Joined-up thinking needed for mental health care services in Kildare

Voices from the frontline

Conor McHugh


Conor McHugh


Joined-up thinking needed for mental health care services in Kildare

File photo posed by models

When Dr Tony Bates, then the Principal Clinical Psychologist at St James Hospital, decided to leave that job in 2007 and establish Headstrong (now called Jigsaw), he wanted to change how people thought about mental health.

He said he was frustrated counselling adults who, if they had had an earlier intervention when they were teenagers, mightn’t have needed any, or at least as much, treatment later in life.

He pointed out an interesting statistic — 80% of all ailments encountered by 20-year-olds were related to their mental health. That figure starts to rise in our teens and falls off just as quickly.

It was self evident, he would always say, that mental health services needed to concentrate on 20 year olds, and the couple of years before and after.

Dr Bates was also involved in a document called A Vison for Change (VfC) in 2006, a government blueprint for the provision of mental health services.

Ten years later, that vision is firmly established as the pre-eminent aspiration, but no more than that.

In 2017, mental health services in Kildare are wholly inadequate, forced to prioritise the needs of those in emergency situations. For that reason, there is little emphasis on early intervention, which was the dominant thrust of VfC.

Early intervention, which is now not being done adequately, would reduce the need for acute services, which is nearly all that is being achieved.

“Unless you’re an emergency case, you’re just not on the radar,” one psychologist, who, like many others interviewed for this piece, did not want to be named, told the Leader.

When somebody gets to the point where they are admitted to Lakeview, the psychiatric unit in Naas, they are are well looked after he said. “But the question needs to be asked why it took for them to get to Lakeview before they were ever seen?

“How did they slip through the cracks?”

He said that 15 years ago he would have spent a good proportion of his time doing early intervention and preventative work with families and individuals — the kind of work that can save people from needing any , or as much, treatment later in life.

In later years, he was just firefighting.

“The other option for people is to go private, which is very expensive, and it’s not fair that people should be put under financial pressure because the service is inadequate,” another psychologist said.

According to Kildare Deputy Fiona O’Loughlin, if you find yourself sufficiently frustrated enough with the waiting lists to get help privately, you are bumped back down the waiting list.

Psychologists working for the HSE say they are a resource that is not being used as effectively as they should. “Psychologists are expensive. They should be supported to spend longer working on what they’re trained to do,” one said, making the case for greater admin support.

“I can spend half an hour ringing clients to confirm appointments, or I can spend longer with a client.”

“These are good people,” he said, referring to people who work for the HSE. “It’s the system that’s inadequate.”

Many psychologists leave the HSE and go into private practice. “They want greater control over their working lives,” he said, adding that they tended not, contrary to popular belief, to work any less or earn any more.

“The problem is that we don’t appreciate social workers,” a woman who is on the frontline of providing mental health services said.

“If you find yourself sitting before a psychiatrist, they will ask you to explain your physical symptoms. A psychologist will ask you how you’re feeling, whereas a social worker will ask you how things are at home.”

Social workers, she argues, are the ones who can connect all the dots and recommend the appropriate services or treatment.

“Social workers deal with the systems, the environment.” She isn’t critical of anybody or any profession. She’d just like greater cooperation and joined up thinking between the various strands of the service.

“People think social workers just take children from families. But they can be the holistic element, like Vision of Change talks about.”