Psychiatrists In Ireland Research Articles

Amid magic and menace: psychiatrists' attitudes to psilocybin therapy.

Understanding variations in knowledge and attitudes of psychiatrists to psilocybin therapy is important for the collective discourse about the potential impact on clinical practice and public health in Ireland. A 28-item questionnaire was designed based on previous studies and distributed to psychiatrists in Ireland via online mailing lists and at in-person academic events. 151 psychiatrists completed the questionnaire (73.3% were under 40 years of age, 76.0% were trainees, and 49.0% were female). In the total sample, 81.5% agreed that psilocybin therapy shows promise in the treatment of psychiatric disorders and 86.8% supported funding research, 86.8% would be willing to refer a patient if it was licensed and indicated, and 78.1% would consider the treatment for themselves, if indicated. Conversely, 6.6% agreed that psilocybin therapy was unsafe even under medical supervision, and 21.9% thought it was potentially addictive. 15.9% of the total sample reported at least one concern including, lack of robust evidence, long-term effectiveness, superiority to current interventions, potential harmful effects, cost and accessibility, and impartiality. Less than half of respondents felt knowledgeable (40.0%) and 9.9% felt adequately prepared to participate in psilocybin therapy. Consultant psychiatrists trended towards less optimism for a potential role in bipolar depression and emotionally unstable personality disorder compared to trainee psychiatrists. Overall psychiatrists in Ireland held positive attitudes towards psilocybin therapy. However, there was a lack of knowledge evident. Addressing the knowledge gap and aligning with the best available evidence will be key if psychedelic therapy is to prevail in a clinical setting.

A survey of Irish psychiatric trainees attitudes to balint groups

Aims1. To compare the experience of psychiatric trainees in Ireland of online Balint Groups (BG) in contrast to face to face groups.2. To assess the general attitudes of trainees to BG using the Psychological Medical Inventory (PMI) (Ireton and Sherman, 1988) scale.MethodAn online survey comprising two sections: 1. A questionnaire exploring participants experience, effectiveness and obstacles to attending the two formats of BG with a free text box response. 2. General attitude of trainees towards BG using PMI scale.An online cross-sectional survey using Survey Monkey. An invitation to participate in the survey was emailed to all trainees by the College of Psychiatrists in Ireland. All data were anonymised, and all data processing was conducted in line with GDPR. Statistical analysis was undertaken using Microsoft Excel. Thematic analysis was applied to the free-text box responses.Result16.49% (64/388) responded to the survey. Responses were uniform across all stages of training. 97% of respondents attended BG; 72% attended both formats, 25% attended only face-to-face and 3% online only. 65% of respondents preferred face to face compared to 18% online, whilst 11% stated no preference.On thematic analysis, trainees asserted a preference for face-to-face, describing better group cohesion, feeling safer to share, increased ease of interpreting non-verbal communication, and that conversation was more fluid. They described greater ease of engagement with the group/facilitator and preferred direct social interaction with peers.Conversely, most trainees acknowledged that online groups were convenient to attend, less time consuming & mitigated COVID risk associated with face-to-face meetings. Common themes against the use of online groups were: less psychotherapeutic in nature, technical issues, silences, unable to see participants faces and as though speaking “into the void”.Regarding trainees' attitudes to attending BG, most of the trainees found BG had been beneficial in developing more interest and confidence in dealing with the psychological aspects of patient care. Trainees agreed that skills improved in developing an excellent doctor-patient relationship, recognising patients under stress/ in distress, systemically obtaining psychological information and making treatment decisions based upon psychological needs and psychotherapeutic engagement. They agreed that they could better understand the influence of doctors' emotions on the doctor-patient relationship.ConclusionThis survey showed that most trainees find BG beneficial in developing better doctor-patient relationships, preferring face-to-face rather than online BG. However, they found online more convenient. A blended learning approach could provide trainees with the benefits of both formats of BG.

Burnout, Work Satisfaction, and Well-being Among Non-consultant Psychiatrists in Ireland.

