Mental Health - A Vision for Change - Ireland's Health Services

1 ChangeAVISION FORREPORT OF THE EXPERT GROUP ON Mental Health POLICY The Greek name for a butterfly is Psyche, and the same word means the soul. There is no illustration of the immortality of the soul so striking and beautiful as the butterfly, bursting on brilliant wings from the tomb in which it has lain, after a dull, grovelling, caterpillar existence, to flutter in the blaze of day and feed on the most fragrant and delicate productions of the spring. Psyche, then, is the human soul, which is purified by sufferings and misfortunes, and is thus prepared for the enjoyment of true and pure happiness. The Age of Fable by Thomas Bulfinch (1796-1867)ARNA FHOILSI AG OIFIG AN TSOL THAIR BAILE THA CLIATHLe ceannach d reach n OIFIG FOILSEACH N RIALTAIS, TEACH SUN ALLIANCE, SR ID THEACH LAIGHEAN, BAILE THA CLIATH 2N tr d an bpost FOILSEACH IN RIALTAIS AN RANN G POST-TR CHTA, 51 FAICHE STIABHNA, BAILE THA CLIATH 2, (Teil: 01-6476834/35/36/37; Fax 01-6476843) n tr aon d olt ir BY THE STATIONERY OFFICEDUBLINTo be purchased directly from theGOVERNMENT PUBLICATIONS OFFICE,SUN ALLIANCE HOUSE, MOLESWORTH STREET, DUBLIN 2 Or by mail order from GOVERNMENT PUBLICATIONS, POSTAL TRADE SECTION,51 ST STEPHEN S GREEN, DUBLIN 2 (Tel: 01-6476834/35/36/37; Fax: 01-6476843)Or through any bookseller.

2 Available from: `10 ISBN 0755773764 Government of Ireland, 2006 ContentsEach citizen should have access to local, specialised and comprehensive Mental Health service provision that is of the highest standard. Page A Message from the Minister of State4 Foreword5 Glossary of abbreviations 6 A note on terminology 6 Preface 7 Chapter Executive summary and key recommendations 8 VISION1 Listening to what we heard: Consultation with Services users, carers and providers 122 Policy framework163 Partnership in care : Service users and carers 244 Belonging and participating: Social inclusion345 Fostering well-being: Mental Health promotion44 PLAN6 Mental Health in Ireland.

3 Where we are now527 Mental Health in primary care608 Framework for Mental Health service delivery 709 The Community Mental Health Team (CMHT)7810 Child and adolescent Mental Health Services 8411 General adult Mental Health services9212 Rehabilitation and recovery Mental Health Services for people with severe and enduring Mental illness10413 Mental Health Services for older people11414 Mental Health Services for people with intellectual disability12415 Special categories of service provision: 136 Forensic Mental Health Services 136 Mental Health Services for homeless people143 Mental Health Services for people with co-morbid severe Mental illness and substance abuse problems146 Mental Health Services for people with eating disorders149 Liaison Mental Health services154 Neuropsychiatry services157 Suicide prevention159 People with borderline personality disorder162 IMPLEMENTATION 16 Management and organisation of Mental Health services16617 Investing in the future: Financing the Mental Health services17618 Manpower, education and training18619 Mental Health information and research 20220 Transition and transformation.

4 Making it happen216 Acknowledgements 221 Appendix 1 Submissions to the Expert Group on Mental Health Policy 224 Appendix 2 Members of advisory sub-groups 228 Annexes to the Report 232 References 2744 Good Mental Health is an integral component of general Health and well-being, allowing a person to fully realise his or her abilities. With a balanced Mental disposition, people are more effective in coping with the stresses of life, can work productively and fruitfully and are better able to make a positive contribution to their communities. We owe it to our citizens to ensure that everyone is facilitated, in as far as possible, in achieving and maintaining, optimum Mental am delighted to welcome this Report, aptly titled AVision for Change , which sets out a comprehensive policy framework for our Mental Health Services for the next 7-10 established the Expert Group on Mental Health Policy in August 2003 in recognition of the need to review long-standing policy in this area and to formulate a blueprint for a modern, comprehensive, world-class service to meet the Mental Health challenges facing our society - not least of which is our significant suicide rate, particularly among young people.

5 I was convinced from the outset that a collaborative approach between service users and carers, professionals and Health service providers represented the best way forward and I appointed the Expert Group accordingly. I am delighted to see that this approach has borne fruit and that A Vision for Change has been endorsed by all the members, without exception. This Report proposes a framework of Mental Health service delivery with the service user at its centre. The emphasis is firmly on recovery and on facilitating active partnerships between service users, carers and Mental Health professionals. Its recommendations are innovative and some of them are challenging. However, I have no doubt that their implementation will bring about far-reaching Change and modernisation in the Irish Mental Health Services , which will be to the benefit of everyone Government s on-going investment in community-based Mental Health Services , the legislative reforms of the Mental Health Act, 2001 and the publication of this Report all confirm that the area of Mental Health is now receiving the attention it deserves.

