A HSE mental health workforce planning report Health and more recently the Disability Capacity Review to 2032 have identified that there is a significant shortfall in the number of psychologists to meet the needs of their respective areas.
The disability capacity review estimated a minimum of doubling of the number of psychologists in child disability services alone would be needed to meet the demands which is directly relevant to the successful implementation of Progressing Disability Services, of which Psychology is a core discipline.
There are many barriers to achieving the stated aim of doubling the number of psychologists in child disability services. The first is the implementation in January 2020 of the Preliminary Team Assessment in the Assessment of Need Process despite the concerns of PSI and our HSCP colleagues and one of the issues highlighted was that significant numbers of psychologists (40%+) indicated they would leave child disability if this SOP was implemented because of their ethical concerns. This unfortunately become a reality and significant numbers have left since the publication of the PSI report. This has now become a wider issue in terms of not just retention but recruitment because psychologists are asking the valid question why would I want to work in a system that doesn’t listen to or respect my professional concerns and expects me to work in a way that contravenes my professional code of ethics and the position of my professional body.
The numbers of psychologists in CAMHS as recommended by A Vision for Change only reached approximately 32% of the recommended levels and at a time when almost 2600 children were waiting to be seen by CAMHS for an initial appointment. You also need to bear in mind that this wait time is only for an initial appointment, not for intervention. The internal wait time for intervention is not measured as Key Performance Indicator (KPI) and Psychologists would be one of the core disciplines providing therapy and intervention in CAMHS. Imagine the frustration of parents & young people at having to wait to get into CAMHS & then they often have to wait a further period for the intervention they need.
The 2021 HSE Psychology Project Team report (page 26) estimated an additional 321.8 psychologists were required in mental health services alone to meet demand.
Where are they going to come from?
Don’t forget there is also competing demand in other areas such as TUSLA. forensic, private services and education.
IN 2021 there were 66 funded hse clinical psychology training places and in addition the counselling psychology training programme has an intake of approximately 14 with the two educational psychology training programmes having intakes of approximately 20-22 in total.
Only a percentage of the trainees who graduate each year will end up / or want to work for the HSE.
Several government departments as outlined above are identifying significant increases in the numbers of professional trained psychologists who will be needed, which is welcomed but it is also a reality that they are competing within the same limited pool of trainees that cannot meet current or future demand.
To achieve the numbers of psychologists identified from capacity reviews a reality several interrelated factors must be considered.
No funding was allocated in Budget 2021 for additional training places, if it had then a lot of work would have needed to have happened over the course of the next year, then in an optimistic scenario an increased cohort could begin in September 2022 and that cohort would qualify in late 2025 to enter the workforce. There is added value to the public service during the period of training as the trainees are on site providing a service under supervision.
So, each year of delay to additional funding being allocated to professional training programmes will add another 3 years to when they will qualify and enter the workforce.
So, as it stands with no engagement from government on increasing the numbers of psychologists in training (or paying 2 of the 3 disciplines of psychology during training) we must wait for Budget 2022 to see if we can increase the numbers of professionally trained psychologists that might choose to work in the public service when qualified in 2026!
A further significant impediment, which has been highlighted to successive governments over the past 10 years, is that the greatest barrier in the successful recruitment of those psychologists who do professionally qualify, is the HSE’s own national panel system of recruitment. Despite the very clear evidence from PSI members (and other HSCPs) that it is the national panel system that impedes recruitment the HSE persists with its operation and has not been willing to engage with representative bodies to listen to or address these changes so that we can improve the efficiency of getting much needed psychologists in post in a timely fashion.
PSI have highlighted to government for several years ( 2021 2020 2019 )in pre-budget submissions and direct correspondence to several Government Ministers & the Taoiseach, that one of the greatest barriers to getting qualified psychologists into the workforce is the inequity that counselling and educational trainees must self-fund for the full period of their doctoral training as well as pay 14k per year in university fees. This results in many not being able to afford to enter the profession or only a select few who can afford to self-fund which risks the psychological workforce not being representative of the full socio-economic spectrum of the community they represent and support. PSI advocated in recent months for a meeting with Minister Donnelly to address this particular issue which they estimated would be addressed through 1.5m in funding per year. PSI also advocated with Minister Harris to work with PSI to find ways to alleviate the burden of fees on trainees counselling and educational psychologists and address the glaring inequity which results in trainee clinical psychologists having 60% of their university fees being paid by the HSE but other trainees having to pay the full 15k.
PSI are the only accrediting body for professional training programmes in Ireland and have specific criteria which must be met in relation to staff / trainee rations so an increase in training places would have to consider what additional resources the courses would require to maintain their accreditation and standards of training,
In recent years, the majority of development posts allocated in psychology have been at staff grade level (first two years post qualification). Both trainee psychologists and staff grade psychologists require specific amounts of supervisory hours in order to support them through their training / early career path.
Any increase in training places would also need to include additional Senior posts in order to meet the supervisory requirements of trainees and staff grades.
An increase in the number of senior posts vs staff grade would also make working in the HSE a more attractive career grade and increase the chances of both recruitment and retention of staff.
We know from research published over the past year, HSE statistics and our own experiences as clinicians on the ground that as a direct result of the pandemic that demand has significantly increased and is likely to continue to so we must begin now to plan for how we increase training places and associated funding to the three professional training programmes to meet current and future demand. There’s no evidence of this planning yet.
Psychologists are key to addressing waiting lists for first appointments and much more importantly to provide evidence-based interventions across the lifespan in mental health, disability, acute hospitals, tusla, forensic, old age.
But, there aren’t enough of us being trained, there isn’t enough funding to train enough psychologists, some psychologists are expected to work for free for 3 years and pay 15k per year in fees at the same time, how many can truly afford that?
There are solutions to all of these issues but so far no-one who wants to listen or action them, this has to change.