Sir, – I welcome Dr Lorcan Martin’s and Dr Patricia Byrne’s comment (Letters, May 25th) on my article “Mental health services are in the grip of a model that fails” (Opinion & Analysis, May 22nd) and in particular their emphasis on the importance of being honest with people who use mental health services. However, given the clear concerns expressed by families and the evidence from the Maskey report, I am surprised at their lack of reference to what Dr Seán Maskey – a psychiatrist – described as “unreliable diagnoses, inappropriate prescriptions and poor monitoring of treatment and potential adverse effects” which exposed many children unnecessarily to the risk of significant harm. Concerns about the appropriateness of diagnosis and drug treatments have to be genuinely owned and addressed, with humanity and humility, not defensively rebutted. The problems with diagnostic approaches are of course to be equally addressed by all those, including those psychologists, who adopt such a medical model approach to mental health.
The main point of my article was that – based on the evidence – mental health teams should be less hierarchical and led on a competency basis, not restricted to leadership from a single professional background. It is telling that Dr Martin and Dr Byrne suggest such arguments “serve no use other than to attempt to drive a wedge between medical and allied health specialties”. A wedge separates, as does hierarchy, as does restricting leadership to only one profession. So let us collectively remove these wedges from mental health services; put people first, background professions and work together in the most effective way possible.
I would welcome an initiative from Minister for Health Stephen Donnelly and Minister of State for Mental Health Mary Butler to establish a working group which considers the implications for mental health services of the recent joint World Health Organisation and HSE report on rights-based leadership and governance. This report was produced by representatives from the HSE, Hiqa, the National Disability Authority, and an Irish psychiatrist; as well as international experts including a former UN special rapporteur on health, who is also a professor of psychiatry.
I believe that such a working group, in the context of the Maskey report and revision of the Mental Health Act, could provide the basis for a truly shared vision that more effectively supports the mental health of our citizens across their life course. – Yours, etc,
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MAC MacLACHLAN,
Professor of Psychology
and Social Inclusion,
Maynooth University.
Sir, – A recent opinion article (May 22nd) in The Irish Times and a discussion on RTÉ's Drivetime (May 23rd) concerning leadership of Child and Adolescent Mental Health Services (Camhs) services in Ireland both cited worries of overprescribing of medication by Irish psychiatrists.
Data on Irish prescribing rates in Camhs has been scarce in Ireland, with previous studies focused on medical card populations only that may not represent the general youth population.
However, since 2016 all Irish youth under 16 are entitled to free medication for mental health conditions, which allows us to capture more accurate estimates of prescribing rates, and subsequent international benchmarking.
Our research group is currently analysing an up to date comprehensive dataset across all medication reimbursement schemes.
We estimate that on average, in 2021, 0.8 per cent of Irish youth aged five to 15 years were prescribed a psychotropic medication. This includes 0.4 per cent of youth on average taking medication for ADHD, 0.2 per cent taking antidepressants, and 0.1 per cent taking antipsychotics.
We note these rates are lower than similar studies from Sweden, Denmark and Norway (3.5 per cent, 2.2 per cent and 2.2 per cent of 5-19 year olds taking medication for ADHD in 2020, the UK (0.6 per cent of five to 17 year olds taking antidepressants in 2018) and the Netherlands (0.8 per cent of seven to 12 years olds taking antipsychotics in 2019).
Across all similar geographies, year on year increases in medication use are common; however, Ireland is operating at a lower prescribing rate base than similar countries. While the risk of inappropriate increases need to be monitored, increasing trends in Camhs medication use are attributed to increased awareness of mental health conditions in youth, and treatment guidelines recognising the evidence base supporting medication use.
Resourcing, management and governance issues persist within the provision of Camhs, and these are receiving appropriate attention. However, we appeal for the discourse not to conflate individual cases of clinical mismanagement, eg the South Kerry Camhs Maskey Review Report, with unfounded blanket concerns of psychotropic medication overprescribing in youth, which can erode the trust of a young person and their family in appropriate evidence-based therapies. – Yours, etc,
Dr JOHN HAYDEN,
REBECCA PARKIN,
School of Pharmacy
and Biomolecular Sciences,
Royal College of Surgeons
in Ireland;
Prof FIONA McNICHOLAS,
Department of Child
and Adolescent Psychiatry,
University College Dublin.