Top psychiatrist withdraws from legal aid scheme over ‘unmanageable’ workload and ‘derisory’ fees

A leading consultant psychiatrist has said she can no longer accept referrals under the criminal legal aid scheme due to the “unmanageable” workload and “derisory” fees paid under the scheme.

Prof Patricia Casey, who has provided reports over decades in many criminal legal aid cases, including concerning people facing trial on charges of murder, attempted murder, rape and sexual assault, informed solicitors earlier this month she, “with regret”, is withdrawing from the scheme and will not be accepting any new referrals dependent on legal aid from September 1st next.

In her letter to solicitors, Prof Casey said criminal law instruction had for many years formed about 10 per cent of her medico-legal practice but has grown to about 40 per cent in the past two years.

During the same period, civil law instructions have grown substantially and she is now receiving about six to eight of those weekly, she said. “This level of work is not sustainable,” she wrote, adding she does similar work for the Medical Council and Tusla, the child and family agency.

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“While criminal law is the most interesting of all the medico-legal work I engage in, and I am intellectually stimulated by the complexity of many of the cases, as well as wanting to provide as good a service as I can for those who are in significant financial difficulty, I have made a strategic decision to discontinue criminal legal aid work, due to the derisory remuneration from the State for this valuable and necessary work,” she said.

“Unfortunately, the amount of behind the scenes work and the emotional energy that criminal cases require is not matched by the remuneration which the State offers.”

She is “more than willing” to continue receiving instruction form solicitors in civil legal aid cases, she said.

“Should the remuneration improve, I will be delighted to re-evaluate this decision.”

When contacted by The Irish Times, Prof Casey said the amount of criminal legal aid work she is being asked to do has risen dramatically in recent years and she had reached a point where the time involved, and the level of fees, meant it is “just not sustainable”.

The €120 hourly fee, before tax, paid to her under the scheme does not take into account the complexity of the work, the emotional energy involved, and the skills and qualifications of those doing it, she said.

Some of the work involves visiting and interviewing prisoners on remand in Cloverhill Prison, she said. Other interviews are carried out in her office and other locations, including hostels.

Some cases take a lot of time and involve multiple interviews and reports and the Legal Aid Board’s procedure concerning fee payments is cumbersome and time-consuming, she said.

Solicitor Maurice Regan, who has obtained reports from Prof Casey for several clients concerning their fitness to instruct, to plead and to stand trial, said it is “dreadful” that the level of fees and workload means that it has become economically unjustifiable for a professional of her experience, a “vital cog” in the legal aid system, to continue this work.

It is very difficult and “prohibitively expensive” to get private psychiatric reports and many of his clients would not be in a position to pay for those, he said.

Separately, barristers will mount another protest at the Criminal Courts of Justice and at other courthouses around the country on Friday over the failure to reverse cuts to District Court criminal legal aid fees. Fees paid to defence counsel in the District Courts include €25.20 for a remand, €50.40 for a full plea in mitigation and €67.50 for a full trial hearing.

The fees issue has been raised with several Government Ministers by the council of the Bar of Ireland. Minister for Justice Helen McEntee said earlier this month she supports the reversal of the cuts and will be raising the matter with the Minister for Public Expenditure and Reform Paschal Donohoe.