ObjectiveThe aim of this study was to explore the areas of psychological well-being, satisfaction at work, and burnout among non-consultant psychiatrists in Ireland, and to assess for potential contributory factors.MethodsThe College of Psychiatrists of Ireland distributed the survey online to 100 non-consultant psychiatry doctors working in Ireland. The survey contained questions relating to demographic and work-related variables, the Abbreviated-Maslach Burnout Inventory (a-MBI), Basic Needs Satisfaction at Work (BNSW) scale, and WHO-5 Well-being Index. Descriptive statistics were used by the authors to summarize the data and univariate associations were explored between baseline data and subscales.ResultsSixty-nine percent of our sample completed the survey. Thirty-six percent of the sample met the criteria for burnout, with lack of supervision the only variable significantly associated with this. Lack of regular supervision was associated with lower scores across all work satisfaction domains of the BNSW scale. The WHO-5 Well-being Index identified that 30% of respondents scored low in personal well-being, indicating that this proportion screened positive for depression, based on international diagnostic criteria. Lack of regular supervision was found to be significantly associated with low psychological well-being.ConclusionThis study indicates that lack of supervision is significantly associated with burnout, lower satisfaction at work, and poorer psychological well-being. Close evaluation of these areas is important to identify vulnerable individuals and areas of training which can be improved upon, which may lead to relevant measures being implemented for the benefit of psychiatrists, patients, and the wider society.

An audit of assessment rooms for mental health assessments in Ireland's emergency departments.

To audit compliance of mental health assessment rooms in Irish adult emergency departments (EDs) which are open 24 hours on 7 days a week with standards identified by the Psychiatric Liaison Accreditation Network (PLAN). A self-audit tool was sent via email to Clinical Nurse Specialists and Consultant Psychiatrists in Ireland's 26 Adult EDs that are open 24 hours on seven days a week. Results were collated and are presented ensuring anonymity. A response rate of 100% was achieved. Full or substantial compliance with PLAN standards was recorded in 73% of services. In seven services, the rooms used for mental health assessments were unsuitable when measured against the PLAN standards. A number of services identified the presence of ligature points within the rooms. The Health Service Executive (HSE) National Clinical Programme for the Assessment and Management of patients presenting to the ED following self-harm is committed to achieving 100% compliance with PLAN standards in all services. Recommendations include introducing formal ligature risk assessments and risk assessments of the use of the assessment rooms. The Chief Executive Officers of all hospital groups were informed of the results of the audits and advised on recommendations for each hospital ED.

184 A National Survey of Clinicians who Assess People with Suspected Dementia: Service Characteristics and Practice

Abstract Background The Irish National Dementia Strategy (2014) identified timely diagnosis and intervention as a priority area. The National Dementia Office established a Dementia Diagnostic Project to develop a framework for diagnostic services nationally. As part of preparatory work, a national survey explored baseline peri-diagnostic practice in geriatric medicine, neurology and psychiatry of old age services. Methods A survey was developed by the project steering group, piloted, and then distributed to all 86 Geriatricians, 39 Neurologists, and 34 Psychiatrists of Old Age Psychiatrists in Ireland. Two reminder e-mails were sent. Results In total, 56 clinicians responded (response rate 35%). The majority (74%) saw 1-20 people with suspected dementia (PwSD) per month. Most referrals came from General Practitioners or other physicians; but rarely from Health and Social Care Professionals. Most people were referred specifically for their memory complaint, rather than a co-morbidity. Waiting times for urgent review varied between 24 hours and 4 years; neurology services had the longest waiting times. Only 30% saw PwSD in a dedicated clinic; about the same proportion saw PwSD in their own home; or in residential care settings. About half reported assessing people with intellectual disability and suspected dementia, mainly the neurologists. The Montreal Cognitive Assessment was the most commonly used cognitive tool (89%), followed by the Addenbrook’s Cognitive Examination (56%). Only 17% commonly used functional brain imaging in diagnosis, mainly neurologists; half of respondents ‘never’ or ‘rarely’ used cerebrospinal fluid analysis. Multidisciplinary input was mainly from Occupational Therapists (61%), Psychology/Neuropsychology (52%), and Nursing disciplines (33%). When asked which discipline would most benefit their diagnostic service, neurologists all chose psychology input; geriatricians selected a range of disciplines. Conclusion The significant variability within current services who see PwSD, in terms of multidisciplinary involvement, waiting times, setting, and supporting investigations, supports the need for a national diagnostic framework.

