by Dr Anne Doherty, Consultant Psychiatrist
Rates of depression and patterns of presentation of depressive illnesses in Ireland are similar to those reported in other developed countries, although there have been few epidemiological studies conducted in the population as a whole. However, service provision is patchy and not standardised. Rates of depression as high as 26% have been reported in primary care[1], and as high as 52% in vulnerable groups such as the homeless[2]. The ODIN study reported higher rates in urban regions of Ireland compared to rural regions[3].
The configuration of Irish mental health services is loosely based on the policy paper ‘Vision for Change’[4]. Published in 2006, VfC sets out how the provision of mental health services in Ireland should progress in to the post-institutional care era. General practitioners (GPs) are the ‘gatekeepers’ to mental health care and treat the majority of patients with depression, referring onwards to community mental health teams (CMHTs) as appropriate.
With respect to the provision of treatment for depression in Ireland, there are no barriers to access to anti-depressant treatments, with any prescribed pharmacotherapy provided free of charge to those eligible for free healthcare. Psychotherapies are less accessible: most CMHTs have two clinical psychologists for a population of 150,000. In the past 5 years, the availability of counselling in primary care has increased, and further counselling and psychotherapy is available via charitable foundations such as Pieta House.
There are significant gaps in service provision for specific groups which have high rates of depression, such as for the homeless, and during the perinatal period. A study by Crotty and Sheehan found rates of depression of 14.4% in the perinatal period in Dublin[5]. Despite the high need in this area, there is minimal provision for perinatal psychiatry with only three 0.2WTE psychiatrists in the three Dublin maternity hospitals and no specific perinatal services for the remainder of the country.
Eleven years on, VfC has proven largely aspirational, as the proportion of the health budget dedicated to mental health services has fallen from 13.5% in 1984 to 5% in 2012[6]. However, the proportion of funding has risen to 6.1% in 2016[7], and this small upswing in funding in the past 4 years gives hope that there will further prioritisation of mental health problems, including depression, in the future.
112 and 999 are the national emergency numbers in Ireland.
Samaritans (http://www.samaritans.org/) is a registered charity aimed at providing emotional support to anyone in distress or at risk of suicide throughout Ireland.
Freephone 116 123 for Samaritans anywhere in Ireland or Northern Ireland.
References
[1] Copty, M. (2004) Mental Health in Primary Care. South West Area Health Board and Irish College of General Practitioners.
[2] ERHA & RCSI. (2000) The Health of Hostel-Dwelling Men in Dublin: perceived health status, lifestyle and health care utilisation of homeless men in south inner city Dublin hostels.
[3] Ayuso-Mateos, J.L., Vasquez-Barquero, J.L., Dowrick, C., Lehtinen, V., Dalgard, O.S., Casey, P., Wilkinson, C., Lasa, L., Page, H., Dunn, G., Wilkinson, G.; ODIN Group (2001). Depressive disorders in Europe: prevalence figures from the ODIN study. Br J Psychiatry 179: 308-316.
[4] Department of Health and Children. (2006) Vision for Change: Report of the Expert Group on Mental Health Policy. The Stationery Office, Dublin.
[5] Crotty, F., Sheehan, J.D. (2004) Prevalence and detection of postnatal depression in an Irish community sample. Ir J Psych Med. 21: 117 – 121.
[6] Faedo, G., Normand, C. (2013) Implementation of ‘A Vision for Change’ for Mental Health Services. Report to Amnesty International Ireland. Trinity College Dublin
[7] Health Service Executive. (2016) 2017 National Service Plan. https://www.hse.ie/eng/services/news/media/pressrel/hse-publishes-service-plan-for-2017.html
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