Ireland’s mental health system is ‘unattractive’ to new recruits, senior medic warns

There are structural problems in Ireland’s mental health services that will take more than a new consultant’s contract to solve, a consultant psychiatrist and head of the Irish Medical Organisation’s consultants committee has said.

Prof Matthew Sadlier said psychiatry “has been the speciality that has the largest number of vacancies when it comes to consultant posts”, with structural issues relating to workload, caseloads and design of services all playing a role in making recruitment difficult.

“As such the contract by itself is not going to solve this problem,” he told Raidió Teilifís Éireann (RTÉ) Radio 1′s Morning Ireland.

Minister for Health Stephen Donnelly yesterday encouraged doctors to accept a proffered new consultants’ contract to help tackle issues with child and adolescent mental health services (CAMHS).

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Problems with the provision for young people have been highlighted in a recent report.

“I know the Department thinks the terms and conditions are better than previous one,” he said. “We have consulted our members since the final document was produced, we’ve had a mixed response – a lot of people have raised concerns about the location aspect of this contracts, the extended working hours of this contract. We’re currently running a ballot of our members – so we’re waiting for the results to come back.”

He highlighted issues with recruiting into a dispersed community model, which is “much more difficult” to recruit staff to than a centralised model.

“If you look at what we’ve done with cancer care in this country, which is spectacular, we’ve had great success and that was based on a system of centres of excellence,” he said.

Psychiatry, he said, is “based on a lowest level of complexity”. “Now if you bought a car in the morning would you prefer a car that was built in a centre of excellence or a car that comes with a badge this was built at the lowest level of complexity?”

There is a morale problem which is very difficult to overcome, he said, and a contract by itself will not overcome it.

“What we need on the mental health side is structural reform from the bottom up and not from the top down,” he said. “We’re blue in the face from saying we are constantly getting restructures of governance structures, of management structures, of national directors, local directors, without that translating to improvements on the ground. What we need is more staff, we need environments where staff are prepared to work, we need to consult the key staff stakeholders because they are the people who will be applying for the jobs and taking the jobs.”