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Patient having a severe psychotic episode was turned away from hospital – Kenny

4 April, 2019 - by Martin Kenny TD


Sinn Féin TD for Sligo, Leitrim, North Roscommon and South Donegal, Martin Kenny, raised the lack of out-of-hours psychiatric services in Sligo with Minister of State Jim Daly during a topical issues debate in the Dáil this week.

Deputy Kenny recounted the recent experience of a constituent of his who has been using the mental health services in the North West for some time and who due to a trauma in his youth can experience severe episodes.

Deputy Kenny said:

“When a severe episode occurs, this person is inclined to self-harm, wrecks his whole house and lashes out at everybody around him.  He is a danger to himself and others. 

“The service providers told him that if ever he sees an episode coming on, he should go to them, that the door would be opened and they would take him in and look after him.  He did so less than a week ago, but when he arrived at St. Columba's out-of-hours there was nobody there. 

“He sat for two and a half hours before he saw a junior consultant, who spoke to him for approximately half an hour and then told him he was okay to go home.  He felt let down by the service and went home as distressed as he was when he arrived. 

“A couple of days later, he phoned gardaí and asked them to come and take him away or he would do something terrible.  The gardaí had to bring him back into the services.  This is one case but there are numerous others, sometimes involving young adolescents and children. They find there are huge holes in the service.

“While there may be a junior consultant on call, that same person is also on call in Sligo University Hospital up the road and may be dealing with people there and not able to leave. 

“I want the Minister of State to find out about this.  When this happens there is supposed to be a back-up junior registrar on call.  How often has that person been called in?  I have been told that person has never been called in.”

Minister of State Daly acknowledged Martin Kenny’s bona fides on this issue and added:

“The HSE is currently rolling out several pilot schemes around the country in the area of delivering mental healthcare online, including psychology and psychiatry.  That is how we will address the gaps in the system.  Rather than psychiatrists spending three hours travelling to see a patient, they will be able to spend that time online treating multiple patients.”

Martin Kenny thanked the minister for his response and asked that one of the pilot areas for the new system might be in Sligo-Leitrim.” ENDS

Note: Please see a transcript of Dáil exchange below

Deputy Martin Kenny: I raise the issue of out-of-hours mental health services in the North West, particularly Sligo.  The Minister of State will read a response and tell me there are out-of-hours services in place, junior doctors on call and a junior doctor on back-up call.  However, the experience of people in the region, particularly counties Sligo and Leitrim, is very different.  I give the example of a constituent of mine who contacted me about his son, a young man who has been using a mental health service for a considerable period.  As a result of abuse suffered in his youth, this young man has had mental health episodes for many years and has been in and out of hospital on numerous occasions.

His family was a great support to him and was working with him and trying to help him but they were advised by the mental health service to back up a little as it was not good.  They were told the mental health service would put a team around him to help him, a social worker would be put in place, which there was, and the primary care unit near his town would come into play and help look after him.  The social worker retired and was not replaced.  The primary care unit that was supposed to provide mental health services is very ad hoc and on numerous occasions when the man phoned nobody answered and he did not get a call back.  On a couple of occasions, his father has helped him, spoken to him about it and gone with him to the mental health services.  When a meltdown happens this person is inclined to self-harm, wrecks his whole house and lashes out at everybody around him.  He is a danger to himself and others.  The service providers told him that if ever he sees a meltdown coming on, he should go to them, that the door would be opened and they would take him in and look after him.  He did so less than a week ago but when he arrived at St. Columba's out-of-hours there was nobody there.  He sat for two and a half hours before he saw a junior consultant, who spoke to him for approximately half an hour and then told him he was okay to go home.  He felt let down by the service and went home as distressed as he was when he arrived.  A couple of days later he phoned gardaí and asked them to come and take him away or he would do something terrible.  The gardaí had to bring him back into the services.  This is one case but there are numerous others, sometimes involving young adolescents and children. They find there are huge holes in the service.

