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Too few staff hampers mental health care
[Posted: Mon 01/10/2007 by Angela Long]

A lack of psychologists, and specialist staff generally, are the biggest limitations on mental health care in Ireland, according to a leading psychiatrist.

Patricia Casey, professor of psychiatry at UCD and consultant at Dublin's Mater Hospital, spoke to after presenting a report on experiences of patients suffering from depression and bi-polar disorder.

The Living With Mental Illness in Ireland survey was co-sponsored by help group Schizophrenia Ireland.

Prof Casey said the survey's results tallied with a similar international study that showed few patients received substantial treatment from psychologists.

As psychologists are not trained medical doctors like psychiatrists, they cannot prescribe drugs but are regarded as essential for 'talking therapies'.

Prof Casey said in her own Dublin health district there were three psychiatrists, but only one psychologist, and this was not enough.

"Psychiatrists [in the health service] tend to be very busy and will not have the time for in-depth talking sessions, but it is absolutely necessary as a complementary treatment to medication," she said.

There has been criticism of an over-reliance on drugs for mental patients, both in Ireland and abroad. The latest is in the book, The Bitter Pill (reviewed on this site), in which a junior doctor claims that we are developing a 'culture of cure by pill' regarding mental illnesses.

Prof Casey says she does not believe drug use is seriously overdone, but that there is an overuse of tranquillisers and sleeping tablets for physically ill patients. "People are often discharged from hospital with medication but no monitoring," she said.

Depression is being over-diagnosed, and accompanying this is an over-prescription of anti-depressants, because there is not time for slower therapies, and people want to feel some action is being taken.

Ongoing freezes and caps on hiring have had a detrimental effect on mental health services in Ireland. "Across the board the HSE restrictions mean we can't recruit new staff when we lose old ones. Recently we hoped the cap on hiring would be lifted, but then the latest freeze began."

She relates one story from the Mater, when a nurse was needed to mind a very disturbed patient admitted in the middle of the night. "There was nobody. If the patient tried to leave they would have had to let him go."

Apart from only having one psychologist and three psychiatrists, Prof Casey said the waiting time for appointments in her clinic is six to nine months.

"That is of no assistance when people need treatment. By the time they get their appointment the problem will have passed, or gotten much worse,? she said.

At the launch of Living With Mental Illness, figures were given to show that most people still feel severely stigmatised by their illness, especially with regard to work and social relationships. Most of the subjects of the survey suffered from schizophrenia and bi-polar disorder.

Perhaps the strongest finding was that only one person in 10 believed their condition was represented accurately in the media. And only one in five believe that the general public understands mental illness.

More than seven in 10 people in the Ireland survey said their condition had negatively affected their relationships. Nearly two thirds, at 64%, said their job prospects had been damaged.

But while three-quarters of the respondents said their mental illness was a bad thing, one in five (21%) viewed it positively, as an experience that had given them insight and depth. ?That is surprising, but a testament to the resilience in people?s lives,? said Dr Casey.

The Irish survey is the result of interviews with 280 people. A similar survey with patients in six other countries, the US, Canada, France, Spain, Italy and the UK, was also assessed and the responses compared with those in Ireland. The interviews were done in the middle of last year.

Generally people in Ireland felt there was more of a stigma on mental ill-health than in other countries, especially Spain and Italy.

Prof Casey said the survey?s main aims were to assess the impact of medication for mental illness, how illness affected patients and their families, and how people felt about media portrayals of mental illness.

Over three quarters of the sample had suffered from their illness for more than 10 years. But an even larger number, at 88%, had only been diagnosed within the past five years.

?There is obviously a delay in diagnosis, particularly with schizophrenia,? Prof Casey said. ?The earlier a mental illness is diagnosed, the better the prognosis.?

She said most people (86%) were chiefly treated by a psychiatrist, while half mainly saw a GP.

Another worrying trend, reported by the survey, was that psychiatrists tended to become responsible for all health problems in a patient, even where they were physical and not mental complaints.

?Psychiatrists tend to take over all treatment, which adds to the separation of people with mental illness from the rest of the population, and I don?t think that is very healthy,? she said.

*World Mental Health Day is on Wednesday October 10.
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