Reform of mental health services must be an election issue
Voters were urged today to raise their concern about Ireland’s outdated mental health services with election candidates – to ensure improving mental health services is an election issue.
Mental Health Reform (MHR) said one in four Irish people experience a mental health difficulty during their lives – and mental health services continue to be outdated and inappropriate.
Speaking at the launch of its Election 2011 Manifesto MHR Director Orla Barry said: “People who are concerned about the poor quality of services available should raise this issue with election candidates – and call on them to commit to reform if elected.”
Ms. Barry highlighted the need to need to move to comprehensive community based services, as set out in Ireland’s mental health services reform plan A Vision for Change.
“Since launched in 2006, implementation of A Vision for Change has been slow, leaving mental health to continue as the ‘Cinderella’ of the health services. At the current rate of progress it will not be implemented – even by the outside target of 2016.”
MHR (formerly the Irish Mental Health Coalition) outlined five key reform areas for candidates to commit to:
- Establish an Accountable Structure: Establish a dedicated executive position at the highest level of the HSE that is responsible for implementing A Vision for Change. This should be led by a Director for Mental Health Services who has executive powers, an implementation budget and responsibility to report publicly on progress.
- Publish a Plan: Publish a comprehensive implementation plan for A Vision for Change setting out deliverables, a timeline and who is responsible.
- Financial Commitment: Commit to raising funding of mental health services from 5% to 8% of the health budget by 2016 and to clear reporting on mental health spending.
- Enact Legislation: Enact legislation to improve the health service’s accountability for planning and financing mental health service reform.
- Promote Cross-departmental Action: Promote specific cross-departmental action on mental health and the implementation of the National Disability Strategy to effectively combat social exclusion, prejudice and discrimination against people with mental health problems.
Mental Health Reform
Mental Health Reform was established in 2006 (then called the Irish Mental Health Coalition) as a coalition of organisations campaigning for improved mental health services. It is committed to placing mental health in a central position within the public discourse for reform.
Mental Health Reform recently rebranded from The Irish Mental Health Coalition (IMHC). The rebrand is to help communicate more clearly that reforming and improving mental health services is at the core of what the organisation is about. The new slogan for the organisation is Campaigning for Improved Mental Health Services.
MHR’s new website is at www.menatlhealthreform.ie
IN DETAIL – FIVE KEY AREAS FOR REFORM OF MENTAL HEALTH SERVICES
1. Establish a Structure
The Problem
- A Vision for Change has no single senior executive within the HSE who is responsible for execution. As a result responsibility falls between the cracks and no-one can be held accountable for ongoing slow progress.
The Solution
- Establish a dedicated senior executive position within the HSE which is responsible for implementing A Vision for Change. This should be led by a Director for Mental Health Services who has executive powers, an implementation budget and responsibility to publicly report on progress.
2. Publish a Plan
The Problem
- A Vision for Change has no comprehensive implementation plan, meaning it is impossible to measure and scrutinise progress.
The Solution
- Publish a detailed implementation plan setting out deliverables, a timeline and who is responsible.
3. Financial Commitment
The Problem
- Mental health services in Ireland are underfunded. Mental health received approximately 5% of the health budget in 2010 having dropped from 13% in 1986. This compares unfavourably with 12% in England and 18% in Scotland.
- There is a lack of transparency as mental health funding is administered from within the overall HSE budget.
- Progress on closing inappropriate Victorian mental institutions in particular has been slow. In many cases this has been delayed by a lack of resources to develop the community based mental health teams.
- Mental health services have experienced a disproportionate loss of staff as a result of the public sector staff moratorium. 20% of posts lost in the HSE in 2010 were from mental health services even though the care group represents just 9% of the workforce.
The Solution
- Bring the proportion of funding on mental health services to 8% of the health budget by 2016, as set out in A Vision for Change.
- Ensure clear reporting on mental health spending.
- Fastrack funding to provide improved community based services. When old institutions are closed lands can be sold reclaiming money for the taxpayer.
- Recruit additional staff to work in community based mental health teams to bring the reduction in staff numbers in mental health services into line with that experienced in other areas of the health service.
4. Enact Legislation
The Problem
- There is no legal framework to require the health service to implement A Vision for Change.
- There is out-of-date legislation to protect people who lack capacity, because of a mental health difficulty, to be able to make decisions for themselves.
- Mental health is not sufficiently recognised and included within the targets of the National Disability Strategy.
The Solution
- Enact legislation that places obligations on the HSE to plan, deliver and report on A Vision for Change and that provides for inspection of community-based mental health services.
- Enact comprehensive capacity legislation that complies with the UN Convention on the Rights of Persons with Disabilities.
- Ensure that mental health is promoted and acknowledged as an integral part of delivering the National Disability Strategy.
5. Promote Cross-departmental Action
The Problem
- Many people with mental health difficulties face discrimination in many areas of their life – securing jobs, getting housing and socialising.
- People with a mental health disability participate in the Irish labour force at less than half the rate of the general population.
- Few specific measures have been taken on mental health within the National Disability Strategy, or in other social inclusion programmes.
The Solution
- Promote specific cross-departmental action on mental health. Departments covering social welfare, education, employment and housing should set out how they will implement A Vision for Change.
- Commit to implementing the National Disability Strategy to effectively combat social exclusion, prejudice and discrimination against people with mental health problems and support the structures required to monitor and drive the Strategy under the direction of the Department of An Taoiseach.
- Ensure that specific measures are taken to improve access to employment and housing for people with a mental health problem.
