Over-prescription identified and ignored four years ago % News

A report published by the Joint Committee on the Future of Mental Health Care highlighted the dangers of over-prescription in the Irish health service over four years ago, but it was ignored.

Earlier this week, the Irish Independent revealed that Dr David Kromer, a junior doctor assigned to the child and adolescent mental health services (CAMHS) unit in South Kerry, had allegedly improperly prescribed medications over a four year period. The issue is currently being investigated by the HSE.

The recent scandal prompted Taoiseach Micheál Martin to call for a nationwide audit on compliance in Child and Adolescent Mental Health Services. But as early as 2018, a report called on government to provide accessible counselling services, a lack of which, it noted, was contributing to an overreliance on prescribing medications.

“The Committee recommends that access to a range of ‘talk therapies’ should be a mainstream part of Mental Health Services and alongside talk therapies, a suite of therapies with a recovery focus such as art therapy and music therapy should be embedded in community mental health services,” the report states.

“These options should also exist in acute services alongside more intensive interventions. Having access to a wide variety of treatment options increases the likelihood that individuals will recover.”

In recent years, initiatives by government have encouraged members of the public to ‘please talk’ about their mental health, prompting some, in the absence of counselling and therapy services, to ask the question: ‘to whom?’

Speaking about the 2018 report in Dáil on Wednesday, People Before Profit Gino Kenny TD, who was on the Committee, highlighted the lack of interventions available for young people suffering from mental health difficulties.

“Overmedication was compensating for a lack of services, and I think that’s key,” he said. “Medication for young people has quadrupled in the last 25 years, which is very concerning.”

Kenny also said he believed that primary care psychological services are not meeting the needs of young people in Ireland today, particularly in light of widespread mental health issues associated with the Covid-19 pandemic.

Ireland currently spends €1.149 billion, 5.2% of its overall healthcare budget, on mental health services. The WHO says that this should be more than doubled and brought up to 12%.

Speaking to the Committee in 2018, Dr. Harry Barry said that the greatest single issue  in in his career regarding talk therapy had been the lack of access.

“While vast amounts of money have flowed into the provision of drug therapy, some of which is justified and some of which is not, there is a definite dearth of State funding and organisation of talk therapy,” he said.

Questions also remain over why Dr Kromer was not supervised by a Consultant instead of making decisions by himself. The South Kerry CAMHS team hasn’t had a permanent Child Consultant Psychiatrist since August 2016, except for limited temporary locum cover for short periods, a statement published by the IHCA today has pointed out.

“A significant brunt of the impact of these staffing shortages is felt in our mental health services, where the combination of gaping capacity deficits with significantly increased demand for treatment of mental illnesses is stretching our acute services to breaking point,” the statement read.

“As at last February, we know that of the 485 approved permanent Consultant Psychiatry posts, some 136 were not filled as needed (either being left vacant or filled on a temporary basis or by agency Consultants).