Portiuncula University Hospital’s (PUH) Emergency Department (ED) has become a focal point of concern regarding its mental health service provision, particularly following a critical review by the Mental Health Commission. The issues were prominently discussed at this week’s Western Regional Health Forum on Tuesday, shedding light on significant challenges faced by the hospital in catering to patients with mental health needs.

The Commission’s April report painted a stark picture, revealing a 12 per cent increase in mental health presentations at PUH in 2023. More alarmingly, the report highlighted a substantial 25 per cent rise in self-harm cases specifically among children under the age of 15. Alongside these figures, presentations related to substance misuse also saw an increase, further compounding the pressure on an already overstretched service.

The findings prompted expressions of serious alarm from councillors. They pointed to a critical deficiency: the hospital's lack of an on-site mental health crisis unit, despite its role in serving a wide geographical area encompassing East Galway and South Roscommon. Cllr Evelyn Francis Parsons emphasized the gravity of the situation, stating, “This is about mental health care, particularly for children. In 2023, there were 446 self-harm presentations – a 12 per cent increase. One in four involved children under 15. These are not abstract statistics; they reflect a system that is structurally under-resourced and operationally vulnerable.”

Echoing these sentiments, Cllr Alan Harney asserted that the current model for mental health care “isn’t working and people are being failed.” He recounted distressing instances where patients, unable to endure long waits in the A&E, had left the department, sometimes leading to tragic consequences. Cllr Harney also lamented the negative impact of the closure of St Brigid’s psychiatric facility in Ballinasloe, which he said resulted in a loss of acute services. Adding to the chorus of concern, Cllr Eileen Mannion remarked, “There is a need to see change. This service is going backwards rather than forward.”

Responding to these serious concerns, HSE Area Manager Ann Cosgrove acknowledged the multifaceted challenges confronting the hospital and its mental health services. She confirmed that PUH lacks a dedicated psychiatric unit on-site. Consequently, patients experiencing a mental health crisis who present at the ED often need to be transferred to Roscommon for specialized care, a process that inherently causes delays in treatment. Some patients, she noted, end up remaining on trolleys for extended periods, sometimes for hours or even days, while awaiting assessment or transfer.

While Ms. Cosgrove outlined some efforts being made to improve the situation, such as the process of appointing a part-time consultant and plans for an Advanced Nurse Practitioner, she candidly admitted that Emergency Departments are not suitable environments for conducting prolonged mental health assessments. The hospital also currently lacks group therapy options for mental health patients. Furthermore, its Child and Adolescent Mental Health Services (CAMHS) provision is described as minimal. A Galway-based nurse is available to assess children during standard working hours, but out-of-hours cover is limited. Although a new child psychiatry consultant is anticipated to start in July, the frequency of their attendance at PUH remains unclear.

The much-needed expansion of PUH’s Emergency Department has also faced delays, with the project now pushed back to late 2025. Cllr Parsons questioned this postponement, stressing the urgency of the situation: “We cannot wait. The model is inadequate. There’s no permanent CAMHS presence or clinically appropriate space for assessments.” Ms. Cosgrove confirmed that the ED upgrade project is currently in the procurement phase and includes plans for an improved paediatric area and a dedicated family waiting space, which could offer some relief once completed.

Looking ahead, Ms. Cosgrove mentioned that the HSE’s 2024–2027 action plan prioritises the development of 24/7 CAMHS services and establishing clear crisis pathways for individuals needing urgent mental health support. In a specific initiative addressing health disparities, she announced that two SCAN (Suicide Crisis Assessment Nurse) nursing posts dedicated to Traveller Health would be based at PUH. This decision acknowledges the disproportionately high rates of self-harm and suicide within the Traveller community.

However, Ms. Cosgrove issued a crucial caveat, emphasizing that any meaningful progress in enhancing mental health services at PUH and across the region is fundamentally dependent on securing adequate staffing levels and sustained financial investment. She stated unequivocally, “All guidance and protocols are contingent on appropriate staffing levels.” This highlights the systemic challenge of resource allocation in addressing the escalating mental health crisis.

The discussions at the Western Regional Health Forum underscore a critical juncture for mental health services at Portiuncula University Hospital. The combination of rising demand, particularly among vulnerable children, significant infrastructural deficits, and resource constraints paints a concerning picture that calls for immediate and robust interventions to prevent further deterioration and ensure patients receive timely and appropriate care.