Proceedings of the Psychiatry Section of the Royal Academy of Medicine in Ireland (RAMI) and the Faculty of Academic Psychiatry of the College of Psychiatrists of Ireland, BST and HST competition. Venue: Albert Theatre, Royal College of Surgeons, 123, St. Stephen's Green, Dublin 2 on Thursday 30th May 2019.

Proceedings of the Psychiatry Section of the Royal Academy of Medicine in Ireland (RAMI) and the Faculty of Academic Psychiatry of the College of Psychiatrists of Ireland, BST and HST competition. Venue: Albert Theatre, Royal College of Surgeons, 123, St. Stephen's Green, Dublin 2 on Thursday 30th May 2019.

Mental healthcare for hospitalized older adults: a national survey of consultation-liaison services provided by old age psychiatrists in Ireland.

In Ireland, the population aged 65 years and over is projected to increase by 20,000 annually with the proportion of the population aged over 65 years doubling over the next 30 years. It is estimated that up to 60% of older people in hospital have or can develop a mental disorder during their admission (Royal College of Psychiatrists, 2005). The needs of older adults are distinct in many ways and a previous systematic review found that old age psychiatry services for hospitalized older adults are effective (Draper and Low, 2005). With regard to models of service provision, there is evidence that a liaison type service is superior to consultation only. The latter service is limited and reactive whereas a dedicated liaison service is proactive and is more likely to succeed in having good mental healthcare adopted as the standard of care within a hospital (Royal College of Psychiatrists, 2005). Consultation–Liaison (CL) services have been associated with decreased psychiatric morbidity, improved function, reduced length of stay, fewer readmissions, and increased cost-effectiveness compared with usual care (Royal College of Psychiatrists, 2005, Parsonage and Fossey, 2011). In Ireland, specialist community services for older adults have developed steadily, while CL services have remained relatively neglected with no specific recommendations regarding CL services for older adults in national guidelines (Department of Health, 2006). This is not necessarily out of step with international trends where in spite of increasing rates of referral to CL services for older adults in the United Kingdom and the United States there is a reported lack of emphasis upon this important area of service provision (Anderson et al., 2011). Consequently, little is known about age-specific CL services for older adults in Ireland, and service development has proceeded in an unstructured way. In particular, it is not known whether such a service is available within each area and if so, what the nature and extent of the services provided are.

Self-neglect: a survey of old age psychiatrists in Ireland

Self-neglect in old age is complex, challenging, and likely to increase in the future. Self-neglect is characterized as the behavior of an elderly person that threatens his or her own safety. Self-neglect is the most common form of abuse and neglect reported to Adult Protective Services in the United States (see Teaster, 2000). Self-neglect is also associated with a significantly increased mortality in victims (Dong et al., 2009). Self-neglect has become a significant public health problem affecting not just the victims but also family members, friends, and frequently the community at large. Characteristics of self-neglect include a failure to provide oneself with adequate food, water, clothing, shelter, or a safe environment and neglect of personal hygiene and medical treatment (O’Brien, 2011).

