Accountability and investment needed to reform mental health services

Greater accountability and investment is urgently needed to deliver reform of mental health services, the Irish Mental Health Coalition (IMHC) warned today at the fifth anniversary of A Vision for Change.

The government’s policy for the radical overhaul of mental health services, A Vision for Change, was launched in 2006 and pledged delivery within a 6-10 year time frame. In the absence of a National Directorate responsible for implementation and a comprehensive plan, the time line is now being pushed to the outer limit of 2016.

Midway through the plan’s extended timeframe IMHC Director Orla Barry said major changes are needed, and efforts need to be fast tracked, if targets are to be reached by 2016.

“A National Directorate for mental health services is one of the most urgent recommendations in A Vision for Change. The fact that Senior Executive accountability was never established has been hugely detrimental to implementing the executive policy. The contrast with the progress of the National Cancer Strategy is stark.

“Positive development has occurred in many areas and the commitment of mental health services management and professional groups to improve services is evident. The involvement of service users, advocates and carers in the development of services is very positive. However during the past five years progress in implementing A Vision for Change and reforming the mental health services has been slow and piecemeal as reported year on year by the Independent Monitoring Group.

“There remain significant differences in the quality of services across the country and the resources available to move to a modern community model. This has been worsened by the staff moratorium which has resulted in a disproportionate loss of mental health posts and a critical reliance on staffing inpatient facilities at the expense of community services. 20% of posts lost in the HSE in 2010 were from mental health services even though the area represents just 9% of the workforce.

“The failure to establish a National Directorate with the necessary executive powers and budgetary responsibility to effect change and implement national plans, means that the best efforts of dedicated managers and professionals is compromised. Urgent action on this matter of structure is required.

“Firstly, there needs to be improved accountability with a Directorate of Mental Health Services appointed to oversee the implementation of the plan and given executive and budgetary powers.

“Secondly, progress is needed in accelerating investment in community services which are the cornerstone of mental health reform. This requires redistribution within the staff moratorium in favour of mental health. Much of the reform required is relatively cost neutral, but it can only progress if initial investment to develop community based services is brought forward.

“We also need to maximise the integration of people who experience mental health difficulties, with access to housing, education, training and employment and community services with the mental health services providing the specialist support.”

Mental health services are already disproportionately underfunded in Ireland having dropped from 13% of the health budget in 1986 to 5.4% in 2010. This compares unfavourably with the rate of 12% in England and 18% in Scotland.

The Department of Health and HSE have called a review meeting on progress on A Vision for Change at the midpoint in its timescale, which takes place tomorrow.

Ms. Barry urged the meeting to be focused on how to overcome the key blocking points of accountability, investment in community services, staffing and improved cross-sectoral working, particularly at this time of social and economic difficulty.

“It is estimated that one in four of us will experience a mental health difficulty at some time in our lives. In addition the established links between mental health, poverty and unemployment means that demand on mental health related services grow in times of economic and social difficulty. This currently is evident in the growing rate of suicide nationally. Now more than ever quality mental health services are needed to respond to and support the urgent need of many people in the community,” she concluded.


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