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Prepared by the Department of Healthhealth.gov.ie
Sharing the VisionA Mental Health Policy for Everyone
Prepared by the Department of Healthhealth.gov.ie
Sharing the VisionA Mental Health Policy for Everyone
Prepared by the Department of Healthhealth.gov.ie
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Sharing the Vision | A Mental Health Policy for Everyone
List of Abbreviations 6
Chapter 1 | Background and Context 11 Introduction 13Therefreshprocess 13OversightGroup 13Methodology 14Framework 15CoreValues 16Thevision 16Principles 17Implementation 19
Chapter 2 | Promotion, Prevention and Early Intervention Domain 23 Introduction 24Positivementalhealthandwellbeing 25Mentalhealthlifecycle 26TheLifecycleApproach 26MentalHealthacrosstheLifecycle 27Mentalhealth,prioritygroupsandstigma 29Additionalhealthpromotionsupports 30HealthPromotionProgrammes 30VoluntaryandCommunitySector 30DigitalMentalHealth 30
Chapter 3 | Service Access, Coordination and Continuity of Care Domain 33 Introduction 34Pathwaystosupport 36PrimaryCare 40Integratedservices 41CommunityMentalHealthTeams 44Clinicalleadership 45AlternativeAccessRoutestoEmergencyCare 45Specialistmentalhealthservicesacrossthelifecycle 47Childandadolescentmentalhealthservices 47The0–25cohort 47Generaladultmentalhealthservices(GAMHS) 48Adultinpatientcapacityandalternativestoinpatientadmission 48Mentalhealthservicesforolderpeople 50
Table of Contents
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Tailoredinterventions 50Forensicmentalhealthservices 50Dualdiagnosis 53Mentalhealthservicesforhomelesspeople 54Liaisonmentalhealthservices 54
Specialistneeds-basedservices 54Intensiverecoverysupportservices(forindividualswithcomplexmentalhealthdifficulties) 54Mentalhealthservicesforearlyinterventioninpsychosis 55Peoplewithanintellectualdisability 56ADHD 56Suicideprevention 56Eatingdisorders 57Specialistperinatalsupports 57Neuro-rehabilitation(includingacquiredbraininjury) 57
Providingmentalhealthservicesthatrecogniseandrespondtodiversity 57Accesstoadvocacy 58
Chapter 4 | Social Inclusion Domain 65 Introduction 66Equalityofaccess 67Housingsupports 67Employmentsupports 68Trainingandvocationaleducationsupports 68Incomeprotectionandsocialwelfare 68Peer-led,peer-runandcommunitydevelopmentprojects 68
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Sharing the Vision | A Mental Health Policy for Everyone
Chapter 5 | Accountability and Continuous Improvement Domain 71 Introduction 72Accountabilityandcontinuousimprovement 73Governanceleadershipandorganisation 73PatientSafety 74Disadvantageandserviceplanning 74Physicalinfrastructureformentalhealthservices 75Measuringperformance 75Capturingandembeddinginnovation 75Meetingstandardsinqualityframeworksandbestpracticeguidelines 76Enablers 76Safeguardingvulnerablepeople 78Serviceusers,self-harmandsuicide 78Involuntarydetention 78
Chapter 6 | Implementation 83 Introduction 84NationalImplementationandMonitoringCommittee 85HSE Sharing the Visionstructure 85Implementationroadmap 85
List of Appendices 89 AppendixI: TermsofReferencefortheOversightGroup 90AppendixII: MembershipoftheOversightGroup 91AppendixIII: ImplementationRoadmap 94References 111Bibliography 113
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Glossary of Abbreviations
ACEs Adverse Childhood Experiences
AHPs Allied Health professionals
AVFC A Vision for Change
CAMHS Child and Adolescent Mental Health Services
CFL Connecting for Life
CHN Community Health Network
CHO CommunityHealthcareOrganisation
CIPC Counselling in Primary Care
CMH Central Mental Hospital
CMHTs Community Mental Health Teams
CNS Clinical Nurse Specialist
COG CAMHSOperationalGuidance
CPD ContinuingProfessionalDevelopment
CRRs CommunityRehabilitationResidences
CRTs CrisisResolutionTeams
DA DisabilityAllowance
DEASP Department of Employment and Social Protection
DES DepartmentofEducationandSkills
DHPLG Department of Housing, Planning and Local Government
DoH Department of Health
ED Emergency Department
EMAP EuropeanMentalHealthActionPlan
FCAMHS Forensic Child and Adult Mental Health Service
FCS Family, Carers and Supporters
FMHS Forensic Mental Health Service
GAMHS General Adult Mental Health Service
IAN Irish Advocacy Network
ICRU IntensiveCareRehabilitationUnit
IPS Individual Placement and Support
IRSS IntensiveRecoverySupportServices
IRST IntensiveRecoverySupportTeams
LMHS Liaison Mental Health Service
MHC Mental Health Commission
MHIAP Mental Health in all Policies
MHIDT MentalHealthIntellectualDisabilityTeams
MHR MentalHealthReform
MHSOP Mental Health Services for Older People
MOC Models of Care
MOCEIP EarlyInterventionPsychosisModelofCare
NCHD Non-Consultant Hospital Doctors
NEPS NationalEducationalPsychologicalService
NGBRI NotGuiltyByReasonOfInsanity
NOSP NationalOfficeforSuicidePrevention
OTs OccupationalTherapists
PBP Population-BasedPlanning
PH&HS PopulationHealth&HealthServicesResearch Research
PICU PsychiatricIntensiveCareUnit
POLL Psychiatry of Later Life
RICO RegionalIntegratedCareOrganisations
SLTs Speech and Language Therapists
SOG StandardOperatingGuideline
SOP StandardOperatingProcedure/Scope ofPractice
SPPMO StrategicPortfolioandProgrammeManagementOffice
SRF SocialReformFund
SRUs SpecialisedRehabilitationUnits
TILDA The Irish Longitudinal Study on Ageing
UNCRPD UNConventionontheRightsofPersonswithDisabilities
VCS Voluntary Community Sector
WHO WorldHealthOrganization
WRC WorkResearchCentre
YMHTF Youth Mental Health Task Force
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Sharing the Vision | A Mental Health Policy for Everyone
A Note on Terminology
Assertive outreach Theassertiveoutreachteamsprovideintensive support for a person with complex needs. The teams aim to support the person to get help from other services. This support can help thepersontomanagetheirconditionbetterandreducetheperson’schancesofgoingbacktohospital.
Crisis resolution CrisisResolution(CR)offersafter-hoursand urgent mental health assistance. CrisisResolutionisanintegralpartof each community mental health team,providing24-houradviceandassessmentforpeoplepresentingin crisis associated with a known or suspectedmentalhealthproblem.