6 I am hopeful that these developments will facilitate further advancements within our Services and that the lives of those who suffer Mental illness, and their families, will be improved and enhanced by our efforts. I would like to thank the Chairperson of the Expert Group, Professor Joyce O Connor, all the members of the Group and the associated support staff for their tireless work and commitment to this task over the past two and a half years. I have no doubt that this fine Report will have a significant influence on the development of our Mental Health Services into the O Malley of State at the Department of Health & Childrenwith special responsibility for Mental healthA Message from the Minister of StateA Vision for ChangeREPORT OF THE EXPERT GROUP ON Mental Health POLICY5 Mental Health concerns everybody. We attain it through the attachments and the supportive relationships we form at each stage of our personal development, through learning to cope with challenging and difficult aspects of life, and finding ways to belong and to contribute to others in line with our core values and Health can be undermined by emotional distress, an unavoidable feature of every human life that can become a sustained and disabling experience for some people, particularly those disadvantaged by constitutional and psychological vulnerabilities or by their social circumstances.

7 As a consequence, people can lose their sense of well-being and capacity to function and may require specialist intervention. Mental Health Services are designed to make available this support and expertise at every stage from childhood to later Vision for Change proposes a framework for promoting Mental Health at all levels of society and for delivering specialist care to everyone who needs it. It recognises both the strengths and inadequacies of existing Services and outlines a strategy for building on the innovations heralded by Planning for the Future. It details a series of actions for developing a comprehensive person-centred model of Mental Health service consultation with service users, families and service providers informed this policy. Of vital importance was the fact that individuals receiving Services contributed critically to every stage of the report s development.

8 The most pressing priority they voiced was the need for an accessible and user-friendly Mental Health service where they can be respected as active partners in their own recovery, and where they can avail of a range of interventions that will enable them to remain meaningfully involved in their own communities. Service providers highlighted their priorities too, articulating a clear need for adequate resources to enable them to respond to the full medical, psychological and social needs of service users and their policy proposes that solutions for people with Mental Health needs lie in establishing effective partnerships, between Health service managers and Health care providers on the one hand, and service users and their carers on the other, in a community-wide context. It proposes specific ways in which managers and professionals can blend their expertise more effectively, forge working relationships with resources that already exist to support service users in the broader community, and involve service users as legitimate collaborators in their own drawing up this policy, the Expert Group considered the various core values that are intrinsic to the design and delivery of a quality Mental Health care service: Services should be person-centred and adapted to each individual s needs and potential; Services should be delivered by skilled professionals working together in community-based multidisciplinary teams, where the contribution of each member is valued and where skills and expertise are combined to design and deliver integrated care plans.

9 The range of interventions offered should be comprehensive and should reflect best practice for addressing any given Mental Health problem. A recovery approach should inform every level of the service provision so service users learn to understand and cope with their Mental Health difficulties, build on their inherent strengths and resourcefulness, establish supportive networks, and pursue dreams and goals that are important to them and to which they are entitled as Vision for Change was commissioned in response to a widespread felt need for an improved Mental Health service. It identifies the critical structural, human and financial resources required to make this a reality. By recruiting the creative cooperation of everyone involved and harnessing the tremendous resources of expertise and compassion already embedded in our Mental Health system.

10 The opportunity to build a Mental Health service in which we can all take pride is now O ConnorChairpersonExpert Group on Mental Health PolicyForewordA Vision for ChangeREPORT OF THE EXPERT GROUP ON Mental Health POLICY6 Glossary of abbreviationsCBTC ognitive Behavioural TherapyCMEC ontinuing Medical EducationCMHCC ommunity Mental Health CentreCMHTC ommunity Mental Health TeamDMBD ifficult to manage behaviourDSHD eliberate self-harmFMHSF orensic Mental Health ServiceGPGeneral PractitionerHSEH ealth Service ExecutiveMHCAM ental Health catchment areaNAPSN ational Anti-Poverty StrategyNDAN ational Disability AuthorityNEPSN ational Educational Psychology ServiceOECDO ffice for Economic Cooperation & DevelopmentSPHES ocial Personal Health EducationWHOW orld Health OrganisationWTEW hole-time equivalentA note on terminologyMany terms are used to describe Mental Health difficulties and there is much debate on the term Mental Health problem has been used throughout this document to describe the full range of Mental Health difficulties that might be encountered, from the psychological distress experienced by many people, to serious Mental disorders and illnesses that affect a smaller term Mental illness is used to refer to specific conditions such as schizophrenia, bipolar disorder and Vision for ChangeREPORT OF THE EXPERT GROUP ON Mental Health POLICY71.