Mental health resources in the State are severely overstretched, and are least developed in deprived areas, according to a survey of psychiatric services, to be published today.
The Stark Facts, an Irish Psychiatric Association survey of psychiatric services in the Republic, found that psychiatric resources are overstretched everywhere and that "rather than being concentrated in areas of greatest need, resources have been paradoxically developed in areas of greatest affluence".
Completed last autumn, the research examined the provision of community psychiatric services across all 10 health boards. It matched this information with an index of deprivation called the small area health research unit (SAHRU) index, which specifically rates deprivation according to social and demographic conditions in the Republic. The need for services was measured by examining the percentage of medical card-holders in each county.
The findings, which the Irish Psychiatric Association described as "disquieting", show that there is an inverse relationship between the availability of psychiatric beds and the percentage of medical card-holders.
This inequity was found throughout the State, but it is most marked in Dublin. In addition, the number of consultant psychiatrists relative to the population is "significantly reduced in areas with the highest level of social deprivation".
According to the survey, "the level of provision of psychologists is very poor throughout the country". Almost a quarter of all services have no psychologists.
The numbers of occupational therapists and social workers are highest in the most affluent areas of the State. The report suggests that service users in such areas would not tolerate the inadequate levels of non-medical staffing found in deprived areas.
Specialist services - required to serve the needs of people with particular psychiatric conditions - "are generally not available outside Dublin". Within the capital, their availability is linked to geographical proximity to centres of expertise.
"Availability of public eating disorder services is largely restricted to those domiciled in the East Coast Area Health Board in Dublin", the report notes. Throughout the State, 88 per cent of community psychiatric teams do not have any access to facilities for the treatment of eating disorders.
People with psychiatric conditions resulting from brain damage or head injury who require specialist neuropsychiatry care have practically no access to such care under the public health system. Women who suffer psychiatric problems during or after pregnancy are equally disadvantaged.
The four authors of the report, who are consultant psychiatrists, say that they wish to state clearly to the Minister for Health that the survey indicates that more resources alone will not resolve the crisis in psychiatric services. They add: "We are also calling for the development of a new national mental health strategy . . . that takes account of social realities, leading to improved mental health for the nation."
The report states: "The absence of an up-to-date national mental health strategy for service development is one of the main causes of current inequities in resource distribution. Lack of a national strategy has also led to a situation where there is a very limited availability of specialist services."
The authors note that a high proportion of temporary staff at consultant psychiatrist and clinical director level is partly responsible for poor service planning and development because this limits the capacity for advocacy and effective clinical leadership.