 70 around the country where there should be at least 100 — Dr Kelleher outlines further problems that lie underneath those figures:

Even that I think is a bit misleading, because people might think “Okay, 70 out of 100, it doesn’t sound so bad.” But actually when you look within those teams, many of them are grossly understaffed. So some have under 50% of their required staffing to run a CAMHS team. So resourcing is an absolutely huge issue across the board, from the individual CAMHS teams, to sub-specialist services that are supposed to support those CAMHS teams, eating disorder teams, psychosis teams, day hospitals… Those are hugely underfunded and under-resourced…. We have one of the lowest numbers of consultant Child and Adolescent psychiatrists in the Western world.

In 2013, the government introduced a pay disparity between consultants, so consultants recruited after 2013 are paid 30% than consultants recruited before 2013. And so the reality is you have equally qualified people coming in to do exactly the same job, exactly the same work, and a huge pay difference between them. And a lot of consultants decide, “I’m going to move abroad where I’ll have a better terms and conditions, and I won’t have to face that daily insult of being massively underpaid compared to some of my colleagues.”

Asked about how this is affecting patients, and especially children:

One of the issues is… long waits. Young people can wait for a very long time on wait list to get to see a specialist. There certainly are CAMHS services that have a wait list in excess of a year. And that’s really not acceptable. We know that early intervention for mental illness has a massive impact. We also know that the majority of mental health issues that will be serious in adulthood actually have onset in childhood and adolescence, and so you are investing early to save later. To save from a health perspective, but also from an economic and fiscal perspective. So not having these resources means that… illnesses become more severe. People drop out of school, people don’t go to college, people don’t go on to training courses, people aren’t able to take part in the work force. They become disabled as a result of not getting the early intervention that they need.

More specifically, there are of course all the risks of running a specialist health service without specialist input, in terms of coming to the correct conclusions about diagnoses, the correct conclusions about treatment, and then monitoring the treatment, monitoring response, monitoring adverse outcomes.

Listen to the podcast in full on Irish Times website.