Thursday, 17 January 2019

Questions (7, 15)

James Browne

Question:

7. Deputy James Browne asked the Taoiseach and Minister for Defence if a psychiatrist has been appointed to the Defence Forces; and if he will make a statement on the matter. [1808/19]

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Aengus Ó Snodaigh

Question:

15. Deputy Aengus Ó Snodaigh asked the Taoiseach and Minister for Defence his plans to implement the recommendations of the review of psychiatric services for the Defence Forces in view of the recent unsuccessful attempts to recruit a full-time military psychiatrist; if other recommendations remain outstanding; and his further plans to strengthen services for the mental health of Defence Forces members. [1801/19]

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Oral answers (14 contributions) (Question to Defence)

I ask the Taoiseach and Minister for Defence if a psychiatrist has been appointed to the Defence Forces and if he will make a statement on the matter.

I propose to take Questions Nos. 7 and 15 together.

A psychiatrist has not yet been appointed to the Defence Forces. A review of the Defence Forces psychiatric service recommended the employment of a full-time military psychiatrist. The previous incumbent providing these services to the Defence Forces on contract retired in May 2018 while arrangements were being made to implement this recommendation.

To continue to provide an interim in-house service until such time as the military psychiatrist position could be filled, efforts were made to engage a locum psychiatrist. However, this proved to be unsuccessful.

Subsequently, it was agreed to launch a procurement process to contract a third-party private service provider for psychiatric services as a bridging arrangement pending the appointment of a locum or full-time psychiatrist.

A direct entrant competition for the position of military psychiatrist was launched on 26 July 2018 and closed on 30 September 2018. No applications were received for this competition.

Further options have been under consideration as to how to proceed. In this regard, I have recently given approval for my Department to conduct a competition for a contracted civilian psychiatrist. It should, however, be noted that there is a nationwide shortage of trained psychiatrists. The difficulty with recruitment for such a position is not unique to the Defence Forces.

Currently, patients presenting to Defence Forces primary carers - medical officers or contracted civilian GPs - with a requirement for urgent psychiatric assessment are referred to HSE emergency departments.

They are then assessed by the duty on-call psychiatric staff who triage referrals. These patients will either be admitted for inpatient care or referred onward to HSE outpatient psychiatric services, where appropriate.

It must be stressed that there is no delay in referring patients requiring immediate psychiatric care or assessment. On presentation to HSE emergency departments, those requiring hospitalisation are immediately admitted. The waiting time for non-urgent outpatient cases is approximately three months. Defence Forces primary carers have been authorised to refer cases to local external private psychiatrists for outpatient treatment where deemed appropriate to provide them with the broadest range of options in dealing with the spectrum of cases that present to them, .

The review of mental health services for the Defence Forces also contained several recommendations regarding clinical psychology services. The recruitment of a civilian psychologist in addition to the existing Defence Forces psychologist has been fully implemented and the arrangement is due to be reviewed after a period of 12 to 18 months has elapsed. In addition, systems have been put in place to collect statistics in respect of the demand for psychological services as recommended in the review.

With regard to mental health supports generally, I assure the Deputies that the health and welfare of the men and women of Óglaigh na hÉireann is a high priority for me, the Department and the Defence Forces. Mental health services are part of a range of medical and non-medical services provided to ensure that Defence Forces personnel are medically fit to undertake the duties assigned to them.

In addition to the clinical supports I have outlined, non-medical mental health services are provided by the personnel support service, PSS. The PSS makes confidential services, including critical incident stress management, and psychological support available to all Defence Forces personnel through its network of barrack personnel support service officers and occupational social workers at formation, unit and barrack level.

As additional support, my Department has arranged the provision of a confidential counselling, referral and support service for serving members of the Defence Forces, civilian employees and Civil Defence members on a wide range of personal and work-related issues. A freephone confidential helpline staffed by fully trained experienced counsellors is available on a 24-hour basis, 365 days a year.

I am satisfied that the available medical services offer comprehensive supports to Defence Forces members and I assure the Deputies that they are kept under constant review.

There will be significant disappointment within the Defence Forces that no psychiatrist has yet been appointed. I may have missed it but will the Minister of State clarify whether there have been any applications for the post of psychiatrist in the Defence Forces? I understand the previous position was at lieutenant colonel level, which has a pay grade of approximately €60,000 to €70,000 or approximately half what a consultant psychiatrist would expect to be paid in the HSE. I ask the Minister of State to address whether that forms part of the difficulty in attracting a psychiatrist to the Defence Forces.

