Will members please look at slide No. 14 in the handout? With the lack of psychologists in situ, many clients do not have access to psychological treatments. The question is what happens to those clients. What is the outcome for clients because of the lack of this service? A psychiatrist colleague of mine put it very simply — clients suffer. They suffer in particular ways which causes a great problem for all of us and ends up costing a great deal more money.
With the lack of psychological services there is an increased risk of harm to self or others. Clients are not getting access to care and their condition deteriorates. This increases the risk to the individual and, in some cases, to others, and in general the client gets worse. Because they get worse, they disproportionately end up coming back into in-patient care resulting in an increase in-patient admissions because we are not treating them effectively. Some people cannot cope with their mental difficulties and end up losing their job. They might lose their family. In the case of children, a child might not finish school or might start to have other difficulties that will set the stage for a very difficult later life. All of this accumulates and results in many more people needing to avail of Government assistance.
Let us now turn to slides Nos. 19 and 20 in the handout. There have been quite a few studies in the west looking at how psychological treatments save the health service money. The studies vary in the amount of savings but they tend to range between 10% and 50%, particularly when they focus on disorders where treatment by a psychologist is particularly effective, such as depression, anxiety, personality disorders and other common disorders. Savings are made when compared with the system that is in place which is a medical-oriented system involving psychopharmacology, medication and visits to a psychiatrist and psychiatric nurse. The studies find savings of between 10% and 50% and the average tends to be around 30%.
To understand why these findings occur and why there are savings it is important to understand an often misunderstood concept: medication is a palliative treatment in mental health, it is not curative. When I say palliative I refer to the reduction of symptoms, not curing a problem and because of this a person will be linked to the medication to keep the symptoms at bay. If they go off the medication the symptoms will, most often, return. This is a complicated issue that we will not go into in detail but this is one of the basics savings we have found. When one uses a psychological treatment for a disorder that shows efficacy, meaning it is effective for that disorder, it is time-limited. The medication is not time-limited and the studies have found savings after just two years of going through the process. However, many people are maintained on medication for ten, 20 or 30 years so the savings are far greater than those shown by the studies.
It is important to understand the factors that contribute to these savings. Psychological interventions are time-limited and highly effective for many disorders. In some cases medication is not even a legitimate option for certain disorders and will not be effective. Evidence shows that the best treatment for disorders such as anxiety, some trauma-based problems and personality disorders is psychological intervention. Best practice in those cases indicates that we should take that route, regardless of cost, however, it also turns out to be cheaper.
By treating specific problems with psychological treatments more people are kept out of inpatient care, due to a lower drop out rate from treatment. The psychological treatment can have a better effect because it is more curative and not just palliative. An analogy might be helpful in understanding the meanings of the words curative and palliative. If a person went to a physician complaining of very bad headaches and a pain-killer was prescribed the headaches would go away and this would be fine, for a while. However, the person would keep coming back to get a prescription for a pain-killer and the underlying issue of the cause of the headache would be ignored. This does not happen because physicians assess situations thoroughly. The physician may discover that the person's eyesight has deteriorated and that the cause of the headache is the fact that the person spends 12 hours a day in front of a computer screen. Psychological treatment looks behind the symptoms of a problem to find its cause. Medication deals only with symptoms and if we continue to do this we will spend a great deal on medication over time.
Many people drop out of treatment because they are put on medication and research finds that because of this they do not get help, their problems get worse and they end up, in disproportionate numbers, as inpatients. In 2006 this was estimated as costing €434 per day, so the medication and inpatient area is where many savings are being made.
With staff that can provide evidence-based treatment that works and will save the health service money, it would make sense to roll out A Vision for Change further and put psychologists into community mental health teams, where they have not yet been. This would be a financially responsible and medically prudent thing to do. With this understood, between 2005 and 2007 development teams were created in the health services and certain psychology posts were part of those teams. The problem is the recruitment embargo, of which we have heard much, kicked in and many of these posts were blocked. The moneys were then redirected to deal with overruns so few of the posts created in recent years were filled. This created a difficult problem. In addition to making room in the system for psychologists we must figure out how to ensure posts that are created come to fruition.
