Why don't the HSE properly advertise their mental health services?

hotspur

Sometimes it seems that across this site that Julius Caesar is fighting a one woman campaign to inform people that one can access psychotherapy for free through the HSE for people who don't have medical cards.

Anyone who has spent time on the HSE's website will not be any the wiser about their ability to obtain free therapy for mental disorders outside of the national counselling service for those who were abused in State institutions.

It was brought home to me last week when somebody asked me about CBT for social anxiety disorder through the HSE for free.

I couldn't even tell them the particulars about it. Other than the generic advice to go to their GP I couldn't tell them what the procedure would then be in respect of having to be assessed by a psychiatrist / clinical psychologist, whether they could choose CBT or a specific CBT therapist, how they would even know from the BACP / ICP database if the therapists worked through the HSE in this way etc.

I thought that I should be able to answer these questions, and that the HSE do nothing to make it transparent. It made me wonder if that were a deliberate strategy to avoid over subscription.

Do you think the HSE should be doing more to promote their out patient psychotherapeutic services? Or would that lead to the service becoming virtually unusable again?

Oh, and what are the actual answers that I couldn't provide?

JuliusCaesar

hotspur wrote: »

Sometimes it seems that across this site that Julius Caesar is fighting a one woman campaign to inform people that one can access psychotherapy for free through the HSE for people who don't have medical cards.

me too!

hotspur wrote: »

It was brought home to me last week when somebody asked me about CBT for social anxiety disorder through the HSE for free.

I couldn't even tell them the particulars about it. Other than the generic advice to go to their GP I couldn't tell them what the procedure would then be in respect of having to be assessed by a psychiatrist / clinical psychologist, whether they could choose CBT or a specific CBT therapist, how they would even know from the BACP / ICP database if the therapists worked through the HSE in this way etc.

I thought that I should be able to answer these questions, and that the HSE do nothing to make it transparent. It made me wonder if that were a deliberate strategy to avoid over subscription.

There would be a couple of answers to that.

One is that the funding for mental health is now down to 5% of the health budget.
Another might be that psychologists generally have huge waiting lists. Another is that provision of services is really patchy around the country i.e. if you live on one street, you could have access to family therapy, CBT, psychodynamic counselling, social anxiety management groups; and if you live on the next road and are in a different area, you could have none of those.
And partly it's to do with the organisation of services.
And interprofessional rivalry and defensiveness also may play a part - there''s a lot of overlap in mental health and probably each member of the team will have some training in counselling either during their original training or on top of that.

Everyone in the mental health services will be assessed by a psychiatrist in the first place and then referred on to whatever service is most suitable. The people doing the counselling/psychotherapy might be nurses or social workers or OTs or even psychiatrists, or there may be group therapy available.
A GP can also refer to psychology, but as said the wait may be long.

hotspur wrote: »

Do you think the HSE should be doing more to promote their out patient psychotherapeutic services? Or would that lead to the service becoming virtually unusable again?

I don't think there's any doubt about that! The mental health services are really set up to meet the demands of the most distressed and distressing and so are usually geared towards treatment of psychosis. But unless people make the demand, the best treatment may not be available. Unfortunately the people we fail are not generally in the best position to be writing letters to TDs.

Valmont

JuliusCaesar wrote: »

Unfortunately the people we fail are not generally in the best position to be writing letters to TDs.

Very true.

Unfortunately those best represented, via powerful and influential public sector unions, are the legions of overpaid paper pushers sucking up the money that could actually be spent on services. I seem to recall that there were bed shortages even during the Celtic Tiger.

Did you find that in the boom years, when there was a lot of public money floating around, that the administration and delivery of mental health services were better than they are now? I'm curious to see if it is a budgetary issue at the moment or a more historical fact of a generally all-round poor delivery.

kumate_champ07

theyre already overstretched and I wouldnt really call it a service, more like a a free prescription for meds.

JuliusCaesar

Valmont wrote: »

Did you find that in the boom years, when there was a lot of public money floating around, that the administration and delivery of mental health services were better than they are now? I'm curious to see if it is a budgetary issue at the moment or a more historical fact of a generally all-round poor delivery.

Tbh, when I first returned here after training in the NHS, I was astonished at the poverty of the services here. They were well below acceptable. They improved but in spots - there was no central planning and it was left up to individuals to try to push for facilities. I took it on once - it took 4 years of my life and was so stressful that I swore I wouldn't try again. (That didn't last long!)

Spending on MH services dropped from 8% to 5% of the total health budget. There was no financial backing for A Vision for Change. There does not seem to be any centralised planning, with the result that, due to the efforts of individuals, services that are available in one area do no exist in another. Mental health staffing is 9% of the entire health workforce - but it is necessarily a staff heavy service - there are no therapy machines (although some computer based CBT might be useful!)

