Dr. Matthew Sadlier:

On behalf of the Irish Medical Organisation, I thank the Chair and the Joint Committee on the Future of Mental Health Care for the invitation to discuss the difficulties in the recruitment and retention of medical staff to our community mental health services.

Mental illness represents a significant and growing burden of disease. It is now estimated that half of all people will experience a mental illness in their lifetime, and approximately one in five working age adults suffers from mental ill health at any given time. Mental health issues have been shown to have serious and detrimental consequences with people suffering from chronic, enduring mental health problems having shorter life expectancies by between ten to 20 years. Prevalence of mental health disorders in children and adolescents is also growing with studies showing the prevalence of diagnosable mental disorders as one in six in young teenagers. Mental health disorders in childhood are a strong predictor of mental health disorders in later life. Good outcomes are most likely if children and young people have timely access to advice, assessment and treatment.

Recruitment and retention of medical staff is a major issue across our health services including within our mental health services, specifically. The recruitment and retention of psychiatric consultants and non-consultant hospital doctors is a significant concern. This lack of recruitment leads to variations in access to services with excessive waiting times for outpatient assessments, high usage of locum staff with consequent impacts on budgets and continuity of care, and access to child and adolescent mental health services has reached a critical point with under-resourcing and difficulties recruiting and retaining medical staff leaving young people and their families particularly vulnerable. In 2016, the Mental Health Commission reported that the most cited challenge facing Community Health Organisations was the recruitment and retention of staff across all specialties with particular difficulty in recruiting consultant psychiatrists in child and adolescent psychiatry. While HSE figures suggest that general adult community health teams across the country operate at 78% staffing levels, psychiatry of old age teams at 58% and child and adolescent mental health teams at 53%, the sharing of staff, overtime hours worked and the filling of key consultant positions by locum staff render the full extent of understaffing difficult to quantify. The HSE, in its quarterly performance report from July to September 2017, highlighted difficulties in the recruitment and retention of skilled medical staff as a significant challenge to the provision of mental health services with high agency costs having a significant budgetary impact on community healthcare organisations. In particular, the HSE highlighted recruitment and retention of medical staff to child and adolescent mental health teams as a key factor contributing to waiting lists in excess of 12 months in CHO 1, which comprises Donegal, Sligo, Leitrim, Cavan and Monaghan, and CHO 3, which is the mid-west, including, Clare, Limerick and Tipperary, CHO 4, including Cork and Kerry, and CHO 8, including Laois, Offaly, Longford, Westmeath, Louth and Meath. It also highlighted recruitment and retention of staff as contributing to difficulties reducing the number of children admitted to psychiatric units.

Only 67 child and adolescent mental health teams are in existence out of the 95 recommended in A Vision for Change with many not working at full capacity. Just 66 inpatient child and adolescent beds are available, a figure that falls far below the 100 beds that were required as a matter of urgency in 2006. Since 2006, there has been a population increase of approximately 200,000 of those aged less than 18 years, an increase of approximately 21%, generating even greater need. Furthermore, inpatient beds are available only in the major urban centres of Cork, Dublin, and Galway. This often places treatment options far from the homes of patients in more remote areas of the country. No inpatient beds for child and adolescent mental health services exist in the country's north west, south west, south east, or the midlands, nor in the State's third most populous city, Limerick. Where referrals are required for patients in these regions, they must be sent to already facilities which are already under pressure in Cork, Dublin, or Galway. If we are serious about putting mental health on a par with physical health, serious action must be taken by the HSE to address the recruitment and retention crisis affecting both consultants and non-consultant hospital doctors in our health services.

It is little wonder that the health services in Ireland experience pronounced difficulties in recruiting and retaining medical staff when both remuneration and working conditions lag significantly behind those available elsewhere in the English-speaking world. Independent research on the emigration of health professionals from Ireland has found that “much recent emigration has been driven by dissatisfaction with working conditions in the health system and uncertain career progression opportunities, aggravated by austerity-related staff reductions, salary reductions and taxation increases". This research also indicated that the overwhelming majority of those who leave do not plan to return to Ireland, and experience superior working conditions, training, professional opportunities, and pay abroad. Simply put, no solution can be found to the staffing issues within the mental health services without services that are appropriately resourced to deliver patient care in a safe environment; competitive remuneration of consultant and non-consultant doctors compared to international levels in English speaking countries; adequate clinical and other supports; increased educational and training supports; and enhanced and improved work-life balance.

My colleague, Dr. Ray Walley will address the issues of general practice.