Compared with the United Kingdom, mental health services in Ireland are under-funded and under-developed. This may be partly due to the neglect of economic analyses concerning mental health services in Ireland, as few policy makers would invest in the sector without evidence that such investment represents ‘value-for-money’ economically.

The aim of this paper is to highlight how mental health services can conduct economic service evaluations that ultimately will drive the policy-making agenda and future governmental investment.

A guide to the economic evaluation of mental health services, based on a narrative review of relevant policy documents and papers, in an Irish context.

Three types of economic analyses that can be undertaken within mental health services are outlined: (a) cost-benefit analysis, (b) cost-utility analysis and (c) cost-minimisation analysis. In addition, a newly formulated questionnaire (i.e. the ‘EcoPsy 12’) is presented.

Economic evaluations of mental health services can provide re-assurances to policy-makers that (much-needed) investment in such services is economically viable.

Attention-deficit hyperactivity disorder (ADHD) is a neuro-behavioural disorder characterised by early onset of persistent inattention–disorganisation and hyperactivity–impulsivity. Symptoms causing significant impairment in psychosocial function commence in childhood and heighten the risk for early substance experimentation and potential development of substance-use disorders (SUD). The research aimed to estimate the occurrence of adult attention-deficit hyperactivity disorder (ADHD) in new treatment cases of adults attending addiction treatment services.

The Adult ADHD Symptoms Rating Scale (ASRS) self-administered questionnaire was administered on entry and 2 weeks later for first admissions to inpatient and outpatient addiction treatment settings The ASRS is a validated and reliable 18-item self-report scale derived from the DSM-IV-TR diagnostic criteria for ADHD, comprising nine items on inattention and nine items on hyperactivity/impulsivity.

A total of 47 new treatment cases took part in the study. The occurrence of ADHD among SUDs in this sample was 13% (n = 6). Four of the participants were being treated for Problem Poly Substance use, whereas two participants were being treated for Problem Drug use. None of the participants screening positive for ADHD were being treated for Problem Alcohol use. Of the positively screened cases, all were male, predominantly single and unemployed.

The ASRS screening instrument may be a useful tool to detect ADHD co-morbidity in SUD treatment-seeking cases. More research is needed to appropriately develop the SUD treatment pathways for adolescent and adult ADHD sufferers in Ireland.

The cognitive functioning of children who received a diagnosis of autistic spectrum disorder (ASD) during the preschool years was assessed at the time of diagnosis (Time 1) and reassessed, on average, 3 years and 5 months later (Time 2).

A total of 50 children were assessed (76% male, n = 38); the group had an average age of 4 years 3 months at Time 1 and 7 years 8 months at Time 2.

There was a significant positive relationship (r = 0.791, p < 0.01) between the group's Full Scale Intelligence Quotient (FSIQ)/Developmental Quotient (DQ) at Time 1 and at Time 2. Results indicated a significant increase in FSIQ/DQ over time for the total group and for both the High Functioning (IQ ⩾ 70) and Low Functioning (IQ < 70) groups. Of the total samples, 32% showed a clinically significant change in FSIQ/DQ of 15 points or more from Time 1 to Time 2. When age at Time 1 was included as a covariate, no significant difference was identified for change in FSIQ over time. The practical implications of the findings are discussed.

More people are living beyond their 90s, yet this group has not been much studied. This study aimed to describe a sample of non-agenarians and centerians attending an old age psychiatry service with a focus on pharmacotherapy.

Retrospective, cross-sectional survey of patients aged >90 in contact with the Department of Old Age Psychiatry in a university hospital over a 1-year period. Results were compared with the Beers, the Canadian and Screening Tool of Older Persons’ potentially inappropriate Prescriptions (STOPP) criteria.

A total of 65 nonagenarians or centerians were identified (mean age 93, 82% female). The majority (65%) resided in a nursing home; dementia was the most common diagnosis (77%), followed by depression (29%). The most commonly prescribed psychotropics were antidepressants (58%), followed by antipsychotics (45%), hypnotics (42%), anti-dementia agents (31%) and anxiolytics (26%). Overall, patients were on a mean of 2.1 (S.D. 1.3, range 0–5) psychotropics and 4.99 (S.D. 2.7, range 0–11) non-psychotropics. Mean Mini Mental State Examination (MMSE) score was 15 (S.D. 8.1). Increasing anticholinergic burden was negatively associated with MMSE scores (B = −1.72, p = 0.013). Residing in a nursing home was associated with a higher rate of antidepressant [OR 5.71 (95% CI 1.9–17.4)], anxiolytic [OR 13.5 (95% CI 1.7–110.4)] and antipsychotic [OR 3.4 (95% CI 1.1–10.4)] use. Potentially inappropriate prescribing included long-term benzodiazepine use (26%) and long-term antipsychotic use (25%).

Our sample had a high psychiatric morbidity burden with high levels of psychotropic use. Ongoing review and audit of psychotropic use in elderly patients can identify potentially inappropriate prescribing in a group vulnerable to high levels of polypharmacy and extended psychotropic use.

Attention deficit hyperactivity disorder (ADHD) persists into adulthood in ∼2/3 of patients, yet services for adults are lacking in Ireland. This may involve negative attitudes and beliefs as to the validity of ADHD or lack of knowledge and training in its treatment. The objectives of this study are to explore the views of Adult Psychiatrists regarding ADHD knowledge and the treatment options available and pursued in Ireland.

A questionnaire was constructed based on the stated aims of the study, and was either posted, emailed or handed to 400 Consultants and Senior Registrars throughout the Republic of Ireland between February and December 2011. A total of 92 questionnaires were returned (23%); one was excluded from analysis due to insufficient information entered by the respondent.

Seventy-five per cent of respondents correctly estimated the prevalence rates of adult ADHD to be under 3%, but stated it is currently under-diagnosed (77%). Seventy-four per cent indicated that Adult ADHD should be a diagnostic category in the Diagnostic and Statistical Manual, 5th Edition (DSM V). Sixty-six per cent of respondents were willing to accept referrals of childhood ADHD for ongoing care and a similar number for new ADHD assessments (61%). Less than half (42%) surveyed had actually diagnosed ADHD and of these, only 33% felt confident in managing ADHD in their patients.

Although there is a general willingness to offer services for new and existing ADHD cases and a recognition that Adult ADHD is valid and under-diagnosed, the low confidence levels when treating ADHD and the perception of under-diagnosis suggests a role for further training and links between child and adult services.

Performance measurement (PM) is central to the current Irish health service policy. However, PM within the Irish mental health services has not been fully implemented. These services lack a national comprehensive suite of performance indicators (PIs). Those indicators that are measured do not tend to reflect the objectives of the managers and staff measuring them. To overcome these challenges, this article suggests a suite of measures and aims to provide a practical guide to PM for managers and staff.

A narrative review of a range of policy documents and articles, relevant to PM in the Irish mental health services, was undertaken.

The search produced a number of themes illustrating the limitations of the current set of PIs for Irish mental health services, in particular the need for comprehensive PIs, including structure, process and outcome PIs. This informed the development of a suite of proposed PIs for mental health services. A number of additional themes highlighted the criticisms associated with the top-down approach used to implement PM. Drawing from these themes, a bottom-up approach to PM is proposed.

Although this review was selective in nature, it illustrates how the concerns of clinicians and service managers can be integrated with the priorities of the Health Service Executive and the Department of Health. This presented the suite of PIs and the practical guide that provide useful PM tools. While also applicable at a national level, this paper provides guidance for service managers as to the process of establishing and implementing a suite of PIs within their own service.