ALIEN NATION
COUNTY WEXFORD’S OUTGOING CONSULTANT PAEDIATRIC PSYCHIATRIST DR KIERAN MOORE TELLS DAVID LOOBY OF THE NEED FOR REFERENDUM ON MENTAL HEALTH AS SUFFERERS ARE TREATED LIKE ‘ALIENS’
COUNTY WEXFORD’S outgoing medical consultant paediatric psychiatrist has called for a referendum on mental health over the crisis in children’s and teenagers’ mental health care, adding that patients are treated like aliens by the State.
Dr Kieran Moore, who left the position in Slaney House on Friday, said the State has been complicit in treating children and adults with psychiatric illness as aliens and called on Taoiseach Leo Varadkar to apologise to the parents of children who have been directed to adult psychiatric units for treatment, Mr Moore began working with the child and adolescent mental health service in County Wexford and County Waterford in December 2012 and says nothing has improved for patients since that time in terms of resourcing mental health care, despite assurances to this effect from successive governments.
He said: ‘ The core work I do is for children who are ill, for things like severe depression. I know people who are lucky enough not to have experienced the illness don’t understand the seriousness of it. Things like Schizophrenia, Anorexia Nervosa, Tourettes, all these kind of medical, neurological illnesses. These really affect a certain percentage of the population. They will always be there.’
He feels bitter-sweet leaving the role, in a month when two other senior child psychologists announced that they are leaving their positions in County Wexford. ‘I have been stuck out in a house (Slaney House), where at the very least the kids I see have to be on medication. It’s not fit for purpose. I can’t do bloods or ECGs. There have been assaults here and the building is not safe for either children or staff.’
He said there are too many managers in the HSE. ‘ There is a lack of clarity as to what they do. They don’t understand. They have no background in the speciality and they can make decisions and there is no evidence base for it and there is no accountability. There has been no improvement, there are more people but there is no actual change. It’s the same issues and the same fights, children in Wexford who have autism aren’t being seen by the autism team; children who need to see me aren’t being seen. The only thing that has changed is patients and parents have become much more aware and there is an understanding even nationally that we have to do something. I think societally it’s the last big issue of stigma we are facing. Homosexuality is being addressed, abortion was addressed, and divorce. 0.6 per cent of the health budget for children’s mental health care is just obscene. We continue to put children into an adult ward.’
Dr Moore said: ‘We tinkered around and the HSE is good at soft-soaping us with words, but deep down very little has changed. I do think we are on the road to it but it will take 20 years.’
Since 2002, 4,486 patients were referred to him. ‘1,444, or nearly one third, were inappropriate referrals, which should have been sent to primary care services. Of the 2,357 patients who were seen by me, (each new assessment takes at least three hours including paperwork), 327 had a primary diagnosis of autism (i.e. no other diagnosis and shouldn’t have been seen by me at all), and should have been seen by the autism service and 800 (one third) should have been seen by the psychology service urgently, but weren’t. This is a ferocious misuse of time and taxpayers’ money.’
He said children today are growing up in a different world. ‘I am a huge fan of electronics and communications myself, but I do think it’s a harder world today. I grew up in the 80s. If you were upset about something there were ways of dealing with it and there was a lot of angst and pain in those times as well, but you didn’t have this extra layer of going online and someone sending you a picture of them cutting themselves or somebody telling you how to kill yourself. It was more about going down town to a disco and hoping someone fancies you; now you have to go online.’
The Tipperary man, who lives outside New Ross, is moving to work at Our Lady’s Children’s Hospital in Crumlin. He described as ‘absolute bunkum’ an assertion made by Mental Health Minister Jim Daly that Wexford is not in the middle of a crisis in care. ‘I know he has to toe the party line, fine, but there is a crisis, not just in Wexford, but nationally. The state has been, and continues to be complicit in treating children and adults with psychiatric illness as aliens. I am not making that up.