Digital health Digital health refers to using online or other digital technology to provide preventionandcare.Somedigitalhealthprogrammesfocusonpromotinghealthandwellbeingandpreventingill health, while others may deliver earlyinterventionandmentalhealthtreatment. There are numerous digital healthprogrammesavailable,coveringa range of mental and physical health concerns, and thus increasing individual healthcare management choices and improving access to support.
Dual diagnosis ‘Dualdiagnosis’isthetermusedwhenapersonexperiencesbothasubstanceabuseproblemandamentalhealthissue such as depression or an anxiety disorder.Treatmentoptionsmustaddressboth.Dual diagnosis may also refer to someone who has a mental health difficultyalongsideanintellectualdisability,autismorboth.
Mental health difficulty Theterm‘mentalhealthdifficulty’hasbeenusedthroughouttodescribethefullrangeofmentalhealthdifficulties
thatmightbeencountered,fromthepsychologicaldistressexperiencedbymany people, to severe mental disorders thataffectasmallerpopulation.
Peer support Peer support is a system of giving and receiving help founded on key principles ofrespect,sharedresponsibilityandmutual agreement as to what is helpful. Peersupportisnotbasedonpsychiatricmodelsanddiagnosticcriteria.Itisaboutunderstandinganother’ssituationempathicallythroughthesharedexperienceofemotionalandpsychological pain.
Recovery colleges Recognisingthatpeoplecananddorecover from mental health distress, recovery colleges work to create an empowering and inclusive culture of recovery and acceptance in the community through the provision of person-centred,strengths-basedholisticlearning,underpinnedbyvaluesofself-determination,choiceandhumanrights.Recoverycollegecoursesaredesignedanddeliveredbypeoplewithexperienceof overcoming mental health distress in partnership with other key stakeholders including supporters such as family membersandfriends,andprofessionals,usingaprocessofco-production.Recoverycollegespromoteacultureofrecovery in Irish society and throughout mental health services, to empower individualsandcommunitiestoembraceand overcome mental health challenges collectively;toimprovequalityoflife;and to promote acceptance, community involvement and opportunity for advancement.
Referral pathway Apatientreferralpathwayistheprocessbywhichapatientisreferredfromonedoctor to another. Normally you do not see specialists without a referral from a generalist (i.e. family doctor).
Scope of practice Thescopeofpracticesetsouttheprocedures,actionsandprocessesthatthe registered or licensed professional is allowed to perform. The individual practitioner’sscopeofpracticeisdeterminedbyarangeoffactorsthatgives them the authority to perform a particularroleortask.
Social prescribing SocialprescribingenablesGPs,nursesand other primary care professionals to refer people to a range of local, non-clinical services.
Talking therapies Talking therapy is a general term to describeanypsychologicaltherapythatinvolves talking such as counselling or psychotherapy. Talking therapies are psychological treatments. They involve talking to a trained therapist to support apersontodealwithnegativethoughtsand feelings. They help a person to makepositivechangesandtheytakeplace in groups, one-to-one, over a computer or over the phone.
Trauma-informed care Trauma-informed care is an approach which acknowledges that many people who experience mental health difficultieshaveexperiencedsomeformof trauma in their life, although this is not the case for everyone. A trauma-informed approach seeks to resist traumatisingorre-traumatisingserviceusersandstaff.Trauma-informedservice delivery means that everyone at all levels of the mental health services and wider mental health provision hasabasicunderstandingoftraumaandhowitcanaffectfamilies,groups,organisationsandcommunitiesaswellas individuals.
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Sharing the Vision | A Mental Health Policy for Everyone
Message from Minister
ThepublicationoftheVision for Changementalhealthpolicyin2006setahighstandardforthedevelopmentofmentalhealthpolicyinIreland.Asaresult,therehavebeenmanyimportantchangesinthepastdecadeaimedatimprovingpeople’shealthandwellbeing.Inrecenttimes,mentalhealthhasreceivedmuchattention.TheoutbreakofCOVID19throughouttheworldcreatedsignificantstress,anxiety,worryandfearformanypeople.Thediseaseitselfwasfurthercompoundedbyotherimpactssuchassocialisolation,disruptiontodailylife,uncertaintyaboutemploymentandfinancialsecurity.TheGovernmentresponsewasrapidandawhole-of-populationplanwasputinplacetosupporthealthcarestaffandthegeneralpopulationbyprovidinghealthandwellbeingadvice,resiliencebasedtrainingandprovidingfreeonlineinterventionssuchascounsellingandcrisistextingforallinneed.Indeed,theabilitytocreateadditionalonlineinterventionstoaugmentexistingserviceswithsuchawidereach,hasinmanywayschangedhowwetreatthemildtomoderatementalhealthneedsofthepopulation. InmanywaysthepandemicassistedIrelandtoimprovepublicattitudestomentalhealth becauseofthestatutory,voluntaryandcommunitycommitmenttoraisingawarenessand creatingpositivechangesinhowIrelandthinksaboutanddeliversmentalhealthservices.
ThispolicyhasbeendevelopedfollowingaprocessofresearchandconsultationwhereinternationalevidencewasexaminedandwherethoseconsultedprovidedtheOversightGroupwithinformationaboutwhattheywouldliketoseeprioritisedintherefreshedpolicy.Basedonthisapproach,theareasthatpeoplefeltwereimportanttothemwereidentified.Thispromptedthedevelopmentofthisaction-oriented,outcome-focusedpolicy,whichadoptsalifecycleapproach that places the individual at the centre of service delivery.
Ourgoodhealthisveryprecioustousall.Mentalhealthparticularlyrequiresarangeofcommitmentsandresponsestoensuregoodoutcomes.Withinthisoutcome-basedframework,high-leveloutcomeshavebeensetthatwilldeliverimprovedbenefitsforeveryone.
Iwouldliketothankallofthosewhogenerouslygavetheirtimeandknowledgetoengageinthisveryvaluableprocess.AspecialthankyoutotheOversightGroupmembers,ablychairedbyHughKane,andtoallthosewhocametotheconsultationstoprovideessentialinputthathelpedshapethis service user-centred policy.
AsMinisterwithresponsibilityformentalhealth,Iamencouragedthatthispolicyiswide-rangingandinnovative.Itpromotesearlyaccesstosupportinvariouslocationsandseekstoprovideindividualisedcaretothosewhoneedhelpassoonaspossible.Thispolicybuildsonexistingservicesandprovidesaframeworkthatwillseektomeasureimplementation.Therearemanychallengesahead,butIamveryconfidentthatSharing the Vision will improve the mental health ofthenationsignificantlyoverthenexttenyearsandbeyondaslongasweallremaindedicatedto working together.
Jim DalyMinister for Mental Health and Older People
Jim Daly
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Chapter 1
Background and Context
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1 KevinCullenandDavidMcDaid.EvidenceReviewtoInformtheParametersforaRefresh of A Vision for Change (AVFC)–Awide-angleinternationalreviewofevidenceanddevelopmentsinmentalhealthpolicyandpractice(Dublin:WRCandLSE,2017).
