Mental Health Policy Climate in Ireland: Challenges, Opportunities & Local Innovation

Vision for Change Framework for complete model of mental health service provision Service user involved at all stages Principle based and respect human rights Holistic approach to mental health problems Person centred approach based on Recovery ethos to inform every aspect of delivery Service user central as partner in own care plan- to reflect needs, goals and potential

Vision for Change 2 Involvement of service users the norm in every aspect of service development and delivery- similarly with carers Integrated multi-disciplinary approach to addressing factors that contribute to mental health problems Specialist community mental health teams to address needs across life span To provide effective community service

Vision for Change 3 Managed by a National Directorate- working directly within the HSE Managed locally by Mental Health Catchment Area Management Teams Service provision to be prioritised on needs basis Services should be meaningfully evaluated Closure of all psychiatric hospitals

Independent Monitoring Group 1 Vision cannot be implemented effectively without a National Mental Health Services Directorate Has impeded progress on poor facilities –Inconsistent approach to embedding Recovery ethos in services –Absence of comprehensive implementation plan Progress made on some priorities, child and adolescents, engagement with service users, –2009 Report-

Inspector of Mental Health Services Lumping all mhs tog. in PCCC + no Mental Health Directorate “caused confusion, misunderstanding, muddied mission, poor decisional capacity ” –Broad Impact –people admitted to institutions –No progress in resource equalisation –Lacking comprehensive community services –Impact of restrictive work practices

Irish Mental Health Coalition “Late for a Very Important Date” progress painfully slow –No Mental Health Directorate –Children in Adult wards –The number of fully staffed Community Mental Health Teams –Government commitment to ring fencing existing mental health funding

Real Life Community in the Gaeltacht presented a purpose built house to the HSE for sole use of the mental health service Five service users, Irish speakers, originally from the area selected-no comprehensive rehabilitation process House furnished by HSE and ready for occupation in 2005 One person lives in a high support hostel, the other people remain in institutional care where between them they have spent many years of their lives The house remains unused… How is policy assisting their recovery and life potential?

Issues arising Offer by an Independent sector to manage the service What are the expectations? Greater cost than the HSE original cost? At least a good solid knowledge of current mental health policy? At least a good solid knowledge of what the Recovery Ethos means?

Impact Mental Health Act 2008-Dail Debate- Minister Harney “unthinkable” that anyone would be lose his/her liberty because of a lack of supported accommodation Informed consent-is it a robust approach? Does it include information on choices and possible disempowerment?

Is legal action an option? Courts are reluctant to get involved in directing how the public purse is spent Rarely make mandatory orders-directing the government (HSE) to do something If there are enforceable rights or specific agreements have been made and reneged on may make order then

Possible Explanations Key issue- Political Motivation No director for mental health at top level of HSE where key decisions are made Unstable, fragmented and inappropriate structures in HSE Local level very important but unless principles and values are recognised…

Impact Are we witnessing the new generation of human rights abuses? –Moving people with mental health problems to nursing homes, or –Keeping them in institutions while the community service is available The context is different from the 1800s and the institutions are smaller now…

Optimism Mental Health Inspector’s Report 2009 Some “tentative” reasons for optimism… “Sense of beginnings of a cultural shift in term of increased professionalism, accountability and awareness of importance of good governance The central importance of service users/patients is increasingly recognised by clinicians Human rights obligations increasingly understood” –Headstrong-Jigsaw Project

Conclusion Policy approach is not enough Attitudinal shift is a key element the objectification of persons with mental health problems must end UNCRPD and Capacity law may strengthen the individual focus Extreme caution and careful monitoring of local activities Advocacy/representation must be made available where any major life changes Staff managing and working in mental health services must become more aware of impact