‘If you look at the system, you don’t resource it. You put people out in the middle of nowhere with no proper facilities and then you treat children in adult units. You don’t have to be very bright to figure out that this isn’t working. There is a mortality associated with mental illness, it’s that serious. People seem to forget that and then when it happens we don’t talk about it. This is to me the thing that needs to be demystified and de-stigmatised. We should be having a referendum on this.’
Dr Moore said the key problem is the misunderstanding of what mental illness is.
The primary care services in Wexford covers the child, adolescent and family psychology service and the autism service. ‘Essentially these services are supposed to see the children who have “mental health difficulties” not amounting to an illness – (which is what paediatric psychiatry or the child and adolescent mental health service deals with, with regards to the former and autism with regards to the latter). The autism team in Wexford has renamed itself the “disability service”. It has a long waiting list.
‘ There are many professionals in it, including a number of managers. They have no single point of referral, expecting referrers to waste time and paper referring to a multiplicity of professionals and they don’t see people based on the urgency of the presentation, allegedly hiding behind waiting lists. Even though it is the services for autism it advises parents to go to a non HSE service.’
He said there is an apparent, alleged reluctance or fear to see children. ‘A lot of people are happy to talk to parents or teachers and very few people tend to see children so with the whole spectrum of help from parent up to an in-patient psychiatric hospital - there is a lack of clarity about who should be doing it. There is also a lack of training and a reluctance to see people based on clinical needs. There is an alleged hiding behind waiting lists so people are put on ludicrous waiting lists. The lack of buy-in across the spectrum is huge. Within that the whole area of self harm and suicide is huge. There is a difference between self harm and suicidal thoughts and wanting to actually kill yourself. People need to be trained in this.’
He said the child and adolescent mental health service only has one fifth of what it needs in terms of numbers set out in the government’s mental health strategy – Vision for Change.
‘We ended up having to see a child any time there was a concern that really isn’t to do with illness so the children with a serious illness who I should be seeing, I couldn’t. It’s about us, as taxpayers, paying a lot of people in the HSE and we all need to be trained and we all need to be accountable and we are not all accountable and that is the difficulty.
‘I think the Taoiseach will have to apologise just like there was an apology about the Magdalene Laundries. I really strongly believe, people have no idea, who haven’t worked in adult psychiatric units for years. They are not great places, but they have improved a lot.
‘But to bring a child into this, it’s hard to get across how appalling that is. I have gone in and you are surrounded by adults who are hallucinating and you have a 13, 14, 15 year old – and despite the nurses’ best efforts they can definitely hear them. I had one child who was definitely traumatised by that.’
He said in all likelihood lives have been lost because of the lack of service for youths in the region.
‘It’s very frustrating. I do this because I actually love it and I love working with children. When you engage it’s so amazing, when you just listen to what patients are telling you and work it out with them and then act on it. It make you feel good, so much good can and is being done.
‘I have such respect for people. I am in the middle of trying to do a book about the stories. It’s about life stories. I won’t be identifying people. Often the child is presented as having a problem, but often it’s not the child who as being behaviourally disturbed or having depression; it’s the parent.’
He said there is a huge problem with recruitment and retention. ‘ This relates to new entrants being paid hugely significantly less than their colleagues. A consultant can go anywhere in the world and be paid more and that applies to other grades as well.’
Dr Moore has no regrets, but wishes the service could have been funded more and run better during his time in County Wexford.
‘I don’t really have regrets and I have learned so much from the people of Wexford. I have been terribly lucky. Work has been terribly frustrating at times, but I have been privileged to be able to help people. People have taught me so much and there are a lot of people who are well who wouldn’t have been well because of the team and I think going in a bizarre way has helped things to change but we have to keep at it.
‘I just regret that we, as humans, generally and as society, that we continue to stigmatise mental illness. It’s like the days before when people they found insulin being the problem with diabetes, they found the urine tasted too sugary and it was the person’s own fault; the same with TB.
‘I think we will change that perception. In the meantime people need to realise they are not mad because of their own faults or foibles. There is actually something wrong and they deserve our respect and care.’