Vision for Change – Mental Health Policy

Significant achievements in implementing “A Vision for Change”

HSE introduces first “Vision Online” survey, findings indicate the majority of service users are actively involved in their own care plan

The HSE has marked the 5th year of “A Vision for Change” implementation with an event in Dublin Castle today (Monday 24th January 2011). Over 130 people will attend the half-day information seminar, hosted by the HSE in partnership with the Department of Health & Children and the National Service User Executive (NSUE), to report on progress towards realising “A Vision for Change”, Ireland’s mental health policy.

“A Vision for Change” is an ambitious 10 year programme which fundamentally revisits the focus and function of mental health care in Ireland. Placing the service user’s recovery journey at the centre of all service efforts, “A Vision for Change” requires a change in behaviours and attitudes from all stakeholders involved in mental health and wellness. “A Vision for Change” describes a mental health service which is fully integrated into its host community and offers services at the earliest opportunity, within primary care, by comprehensive community based teams and in modern purpose built facilities. The expert group on mental health policy recognised that this challenging mental health reform programme would require a 10 year timeframe.

In five years, significant achievements have taken place in a number of key areas including:

Supporting the Service User
Every HSE acute inpatient admission unit has a trained and accredited Peer Advocate
The HSE fund and support the National Service User Executive which has an elected representative role
Three cohorts have already participated in the specially commissioned Co-Operative Learning Leadership Course developed with DCU. This course includes Service user, family friends and service provider in a shared process of leading change within their local service area.
Development and funding of unique service user ‘Expert by Experience’ post in DCU
HSE support many service arrangements with NGOs supporting the service user voice and building capacity.
Service user representatives are active on all major national projects – capital programmes, service design and evaluation.

Mental Health in Primary Care
The HSE support a Project Officer post in Irish College of General Practitioners (ICGP) as a resource to General Practitioners on mental health issues
“Power of Words” prescribed reading resource delivered in collaboration with local libraries, National Library Council and the Irish College of General Practitioners
Team-based approaches to mental health in primary care: Accredited training programme for primary care team staff to enhance their skills in responding to mental health issues in a primary care setting
Development of comprehensive resource pack for GPs relating to mental health issues; management of depression, anxiety and counselling in primary care and Irish research findings

Child and Adolescent Mental Health Services (CAMHs)
Extensive consultation exercise with over 350 young people ‘Teenage Mental Health – What Helps, What Hurts’ conducted in association with the Office of the Minister for Children and Youth Affairs
Support and collaboration on Jigsaw initiatives with Headstrong in Galway, Roscommon, Ballymun and Meath
Increased number of CAMHS teams from 39 in 2006 to 55 today
Reduced numbers waiting and waiting times for CAMHS services. 47% are seen within one month of referral and 70% of children are seen within three months (emergency cases do not wait and are seen immediately)
Additional training for CAMHs staff in waiting list management to improve service access
Inpatient bed capacity tripled since 2006. 16 in 2006 to 52 in 2011
Two comprehensive CAMHs Annual Reports published for 2008 and 2009/10 improving transparency and performance.

Capital Expenditure and Infrastructure
A major capital development programme including 5 new Acute inpatient units at Beaumont, Letterkenny, Galway, Cork and Louth is underway
Additional continuing care capacity with specially designed Adapted Community Nursing Units at Clonmel, Wexford, Kerry, Mullingar and Ballinasloe
Progressive closure of traditional psychiatric hospitals and replacement with high quality facilities
Two bespoke 20 bed CAMHS units in Cork & Galway
CAMHS unit at the National Paediatric Hospital in design.

Promoting Positive Mental Health
Many Mental health promotion programmes developed with NGO partners
“Your Mental Health” TV, cinema, internet campaign for raising mental health awareness amongst adults
“Let Someone Know” campaign, developed with young people for young people – TV, cinema, internet
Active participation the SEE Change Anti-stigma campaign.

Improved Interagency working
The HSE has actively engaged with fellow statutory agencies to improve access to housing, education and vocational opportunities
A formal Memorandum of Understanding signed by the Garda Commissioner and the HSE CEO enhances interagency working and cooperation
Regular Cross Sectoral meetings with the Department of Justice Equality & Law Reform on shared interests, including Youth Justice, mental health in prisons, and training
Training with An Garda Síochána on aspects of mental health.

Mr. Cathal Magee, CEO of HSE commented: “The HSE is fully committed to delivering “A Vision for Change”. Much has been achieved in the area of mental health over the past number of years by our staff and partner agencies. This provides a good foundation whereby we can build and sustain a high-quality, accessible and effective mental health service right across the country.”

The Vision Online survey provides a quantitative update on every HSE related recommendation in “A Vision for Change” at a local and national level. This on-line reporting tool will provide baseline information to assess the advancements made in the second five years and to identify gaps in service provision. The Survey was completed in December by the 13 Executive Clinical Directors and the National Forensic Service (centred at the Central Mental Hospital in Dundrum).

The survey has been developed in two phases. Phase I has been developed allowing for the collection and analysis of quantitative data. Phase II will allow for the development of more qualitative approaches and provide a basis for transfer of learning from service to service.

Some of the findings of the inaugural survey include:
100% of in-patient settings have an accredited peer advocacy service
77% of services actively include service users in service planning
84% of services report that they offer access to information and advice to colleagues at primary care level, 50% have formal shared protocols
In mental health services for older persons, whilst 70% provide home based care, 21% of services report some gaps in their specialist mental health programmes for older persons.

Speaking at the event, Martin Rogan, Assistant National Director of Mental Health, HSE, unveiled the survey: “This inaugural Vision Online survey gives us a unique insight into progress achieved to date and allows us to refocus our efforts on particular areas that may have found it difficult to keep pace with policy. The findings from the “Vision Online” survey, indicated that at this mid-point of a ten year implementation plan that many of the objectives have been fully delivered and significant progress has been made in the remainder. It is heartening to note that a key finding of the survey, which is endorsed by the National Service User Executive, is that service delivery is improving for users. Mental health service users are no longer passive recipients of care but and are actively involved in their own care plan, service development and national projects.

The principal of recovery is increasingly gaining ground. In 2011 the HSE has committed to €721 million to mental health and employs over 9,500 staff across its hospital and community based mental health services. The €50m capital funding secured in 2010 will provide for 12 major capital development projects in mental health. However, we need to recognise that whilst many of “A Vision for Change” objectives can be realised within the existing resource base, we need to continue to innovate in how we create and sustain our services.”

Dr Ian Daly, the National Clinical Programme Lead for Mental Health, commented: “The Clinical Care Programmes in Mental Health are designed to improve the quality of clinical care for individuals with early psychosis, eating disorders, people who present with self harm or at risk of suicide while improving the physical healthcare to those with severe and enduring mental illness.”