New report identifies shortfall of 830 acute mental health beds across the country
Unpublished HSE report identifies shortfall of 830 acute psychiatric inpatient beds nationally;- Consultants say true deficit may be as high as 1,800 beds;
- IHCA Vice President Prof Anne Doherty: “With only 23.8 adult acute mental health beds per 100,000 population in public approved centres in Ireland, compared to an EU average of 73 beds, inpatient psychiatric care is now reserved only for the ‘seriously ill’.”
An immediate shortfall of 830 acute psychiatric inpatient beds against recommended levels has been identified in a new report from the HSE.
The as yet unpublished report1, obtained by the Irish Hospital Consultants Association (IHCA) under the Freedom of Information Act, confirms there were just over 1,100 acute psychiatric beds across the public health service during a bed census carried out for the review, representing a rate of 23.8 beds per 100,000 population.
In 2018, the Joint Oireachtas Committee on the Future of Mental Health Care recommended the number of acute psychiatric beds in both public and private mental health facilities should be increased to 50 per 100,000 by 2021 – a deficit of around 1,355 acute beds against current levels.2 However, the HSE report states that given there are 523 private psychiatric beds nationally, the shortfall in public acute psychiatric beds is 832.
The new HSE report is the work of an Acute Bed Capacity Specialist Group established by the HSE in 2021 to make recommendations on bed capacity in the mental health services. It has recommended a phased increase to an initial 25 beds per 100,000 population, which would require the opening of an additional 164 acute psychiatric beds.
Consultants have pointed out that the 2018 report from the Joint Oireachtas Committee recommended that Ireland’s inpatient psychiatric bed capacity should in fact increase further to reach the European average, which is 73 beds per 100,000 population, by 2023. Taking this latter target, the current shortfall is more than double the above HSE estimate at around 1,800 inpatient beds. As the HSE has used population data from the 2016 census in its report, the true deficits are greater still given the growth in population of almost 570,000 over the past eight years.
High bed occupancy rates are also a concern for Consultant Psychiatrists, with the HSE report confirming a 77% occupancy rate nationally for acute adult beds on the census night of 23 November 2021. When broken down regionally, three CHO areas had occupancy rates above the recommended threshold of 85% - CHO 2 (Galway, Mayo and Roscommon), CHO 3 (Clare, Limerick and North Tipperary) and CHO 5 (Carlow/Kilkenny, South Tipperary, Waterford and Wexford). Separately, the occupancy rate for Child and Adolescent mental health beds was highest in CHO 7 (Dublin South City/South West/West, Kildare and West Wicklow) at 92%.
These stark capacity deficits come in the wake of a separate damning report from the Mental Health Commission this week which found that a number of acute inpatient facilities are struggling to meet minimum standards, largely due to inadequate investment and poor staffing levels.3
The unpublished HSE report confirms that on the census night in September 2021, staffing levels nationally were just 80% of the target recommended in the 2006 mental health policy A Vision for Change.
The IHCA has consistently called for a doubling in the portion of the total Health Budget allocated to mental health to address these severe capacity and staffing deficits. At 5.6% of the total Health budget, the current spend on mental health remains extremely low by international standards and approximately half that of most Northern European countries. It also remains significantly below the 10% of the overall health budget as recommended in the Sláintecare Report in 2017.
Commenting on the new HSE report, IHCA Vice President and Consultant Liaison Psychiatrist, Prof Anne Doherty says:
“This latest HSE report underlines once again the scale and severity of the deficits faced day-to-day in mental health services. With only 23.8 adult acute mental health beds per 100,000 population in public approved centres in Ireland, compared to an EU average of 73 beds, inpatient psychiatric care is now reserved only for the ‘seriously ill’.
“When I graduated from medical school in 2005, there were 4,000 acute mental health beds in Ireland. That number has now decreased to around 1,100. In real terms, what that means is that for every four patients we would have admitted to hospital in 2005, we would only admit one today.
“Deficits in staffing and resources, especially the scarcity of adult acute mental health beds, is also making it harder to retain mental health specialists. As a result, many doctors are left agonising over whether to stay in this country, or to move abroad for better working conditions.
“We train enough doctors in the specialty every year, but the problem is, like with every other area of medicine in Ireland, psychiatrists are leaving for or remaining in other English-speaking countries, where they have enhanced working conditions and the health service functions better. Because of this, it’s very difficult for Irish doctors to decide to come home and, for example, make those very difficult choices of who gets that single psychiatric bed when you have four people who need it.
“Time and time again, Consultants and others in the service have raised their serious concerns about capacity and staffing shortages and highlighted the impact this has on people’s mental health and their ongoing care needs. Lessons are not being learned. There is no shortage of reports but very little by way of meaningful action.
“The very fact that our benchmarks for staffing are rooted in an 18-year-old mental health policy, A Vision for Change, also points to a lack of priority given to addressing this issue over the past decade and more.”
ENDS
Notes:
1. HSE Acute Bed Capacity – Report of the Specialist Group; https://www.ihca.ie/_fileupload/acute-bed-capacity-report-of-the-specialist-group-final.pdf
2. Joint Committee on the Future of Mental Health Care Final Report October 2018; https://data.oireachtas.ie/ie/oireachtas/committee/dail/32/joint_committee_on_future_of_mental_health_care/reports/2018/2018-10-17_final-report-joint-committee-on-the-future-of-mental-health-care_en.pdf
3. Mental Health Commission Annual Report 2023, 25 June 2024; https://www.mhcirl.ie/sites/default/files/2024-06/MHC%202023%20Annual%20Report%20FINAL%20FINAL.pdf
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