Chapter 1 | Background and Context
Introduction
ThepublicationofA Vision for Change (2006)represented an important milestone in the development of mental health policy in Ireland. Many significantchangesandimprovementshavetakenplaceoverthelifetimeofthepolicysince2006.Although A Vision for Change (AVFC) has supported significantdevelopmentoverthepast13years,wehave much more to do in developing stronger, more appropriate mental health supports at community andprimarycarelevelsandindevelopingrobustandreliableservicesandensuringeffectiveuseofappropriateinpatientcare.
TheeconomicdeclineexperiencedinIrelandin2008influencedtheabilityoftheStatetofundtheoriginalAVFCpolicytoanticipatedlevels;however,between2012and2020,theHSEMentalHealthServicesbaseincreasedby€315m,oraround44%,with€233.6mofthis funding new developments. AVFC did not include aframeworkbywhichtomeasureoutcomesorassesstheimpactoftherecommendationsoverthelifetimeofthepolicy;thereforethesignificantgrowthwithinmentalhealthservicesisdemonstratedbyincreasedactivity,improvedaccessandotheroutputs,someofwhicharehighlightedbelow:
• Between2012and2018,therewasanincreaseof24%inthenumberofreferralsacceptedbyChild and Adolescent Mental Health Services (CAMHS).Whilewaitinglistsincreasedbyjust4%over the same period, it is noted that the CAMHS waitinglistreducedbyabout20%betweenDecember2018andAugust2019.IncreasedaccesstoCAMHSissupportedbytheadditionalstaffingofCAMHSteamsbetween2008and2017.
• InlinewithnationalpolicytoenhancecommunityservicestherehasbeenadecreaseinadmissionstoadultacuteinpatientunitsoverthelifetimeofAVFC. Acute hospital admissions were reduced by4,138between2008and2017andthe
re-admissionratewasreducedby8%.Thisindicatesthattheshiftfrominstitutionalcaretocommunity care has progressed.
• Overall,mentalhealthstaffinghasincreasedwithanadditional1,700new-developmentpostssince2012,andincreasedmentalhealthcapacityhasbeenbuiltintoprimarycaretohelprelievepressures on CAMHS services.
• FourNationalClinicalProgrammes(NCPs)formental health are in various stages of design and implementation:(i) Assessment and management of service
userspresentingtoemergencydepartmentsfollowingself-harm;
(ii) Thenationalclinicalprogrammeforeatingdisorders;
(iii) Anearlyinterventioninpsychosismodelofcare;and
(iv) Theestablishmentofamulti-disciplinarynationalworkinggrouptoprogressanNCPfor ADHD in adults.
• Voluntary and community services have also seenimprovedaccessandincreasedactivity.Non-governmentalorganisations(NGOs)havesupportedindividualsbyprovidingworkshopsand training on healthy living, mental health awareness,resilienceandmentalhealthfirstaid,andbybuildinginclusivityandcohesion.Importantly the development of peer support andserviceuserinvolvementatnationallevelhasensured that the voice of those using services is heard and incorporated into service provision.
IrelandhaschangedsignificantlysinceAVFC wasfirstpublishedin2006andourunderstandingofmentalhealthhasimprovedgreatlyinthattime.Sharing the Visionisapolicythatbuildsuponthegoodworkachieved over the past decade and it will provide aframeworkforinvestinginamodern,responsivementalhealthservicefitforthenexttenyears. Workbeganin2016onthisprocess
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2 Kevin Cullen. Stock-take of progress on A Vision for Change (AVFC)(Dublin:WRC,2018).3 A Vision for Change Oversight Group. Change for the Future – A Vision for Change ‘refresh’(Dublin:2019).
The refresh process AVFCcametotheendofitsten-yeartermin2016andpreparationsforareviewandupdateofthepolicycommencedwiththecommissioninginFebruary2017ofanExpertEvidenceReviewbytheWorkResearchCentre(WRC)toinformtheparametersofthe planned refresh of mental health policy in Ireland.1 The approach encompassed a stock-take of recent successinmentalhealthandareviewofinternationaldevelopments,innovation,evidenceandgoodpractice.Thereviewhadabroadbriefcoveringthevariousdimensions of the mental health terrain that might have relevance for informing the refresh of mental health policy in Ireland.
Thekeyprioritiesthatemergedoutofthereviewwere: • TheprioritisationofmentalhealthinIrelandasa
majorsocietalissue• Theimportanceofprimarypreventionand
positivementalhealth• Arequirementtofocusonsocialinclusionand
recovery • Expansion of mental health services to address
thespectrumofconditionsandneeds• Developmentofgovernanceandfinancingto
includeresearch,evaluationandqualityassurance
TheWRCcompletedasupplementarypapertobuildontheworkintheExternalEvidenceReview,whichidentifiedspecificpolicychangesforwhicharequirementmayhavearisensince AVFCwasdrafted.2 Thereviewidentifiedpolicythemesthatmayrequireattentionintherefreshsuchastheidentificationofvulnerablegroupsandassociatedactionsnotmentionedinthepreviouspolicy.Thereportalsosought to consider new policy areas including a wider focusoneducationandprevention,andthewideruseofaccrediteddigitalhealthinterventions.Inaddition,thereportsoughttoevaluateeachrecommendationfrom the previous policy and to rate progress to date onwhatactionswereimplemented,whatrelevantactionsremainedandwhatactionswerenolongerneeded.BothWRCreportsassistedinidentifyingpriority areas for the newly formed Oversight Group toconsiderastheydraftedtheirreportfortheDepartment of Health.
Oversight Group AspartoftheRefreshprocess,andinlinewithacommitment given in Dáil Éireann, an Oversight Group (OG)wasestablishedinOctober2017toprovideareporttotheDepartmentofHealthsettingoutcurrentandfutureserviceprioritiesforconsiderationbygovernment in the development of a successor policy to AVFC.ThisreportwasrequiredtotakeaccountofexistingmentalhealthpolicyandtohaveregardtotheExpertEvidenceReviewofinternationalbestpracticeandprogressoncurrentservicedevelopmentsinIreland.TheOversightGroupwaschairedbyMrHughKane,withamembershipreflectingservice users, advocacy groups, service providers, operationalmanagers,andprimarycareandmentalhealthclinicians.TheGroup’stermsofreferenceandmembershipcanbefoundatAppendicesIandII.
In accordance with the terms of reference, the OversightGroupsubmitteditsreporttotheDepartmentofHealthforconsideration.3 The OversightGroupreportwasreviewedbytheDepartment and a successor policy document to AVFC was produced that carries forward those elements oftheoriginalpolicywhichstillhaverelevance,whileintroducingnewrecommendationstocreateamodernmentalhealthgovernmentpolicysuitableforthenextten years.
