Consultant psychiatrists have warned of a risk to patient health due to the shortage of beds for those suffering from mental illness such a bi-polar disorder and schizophrenia.
While Ireland has moved away from the large mental institutions of the past, the Irish Hospital Consultants Association (IHCA) says there are too few beds now.
This means only the sickest patients are being treated in hospital.
"Increasingly we find when there is pressure on beds, the threshold for admission gets higher and higher. Patients are sicker coming to us," said Prof Anne Doherty, who works in the emergency department at Dublin's Mater Hospital.
Speaking to RTÉ's News at One, she said that for patients suffering from severe illnesses, such as schizophrenia or bi-polar disorder, there is often no option other than admission.
"There is a major flurry to find a bed somewhere in the system, which is often very challenging. Some times we have no beds at all."
Prof Doherty, a consultant psychiatrist and vice president of the IHCA, said there were 4,000 mental health beds when she qualified in 2005.
That's three or four times today's number.
A HSE audit in 2021 found just over 1,100 mental health beds across the HSE system.
"This gives us a rate of 23 per 100,000, which is less than a third of the EU average of 75 per 100,000, so we are very much at a deficit there," Prof Doherty added.
The same report found that a majority of the beds had occupancy levels above 85%. Some beds were occupied by the same patient for upwards of five years.
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While the large institutions of the past are gone, Prof Doherty fears that Ireland has reduced inpatient psychiatric care too drastically.
"Those large institutions absolutely had to be closed down, but I think the numbers are showing that we have gone beyond what other countries stopped at in terms of that reduction," she said.
The impact of delayed care on some patients, she added, can be severe.
"I would certainly say health is being put at risk, and with mental health problems that can be extremely serious," Prof Doherty said.
"In the north inner city, a lot of people are experiencing homelessness. We see a pattern that as people's mental health deteriorates, their ability to maintain their accommodation deteriorates as well."
Prof Doherty noted there were just three public beds for adults with eating disorders, and these were in Dublin.
The new Programme for Government has committed to addressing the shortage of beds for eating disorders. It promises to increase community services for mental health but does not make specific commitments about increasing adult psychiatric beds.
'I didn't feel safe at home'
Rebecca Gilmartin knows all about the squeeze on mental health beds.
She was admitted to the psychiatric hospital in Sligo in 2020 while suffering from depression and anxiety, as well as feeling suicidal.
But after several weeks of treatment, she had to make way for a sicker patient.
"I didn't want to go home. I didn't feel safe at home, " Rebecca recalls.
"The following night I went downstairs with the intention of ending my life. I was sitting on the couch just thinking what I was going to do. My husband landed down and only for that I may not be here today.
"I felt very let down by the services."
Rebecca said that going home while still unwell impacted not just her, but her husband.
"He ended up having to hide every bit of medication in the house. He had to give me my medication morning and night. He was constantly looking after me," she said.
Rebecca did manage to get better and is a mother of three children. She is also a coordinator for the free counselling service at North West Stop, a community mental health organisation covering Donegal, Sligo, Leitrim, west Cavan and Longford.
These days, she hears stories about other people's wait for treatment.
Rebecca said those who go to hospital are often given a prescription and asked to go home and wait for an appointment with a psychiatrist or counsellor.
"You can't facilitate everybody, but if you are in a position like that and you go with the hope of getting help and it doesn't happen, it really pushes you back a lot mentally."
Rebecca said calls to North West Stop have doubled in the year since she began working there. Without Government funding, the charity is trying to help people of all ages with depression, anxiety, and other illnesses.
"We have children as young as four being referred by their parents. We have people in their 80s calling us," Rebecca said.
"While it's great to see people reaching out for help, it's also sad to see they are reaching out to us because of the lack of services in the area."
Rebecca screens calls and organises free counselling for those would benefit.
"It's hard to look for help and then to be pushed away again. It's nearly like they don't believe you," she said.
"It's a real mind battle when you reach for help and you don't get the help you are looking for."
The HSE said the number of registered beds across all its approved centres was closer to 1,800 at the end of 2023.
It did not provide a breakdown of where the beds are located or whether the ratio of beds had reached 25 per 100,000 population as recommended in the 2021 Bed Capacity Report.
A statement to News At One said work on bed numbers will take account of "emerging models of care, clinical programmes and more flexible approaches to service provision."
This, the HSE added, will be driven by the national mental health policy Sharing the Vision as well as the recommendations in the Acute Bed Capacity report.
If you have been affected by the issues raised, a list of helplines can be found here.
