6 hours Ago By Michael McHale
Consultants committee head describes move to community psychiatric services as ‘a logistical mess’ with service availability ‘increasingly determined by a patient’s Eircode’. The ‘dumbing down’ of psychiatric services is having an adverse effect on patients through increased waiting lists, and poor governance and oversight of services, the chair of the IMO’s consultant committee has warned. Prof Matthew Sadlier also criticised the fact that medical professionals across several areas that receive no psychiatric training can determine if a patient lacks capacity.
The consultant psychiatrist was speaking at a panel discussion entitled ‘Confronting the Care Deficit for Patients with Severe and Enduring Mental Illness’ at the IMO AGM in Killarney on Saturday. Prof Sadlier said that the move of psychiatric services from hospital to community settings has resulted in patients not being able to have adequate monitoring of medications and diagnostic investigations, leading to potentially negative outcomes. He added that the distributed model of service delivery has led to a significant postcode lottery for access across the country.
This model leads to non-consultant hospital doctors (NCHDs) and supervisors working in separate locations, which Prof Sadlier believes leads to unnecessary travel and a significant wastage of time and productivity. “Psychiatry is a complex medical specialty, but the HSE treats it as it is a form of applied social care,” he said. “The move to community psychiatric services is a logistical mess, with several key stakeholders regularly working in different locations and the availability of accessible services increasingly determined by a patient’s Eircode.
” According to Prof Sadlier, there has been a consistent downgrading of the expertise of psychiatry. He said that the Assisted Decision-Making Capacity Act and proposed Mental Health Act attempted to make a false equivalence between different professions. Under current legislation, practitioners from eight different fields can determine if a patient lacks capacity and subsequently hand over control of their affairs to another person.
These specialties include occupational therapists, registered midwives, registered nurses, social workers and speech and language therapists. Prof Sadlier criticised this policy and argued that many practitioners from these specialties would have neither the requisite training nor expertise to make a decision on a patient’s capacity. “Neurocognitive assessment is a complex task that requires specialisation to complete adequately,” he added.
“Given that this function can lead to the loss of personal liberty guaranteed by the constitution, not making this a specialist function is mind-boggling.”.
