New figures indicate major gaps in the provision of mental health services for older people with the number of specialists falling short of goals set by the Government 20 years ago.
In 2006, the Department of Health’s Vision for Change document recommended people over 65 should have access to multidisciplinary teams consisting of a clinical psychologist, psychiatric nurses, a social worker, an occupational therapist and a number of other roles.
In 2019, the HSE’s Model of Care document said there should be one such team per 10,000 people aged 65 and over. There are currently over 783,000 people in Ireland in this age bracket, meaning there should be approximately 78 psychology posts, 78 occupational therapy (OT) posts, 78 social work posts and 235 community mental health nursing posts in psychiatry of older age (POA) services.
New figures released by the HSE show, per 100,000 people aged 65 and over, there are approximately 23.6 whole-time equivalent (WTE) occupational therapists, 36.9 social workers and 151.7 community mental health nurses in POA services. WTE posts measure total hours worked rather than exact staff headcount.
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There are 24.3 WTE clinical psychologists working within these services nationally. A further 5.8 WTE psychology posts have been approved but are currently vacant.
The figures were released to Liam Quaide, the Social Democrats’ spokesperson for mental health.
The Cork East TD said, compared to the HSE’s own benchmark, the figures suggest a shortfall in approved posts of about 48 psychology posts, 54 OT posts, 41 social work posts and 83 community mental health nursing posts.
Quaide, a psychologist who previously worked with the HSE, said some of the local figures are “especially stark”. There are no approved occupational therapy posts in Dublin South West, Limerick City and Tipperary North, Cork North and East, and Cork South and West, according to the figures.
Dublin South West has one approved but vacant clinical psychology post, while Kildare West/Wicklow and Donegal have no approved psychology post.
“This is a remarkable deficit 20 years on from A Vision for Change,” Quaide said.
Following a number of controversies involving Child and Adolescent Mental Health Services (Camhs) in recent years, Quaide said there has “understandably” been a focus on supports for younger people. However, he said, issues affecting older adults “have too often flown under the political radar”.
“When these teams are not adequately staffed, the consequences are felt not only by older people and their families, but across the wider health system through greater pressure on hospitals and emergency departments.”
Dr Nick Kidd, a chartered member of the Psychological Society of Ireland, said older adults “present with such complex difficulties that are so individual to being an older adult - retirement, bereavement, loneliness, physical and cognitive decline”.
“So, having those specialist teams available that can surround the client, the service user, to make sure that they’re getting all of their needs met, is a huge need that is probably, you might argue, only recently being properly fleshed out.”
Kidd, who has worked with older adults in mental health services, said there was still a lot of stigma attached to seeking help later in life. As such, many people “might not be putting their hand up when they might really need some help, and are suffering in silence”.
Figures released by the Mental Health Commission last year showed that electro convulsive therapy (ECT) was administered to 205 residents of mental health centres in 2024, and the average age of people who received ECT was 64.
“That does not in itself prove inappropriate use in any individual case,” Quaide said. “But it does underline why older people need real access to the full range of multidisciplinary supports – including psychology, occupational therapy and social work – rather than a service that is too thinly staffed in those areas.”
A spokeswoman said the HSE was “committed to providing access to care and to delivering efficient, high-quality services for all patients and service users”.
“Recruitment of staff is an ongoing challenge for POA services, as it is for all other areas of mental health services, and indeed for the broader health service,” a statement noted.
In January, 9,343 appointments were booked with POA teams, a 7.3 per cent increase compared to the same time last year.
Minister for Mental Health Mary Butler this year allocated €2.15 million in new annual recurring funding to the POA clinical programme, the statement added.
