The Irish Defence Forces has been without an in-house psychiatrist for nearly a year, amid a nationwide shortage of trained professionals in the health sector.

Currently, Defence Forces' patients who need urgent psychiatric assessment are referred to hospital emergency departments.

In a statement, a spokesman for the Minister with responsibility for Defence, Paul Kehoe, confirmed the in-house psychiatrist for the Defence Forces retired in May 2018 and said the difficulty with recruitment for such a position is not unique to the Defence Forces.

In an effort to address this, approval has been given to conduct a competition for a contracted civilian consultant psychiatrist at pay rates equivalent to those available in the Health Service Executive, the statement added.

The spokesman said the health and welfare of the men and women of the Defence Forces is a high priority.

According to Professor of Defence Mental Health Neil Greenberg, psychiatrists who have an understanding of military mental health are an important source of support for duty-related issues.

Prof Greenberg, of King’s College London, said a specialist who understands the particular issues that soldiers struggle with can also be invaluable in educating GPs and other healthcare professionals, as well as providing the care for those who need it.

"Healthcare professionals who don’t understand the military can find it very tough to deal with military personnel," said Prof Greenberg.

"For instance soldiers frequently have to deal with incredibly complex situations, often with very limited time and backup; military-unaware healthcare professionals sometimes can’t really understand how difficult that can be."

Scenarios that are specific to the military can have a negative impact on troops' mental health.

For example, peacekeeping troops may have to travel through checkpoints or deal with rebel groups at borders. Some of these situations can go well beyond what the soldiers are trained to deal with, forcing them to make difficult decisions and navigate challenging diplomatic tensions.

"To do these jobs, they are put in really difficult situations - often while they are on humanitarian missions," said Prof Greenberg.

The military mental health expert pointed out that in an area of conflict, soldiers are trained to act if they are directly threatened.

"If there are enemies shooting at you, it’s clear on what to do," he said. But when you are not being directly attacked, but are witness to violent or harrowing situations, "there isn’t a right thing to do" and even the best military training may not prepare troops for the morally challenging decisions they have to make.

These kinds of situations can often take their toll on the mental health of those present, he said.

Peacekeeping missions not 'watered down war'

These challenges are relevant in an Irish context, as Irish troops are most often deployed on peacekeeping and humanitarian missions in difficult territories.

And it is wrong to think of peacekeeping missions as "watered down war", stated Prof Greenberg, who said his research has shown that humanitarian missions, often requiring troops to make difficult decisions, can have a powerful effect on the mental health of troops.

"During peacekeeping missions, you get less threats to your own life, but you get more threats to your own rules, to your reasoning, to your judgement," he said.

"If you are looking after an area and identify some rebel forces, as a military person, you might be inclined to react in a combative way as that’s the way you are trained.

"But (with humanitarian work) you are only allowed to act combatively if you are directly under threat. Sometimes you can be powerless to intervene. You can’t just intervene, indeed you may not be allowed to act within the rules of engagement, even though you have the weaponry/tools to take action.

"Peacekeepers often have to make incredibly difficult decisions, and they can have powerful reactions to those kinds of things," said Prof Greenberg.

The most common forms of mental health issues in the military are those that also affect the general population, such as anxiety and depression, he said.

But alcohol misuse, and the social problems that come with it, are also common. This often has an impact on the families of soldiers and veterans, said Prof Greenberg.

He added that many people believe that post-traumatic stress disorder is linked with soldiers who are deployed to a war zone, but over 50% of the British military PTSD cases are not related to deployment.

Today also saw the launch of an initiative to highlight homelessness among Defence Forces' veterans.

Prof Greenberg said that there are significant challenges for those who leave service, and these challenges can be exacerbated in those who suffer from mental health issues.

"When you leave the military, you have to deal with healthcare, getting a job, getting a home. Most veterans are able to sort that out, but if you’ve got a mental health issue and you don’t have experience of being outside the army, that’s a double whammy."

Prof Greenberg said that veterans who leave the army having had access to a good mental health service have a higher chance of success in the outside world.