I thank the Chair and the committee for its invitation to attend today. We welcome this opportunity. I am a GP in Galway and I am the assistant medical director with the Irish College General Practitioners.
The ICGP is the professional body for general practice in Ireland. General practice teams deliver continuing personal medical care provided by generalist healthcare professionals, including GPs, practice nurses and a growing strand of practice based allied health professionals in the fields of psychology and counselling.
When well supported and adequately resourced, GP teams can engage systematically in activities known to prevent and care for a range of mental health issues and medical conditions. This is achieved using brief interventions in relation to alcohol and tobacco use, lifestyle interventions in the context of exercise and stress management as well as delivering continuing community based care.
The Covid-19 crisis has had profound economic, social and educational impacts. Countries that are more unequal suffer with higher levels of mental illness, including drug addiction and anxiety. The social determinants of mental health are hugely significant.
Supporting mental health, lives and livelihoods should be the role of every Department, and not just the Department of Health.
In April, researchers from Ireland released the first wave of the Irish Covid-19 psychological survey, a multi-wave study running throughout the Covid-19 outbreak, to better understand how people are responding to, understanding and coping with the pandemic. Initial results suggest that mental health problems are common: 41% reported feeling lonely; 23% had clinically meaningful levels of depression; 20% had clinically meaningful levels of anxiety; and 18% reported clinically meaningful levels of post-traumatic stress. Women seemed to be experiencing more anxiety whereas men were experiencing post-traumatic stress at a higher rate.
In May, the UN launched a report, Policy Brief: COVID-19 and the Need for Action on Mental Health, which highlighted that those most at risk were front-line healthcare workers, older people, adolescents and young people, those with pre-existing mental health conditions and those caught up in conflict and crisis. Even when the pandemic was brought under control, grief, anxiety and depression continued to affect people and communities.
Every day, thousands of people all over the country get to see their family doctor without any waiting time and receive quality attention and care. Around one quarter of such consultations include a mental health component. Over 90% of mental healthcare takes place in a general practice setting. GPs are the first port of call for many experiencing mental health difficulties, including symptoms of depression, suicidality, anxiety disorders, addiction problems, eating disorders and behavioural symptoms. Furthermore, GPs provide physical and psychological supports to those persons with lifelong mental health conditions, such as schizophrenia. People with severe mental disorders have a higher prevalence of many chronic diseases and are at a higher risk of premature death associated with these diseases than the general population. There is a reduction in life expectancy of ten to 25 years among patients with severe mental disorders. The excess mortality among this group largely relates to cardiovascular, respiratory and metabolic diseases. Since general practice services are not associated with any particular health condition, stigma is reduced when seeking mental healthcare from a general practice team, making this level of care far more acceptable and accessible for people and their families. General practice is one of the few parts of the health system that has remained open and accessible throughout the Covid-19 pandemic. The traditional model of general practice has had to change. We now consult patients by telephone and video, or in person with appropriate precautions.
Not all parts of the health system, particularly the mental health system, are as accessible as general practice. Access for children and their families to CAMHS can be problematic. There are restrictive referral criteria, waiting times can be long, and children's conditions often worsen while they are waiting to be seen. A particular problem in the service arises when children are between 17 and 18, when they fall between child and adult services and referrals are rejected by both services. To state the obvious, this is detrimental to the care of these patients.
Access to psychology and primary care is haphazard. Again, there are long waiting times. For example, there is an 18-month wait for the service in Galway at present. Counselling in primary care, CIPC, has seen increasing waiting times, and the service is limited. The following problems preclude a patient from accessing the service: moderate to severe psychological problems; long-standing depression; severe anxiety; behavioural problems or personality disorders. Where are these patients supposed to gain access to psychological supports?
Many improvements have taken place since the publication of A Vision for Change in 2006 but, as Sharing the Vision acknowledges, there is much more to be done in developing stronger mental health supports at community and primary care levels. Mental health services, like general practice, should be accessible for all. General practice provides care for over 90% of mental health conditions without the need for secondary care input, and GPs have a pivotal role in providing first and ongoing care for these patients. General practice needs to be supported in caring for these patients, with greater access to talk therapies, including on-site sessional talk therapy in a general practice setting, addiction services, improved integration with primary and secondary care, and upscaling of digital technologies, in mental health services in particular.
The physical healthcare of patients with mental health conditions, including severe and enduring mental illness, should be led by the patient's GP. A properly funded, integrated, structured programme of care for these patients needs to be implemented as a matter of urgency.