Real mental healthcare reform is progressing

POLICY for the future development of our mental health services is outlined in the Report of the Expert Group on Mental Health Policy, A Vision for Change (2006), which proposed a new model of service delivery.

The aim was and still is to move, over time, from the old traditional institution-based model to a patient-centred, flexible and community-based mental health service, where the need for hospital admission is greatly reduced and the quality and effectiveness of the service is improved.

It is accepted that progress on implementation has been slower than expected, however, it is important to recognise and acknowledge that in many parts of the country substantial change has already been effected and mental health services are pressing ahead with developing new ways of working and initiatives to implement A Vision for Change.

Progress on implementation to date includes:

- A 17% decline in the number of patients resident in Irish psychiatric facilities since 2006.

- Fewer admissions, including involuntary admissions to approved centres.

- The number of patients readmitted to hospital has shown a year-on-year reduction since 2001 — this reduction points to an improvement in community- based services.

- The length of stay in approved centres has reduced — in 2010, 48% of the patients were discharged within two weeks of admission.

- The child and adolescent mental health service has seen a very significant improvement, with 61 mental health teams in place around the country.

- Bed capacity for children and adolescents has increased from 12 beds in 2007 to 52, with further developments planned to bring capacity to 66 by 2012.

Work on the capital programme is continuing:

- Work on a new child and adolescent mental health day facility in Cherry Orchard, Dublin, is close to completion.

- Acute admissions to St Brendan’s, Grangegorman, have ceased and enabling works are underway on the development of a 54-bed replacement long-stay facility as part of the Grangegorman redevelopment project.

- The current acute admissions unit at St Ita’s Hospital will transfer to a purpose-built facility at Beaumont Hospital in 2013. The contract for this unit has been awarded subject to planning approval.

- The closure of the long-stay accommodation at St Senan’s, Wexford, will be completed during 2011/2012, with the implementation of a €16 million capital investment programme in modern community-based facilities in the area.

- A residential unit is under construction in Clonmel which will allow for the closure of St Luke’s Hospital; a range of community services are being developed which will provide alternatives to in-patient admissions.

- A community nursing unit has opened in Ballinasloe and the long-stay patients have been transferred there from St Brigid’s Hospital.

The active involvement of service users is one of the most significant reforms that has taken place in our mental health services in recent years. The establishment of the National Service Users Executive (NSUE) is one of the major success stories of A Vision for Change and service users are now actively engaged in the planning and development of services.

The national stigma reduction campaign, See Change, which was launched in April 2010 is continuing in 2011. The aim of the campaign is to positively change social attitudes and behaviour, to inspire people to challenge their beliefs about mental illness, to be more open in their attitudes and behaviour and to encourage people in distress to seek help.

Within the HSE, the assistant national director with responsibility for mental health ensures the delivery of mental health services in line with legislation and Government policy. Executive clinical directors have also been appointed to lead reform in catchment areas serving populations of 350,000 to 400,000, which is in line with the recommendations in A Vision for Change.

My priority as Minister of State with responsibility for mental health will be to further advance the implementation of A Vision for Change. Towards this end, I have asked the HSE to prepare an implementation plan, which will identify specific recommendations of A Vision for Change that can now be progressed over the next three years, with timelines, detailed costs, person(s) responsible for implementation etc. I am also in discussions with officials in my department with a view to establishing a directorate within the HSE to take overall responsibility for and drive implementation and I hope to be in a position to make a decision on this over the coming months.

The Government is committed to reforming our mental healthcare services and to the implementation of A Vision for Change. This commitment was clearly shown in the Programme for Government which provides that €35 million will be ringfenced annually in future budgets to develop community mental healthcare services and to ensure early access to more appropriate services for adults and children.

A Vision for Change provides the framework for the development of mental health services with the service user at the centre and with an emphasis firmly on recovery. It is essential that individuals with mental illness can reclaim their lives, be involved in society and live as independently as possible.