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TheJournal.ie: Emergency departments ‘ground zero’ for a stretched mental health system
Dr Anne Doherty, Consultant Liaison Psychiatrist at the Mater Hospital, Associate Professor of Psychiatry at UCD and chair of the Faculty of Liaison Psychiatry at the College of Psychiatrists of Ireland writes for TheJournal.ie about how emergency departments are drowning under the additional pressure of increased mental healthcare need during COVID-19.
Read excerpts from the article below. You can read the article in full on TheJournal.ie here.
Dr Doherty details the role of specialist liaison psychiatrists working in emergency departments, where many people present with self-harm and attempted suicide. This leads to a high risk of burnout even with adequate staffing.
“Such services were stretched before Covid-19, but with the reduction in face-to-face appointment in the community, and rising need for services, EDs are now busier than ever.
“They have become ‘ground zero’ in the post-Covid world of increased mental healthcare need.”
Also noted is the worrying fact that Ireland has one of the lowest proportions of hospital beds for psychiatric care in the developed world, and that this number is dropping every year. Today, “we have just 22 acute public mental health beds per 100,000 population, compared with the EU average of 70 per 100,000.”
“With every bed we lose, our threshold to admit someone to hospital must rise. Patients need to be sicker and sicker before we can justify an admission to hospital. […]
“What ultimately happens when we don’t have enough beds? The people who need them end up homeless, in prison, and in the ED. We read with horror, a report published in November by the Council of Europe that detailed inhumane conditions endured by mentally ill prisoners, who cannot be transferred to hospital because there are no beds for them.”
Liaison teams in Irish hospitals across the country are “drowning under the additional pressure.”
“No liaison psychiatry teams in Irish hospitals are resourced to the minimum standards in the HSE’s A Vision for Change policy report published when we had 400% of our current number of beds. Many hospitals do not have psychologists or social workers on the teams.
In University Hospital Galway, for example, the liaison psychiatry team is staffed at 30% of the recommended level in A Vision for Change.”
Despite the overwhelming strain on liaison teams, sufficient emergency department services alone are not the answer.
“Patients need to have access to beds and community-based crisis services: whichever the person needs at a given time. The policy of continually reducing bed numbers needs to stop now.
“We need to implement the recommendations of the Joint Committee on the Future of Mental Health Care and ensure adequate bed provision. Properly resourced specialist teams are urgently needed, and mental health services need adequate funding.”