Mental health – a continuing scandal


Sir, – The following from a HSE spokeswoman, quoted in Paul Cullen’s lead story on Thursday on the most recent scandal, was surely superfluous: “It would be unfair of us as an organisation to single out any identifiable individual or individuals” (“Kerry mental health service issues to be referred to Garda”, News, January 27th).

That sounds familiar.

The quotation is preceded by the following: “The very fact that there are 35 recommendations shows that the issues are many and varied.”

The only sense I can make of this is that the HSE is saying that things were so bad in the service which it provides that it could not possibly be the responsibility of one person.

Sadly, I suspect the HSE right. – Yours, etc,



Dublin 6.

Sir, – In reference to the recent HSE review on South Kerry Child and Adolescent Mental Health Services (CAMHS), an inability to fill the permanent consultant child and adolescent psychiatrist post seems to be one of several causal factors. I completed the higher specialist training programme (HST) in child and adolescent psychiatry in Ireland, and I received excellent training and supervision in the pharmacological and non-pharmacological aspects of child and adolescent psychiatry in a multidisciplinary setting. The HST programme in Ireland compares well to child and adolescent psychiatry fellowship training in the US in terms of academic and experiential rigor. It is reasonable to conceptualise the deficiencies highlighted in this report as the product of a health system that neither sufficiently retains those who complete the HST, nor provides adequate resources to the highly skilled consultant psychiatrists who remain to work in the service. – Yours, etc,



Oyster Bay,

New York.

Sir, -The recent controversy with regard to care in south Co Kerry once again highlights the complete absence of oversight of HSE management. Are we as a nation going to blame a junior doctor or are we going to finally ask questions of HSE management who are in receipt of €21 billion annually from the Irish taxpayer yet are unable to attract qualified medical staff in sufficient numbers?

We currently have 748 unfilled hospital consultant posts. The inevitable consequence of this is lengthy waiting lists and more errors occurring. Allied to this the HSE’s implementation of the Department of Health’s “deny and delay” approach to medical negligence means lessons cannot ever be applied in a timely manner and repeat errors are an inevitable consequence.

The financial costs of the HSE’s failure to attract sufficient consultants was shown last year with the doubling of medical negligence costs to €4 billion.

It is a complete abdication of responsibility for politicians and senior permanent health management to try and blame this on individual doctors or nurses. The reality is errors and failings are an inevitable consequence of the Department of Health policies which are being implemented by the HSE.

It is welcome that the complete absence of managerial oversight in our health service has now been highlighted. We have a system in our health service where doctors and nurses can face public regulatory body inquiries for failings yet managers in the HSE and Department of Health are never subject to any level of independent oversight.

In the case of the HSE , the “Your Service” service takes complaints and passes them on to individual departments to investigate themselves!

Independent regulatory body oversight of HSE and Department of health management is long overdue. One cannot expect HSE and Department of Health managers to push this; it needs to come from politicians, and in particular the Minister for Health. Politicians are ultimately accountable to the electorate and doctors and nurses to their regulatory bodies. We urgently need a functioning level of independent oversight and accountability for permanent health service management.

Even before the recent pay rises, Irish permanent health service management were exceptionally well paid. Once would expect that they might at least take responsibility for the consequences of the policies they themselves have implemented over the last number of years. Politicians, particularly former ministers for health, should desist from feigning outrage over events in South Kerry and reflect on the reality that they are a direct consequence of the policies they themselves implemented. Patients and highly qualified medical staff have had to deal with the consequences of Irish health service policy for years, and it is long past time that permanent health service managers and politicians did so. – Yours, etc,



Dublin 18.