Sharing the Vision, the successor policy to AVFC, considersthemanyvarieddeterminantsthataffectgood mental health and seeks to incorporate inter-departmentalrecommendationsintothepolicy.Theambition,intendedoutcomesandrecommendationsset out in Sharing the Vision are the product of intensive work coordinated through the Department ofHealthandtheOversightGroup.Theyarebackedbyextensiveresearch,benchmarkingactivityandevidence-basedreviews,togetherwithawide-rangingconsultationprocess.Asaresult,thispolicyfocusesverystronglyondevelopingabroad-based,whole-systemmentalhealthpolicyforallofthepopulationthat aligns closely with the main provisions of Sláintecare.
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4 DepartmentofHealth.Women’sTaskforcementalhealthreport(Dublin:2020).5 England,Scotland,Canada,AustraliaandNewZealand.TakenfromCullenandMcDaid,EvidenceReview.
Chapter 1 | Background and Context
Methodology Sharing the Vision wasinformedbyamajorstakeholderconsultationprocessundertakenbytheOversightGroupandsupportedbytheDepartmentofHealth.Over1,200individualsrepresentingserviceusers,peerworkers, carers, health workers, managers and others attendedfivestakeholdersessionsatvariouslocationsthroughoutIreland.Participantswereprovidedwithan overview of the proposed organising framework (Figure1.1)andwereaskedtoconsiderpriorityareasfor each domain within that framework.
The work of the Oversight Group was further guided byaReferenceGroupestablishedtoconnectwithawider group of experts as the policy proposals were evolving.Thisincludedrepresentativesofclinicalbodies,NGOsandserviceuserorganisations,whomettodiscusstheframeworkandfeedbackfromthestakeholder process.
TheconsultationprocesswasalsoinformedbyareviewbytheOversightGroupofexistingpoliciesandreportswithmentalhealth-specificrecommendations.Toavoidduplicationandmaintainconsistency,theGroup made reference to and supported relevant recommendationsfromthefollowingkeydocuments:• LGBTQ Strategy (DCYA)• Children First (DCYA) • Connecting for Lifesuicidestrategy(DoH/HSE)• HSE Service Plan • Peer Advocacy Services report (Irish Advocacy
Network) • AllsubmissionstoJointOireachtasCommitteeon
the Future of Mental Healthcare in Ireland • RecommendationsarisingouttheNational Youth
Mental Health Task Force Report 2017 • HSE service user Engagement Document • ReportoftheReviewoftheIrishHealthServices
forIndividualswithAutismSpectrumDisorders(HSE)
• JointWorkingProtocolswithChildandAdolescent Mental Health Services (CAMHS) and Primary Care
• NationalMHIDServiceDevelopmentProgramme• ‘MyVoiceMatters’serviceusersurvey(Mental
HealthReform)• MentalHealthReformreportonprogressof
A Vision for Change.
TheworkoftheOversightGroup,supportedbythecommissionedresearchbyWRCandtheinputoftheJointOireachtasCommitteeontheFutureofMentalHealth,informsthispolicy.ItisnotablethatthereisasynergybetweentherecommendationsoftheOversightGroupandtheworkoftheJointCommitteeon the Future of Mental Health. Many of the issues andactionsemergingfromtheworkoftheJointCommitteeresonateandalignwiththoseencounteredduring the countrywide stakeholder engagement bytheOversightGroup.Thecross-partySláintecare report,withitscoreemphasisonintegrationanddelivery of services at community level, represents a new development in whole-system leadership in Irish healthcare and a real opportunity to deliver our specificvisionformentalhealth.
Inadditiontotheseinputs,theconsultationprocesshasbeeninformedbyrecentworkundertakenbytheDepartmentofHealth’sWomen’sHealthTaskforce,2019.Earlyresearchbythisgrouphasidentifiedarangeofgenderdifferencesinmentalhealthwhichhaveasignificantimpactontheneedsandservicerequirementsofwomen,andgirlsinparticular.TheWomen’sHealthTaskforce,workingwiththeNationalWomen’sCouncilofIreland,haspreparedasummarydocumentofthisresearch,whichispublishedalongside this report on the Department of Health website.4
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Framework The Oversight Group decided to focus on outcomes in order to emphasise the importance of policy supportingtangiblechangesinthelivesofpeopleusing mental health services. The Oversight Group engaged in a literature review of mental health outcomesfromotherjurisdictionstogainasenseofthevariousinterventionsanddescriptionsofoutcomesandoutcomemeasuresbeingdeliveredinternationally.Fivecountrieswereidentifiedashavingwell-developed and well-resourced mental health outcome infrastructures that moved from a focus on the volume of services delivered to the value created for service users.5
The Oversight Group proposed developing an overarching framework containing domains, and organised outcomes into groups focused on ‘what
matters’.Thisisanimportantfirststepandisseparateto choosing outcome measures or indicators. Central tothedeliveryofavalue-basedhealthcareserviceisthecustomerandwhattheydefineasvalue,andwhatoutcomestheyexpectfromtheirinteractionwiththeservice. To achieve this streamlining, the Oversight Groupcombinedrelatedpolicy/servicedeliveryareasintofour‘domains’requiringactionandoversightintherefreshedpolicy.ThesearereflectedintheorganisingframeworkdetailedinFigure1.1,whichfollows through to the report structure. The Oversight Groupalsoidentifiedanumberofspecifichigh-leveloutcomes within each of the four domains and thesearedescribedatthebeginningofeachof the domain chapters.
To test the logic of the organising framework, additionalinter-departmentalmeetingswere
Figure 1.1: The Organising Framework
Outcome Enablerse.g. Mental Health Information Systems, Legislative enablers/reform, Investing in the Workforce and Commissioning Models/Framework
Actionsi.e. services/supports/interventions
that should be in place to meet prevailing needs
Processesi.e. the working practices needed to implement and
track delivery
Domain 1Promotion,
Prevention and Early Intervention
Domain 3Social
Inclusion
Domain 2Service Access,
Co-ordination and Continuity of Care
Domain 4Accountability
and Continuous Improvement
Outcomes Domain 3
Outcomes Domain 2
Outcomes Domain 4
Outcomes Domain 1
Core Values and Service Delivery Principles
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Chapter 1 | Background and Context
conducted across government and with wider publicservices/agenciestoconnectrelatedpoliciesandinitiativestotheworkoftheOversightGroup.TheconsultationprocessandtheassociatedworkcompletedbytheOversightGroupandvariouscommitteestoincorporatethosefindingsintothispolicyhasresultedinrecommendationsthattrulyrepresentthemanyvoicesofthosewhoparticipated.Consequently, Sharing the Vision is a powerful representationoftheviewsofmany,whoemphasisedthattherevisedpolicybeunderpinnedbythecorevaluesofrespect,compassion,equityandhope.
