Martin Daly: Exposes Gaps in Mental Health Data and Access
Martin Daly speaks to the committee about persistent gaps in mental health services across the country, highlighting a disturbing lack of aggregated data and inconsistent access to consultant-led care. He draws on his experience as a GP to illustrate how patients are falling through the cracks despite record investment in mental health.
Martin Daly acknowledges the government's record investment of
1.8 billion into mental health services but warns that spending still falls short of the 10% of the health budget he says is required. He places the current spend at about 5.7% and stresses that capacity and population growth mean services are still playing catch up.
Daly offers a first-hand account from his work as a GP: a young mother who attempted suicide, was found by local gardai and spent 12 hours in an emergency department before a junior doctor assessment and minimal follow-up until a consultant review days later. He uses this case to argue that access to consultant psychiatry and timely community care remains uneven.
Daly details a response to a parliamentary question from HSE West North West which returned no usable data on referrals to CAMHS, adult mental health diagnoses or transitions from child to adult services. He calls this lack of collated data unacceptable and links it to inadequate ICT systems and the absence of universal electronic patient records.
The speaker interrogates whether sectoral referral and current geographic arrangements for multidisciplinary teams are appropriate, arguing that community-based delivery explains sectoral boundaries but pointing to real disconnects in areas such as Roscommon and Portumna. He urges better data collection, electronic records and more consistent consultant access to improve planning and patient outcomes.
Record investment, lasting shortfalls
Martin Daly acknowledges the government's record investment of
1.8 billion into mental health services but warns that spending still falls short of the 10% of the health budget he says is required. He places the current spend at about 5.7% and stresses that capacity and population growth mean services are still playing catch up.
A GP's case study of failure
Daly offers a first-hand account from his work as a GP: a young mother who attempted suicide, was found by local gardai and spent 12 hours in an emergency department before a junior doctor assessment and minimal follow-up until a consultant review days later. He uses this case to argue that access to consultant psychiatry and timely community care remains uneven.
A data gap that hinders planning
Daly details a response to a parliamentary question from HSE West North West which returned no usable data on referrals to CAMHS, adult mental health diagnoses or transitions from child to adult services. He calls this lack of collated data unacceptable and links it to inadequate ICT systems and the absence of universal electronic patient records.
Structure and service delivery issues
The speaker interrogates whether sectoral referral and current geographic arrangements for multidisciplinary teams are appropriate, arguing that community-based delivery explains sectoral boundaries but pointing to real disconnects in areas such as Roscommon and Portumna. He urges better data collection, electronic records and more consistent consultant access to improve planning and patient outcomes.
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Transcript
I do want to also recognise that the government's record investment in mental health services of £1.8 billion, which is the highest ever investment. It's still obviously not enough. We need to reach at least 10% of our health budget invested in mental health services. We're running at about 5.7 and we're playing catch up because of our lack of capacity and our growth in population. Notwithstanding, and I pay tribute to Minister Mary Butler in her commitment to that, notwithstanding that we have very significant problems. Sometimes it's easy to be in a committee here and have this sterile discussion where people present facts, figures, opinions, and often based on their own experience. So I'm going to give you something from my experience as a GP. A young mother, very distressed, two children, difficult social circumstances, makes a serious attempt on her own life. A search party is sent out and she's found by one of the local guards in the woods with a rope. She's brought to the emergency department. She's eventually seen after 12 hours by a junior doctor. No disrespect to that junior doctor. She was sent home after a phone consultation between the junior doctor and the consultant psychiatrist. She received a five-minute phone call from a nurse each day for seven days until she eventually was assessed by a consultant psychiatrist. In my view, as her GP, she was suffering from severe depression. Yes, her circumstances contributed to that, but she deserved to be seen by a consultant psychiatrist for assessment when she was brought to that emergency room. That's the reality on the ground in relation to access to mental health services around the country. You're quite right to point out there are some excellent examples, but there is an inconsistency right around the country to access to mental health services around the country. You're quite right to point out there are some excellent examples, but there is an inconsistency right around the country. Some of that is capacity, but some of it is culture as well, and we need to recognise that. I also, in response to a parliamentary question, which I find came back to me yesterday to HSE West North West, asking for the data in relation to the number of referrals to the CAMS service in the last five years in HSE West North West. They were unable to provide me with the data because they have no data about the people who are using the service or need to use the service. They were unable to provide me with the data or diagnosis of adult referrals to the mental health service in HSE West North West. That is simply unbelievable in this day and age. And more