IMO argues ‘dumbing down’ of psychiatric services having adverse effect on patients

The Chair of the IMO consultant committee has warned that the “dumbing down” of psychiatric services is having an adverse effect on patients through increased waiting lists, and poor governance and oversight of services.

Prof Matthew Sadlier, who is also a  Consultant Old Age 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 26 April.

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 difficulty in governance, with NCHDs and supervisors working in separate locations, and unnecessary travel leading to significant wastage of time and subsequent productivity.

He said: “Psychiatry is a complex medical specialty, but the HSE treats it as it is a form of applied social care. 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.”

Prof Sadlier added that there had 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.

Prof Sadlier said that practitioners from eight different specialties 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. He said 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. 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.”