Core Values Consistent with the original policy, core values are central to Sharing the Vision and underpin its service philosophy.Becausehumaninteractionisattheheartof the delivery of mental health supports and care, and isanexpressionofindividualandorganisationalvalues,thispolicyisunderpinnedbythefollowingcorevalues.
CORE VALUES
Respect
Respecting each person as an individual and treating everybody with dignity at every level of service provision
Compassion
Treating everybody in a friendly, generous and considerate manner and developing a rapport with each person – demonstrating understanding and sensitivity
Equity Access to services characterised by inclusiveness, fairness and non-discrimination
Hope
Interactions during the course of service delivery full of positivity, and empowerment, with a strengths-based focus
AVFC contained mixed principles underpinning servicedelivery,characteristicsof‘good’servicesandapproachestoservicedelivery–allofwhichhavebeenreviewedbasedontheconsultationtodevelopthese core values as well as the service delivery principles outlined in Appendix III.
The vision Several aspects of the original policy remain core to theeffectivedeliveryofmentalhealthservicesandsupportinIreland.Theholisticviewofmentalhealthis maintained in this policy while also recognising the complexinterplayofotherfactorsthatcontributetomentalhealthdifficulties.Theperson-centredapproachthatfocusesonenablingrecoverythroughan emphasis on personal decision-making supported byclinicalbestpracticeandthelivedmentalhealthexperiencewasamajorrecurringthemeinthestakeholderconsultationprocess.
The policy that follows has captured all of the feedbackreceivedtoshapetherevisedvisionformental health in Ireland:
The vision embodied in this policy is to create a mental health system that addresses the needs of the population through a focus on the requirements of the individual. This mental health system should deliver a range of integrated activities to promote positive mental health in the community; it should intervene early when problems develop; and it should enhance the inclusion and recovery of people who have complex mental health difficulties. Service providers should work in partnership with service users and their families to facilitate recovery and reintegration through the provision of accessible, comprehensive and community-based mental health services.
AVFCenvisagedthatasignificantproportionofmental health services and supports could and should beprovidedaspartofprimarycare,anapproachreiterated/supportedintheSláintecare report. Over thedecadeofthepolicy(2006–16),thisincreasedroleforprimarycarehasnotbeensufficientlyresourced,resultinginshortfallsincreatingthenecessaryintegrationbetweenprimarycareandspecialistmental health services. Sharing the Vision is therefore groundedintherealitiesofthechallengesandissuesthat presently exist. The revised policy acknowledges thatwhileconsiderablechange,ongoingreformandre-investment are needed, much of the AVFC policy remainsrelevanttoday.Somerecommendationsremainvalid(withminorrefinements);othershaveledtoadvanceswhichrequireupdates;andothersarenolongervalidor,havingbeendelivered,arenolongerneeded.Finally,therearemanyrecommendationsinthispolicythatareentirelynew,reflectingissuesthathave arisen during the course of the refresh work.
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Principles Mental health for individuals is neither separate nor isolated from the other dimensions of their overall personalwellbeing.Peoplewithmentalhealthneedsarenotinsulatedorshieldedfromvariouspolitical,
economic,materialandsocialconditionsaroundthem.Multiplefactorsacrossthesedimensions,aswellasanindividual’smorepersonalbiologicalandpsychologicalwellbeing,haveaninfluenceonmentalhealthasshowninFigure1.2(overleaf),the‘determinantsofhealth’.
* HSE.ANationalFrameworkforRecoveryinMentalHealth2018–2020(2017).Availableat:https://www.hse.ie/eng/services/list/4/mental-health-services/advancingrecoveryireland/national-framework-for-recovery-in-mental-health/recovery-framework.pdf
Recovery
Recoverymeanspeopleexperiencingandlivingwithmentalhealthissueswhilepursuingthepersonal goals they want to achieve in life, regardless of the presence or severity of those mental healthdifficulties.Thisunderstandingofrecoveryisbestachievedthroughtheprimacyofpersonaldecision-making,supportedbyinformedclinicalbestpracticeandlivedmentalhealthexperience.
InlinewiththeNationalRecoveryFramework*,recovery-orientedservicesempowerandfacilitatetheprocessofaperson’sself-determinedrecovery.Suchservicesofferhopeandchoice,workinpartnership with service users and FCS and are outward-looking. They engage with all the aspects andsupportsthatwillconstituteandsustainrecoveryinaperson’slife.
Trauma-informed
Trauma-informed service delivery means that everyone at all levels of the mental health services andwidermentalhealthprovisionhasabasicunderstandingoftraumaandhowitcanaffectfamilies,groups,organisations,communitiesandindividuals.Peopledeliveringservicesrecognisethesignsoftrauma,whichmaybegender-,age-,orsetting-specific.Servicesrespondbyapplyingtheprinciplesofatrauma-informedcare.Staffineverypartoftheorganisationchangetheirlanguage,behaviourandpoliciestotakeintoconsiderationtheexperiencesofthosewhohavetraumahistories,includingstaffmembersthemselves.
Atrauma-informedapproachresiststraumatisingorre-traumatisingserviceusersandstaff.Staffaretaughttorecognisehoworganisationalpracticesmaytriggerpainfulmemoriesforserviceuserswith trauma histories. Applying a trauma-informed approach does not mean that everyone with a mentalhealthdifficultyoreveryoneusingmentalhealthserviceshasexperiencedtrauma.Itsimplymeansthattheservicesystemneedstobeawareofandrespondtothepresenceoftraumainpeoplewhomaybeusingawidevarietyofsupports.
Human rights
Humanrightstreatiesrecognisetherightofeveryonetothehighestattainablestandardof physicalandmentalhealth.AtthecoreofIreland’shumanrightstreatycommitmentsisarange ofprinciplesthatunderpinthefulfilmentofallcivilandpolitical,socialandeconomicrightsfor all people.
Service users and their FCS as appropriate should lead in the planning and delivery of their care. Partnershipshouldexistintheplanning,development,delivery,evaluationandmonitoringofmentalhealthservicesandsupports,andincludeallstakeholders.Partnershipwillbuildtrust for all involved.
Valuing and learning
Everyoneaccessinganddeliveringmentalhealthservicesshouldbevaluedandrespectedashumanbeingsintheirownright,andfortheexperience,expertiseandskillstheybring.Staffandallthoseinvolvedalsoneedtobevaluedandrespected.Reflectivepracticeandopennesstolearningareessentialqualitiesforstaff,peopleusingmentalhealthservicesandfortheservicesystemitself.Allneedtobeopentocontinuouslearninganddevelopment.