We have moved from having huge populations incarcerated in massive asylums to moving beds to general hospitals with short stays the norm. But have we invested what we saved into the provision of community services? No. That money - from selling the land - was supposed to be ring-fenced. But it vanished into the wider health budget and was never seen again.

kumate_champ07 wrote: »

theyre already overstretched and I wouldnt really call it a service, more like a a free prescription for meds.

Given the price of anti-depressants, it's a good thing the mental health services provide medication free of charge!

MUSEIST

...because there is not anything to advertise based on my experience.

ash xxx

JuliusCaesar wrote: »

Given the price of anti-depressants, it's a good thing the mental health services provide medication free of charge!

Only the Dublin Health Boards provide anti-depressant medication for free.

I do not qualify for this as I am the Meath/ Louth area and thus have to pay for my prescriptions even though I see a HSE Psyciatrist. So its roughly €100 a month which has me broke.

Odysseus

MUSEIST wrote: »

...because there is not anything to advertise based on my experience.

Actually there is, JC can sapeak of the Psych services much better than me, but I seen a list of services for drug related problem in the area I work in, whilst it did metion my service under one heading, we where left out under the counselling/psychotherapy heading where most community services had their name under various headings. So I do think our services are not publishised as much as they could be, another example being that most GPs in my area did not think they could refer patients to me directly; they though we only offered therapy to people already on our programme.

So more could be done to make people aware, there can be waiting lists, etc, but most people are not aware of the services that are available if they look for them. So trying to inform people both professionals and those who may need our service; really does need more work. I'm not saying that we can fulfil everybody's needs, but we do offer high quality services which vary from locality to locality.

Odysseus

ash xxx wrote: »

Only the Dublin Health Boards provide anti-depressant medication for free.

I do not qualify for this as I am the Meath/ Louth area and thus have to pay for my prescriptions even though I see a HSE Psyciatrist. So its roughly €100 a month which has me broke.

I'm guessing this is because you don't have a medical card, as far as I know if you have a serious life long mental illness you would get the long term illness benefit/card' I'm not sure what it is currently called. By stating the above I do not meant to imply your depression is not a serious issue, so please forgive me if it came across that way.

However, at least you get the psych consult for free, do you get any therapy as part of your treatment, if you do [which I believe that you should have it at least offered]; this would cost anywhere from 60-100e in private fees.

In an ideal world you who get the whole package for free; and you should have access to the best quality of care; no matter how much or little you have. However, sadly for my side of the fence I can only focus on the aspect of the service I deliver; the same as all of us involved in the psych/therapy side of the HSE.

JuliusCaesar

Yup, psychiatric meds are free of charge in my area, whether or not you have a medical cards.

Same goes for therapy and counselling - no charge.

As to the inequalities around the country in charges and services and facilities - we need proper central planning and a committment to serving people equally.

Odysseus

It is a very unusal set up JC, that a patient may get meds free of charge in one area, but not another. Is that correct? With the Addiction Services any meds prescribed by our GPs or Psychs are free of charge, not just the methadone but any other meds which may be needed. Though I can imagine cut back requiring that the patients own doctor will have to prescribe any meds other than methadone icoming into play the future.

JuliusCaesar wrote: »

Yup, psychiatric meds are free of charge in my area, whether or not you have a medical cards.

Same goes for therapy and counselling - no charge.

As to the inequalities around the country in charges and services and facilities - we need proper central planning and a committment to serving people equally.

MUSEIST

JuliusCaesar wrote: »

Yup, psychiatric meds are free of charge in my area, whether or not you have a medical cards.

Same goes for therapy and counselling - no charge.

As to the inequalities around the country in charges and services and facilities - we need proper central planning and a committment to serving people equally.

^^^I am shocked at this, free of charge. Whats so special about the citizens in your region that gives them this luxury I wonder. Some psych meds are ridiculously expensive.

Victor

hotspur wrote: »

Why don't the HSE properly advertise their mental health services?

(a) Because it would cost them money in the short term (but possibly save money in the long term).
(b) Mental health problems aren't as sexy as (other) childhood diseases.
(c) Some interventions are relatively expensive.

Odysseus wrote: »

It is a very unusal set up JC, that a patient may get meds free of charge in one area, but not another. Is that correct? With the Addiction Services any meds prescribed by our GPs or Psychs are free of charge, not just the methadone but any other meds which may be needed. Though I can imagine cut back requiring that the patients own doctor will have to prescribe any meds other than methadone icoming into play the future.

As I understand it, before the health boards were abolished, they received the health component of PRSI directly, Revenue merely collected it for them and the Department had no control over it. This allowed each board a certain discretion in their spending. The Eastern Health Board went for a free psychiatric scheme, others went for other schemes.

Valmont

Victor wrote: »

As I understand it, before the health boards were abolished, they received the health component of PRSI directly, Revenue merely collected it for them and the Department had no control over it. This allowed each board a certain discretion in their spending. The Eastern Health Board went for a free psychiatric scheme, others went for other schemes.