  With regard to primary care, there is supposed to be a community service for mental health patients.  However, that community service is effectively vacant when people look for it, certainly in the Sligo and Leitrim region.  When people arrive out-of-hours at St. Columba's in Sligo nobody is there to help.  This is a reality for many people.  While there may be a junior consultant on call, that same person is also on call in Sligo University Hospital up the road and may be dealing with people there and not able to leave.  I want the Minister of State to find out about this.  When this happens there is supposed to be a back-up junior registrar on call.  How often has that person been called in?  I have been told that person has never been called in.  People have waited for hours with nobody to see them in very distressing and disturbing circumstances.  This is a serious problem that needs to be dealt with.  If people are continually turned away from the service, the next time we speak will be to discuss a tragedy after someone has been turned away from the service.  We do not want this to happen.  I certainly do not want it and the Minister of State and the Government, who are responsible for the situation, certainly do not want it.

Deputy Jim Daly: I thank the Deputy for raising the issue of mental health services in his area.  As he knows, this is a priority.  It is not just about money.  Money will not solve the problems in the service but €105 million has been provided in new development funding over the next three years, very specifically to extend mental health services to a seven-day week.  This is our first priority.

Sligo Leitrim mental health services provide a broad range of mental health services to the populations of Sligo, Leitrim, south Donegal and west Cavan.  Services provided encompass general adult psychiatry, psychiatry of old age, rehabilitation and recovery, mental health of intellectual disability and child and adolescent mental health services.  Services are provided directly in the community and in clinical and residential settings.  Sligo Leitrim mental health services operate a seven day a week, out-of-hours service based in the primary care centre in Ballymote.  This provides acute mental health treatment and support to individuals from the hours of 9 a.m. to 5.30 p.m. seven days a week.  The services also provide a rehabilitation and recovery service that includes home-based treatment and assertive outreach models of care to clients known to the mental health services.  These are also co-located in the Ballymote primary care centre and operate from 8 a.m. to 8 p.m. seven days a week.  In addition, our emergency departments provide national coverage through a 24-7 service from which members of the public receive acute mental health care and treatment.  In Sligo, the emergency department of Sligo University Hospital provides this out-of-hours service.

I acknowledge the case raised by the Deputy.  I will not comment on a specific case and I know the Deputy is not asking me to do so but is using it as an illustration.  He will understand and appreciate, therefore, that I cannot respond.  However, I will say that I recognise and acknowledge that one of the greatest causes of distress for parents and other family members is to be with somebody who has, as the Deputy described, a meltdown or an episode of psychosis.  Having to deal with this is very traumatic.  The reality is that the out-of-hours service available at 1 a.m. or 2 a.m. is based in the emergency department of the local hospital.  The Deputy referred to somebody being turned away from the service.  This is something I will not be able to comment on or deal with because it is a clinical decision made by a medical person and I am not here to judge the decision made by a qualified medical practitioner.

To give the Deputy some idea of the thinking on this, the challenge we will have far into the future, and what I am trying to do in this area, is to provide for online psychiatry.  We will never be able to staff a 24-hour, seven day a week service led by a consultant psychiatrist in every county.  It will never be possible and that is the reality.  There is a real shortage of consultant psychiatrists worldwide.  We will look at how we provide that cover a bit better.  The worst place for anybody to be having an episode of psychosis or a meltdown is inside in an emergency department while waiting for two or three hours to be seen by a consultant psychiatrist.  What they do in other parts of the world is deal with this through online psychiatry, whereby people can be assessed by a consultant psychiatrist immediately through online televisual conferencing.  People can be assessed, diagnosed, prescribed and admitted, if necessary, there and then by wheeling up a cart similar to a blood pressure or BP cart, turning on a screen and having a psychiatric consultation.  We will never be in a position of having a consultant psychiatrist sitting in Sligo waiting for the one presentation that might occur in a 24-hour period.