importantly, because this is an area of real contention, they were unable to provide me with any data in relation to the referrals of young people who are in the CAMS service transitioning to adult mental health services. And we know that's already problematic. So I'm going to start there, because a lot of these people, these people, these young people and people with mental health issues, end up in the emergency room because they can't access services in a timely manner. So firstly, in relation to data around the need for mental health services and diagnosis, is that true, that there is no data? It's not true that there is no data. I think one of the difficulties is that we are largely without the information technology required to collect and collate and then be able to forward on that. But do you record diagnoses? Oh, diagnoses are recorded every time. And if diagnoses are recorded, where is that data kept? That data is usually kept on the patient's chart. Now, depending on where you are, some people would have more developed ICT systems than others, in which case you may have databases. But it's a lottery, because unfortunately, as we've been saying for years, we need, across the board, ICT systems, we need electronic patient records. In most organisations, audits are carried out, whether or not you have information technology or not. An audit is carried out. We have so many people with enduring mental health issues, schizophrenia, bipolar disorder, whatever. There are simply no figures. I find that incredible. I don't know how we can plan a service if we don't know how many people need to use that service. Coming to the emergency room, we've been, the last number of weeks, talking about slaughter care and the access to consultant delivered service. Is there a reality, is that a capacity issue that junior doctors out of hours don't have adequate access to? And this is not a criticism, I'm just trying to understand access to specialists. So if I've experienced a GP sending someone in with an acute psychotic episode, one would expect that they would be seen by someone who's competent in that area. Now, I was a GP trainee in my time, and it was an inadequate service that I, as a GP trainee, would assess someone who was psychotic. That's a long time ago. But that practice is still going on. Well, the initial assessment would usually be carried out by somebody who was a non-consultant grade. But there would always be a consultant supervising them, who is available to them, either by telephone or in person, if necessary. So there would be access to a consultant at all times. In an ideal world, is it a capacity issue, if we had enough consultant psychiatrists, would we be able to provide a different type of service to the appropriate referrals to the acute, to acute centres? I suppose the emphasis there is in an ideal world. But the sheer volume required would be very large. Only just because I work in early intervention psychosis. So really what you want is that that referral comes into an early intervention psychosis team, and that person is seen in the community, that they don't ever have to make it to the emergency department. And then they'd be seen by a multidisciplinary team. And I accept that. But that's not the case where I live. No, no. And I understand that. And where I work. No, no. And I accept that, that's the answer I accept. And that's where we want to go. So what we have in Roscommon East Galway is we have an acute psychiatric unit in Roscommon, 30 miles almost away from the emergency room in Forteancla hospital. So we have no link up. We have two different physical settings, we don't, to provide that service. So we have that disconnect. We have a CAM service that essentially exists in Roscommon, but the people who are in Portumna have to go to Roscommon to get it. Yes, and thank you very much, first of all, for the very welcome tone of the discussion here, which really underlines the challenges that we're facing in terms of, I tend to use medical analogies as a liaison psychiatrist, similar to sending every patient who's having a heart attack into the ED, which is important, but having no bed access to coronary care and having no access to cardiology services out with that. So the challenge is, do we say every single chest pain needs to be seen by a cardiac consultant? And similarly, does every single patient who presents with distress need to be seen by consultant psychiatrist? Or how do we determine? Sorry, I'm not saying that, but I am saying that if someone is sent in, and I was specific in what I said, enduring mental health, psychosis, someone who's deeply distressed, deeply depressed, I should say, and suicidal, in the estimation of a senior GP in the community, there's no other service that doesn't get that access. And that is in particular, and again, I come back to, you don't have the data. Most of the services have the data. How many people presented with chest pain had a heart attack? How many strokes there were? How many people came in with diabetic crisis? There is no data in our mental health services. I can't believe that. Data is key. When I chaired the National Clinical Programme for the Management of Self-Harm, we introduced within the resource and the nursing resource, time for data collection. And that has been a key component of how we've been able to measure the output of the self-harm programme, and then improve developments. One last question, because I'm running out of time. Do you believe that we should have sectoral referral? There's no other specialty in medicine that has sectoral referral. If I have someone with chest pain, I can send them to Tullamore, to Galway. Sorry, I got a very brief answer, because he's out of time. Just a brief answer. The reason for the sectoral geographical range for the mental health service is because so much of mental health service delivery happens in the community. And geographically, it would be extremely difficult to have your multidisciplinary team maybe spread between three and four counties. So that's the reason for it. And there's no choice. Thanks very much.