Interesting, this is an example of more central planning, as JC puts it, but with calamitous effects. Perhaps greater autonomy and decentralisation would help? i.e. budget foresight and wiggle room policy-wise, that way if something is found to work in one area, others are free to adopt it.

SparkyTech

No wonder they don't advertise whats on offer. I had the displesure of trying to navagate through the menatal health systym last year. Ended up going private and taking money out of my own savings, thats how bad the service was, all because I hapened to live in the wrong catchment area with a 3 month waiting list to see someone! Its appauling.

Odysseus

SparkyTech wrote: »

No wonder they don't advertise whats on offer. I had the displesure of trying to navagate through the menatal health systym last year. Ended up going private and taking money out of my own savings, thats how bad the service was, all because I hapened to live in the wrong catchment area with a 3 month waiting list to see someone! Its appauling.

I don't disagree with you, but in my service you will get to see me within a week, and medical tx within one month. Yes the service can be very bad, imagine what it like for us, leaving people without tx. I remember a time where there was a 2 and half year waiting list for medical tx for my clients.

The Black Oil

I was visiting somewhere recently and a poster was up asking for feedback or comments. Can't remember the abbreviation now, I don't think it was HIQA, though I may well be mistaken.

Victor

Odysseus wrote: »

I don't disagree with you, but in my service you will get to see me within a week, and medical tx within one month. Yes the service can be very bad, imagine what it like for us, leaving people without tx. I remember a time where there was a 2 and half year waiting list for medical tx for my clients.

What is "tx"?

mathepac

Odysseus wrote: »

... as far as I know if you have a serious life long mental illness you would get the long term illness benefit/card' I'm not sure what it is currently called. ...

Untrue - the list of conditions which entitle a client to a long-term illness booklet is here - http://www.citizensinformation.ie/en/health/health_related_benefits_and_entitlements/long_term_illness_scheme.html

Depression is not covered.

Victor wrote: »

What is "tx"?

Shorthand for "treatment", pt for "patient", etc

Odysseus

mathepac wrote: »

Untrue - the list of conditions which entitle a client to a long-term illness booklet is here - http://www.citizensinformation.ie/en/health/health_related_benefits_and_entitlements/long_term_illness_scheme.html

Depression is not covered.
Shorthand for "treatment", pt for "patient", etc

Hi, yes I said I was unsure, pity about that but at least I know now. Sorry first thime I ever used tx or anythin like it here I was in a bit or a hurry. Tx=treatment

starviewadams

I assumed every health board in the country provided mental health services for free.Within a week of my GP referring to the community clinic I saw a psychiatrist who I now visit weekly,was prescribed anti-depressants and am seeing a psychologist next week,all for free(well the meds cost 50c).I guess I'm just lucky that I live in an area with access to these services,because there is no way that I could afford any of them privately.I dont have a medical card either btw.

sam34

starviewadams wrote: »

I assumed every health board in the country provided mental health services for free.Within a week of my GP referring to the community clinic I saw a psychiatrist who I now visit weekly,was prescribed anti-depressants and am seeing a psychologist next week,all for free(well the meds cost 50c).I guess I'm just lucky that I live in an area with access to these services,because there is no way that I could afford any of them privately.I dont have a medical card either btw.

every area has a psychiatric service which is free. however, waiting lists vary greatly from area to area, and what is available in eash area varies greatly also, ie some areas have psychology services, some dont, some have occupational therapy etc

sambuka41

hotspur wrote: »

Sometimes it seems that across this site that Julius Caesar is fighting a one woman campaign to inform people that one can access psychotherapy for free through the HSE for people who don't have medical cards.

:eek::eek: Did not know this!! Curse if only i knew that before the year of €70 quid a pop!!

How does one go about this? Do they just say to their GP that they would like to see a psychotherapist. I know someone at the moment who is looking into this but she is very broke. Her issues aren't psychiatric,mainly family dynamics and stress related. Does she just go to GP explain and a referral goes for a psychotherapist or does she have to be assessed by psychiatrist first?

Ive been looking at (getting confused by) the HSE website for info but im drawing a blank. Trying to make sure that whoever she goes to is actually qualified. :rolleyes:

JuliusCaesar

sambuka41 wrote: »

How does one go about this? Do they just say to their GP that they would like to see a psychotherapist. I know someone at the moment who is looking into this but she is very broke. Her issues aren't psychiatric,mainly family dynamics and stress related. Does she just go to GP explain and a referral goes for a psychotherapist or does she have to be assessed by psychiatrist first?

Yes, go to the GP; the GP will send her for assessment by the psychiatrist, who will refer to the most suitable person available. Tell the GP, and tell the psychiatrist what you want and they will take that into account.