Psychiatrists' experiences of stalking in Ireland: prevalence and characteristics

Aims and methodAccumulating evidence suggest that psychiatrists may be at greater risk of being stalked compared with the general population. We used a self-administered questionnaire to survey psychiatrists in Ireland about their experiences, practices and attitudes regarding work-related stalking.ResultsWe found that 25.1% of psychiatrists in Ireland had been the subject of stalking behaviour at some point in their career. At the time of the survey, 5.5% of respondents were actively being stalked. The majority of the stalking occurred in the workplace and most of the perpetrators were patients. Most of the victims were unaware of guidelines or other supportive mechanisms in their workplace. Of those who reported their experiences to authorities, almost half were not satisfied with the support they received.Clinical implicationsStalking of psychiatrists is not uncommon. Employers should put in place supportive structures backed up by education and training to reduce the incidence, associated morbidity and other wider consequences of stalking.

The Challenge of Managing Severely Ill Patients with Anorexia Nervosa in Ireland.

Anorexia Nervosa (AN) has the highest rates of morbidity and mortality of any psychiatric disorder. Psychiatrists in Ireland have reported difficulties in managing patients with AN, particularly those with severe levels of illness. This paper explores these management difficulties, including the financial and organisational impediments to service provision, and the legal and ethical dilemmas involved in dealing with those patients who refuse treatment.

Shared Care between Specialized Psychiatric Services and Primary Care: The Experiences and Expectations of Consultant Psychiatrists in Ireland

Internationally, there has been a growing interest in the pursuit of collaborative forms of care for patients with enduring mental health difficulties. The study aims to explore the views of consultant psychiatrists in Ireland on shared care between specialized psychiatric services and primary care for patients with mental health difficulties. A self-administered questionnaire was designed and posted to 470 consultant psychiatrists who are members of the College of Psychiatry of Ireland. Stamped self-addressed envelopes were included for the return of completed questionnaires. Overall, 213 questionnaires were returned, giving a response rate of 45%. Of the respondents, 194 (91%) reported that they would support a general policy on shared care between primary care and specialized psychiatric services for patients who are stable on their treatment. However, 181 (85%) reported that they foresaw difficulties for patients in implementing such a policy including: increased financial burden on some patients (141, 66%); some patients may lack confidence in GP care (100, 47%); primary care is not adequately resourced with allied health professionals to support provision of psychiatric care (128, 60%); primary care providers are not adequately trained to provide psychiatric care (111, 52%); and lack of adequate cooperation between primary care and specialized mental health services (96, 45%). The Irish government and the Colleges of General Practitioners and Psychiatrists in Ireland need to work together to remove the bottlenecks that hinder the active involvement of primary care in the management of patients with enduring mental health difficulties. Also, the health care systems need to be organized along a shared care model to facilitate effective collaboration between primary and specialized psychiatric services.

P03-524 - Shared care between specialised psychiatric services and primary care - the experiences and expectations of consultant psychiatrists in Ireland

ObjectiveThe study aims to explore the views of consultant psychiatrists in Ireland on shared care between specialist psychiatric services and primary care.MethodsA self-administered questionnaire was posted to all 470 consultant psychiatrists working in Ireland. Self addressed envelopes were included for the return of completed questionnaires. Data was analysed using descriptive statistics and ANOVAResults213 questionnaires were returned giving a response rate of 45%. 47.9% of the respondents were male and 52.1% were female. Over all, 91% of respondents reported that they would support a general policy on shared care between primary care and specialised psychiatric services for patients who are stable on their treatment. However, 85% reported that they foresaw difficulties for patients in implementing such a policy, including: increased financial burden on some patients (66%), lack of adequate allied health professionals resources in primary care (60%) and GP's not adequately trained to provide psychiatric care (52%). Most psychiatrists did not feel comfortable to transfer the care of patients with schizophrenia or bipolar disorder to their GP's and Child psychiatrists were significantly less comfortable than other psychiatrists to discharge patients with Depression, Bipolar Disorder, Anxiety Disorder, Alcohol Dependency Syndrome and Personality Disorder into the care of GP's after they have been stabilised in their medication.ConclusionAlthough most psychiatrists in Ireland would support a policy of shared care, they identify several constraints which would currently hamper the effective implementation of a policy of active collaboration between primary care and specialised psychiatric services in Ireland.