Service Delivery Principles
Chapter 1 | Background and Context
Understandingthevariouscomponents,personalandsocietalthatinfluencementalhealthisimportantin order to deliver a comprehensive mental health policythatprovidesinterventionsandsupportsthataddressthewellbeingofthewholepopulation,preventingmentalhealthdifficultiesandenhancingthepossibilitiesfortherecoveryandinclusionofpeopleexperiencingmentalhealthdifficulties.Sharing the Visionisunderpinnedbyapopulation-basedplanningapproachwhichhelpstoguidethedistributionanddevelopment of mental health services and supports inIrelandinresponsetoneed(Figure1.3).Individualsmovethroughdifferentlevelsofsupportandservices, from informal care and support in their own community to primary care, to specialist mental health services,allbasedontheirmentalhealthneeds.
This policy recognises the need for a whole-of-population,whole-of-governmentapproachtothe
delivery of mental health services.6Inadoptingthisapproach,thepolicyisunderpinnedbyanecologicalmodel which uses a stepped care approach that ensures that the values from Sharing the Vision are preservedthroughout.A‘steppedcare’approachseeks to ensure that each person can access a rangeofoptionsofvaryingintensitytomatchtheirneeds.Inotherwords,therecanbea‘steppingup’ora‘steppingdown’inaccordancewiththestageofrecovery. A stepped approach to care should also help toincreaseefficiencyby‘shifting’constituenciesofneedtowardsmoreofthe‘upstream’services,thatis,promotion,prevention,earlyintervention,recoveryandparticipation.Overtime,thisshouldreducetheneedformoreexpensive‘downstream’acuteandcrisisresponse services. In this context, strategic investment in‘upstream’servicesshouldbeviewed as an investment rather than a cost.
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Figure 1.2: Determinants of health
Age, sex and
hereditaryfactors
Individual Lifestyle factors
Social and community networks
General socioeconomic, cultural and environmental conditions
Living andworking conditions
UnemploymentWorkenvironment
Water andsanitation
Education
Agricultureand foodproduction
Healthcareservices
Housing
Sharing the Vision | A Mental Health Policy for Everyone
19
It is understood that throughout life individuals mayexperienceharmfulphysical,emotionalor life-threatening life events that could undermine their mental health. The emerging evidence that trauma-informedsystemscanresultinbetteroutcomesforpeopleaffectedbytraumaisacknowledged. A‘trauma-informedapproach’highlightshoweveryonecanhaveapositiveroleinpreventingmentalhealthdifficultiesfromarisingbyinterveningearlytolimitfurtherescalationofdistress.
Inaddition,acommunity-basedapproachtocareis central. It is wider than providing mental health services and includes a core role for the Voluntary andCommunitySector(VCS)andforotherpublicagenciesandorganisationsnotspecificallyengagedin mental health. Integrated and coordinated care accordingtoaserviceuser’stotalindividualneedsshould include these wider community supports. Mentalhealthservicesshouldbeaccessibleforall, notjustgeographicallyaccessiblebutprovidedat atime,inasetting,inaculturallycompetentmanner,thatmakesaccessaseasyandstraightforward aspossible.
Implementation Theimplementationofgovernmentpolicyisachallenging process. The literature on what determines asuccessfultransitionfrompolicythinkingintorealityemphasisesthatimplementationiscomplex,contextualandasmuchabottom-upasatop-downimperative.ThisisparticularlythecasesincethestrategicambitionofSharing the Vision is characterised byitsbeing: • Long-term–aten-yearframeworkwithsome
returnsmeasurableonlyoverseveralyears• Whole-system –coversallaspectsofthemental
healthdomainandbeyond• Dispersed governance–multipleactorswith
distinctmandatesandaccountability• High requirement for collaboration –working
through partnership is a core value. A repeated theme in the extensive process of consultation,reviewandvalidationwhichunderpinnedthe review process was the need to do everything possibletoensureeffectiveimplementationofthenextphaseofthenationalplan.Inconsideringthe
6 Mentalhealthisnotamatterforthehealthsectoralone.Itsitsinamuchbroadercontextofhowsocietyviewsmentalhealthandhowdecisionscanbemaderightacrossthespectrumofrelevantpublicservicestoinvestinthewellbeingofthepopulationandsupport individualslivingwithamentalhealthdifficultyontheirrecoverypath.GoodmentalhealthforthepopulationofIrelandcannotbe achievedwithoutmeasuresbeingtakenbyothergovernmentdepartmentsaswellbyastheDepartmentofHealth.
Figure 1.3: Population-Based Planning
Population-based planning approach – For effective and efficient person-centered system
People-to-People Support
Through actions to foster positive mental health and resilience; actions that invest in prevention and early intervention;
and anti-stigma initiatives to build community support and empathy for people living with a mental health difficulty.
Including CMHTs as the first line of care, supporting recovery of individuals in their own community. Also a range of crisis response and more acute
services including where appropriate access to residential in-patient supports.
Including informal one-to-one support from family, carers and supporters (FCS) as well as access to
structural peer support groups.
Local, accessible, personalised supports – with clear referral pathways (from primary care) for those who need further support.
Through resources available to the entirepopulation including e-mental health tools.
Complex and enduring needs.
Mental Health, Wellbeing and Resilience
Self-Agency
Primary Care and VCS
Specialist MentalHealth Services
Increased frequency of need for the
services andsupports
Increasing cost of the
services andsupports
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Chapter 1 | Background and Context
implementationapproachagainstthisbackdropwehaveborneinmindanumberofcriticalsuccessfactorswhichexperiencehasshowntobedecisive.Thesekeyfactors include:
Leadership
Implementation structures
Planning
Resourcing
Communication
Data and research evaluation
In order to ensure delivery on the commitments made inthispolicy,anoverarchingNationalImplementationandMonitoringCommittee(NIMC)willdrivereconfiguration,monitorprogressoverallandensuredelivery.TheNIMCwillhaveparticularregardtotangibleoutcomesandtheirmeasurementsothatrealimpactforserviceusersandtheirfamiliescanbeassessed.Thisstructurewilltakeaccountofactionsandoutcomesrelatingto‘all-of-government’–notjustthosewithintheremitofthehealthservice.TheNIMCwillbeestablishedwithserviceuserandpeerrepresentationtorollouttherecommendationswithinthissuccessorpolicy.Itwillhaverepresentationfromthe statutory, voluntary and community sectors.
The NIMC will work together with the key stakeholders involved in delivering this policy and strategyactions–identifiedinFigure1.4/identifiedbythePolicyRoadmap-todeliversharedgoalsandcommonactions.Together,theywillalsoensure momentum is maintained in delivering the recommendationscontainedinthispolicy.WehavesetouttheproposedimplementationstructureinFigure1.4opposite. Theoutcomes-basedapproachthatunderpinsthispolicywillrequireafundamentalshiftinhowmentalhealth services are delivered. If a person-centred, whole-of-governmentapproachistobeachievedinpractice,therewillneedtobearealfocusonhowmental health services are planned and delivered. Sharing the Vision promotes outcomes that are dependentonpartnershipsbetweengovernmentdepartments, service providers, voluntary and communityorganisations,andserviceusers.Thesegroupswillworktogethertopromotebettermentalhealth,buildmentalresilienceandofferservicesspecifictotheirresourcesandcapabilitiestothosewithmentalhealthrequirements.
