What is A Vision for Change ?
A Vision for Change details a comprehensive model of mental health service provision for Ireland. It describes a framework for building and fostering positive mental health across the entire community and for providing accessible, community-based, specialist services for people with mental illness.
An expert group, which combined the expertise of different professional disciplines, health service managers, researchers, representatives of voluntary organisations, and service user groups developed this policy. A broad consultation process was undertaken between the expert group and service users and providers, through invited formal submissions and through public meetings. The results of this consultation process were published in 2004 and critically informed the policy described in this document.
A Vision for Change builds on the approaches to mental health service provision proposed in previous policy documents. It proposes a holistic view of mental illness and recommends an integrated multidisciplinary approach to addressing the biological, psychological and social factors that contribute to mental health problems. It proposes a person-centred treatment approach which addresses each of these elements through an integrated care plan, reflecting best practice, and evolved and agreed with service users and their carers. Special emphasis is given to the need to involve service users and their families and carers at every level of service provision. Interventions should be aimed at maximising recovery from mental illness, and building on the resources within service users and within their immediate social networks to allow them to achieve meaningful integration and participation in community life.
Specialist expertise should be provided by community mental health teams (CMHTs) - expanded multidisciplinary teams of clinicians who work together to serve the needs of service users across the lifespan. CMHTs should serve defined populations and age groups and operate from community-based mental health centres in specific sectors throughout re-configured mental health catchments areas. These teams should assume responsibility for self-governance and be accountable to all their stakeholders, especially service users, their families and carers. Some of these CMHTs should be established on a regional or national basis to address the complex mental health needs of specific categories of people who are few in number but who require particular expertise.
To monitor service developments, ensure service equity across the HSE and evaluate performance of CMHTs, it is critical that systems of gathering information on mental health be established locally and nationally. In addition, mental health service research should be encouraged and funded to evaluate the effectiveness of proposed innovations and to improve our understanding of the unique and changing mental health needs of our community.
The mental health service should be organised nationally in catchment areas for populations of between 250,000 and 400,000. Organisation and management of services within each catchment should be coordinated locally by Mental Health Catchment Area Management Teams and managed nationally by a National Mental Health Service Directorate within the HSE. The National Directorate should be comprised of mental health service managers, clinicians and service user representatives, charged with responsibility to coordinate and implement the recommendations of this report. It is proposed that the Directorate should also establish a national manpower planning and training structure to review education and training needs for the mental health service to ensure that the increased manpower required for the proposed mental health system can be provided.
This policy envisions an active, flexible and community-based mental health service where the need for hospital admission will be greatly reduced. It will require substantial funding, but there is considerable equity in buildings and lands within the current mental health system, which could be realised to fund this plan. Therefore, this report recommends that steps be taken to bring about the closure of all mental hospitals and to re-invest the resources released by these closures in the mental health service. A programme of capital and non-capital investment in mental health services as recommended in this policy and adjusted in line with inflation should be implemented in a phased way over the next seven to ten years, in parallel with the reorganisation of mental health services.
KEY RECOMMENDATIONS OF A Vision for Change
- Involvement of service users and their carers should be a feature of every aspect of service development and delivery.
- Mental health promotion should be available for all age groups, to enhance protective factors and decrease risk factors for developing mental health problems.
- Well-trained, fully staffed, community-based, multidisciplinary CMHTs (Community Mental Health Teams) should be put in place for all mental health services. These teams should provide mental health services across the individual’s lifespan.
- To provide an effective community-based service, CMHTs should offer multidisciplinary home-based and assertive outreach care, and a comprehensive range of medical, psychological and social therapies relevant to the needs of services users and their families.
- A recovery orientation should inform every aspect of service delivery and service users should be partners in their own care. Care plans should reflect the service user’s particular needs, goals and potential and should address community factors that may impede or support recovery.
- Links between specialist mental health services, primary care services and voluntary groups that are supportive of mental health should be enhanced and formalised.
- The mental health services should be organised nationally in catchment areas for populations of between 250,000 and 400,000. In realigning catchment boundaries, consideration should be made of the current social and demographic composition of the population, and to geographical and other administrative boundaries.
- Organisation and management of local catchment mental health services should be co-ordinated locally through Mental Health Catchment Area Management teams, and nationally by a Mental Health Service Directorate working directly within the Health Service Executive.
- Service provision should be prioritised and developed where there is greatest need. This should be done equitably and across all service user groups.
- Services should be evaluated with meaningful performance indicators annually to assess the added value the service is contributing to the mental health of the local catchment area population.
- A plan to bring about the closure of all mental hospitals should be drawn up and implemented. The resources released by these closures should be protected for re-investment in the mental health service.
- Mental health information systems should be developed locally. These systems should provide the national minimum mental health data set to a central mental health information system. Broadly-based mental health service research should be undertaken and funded.
- Planning and funding of education and training for mental health professionals should be centralised in the new structures to be established by the Health Services Executive.
- A multi-professional manpower plan should be put in place, linked to projected service plans. This plan should look at the skill mix of teams and the way staff are deployed between teams and geographically, taking into account the service models recommended in this policy. This plan should be prepared by the National Mental Health Service Directorate working closely with the Health Service Executive, the Department of Health and Children and service providers.
- An implementation review committee should be established to oversee the implementation of this policy.
- Substantial extra funding is required to finance this new Mental Health Policy. A programme of capital and non-capital investment in mental health services as recommended in this policy and adjusted in line with inflation should be implemented in a phased way over the next seven to ten years, in parallel with the reorganisation of mental health services.
- A Vision for Change should be accepted and implemented as a complete plan.