Mental health services need long-overdue cultural and structural revamp
When a government policy is approaching its ‘sell by’ date and has not yet been fully implemented, there can be a temptation to consign it to a dusty shelf and think of it as yesterday’s news.
The Government’s mental health policy A Vision for Change (AVFC), published in 2006, was to be implemented by 2016. Mental Health Reform has been calling for the full implementation of the policy since 2006, which would see a departure from overly medicalised hospital-based services to modern, multi-disciplinary, recovery-focused and community-based mental health services.
Now, seven years into the policy, A Vision for Change remains an unfulfilled promise of a radical transformation. The painfully slow progress is mainly due to structural and cultural barriers. Structurally, clear authority and accountability within the HSE to deliver a national plan have been lacking. Culturally, immense change in attitudes, behaviour and power structures by professionals and people using services are required to embody the Recovery ethos of hope, partnership, listening, choice and social inclusion at the heart of AVFC.
2013 is a time for taking stock. A review of the Mental Health Act is underway; and a review of AVFC is expected to be undertaken this year, which should lead to an updated and extended policy beyond 2016.
2013 is also the year when mental health services will have, for the first time, a National Director for Mental Health. The elevation of mental health to a distinct programme within the HSE under the leadership and management of a National Director, reporting directly to the CEO and part of the HSE senior management team, marks a defining change in how the mental health services are governed. However, it is imperative that the new National Director have the authority, accountability and budgetary control to deliver on the modernisation of Ireland’s mental health services.
It is a credit to the Assistant National Director for Mental Health that such progress as has been made to date was achieved, against the odds. The role of Assistant National Director has been advisory and policy-focused only, with control of budgets held by the four Regional Directors of Operations. The majority of the old psychiatric institutions have been closed; innovative services have been nurtured; the value of Recovery has been promoted. However, without power to direct plans nationally, there still remain significant inequities across the country. Differences in the pace of modernisation and in culture mean that the service I receive in one area may be quite different to the service my neighbour receives. The key message Mental Health Reform hears is still that people want to be listened to, to have a consistent relationship with a professional and to have an offer of treatment that is more than just medication.
The challenge to the newly appointed Director for Mental Health will be to keep reform moving on the twin tracks of structural and cultural change and, in the immediate future, to protect the budget for mental health. While the Programme for Government made a commitment to invest €35 million annually in community mental health services, the bulk of these monies were not spent last year and there has been an unacceptable delay in appointing staff. In 2013, mental health services are still staffed at 24% below the level recommended in AVFC. Mental Health Reform has high expectations of what can be achieved with the full authority and clear accountability now invested in the role of Director.
A Vision for Change articulated a policy for the mental health of the nation – a ‘population health’ approach that recognised the roles of primary care, mental health promotion and suicide prevention as part of the strategy. However, these sections are some of the least implemented by the HSE.
For Mental Health Reform, the review of A Vision for Change needs to reaffirm this ‘population health’ approach to mental wellbeing, which supports people from the cradle to the grave and takes account of different forms of emotional distress and mental health difficulties, with a choice of services based on listening, consistent and respectful relationships and a range of therapeutic supports that are ‘more than medication’. In other words, a recovery approach underpinning good quality mental health services and helping the achievement of Mental Health Reform’s goal ‘for an Ireland where people with mental health difficulties can recover their good health and live a full life in their community.’
About Mental Health Reform
Mental Health Reform is the national coalition of organisations working to promote improved mental health services in Ireland. www.mentalhealthreform.ie