Challenges of burnout and training raised by President

Psychiatry in Ireland continues to face the challenges of limited resources, and legislation and regulation which are not fit-for-purpose. This was the message from Dr Lorcan Martin, President of the College of Psychiatrists of Ireland, in his opening address at the College’s Winter Conference 2023 held on 16 and 17 November at the Sheraton Hotel in Athlone. The theme of the conference was ‘Global perspectives on psychiatry: Bridging borders for better mental healthcare’.

“Like our colleagues in other medical specialties, we are happy to offer our expert advice for development of policy and strategy, even if we have to bang loudly on the doors of power to get that opportunity,” he said.

Speaking to the Medical Independent, Dr Martin said the main challenges facing the profession tied in with some of the key messages from the conference. “Obviously, the most important thing is that our patients have to come first, and in order to provide a gold standard service in a timely fashion, you need resourcing.”

He explained that one of the key difficulties faced by psychiatry was that many of the mental health teams in Ireland were under-resourced. “There aren’t enough of them to begin with, and the ones that are there don’t have the full complement of team members.” When it came to resourcing, one of the major problems was the proportion of the health budget allocated to mental health in Ireland, which was only 6 per cent. “In other comparable developed countries, it will be 12-to-13 per cent. This is something we have been saying for a very long time.”

He stressed that it was not about changing the system, as the system that was in place worked well when it was supported.

Another priority for the College was training specialists for the future, he said. Dr Martin pointed out the College of Psychiatrists of Ireland has a comprehensive and established training scheme. Although the College was keen to take on more NCHDs who wanted to qualify in psychiatry, it again came down to resources: “You cannot train somebody on goodwill and aspirations.” He stressed that training a doctor to become a specialist took significant effort, resources, and personnel.

The other key challenge highlighted by Dr Martin was that many doctors – as well as other team members – suffer from burnout and work-overload due to a lack of resourcing. “People are trying to do more and more with less and less.” It was not only a problem for those in the profession, he said, but “getting people to take up jobs”. This resulted in psychiatrists and other medical specialists moving abroad or retiring earlier than they might otherwise do “simply because the job is becoming too onerous”.

He referred to the new consultant contract which, he said, provided a much better salary for psychiatrists.

However, he stressed that there were issues beyond salary that needed to be addressed. These included long waiting lists, insufficient capacity, and out-of-date technology. “These are the kinds of things people need to do their jobs properly and make sure that patients get what they need in a timely fashion. No one wants to hear about getting a wonderful service if you have to wait two years to get it.”

Dr Martin added that “psychiatry is fundamentally about people”.

“First and foremost, obviously, it is about the patients… and beyond that you are talking about the families and carers; they often need a lot of education and support. Looking after somebody with a serious mental illness can be extremely stressful for someone in their immediate vicinity.” He said psychiatrists and their teams also needed support. “It’s in a different way, a professional way, but has its own stresses.” And, finally, Dr Martin said, it is important for doctors to be aware of their own health status. “If we do not look after ourselves, we cannot give our best to those we are supposed to be helping.”