Missing the Tide

Guest Blog by Dr John Owens, former Chairperson of the Mental Health Commission, on the implementation of the National Mental Health Policy Document –  Vision for Change.

The Health Service Executive launched an information seminar at Dublin Castle on Monday 24th January 2011.  This was to mark the fifth anniversary of the publication of the National Mental Health Policy Document –  Vision for Change.  This policy document recommended radical changes in the delivery of mental health care and spelt out in some detail the strategies for its implementation over a ten year period.  The Health Service Presentation at Dublin Castle  might appropriately be given the title of  ‘Half Way There’.  Clearly, progress has been made particularly in the area of Child and Adolescent Services and the Vision for Change on line survey documenting the current state of services is a very useful development.  Overall, however, there must be deep disappointment with the degree to which the Health Service Executive have implement the Policy Document.  One of the recommendations of the Policy Document was the setting up of an Implementation Committee to support and monitor the implementation of the policy recommendations.  This groups annual report has been trenchant in its criticisms of failure to progress the policy.  The service providers and user groups welcomed the publication of the policy in 2006 but the failure to appropriately implement the recommendations has resulted in considerable disillusionment and decline in service morale.  The Mental Health Commission and its Inspectorate, while noting some improvements, continue to be very critical of service structures and care delivery.  The picture, however, is not uniformly negative and in some areas high quality services have been developed.  Indeed, examples of these services based in West Cork and East Galway were mentioned at the meeting in Dublin Castle.  These developments are typical ground up developments based on local innovative service management.

Vision for Change recognise that successful implementation of the new policy required two fundamental priorities to be achieved.  One a new Mental Health Management Structure and two, the provision of adequate resources.  The management structure recommended in Vision for Change, was a tiered one with a National Mental Health Service Directorate, a Catchment Area Management Team and a Self Managing Community Mental Health Team.  These management structures needed to be multidisciplinary in nature including user representation and were assigned specific areas of responsibility.  The failure to develop a National Mental Health Service Management Structure and Self Managing Community Mental Health Teams implementing agreed and costed service plans has been deeply disappointing.  With regard to resources Vision for Change recommended that relatively modest extra funding (€22 million) a year over a seven year period was required to implement the new policy and this money was needed to provide for the extra staff required.  Major Capital funding was also needed.  It was reckoned that this could be provided from the sale of redundant mental health lands and buildings.  If the Policy document had been implemented promptly adequate financial resources would have been available.  Unfortunately, the financial recession and necessary retrenchment in state services has changed the financial landscape to a dramatic extent.

In 2006, following the implementation of the New Mental Health Act and the setting up of the Mental Health Commission there was great optimism within the Mental Health Service that the new policy recommendations would be rapidly implemented.  This “flood tide” was unfortunately missed and there has been resultant disillusionment.  There need not, however, be “shallows and miseries” There are substantial resources available within the Mental Health Service that would allow significant implementation of the policy recommendations.  What is key in bringing this about if the full implementation of the Policy Document’s recommended management structures.


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