Children with learning disabilities and adults with depression are among those severely affected by a shortage in clinical psychologists, reports Sylvia Thompson
Hundreds of children with learning disabilities are waiting for more than a year for psychological assessments due to the extreme shortage of clinical psychologists in the health services. Similarly, adults suffering from anxiety, depression and other psychological problems resulting from family breakdown are worsening or being treated by sometimes inappropriate drug therapy while awaiting appointments with clinical psychologists.
Almost two out of every three posts for clinical psychologists are unfilled in the Eastern Regional Health Authority. Vacancies of up to 50 per cent also exist in other health board regions. In some specialist services, psychologists have closed waiting lists because they cannot bear to extend them beyond a year.
The problem is further exacerbated because attempts to address the shortage through postgraduate training courses (in which the trainees' supervised work in placements would relieve some of the workload from senior staff) have been thwarted by cutbacks in funding from the Department of Health. For instance, 12 trainees were due to start a three-year clinical psychology doctorate at Trinity College Dublin in October but, due to lack of funding, couldn't begin their course. Last year, the Department of Health funded 30 places on a post-graduate diploma course in clinical psychology run by the Psychological Society of Ireland with the University of Ulster in Jordanstown. These funded places were a response to a report which specified the need for 50 newly qualified clinical psychologists a year in the ERHA area. The members of the Joint Review group on Psychological Services in the Health Services believed such funding would be on an annual basis. It now appears that the Department of Health will fund only 30 new places every three years.
"It [the lack of funding for training] is an outrageous situation which is becoming intolerable." says Niamh Ross, chairperson of the clinical division of the Psychological Society of Ireland. "There seems to be a lot of emphasis on the physical health of the population but not a lot of consideration of the mental health. In terms of waiting lists, the problem is a slow-burning one because many people's problems become more chronic while on waiting lists. And then there is the problem that those most in need don't always know how to access the services." Ross also points to research that suggests psychological intervention with children with mild to moderate Attention Deficit Hyperactivity Disorder (ADHD)can be just as effective in the long term as drug therapies. "In the US, for instance, there is a 22-week psychological programme in which some children actually lose the diagnosis of ADHD after treatment." If such intervention was available here, long-term costs to the health services for these children could be reduced.
Ger O'Donovan, whose twins were diagnosed on the autistic spectrum three years ago, has first-hand experience of how the unavailability of psychological assessment is slowing down the progress of her children. "A psychological assessment is the motor which drives things onwards. My sons, Gareth and Nathan, were seen to be at the same level when they were three. Now, Nathan can read and write and is ready to move into more mainstream education but without a psychological assessment, he can't. I had Gareth assessed privately and he has got a place in the CABAS (Comprehensive Application of Behavioural Analysis to Schooling) school in Clontarf, which is State funded. But the tragedy of all this is that neither of my sons was psychologically monitored throughout the three years of their schooling so the system isn't even being reviewed to see how well it works for some children."
Gerard Perry, also a member of the clinical division of the Psychological Society of Ireland, was, until the beginning of this year, the only clinical psychologist working in a catchment area of 250,000 people in the South Western Area Health Board (one of the three areas managed by the ERHA). "Of the 10 consultant-led teams in the South Western Area Health Board, there are only three psychologists, whereas there should be one per team, " says Perry. Some services, such as rehabilitation services for those with chronic mental health problems, and mental health services for older adults, have no psychologist at all.
In terms of child services, he adds: "Psychological assessment is a gateway to many services for children which allows them to get resource teachers and special classes in schools or programmes within learning disability services so if the children aren't getting asssessed, they won't get appropriate treatment either. And the stress on the parents of these children who can't access services is huge." Perry also believes the mental health services are becoming burdened by problems which should be dealt with at primary care level. "People suffering from anxiety or panic attacks, or those who become depressed as a result of a life change, should be dealt with by psychologists in GP practices so that those with more serious problems such as schizophrenia can have better access to combined psychological and biological \ treatments in the mental health services. Psychological intervention over three to 12 months can deal with many mild to moderate problems. In fact, you can do an anxiety management programme in eight to 12 weeks. Compare this to the cost of pharmaceuticals. People become psychologically dependent on medication and remain on it for up to 20 years," he adds.
Dr John Fleetwood, a GP practising in Blackrock, Co Dublin, acknowledges that the effect of the shortage of clinical psychologists at primary care level can result in patients being given medication for problems which could be dealt with through psychological intervention.
"We often have to give medication to patients with stress and anxiety to tide them over until they see a psychologist, even though we know some problems don't need medication but the patient needs to talk to someone trained in psychology. GPs are not well trained in this area and don't have the time to deal with these problems. But psychologists are under incredible pressure and they can't devote time to those who need it."