Today, I looked at the figures for another part of the country and the number of presentations in a busy city area.  There were 14 out-of-hours presentations there in the entire year.  We have to look at how we do what we do, and the plan I am trying to develop is having available online psychiatry.  It works throughout the world and would cover a number of different sites and provide immediate access to that key decision capacity.  It would be done in an emergency department with doctors and nurses but the consultant psychiatrist providing the clinical governance would cover a number of different sites with online availability.  This is my hope for the future.

Deputy Martin Kenny: I thank the Minister of State.  I acknowledge that nobody expects there to be somebody there every minute of the day but, at the same time, the level of difficulty that people come across in these situations is acute.  The Minister of State mentioned the out-of-hours service in Ballymote.  Much of the time that service consists of one member of staff who is alone in the building and very often feels vulnerable.  The out-of-hours service is far from perfect in this respect.

I know we cannot comment on an individual case but many of the reasons a person is turned away is because the beds are all full.  There are no beds and no space or capacity.  That is certainly a real situation.  I know a new mental health unit is being built in Sligo but this is certainly the problem in St. Columba's at the moment and the main reason people are being turned away.

The Minister of State mentioned the recruitment of staff.  Does the recruitment of staff for mental health services go through the national recruitment service?  The Minister of State nodded his head to indicate that it does.  The amount of time it is taking is absolutely outrageous.  When the mental health service in Sligo and Leitrim decides to recruit someone and advertises, the first problem is that an advertisement can be made for only one person per day in the service nationally, for some peculiar reason that nobody seems to be getting a hold of.  That is ridiculous.  When the service does advertise, it can take up to six months to recruit the person.  It is diabolical that we are standing over this situation.  There is no reason for it other than that somebody somewhere decided to draw up a set of rules by which everybody has to live, as if it is the reality of life.  It is not the reality of life.

The Minister of State has put out the concept that people will be able to have online consultation.  When will this happen?  If he is saying this is the answer he is putting forward, I will not be sceptical.  I will embrace it and ask to see it.  When can it happen?  If the Minister of State is saying this can happen, surely there should be no reason we have to wait one year, two years or five years for somebody to write a report or a consultant to do a report on it.  It should happen immediately.  The Minister of State should at least tell us there will be a pilot and that it will be in the Sligo and Leitrim area.  Will he give that commitment today?

Deputy Jim Daly: I acknowledge the Deputy's bona fides in this area.  I have had many conversations with him on the subject of mental health.  I have always found him to be very responsive and responsible in his approach.  He does not take a narrow view but, rather, seeks to serve the greater good.

I share some of his frustrations regarding the national recruitment service and trying to see how it works.  I recently invited the executive clinical directors in the area of mental health from across the country, including the Deputy's CHO area, to a meeting.  I wrote to them afterwards and asked them to give me examples of the difficulties they were having with recruitment and their experiences of the current recruitment process within the HSE.  I am going through their responses, which I received in the past week or ten days.  I have sought a meeting with the national recruitment service to better understand its work.  We often pass on blame in a kind of circular way, but one must follow the chain each way.  I want to hear the side of the national recruitment service.  I am aware of the frustrations being expressed, as is the Deputy, particularly in the area of mental health, and I am following the chain to see if I can address some of the blockages, difficulties and challenges in the area of recruitment.

The Deputy asked a specific question about the pilot.  I thank him for embracing it.  We must embrace change.  It is easy to be sceptical and knock everything but if we do what we always did, we will get the response we have always got and that is not good enough.  I recently convened a meeting in the national convention centre and explained to the attendees from across the country the concept of online psychiatry.  The clinical staff believe in it and accept that it is the way forward and will complement the existing mental healthcare provision.  They are up for the challenge.  The HSE is currently rolling out several pilot schemes around the country in the area of delivering mental healthcare online, including psychology and psychiatry.  That is how we will address the gaps in the system.  Rather than psychiatrists spending three hours travelling to see a patient, they will be able to spend that time online treating multiple patients.

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