Defence Forces members are under significant mental strain in the normal course of their duties. They operate in strenuous circumstances, often in dangerous environments. Post-traumatic stress disorder, PTSD, is common among soldiers. It is treatable but requires early intervention. The availability of a psychiatrist to soldiers at the earliest point is of critical importance. The Workplace Climate in the Defence Forces research identified the type of stress and strain under which soldiers operate. The current low staffing levels place additional strain on members of the Defence Forces.

A direct entry competition for the position of military psychiatrist was launched on 26 July 2018 and closed on 30 December 2018. No applications were received for the competition. Further options have been under consideration as to how to proceed. In this regard, I have recently given approval for my Department to conduct a competition for a contracted civilian psychiatrist. However, it should be noted there is a nationwide shortage of psychiatrists, as the Deputy recognised. The proposal I approved before Christmas has gone to the Department of Public Expenditure and Reform for final sign-off. As the Deputy stated, the salary offered is only half of what may be on offer in the private sector or the HSE. That is probably the main reason for the lack of applications for the position that was advertised.

I have outlined that we have all the back-up services required for members of the Defence Forces. The PSS in place for serving members of the Defence Forces in Ireland and overseas is excellent and I compliment it on its work.

I have previously asked about this issue. I am not surprised that there were no applications for the advertised position. That is the current situation. There is an urgency to this because men and women deployed abroad may return with PTSD. There are also the issues we have raised in terms of the work and pay conditions and other stressors.

Has the Minister asked the College of Psychiatrists of Ireland for its view on the lack of applications? He stated that low pay may be the reason for the lack of applications but there may be others. We urgently need to find out from the professional body what is the reason for the lack of interest such that there are applications when the position is next advertised and a service can be set up which will serve the Defence Forces well in the future.

There is a nationwide shortage of suitable psychiatric personnel across the board in the HSE, not just within the Defence Forces. There are issues with a significant shortage of psychiatrists in the south east and in many other parts of the country. Pay may be one of the reasons for the shortage. It is one of the reasons I approved the proposal to go to the Department of Public Expenditure and Reform. I hope that will be approved and that we will soon be able to re-advertise for the post.

The Deputy referred to PTSD among those returning from service overseas. The PSS personnel in barracks across the country are excellent. They work in a professional and discreet manner and refer people on for further health assistance or care if required. Deputies should be aware that assistance is available for any member of the Defence Forces serving in Ireland or overseas who is suffering from any sort of stress and I encourage such members to seek that assistance if required.

My question regarded whether the Minister had sought the input of a professional or representative organisation, which may prove worthwhile.

I will take three supplementary questions. I call Deputy Browne.

Members of the Defence Forces give loyal and determined service to this country and deserve the best supports they can be given, including the availability of a psychiatrist. There have been many reports regarding the poor pay and other conditions in the Defence Forces. The pay on offer may be one difficulty in attracting a psychiatrist but there is a difficulty in respect of conditions, supports and facilities for psychiatrists to carry out their work in many general mental health services. Are the proper facilities and necessary supports in place to attract a psychiatrist into the Defence Forces?

When difficulty is experienced in recruiting a psychiatrist, the HSE will take emergency measures such that a psychiatrist working in another part of the HSE will provide cover until a psychiatrist has been recruited. That is currently being done in respect of child psychiatric services in Wexford. Has the Minister of State asked the HSE if it can provide cover until such time as a psychiatrist is recruited to the position in the Defence Forces?

Does Deputy Ó Snodaigh have a supplementary question?

As I asked earlier, has the Minister of State contacted the College of Psychiatrists of Ireland for its input?

There is a new strategic HR unit within the Department of Defence. It does not take a rocket scientist to know that if one advertises for a position at half the salary being offered by the HSE, there will not be any applications. There have been no applications for many of the vacant positions within the HSE.

Has the Minister of State asked the Department of Public Expenditure and Reform for military salaries to have equivalence to the HSE salary scale? What is he doing to bridge the gap? If the position is re-advertised at a median point between the HSE salary scale and what was advertised before, there will be no further applicants. It would not be a proper advertising of a position if the Minister of State knows there will not be any applicants.

There are other Members waiting and I have called the Minister of State to reply. I cannot deprive other Members.

I have approved the proposal that a civilian psychiatrist on contract should be recruited to provide services to members of the Defence Forces. There are several steps under way with a view to commencing the recruitment campaign. I am hopeful the position I have proposed to the Department of Public Expenditure and Reform will be filled.

I am not going to indicate what the proposal is because it would not be appropriate to do so. However, we are also looking at formalising arrangements with external service providers. Arrangements for this procurement process are also under way. In the interim, measures are in place to ensure services are available to members of the Defence Forces through the HSE. The Defence Forces deserve the best. That is why I believe we have the best personnel support services, PSS, available. The staff in that unit need to be applauded for the work they do above and beyond the call of duty. I note they do that work in a professional and discreet manner.