Furtherdetailsinregardtotheimplementation,planningandevaluationofSharing the Vision are set outinChapter6.
Sharing the Vision | A Mental Health Policy for Everyone
21
Figure 1.4: Implementation committee structure
National Implementation Monitoring committee
National Implementation
Team
Healthy Ireland SláinteCare
HSE and Lead Agencies
National Steering and Implementation
GroupsStakeholder Groups
Government Departments
Voluntary Community Sector
Service Users
Cabinet Committee of Social Policy and Public Services
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Chapter 2
Promotion, Prevention and Early Intervention Domain
Sharing the Vision | A Mental Health Policy for Everyone
Chapter 2 | Promotion, Prevention and Early Intervention Domain
Introduction
Mentalhealthdescribeshowwethinkandfeelaboutourselvesandourrelationshiptoothers,andhowweinterpreteventsineverydaylife.Italsorelatestoourabilitytocopewithchange,transitionandsignificantlifeevents,andtounderstandhowtodealwiththestressesthatoftencomeourway.
Everyonehasmentalhealthneeds,whetherornottheyhaveadiagnosisofmentalillhealth.Thepopulation-basedactionsoutlinedinAVFCfocusontheprotectivefactorsforenhancingwellbeingandqualityoflife,togetherwithpreventionandearlyintervention.Mentalhealthpromotionworksonthreelevels:tostrengthenindividualsandimprovetheiremotionalresilience;tostrengthencommunitiesandimprovesocialcapitalthroughincreasedparticipation;andtoreducestructuralbarrierstogoodmentalhealththroughinitiativesthatreducediscriminationandinequalities.Theimportanceofsupportingpositivementalhealthaspartofaspectrumofpopulation-basedresponsesrecognisesarangeofpolicydevelopmentssincethepublicationofAVFC.Figure2.1showstheoutcomesforthedomainpromotion,preventionandearlyintervention.
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Figure 2.1: Outcomes: Promotion, prevention, early intervention
Positivementalhealth,resilience andpsychologicalwellbeing amongstthepopulation
as a whole
Reducedprevalenceofmental healthdifficultiesand/orreducedseverity of impact(s) through early interventionandpreventionwork
Positivementalhealth,resilience andpsychologicalwellbeing amongst priority groups... throughtargetedpromotion andpreventivemechanisms
Reducedstigmaanddiscriminationarising through improved
community wide understanding ofmentalhealthdifficulties
Outcome 1(a) Outcome 1(b)
Outcome 1(d) Outcome 1(c)
Sharing the Vision | A Mental Health Policy for Everyone
Positive mental health and wellbeing Positivementalhealthbuildsresiliencesothatpeoplecan adapt to challenges and adversity, get the most outoflifeandmaintainapositivesenseofwellbeingandself-worth,combinedwithasenseofcontrolandself-efficacy.Theconceptalsomeansthat‘mentalhealth’isnotjustanabsenceof‘mentalillness’butisaseparablecharacteristicfocusedonpositivewellbeingandhavinggoodmentalwellbeingwhilelivingwithamentalhealthdifficulty.Itinvolvesmovingcontroltowardsthecommunitythrougheducatingthewiderpublicaboutmentalhealthandwellbeingandmentalhealthdifficulties,andprovidingstructuralsupportsthatencourageresilience.Promotingwellbeingforeveryoneinthecommunityalsoinvolvestargetingboththesocialfactorsoutsidethedirectcontrolofthehealthservicesthatfosterpositivementalhealth,andthe development of resilience.
Theneedfora‘wholeperson’approachtoachievingthehighestpossiblestandardsofphysicalandmentalhealthandwellbeingisacknowledged,andtheinterdependenciesbetweenphysicalandmentalhealtharerecognisedbytheWorldHealthOrganization(WHO).WHOresearchsuggeststhatkeyrisk factors for poor physical health and reduced life expectancy are more prevalent among people living withamentalhealthdifficultythanamongthegeneralpopulation.7Equally,therecanbehigherratesofmentalhealthdifficultiesamongpeoplewithlong-termphysicalhealthproblemsandaneedtosupportthewider psychological aspects of such physical health challenges.
This domain is consistent with the overarching nationalframeworkforhealthandwellbeing,Healthy Ireland, and recognises the need to explore improved integrationbetweenphysicalandmentalhealthasprioritisedintheSláintecare report.
7 WorldHealthOrganization.TheWorldHealthReport2001–MentalHealth:NewUnderstanding,NewHope(Geneva:WHO,2001). Availableat:https://www.who.int/whr/2001/en/whr01_en.pdf?ua=1
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Chapter 2 | Promotion, Prevention and Early Intervention Domain
Mental health lifecycle
You said...
Mentalhealthaffectseveryone in some way. The refreshed policy should seek to provide mental healtheducation,supports and services to all people when and where they need it.
We listened.
The Lifecycle Approach Mentalhealthdifficultiescanbeginearlyinlife,buttheseverityofimpactcanbereducedthroughactionsacrossarangeofsectorsthatpromotehealthyenvironmentsandfostermentalwellbeinginschools,communitiesandworkplaces.Positivementalhealthisnotamatterforthehealthsectoralone,andthereforethisdomainproposesthatrelevantpublicservicesinvestinthewellbeingofthepopulationtosupportindividualslivingwithamentalhealthdifficultyintheirrecovery. The lifecycle approach acknowledges that thefoundationsformentalwellbeingareestablishedbeforebirthandthatmuchcanbeachievedthroughinterventionsandsupportstobuildresilienceandimprovewellbeingthroughoutchildhood,theteenageyears and on into adulthood and later life. As a result, greateremphasisonpromotingmentalhealthandbuildingresilienceatallstagesinthelifecycleisrequiredandshouldincludetailoredapproachesforprioritygroupsdeemedtobeatrisk.
Centraltoallofthisisempowerment,atbothpersonaland community levels. At a personal level, individuals are empowered to take charge of their health andwellbeingandtoaccessinformationtomakeinformeddecisionswhenpossible.Atacommunitylevel,empowermentisabouthavingopportunitiestoparticipateinandinfluencedecisionsaboutaccesstolocal services and supports.