Consultant psychiatrists' experience of workplace violence - a national survey.

In recent years there have been a number of high profile cases in Irish psychiatry where consultant psychiatrists have been subjected to serious physical assaults. The last survey of assaults on consultant psychiatrists in Ireland was carried out in 1998. Therefore we sought to update the data on this topic. An anonymous questionnaire was sent out by post to all consultant psychiatrists (n = 330) identified as currently working in the Republic of Ireland. The response rate was 48.2%. Sixty per cent of respondents were working in general adult psychiatry and respondents were evenly spread throughout the country. Ninety per cent of respondents had been the victim of verbal aggression/intimidation/threatening behaviour while 55% had been physically assaulted. The majority of incidents involved male patients aged between 21-40 years with a diagnosis of paranoid schizophrenia. Nearly 66% of incidents of physical violence occurred during a relapse of illness. The perpetrator had a history of violence in approximately half of all reported incidents. Physical assaults tended to occur more commonly in inpatient settings (63.7%). Incident reporting occurred more often in physical assaults with 66% reported informally to colleagues and 20% reported to An Garda Siochana (police force of Ireland). Eighty-nine (56%) consultants described feeling 'safe' at work. Less than 50% reported the provision of standard safety equipment in the workplace and nearly half ofrespondents had not attended any safety training courses since their appointment. Longer experience working as a consultant psychiatrist did not appear to have an impact on reducing the rate of assaults. In addition, those who attended safety training courses did not report a reduced rate of physical assaults. These findings highlight the need for both organisational and personal changes in practice in order to reduce the assault rate. Organisational changes include the provision of appropriate safety equipment, safety training for consultants, enhancing multidisciplinary teams and utilising risk assessment. Consultants' personal practices to improve their safety may offer useful information for inclusion in safety training courses. This is an area which merits further research.

Impact of patient suicide on consultant psychiatrists in Ireland

Aims and methodTo study the effects of patient suicide on both personal and professional life of consultant psychiatrists in Ireland. A questionnaire was sent to all practising consultants.ResultsMost respondents (80%) had experienced patient suicide in their careers; in up to 97% it had an impact on either their professional or personal life. The most common effects were preoccupation with the suicide and guilt. Unpredicted suicides and perceived effect on patients' families worsened the distress. Informal support was of most help, with a large proportion of study participants suggesting independent case review would be helpful.Clinical implicationsPatient suicide is an almost universally distressing event for psychiatrists. Although consultants receive psychological support from family and friends, many would also welcome an objective professional review.

National survey of psychiatrists’ responses to implementation of the Mental Health Act 2001 in Ireland

Ireland's Mental Health Act 2001 resulted in substantial changes to mental health services and the process of involuntary admission. To determine the views of Irish psychiatrists regarding the new legislation, 1 year after full implementation. We sent questionnaires to all 735 members of the Royal College of Psychiatrists in Ireland. The response rate was 43.7%. As much as 84% of respondents reported satisfaction with training; 69.1% reported increased workloads; 26.8% reported decreased time with service-users; 40.7% reported changes in relationships with service-users (e.g. increased empathy, but more legalistic, conflicted relationships). Almost one in three (27.4%) stated that it was not feasible to implement the Mental Health Act. Negative comments highlighted the adversarial nature of mental health tribunals, effects on therapeutic relationships and issues related to children. The implementation of the Mental Health Act 2001 has resulted in increased workloads, more conflicted relationships with service-users and adversarial mental health tribunals.

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Digest

What's Irish about psychiatry?

AbstractThis lecture examines issues which have preoccupied psychiatrists in Ireland over nearly 200 years, as recounted in their writings. Some issues: alcoholism, high rates for hospitalised mental illness, and the reported suicide rate, have changed little until the last decade. The valuable contributions of Dr. William Saunders Hallaran, Dr. Connolly Norman and Dr. Dermot Walsh have deserved particular mention.