Sir, – The faculty of Psychiatry of Old Age (POA), College of Psychiatrists of Ireland, commends the coverage of the serious issue of staff shortages by Orla Ryan (“Major gaps in mental health services for older people, figures show”, March 13th).
We welcome Minister of State with responsibility for Mental Health Mary Butler’s support to address the gaps in the 2026 estimates with 28 posts and look forward to other POA posts being prioritised in each HSE region.
The shortfall stands at nearly 50 per cent of the number of consultant-led community mental health teams needed at present, not accounting for the shortage of hospital beds, day hospitals and hospital liaison psychiatry teams.
The POA faculty would like to add that this situation has been highlighted for a long time by faculty members individually and then collectively, and astatement highlighting the chronic underfunding of this specialty was published by the College of Psychiatrists in 2024. It highlighted widening gaps between population needs and the capacity of urrent teams to deliver the services needed.
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There has been a significant increase in the ageing population in Ireland. Prevalence of mental health difficulties, especially depression and anxiety disorders, is higher in this age group because of factors such as social isolation and frailty.
The needs of our patients tend to be more complex because of the higher rates of physical morbidities and frailty. The rates of neurological disorders, dementia, stroke and cancer are much higher among older adults, which create a huge mental health burden and need appropriately staffed multidisciplinary teams to provide timely care.
Most POA teams see patients in their places of residence – in their homes or nursing homes. This outreach model ensures the patients who cannot attend clinics are seen and get the same high-quality, multidisciplinary management delivered to those for whom access is not an issue. POA liaison psychiatrists based in hospitals attend to those admitted to general hospitals and this shortens the length of hospital stay for many people. There is a constant need for engagement and integration with all other health services providing care to older adults, such as geriatric medicine teams and primary care teams.
The capacity to meet these demands has not been developed in psychiatry of old age teams.
What is referred to as the clinical programme in the article is a clinical lead without a clinical programme.
Placing a few professionals, albeit highly skilled in delivering excellent care, without adequate resourcing or correct grades, because of chronic underfunding, does not just demoralise these professionals. It also comes with additional costs to the exchequer in more crisis admissions, prolonged hospital stays and increased morbidity for these people.
On the contrary, developing this human resource and speciality has the potential of seeing real integration of health services for older people and even more timely service provision, resulting in better health outcomes for patients and families, and reducing crisis admissions and related costs. – Yours, etc,
Dr ATIQA RAFIQ
Consultant old age psychiatrist,
POA faculty chair, College of Psychiatrists of Ireland.