Thereisgeneralagreement–atbothnationalandinternationallevel–thatmentalhealthpromotioncanbeimprovedbybuildingoncurrentinfrastructureandembeddingprinciplesofmentalhealthpromotionintotheexistingfabricofcommunities.The Healthy IrelandFrameworkseekstostrengthencommunities’capacitytofostermentalhealthbyaddressingtheenvironmentalfactorsthatcontributetomentalhealthandwellbeingandthebuildingofresilienceinindividuals.TheFrameworkaimstobuildsustainable,nurturingcommunitiesbydrawingonresourcesfromallsectorsofsociety,includinghealth,education,employment and transport, to promote mental health. Healthy Ireland recognisesthatpositivelifestylechanges can prevent mental health issues arising andseekstobuildawarenessaboutthebenefitsofgoodnutritionanddietonbothmentalandphysicalhealthandwellbeing,forexample.Toenhancethiswork,aNationalMentalHealthPromotionPlanwillbeproducedbyHealthy Irelandthatwillbetheframeworkof reference and the overarching context for all mental healthpromotionandcampaignactivityinIreland.
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Sharing the Vision | A Mental Health Policy for Everyone
Mental Health across the Lifecycle
You said...
Mental health issues canbeginfrombirth.Awareness,educationand supports are essentialcomponentstobuildresilienceandcreate understanding.
We listened.
‘First 5’, A Whole-of-Government Strategy for Babies, Young Children and their Families 2019–2028 was launchedinNovember2018bytheDepartmentofChildrenandYouthAffairs(DCYA).8Objective6ofthestrategyisthat‘babies,youngchildrenandtheirparentsenjoypositivementalhealth’.Theaimofthisobjectiveistoimprovetheearlyidentificationofmentalhealthdifficultiesamongbabies,youngchildren and families, and to provide access to mental health supports and services that integrate into child-servingsettingsandthewidercommunity.TheDepartmentofHealthwillcontinuetoworkwiththeDCYAtoimplementtheactionsoutlinedintheFirst 5 policy.Inadditiontothiswork,specialconsiderationwillbegiventotheprovisionofadditionalsupportsforchildrenwhohavebeenexposedtoAdverseChildhoodExperiences(ACEs)suchasdomesticviolence,alcoholordrugabuse,mentalhealthdifficultiesandbereavement.Preventionandearlyinterventionarecriticaltothereductionoftrauma
associated with these early events, which can lead todifficultieslaterinadultlifeifnotaddressedatanearlyage.TherelevantrecommendationsoftheFirst 5strategyunderObjective6relatingtoprimaryprevention,earlyinterventionandpositivementalhealthshouldbeimplemented.
Schoolsandeducationalsettingsprovideapowerfulcontextforthepromotionofwellbeing.In2018,theDepartmentforEducationandSkills(DES)launcheditsWellbeing Policy Statement and Framework for Practice (2018–2023) which recognised that the mental health andwellbeingofyoungpeopleiscriticaltosuccessin school and life. Within its policy statement and framework,theDESproposesawhole-school,multi-component,preventiveapproachtowellbeingandmentalhealthpromotionineducationthatincludesinterventionsatbothuniversalandtargetedlevels.Itprovides an overarching structure that encompasses existinganddevelopingworkintheareaofwellbeingandmentalhealthpromotionineducation,includingtheJuniorCyclewellbeingprogramme.TheroleofNEPSpsychologistsintheareaofwellbeingpromotionandearlyinterventionwillalsobedeveloped.Assuch,itwillcontributestronglytothetargetedoutcomesin,andambitionof,thisDomainoftherefreshedAVFCpolicy.ToreinforcetheeffectivenessoftheDESframework,aneffectivestructureforcross-sectoralcollaborationintheareaofwellbeingandmentalhealthpromotionwillbeincorporatedintotheNationalMentalHealthPromotionPlan.
TheNationalYouthMentalHealthTaskForce(YMHTF)wasestablishedinresponsetoanundertakinginthe Programme for Partnership Government to provide nationalleadershipinthefieldofyouthmentalhealthandtoensurethatthepublic,private,andvoluntaryand community sectors work together to improve thementalhealthandwellbeingofyoungpeople.InDecember2017theTaskForceproducedasetoftenrecommendationareasthatweredistilledfrom12monthsofdiscussionandconsultation.Initsdomainofeducationandprevention,theYMHTFreportcontainsseveralkeyrecommendationsthatareconsistentwiththemes raised during the engagements and work done during the refresh process. While it is acknowledged
8 GovernmentofIreland.First5,AWhole-of-GovernmentStrategyforBabies,YoungChildrenandtheirFamilies2019–2028 (Dublin:GovernmentPublications,2018)Availableat:https://assets.gov.ie/31184/62acc54f4bdf4405b74e53a4afb8e71b.pdf
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Chapter 2 | Promotion, Prevention and Early Intervention Domain
thattherehasbeenprogressonmanyoftheactionsoutlined in the report, it is important to maintain momentumandimplementthereport’sremainingrecommendationswithinthethree-yeartimeframeidentified.
AdultsinIrelandtakeonvariousnewresponsibilitiessuchasraisingfamilies,settingupahome,caringforill parents, and maintaining employment. While many oftheselifetransitionsarepositivelifeexperiences,sometimesnegotiatingthemanydifferentrolesandresponsibilitiescanbechallengingandstressfulandacttothedetrimentofanindividual’spositivementalhealth.Manyadditionalchallengescanariseinthelifeofanadult.Unpredictableadditionalstressorssuchasunemploymentorfinancialinsecuritycancauseanxietyandnegativelyimpactonmentalhealth.Inaddition,theHealthy IrelandFrameworkestimatesthatmentalhealthdifficultiescosttheIrisheconomy€11billioneachyear,muchofitrelatedtolostproductivityinthelabourmarketfrombothabsenteeismandpresenteeism,thatis,functioningatlessthanoptimumcapacitywhileatwork.Improvedwellbeingreducesabsenteeismandincreasesperformanceandproductivity.Workplaceswhichallowforopendiscussionaboutmentalhealth,includingpeople’sown personal experiences, can promote overall organisationalandindividualwellbeing.Sharing the Visionsupportsindividualsbyraisingawarenessoflifeinfluencesthatcanleadtothedevelopmentofmentalhealthproblems,butthepolicyalsoseekstoimprove access to mental health supports in a variety ofsettings.
An important element of healthy ageing is the promotionofgoodmentalhealthandwellbeing.As
Ireland’spopulationover60issettodoublebefore2050itisimportanttopromotepositivementalhealthamongthispopulation,manyofwhomareatrisk of developing poor mental health. Older people areexposedtomultipleriskfactorsthatcontributetopoormentalhealthsuchasreducedmobility,chronicpain,frequentillness,loneliness,lossandbereavement.TheHealthy Ireland Framework makes a clear commitment to improving ‘partnerships, strategiesandinitiativesthataimtosupportolderpeople to maintain, improve or manage their physical andmentalwellbeingbyaddressingriskfactorsandpromotingprotectivefactorstosupportlifelonghealthandwellbeing’.Thiscommitmentwillsupportthegoalsof the National Positive Ageing Strategy byprovidingadditionalmentalhealthtrainingandsupportsforhealth professionals, home help teams and carers who provide services for older people. The Framework will also lead to increased mental health supports for those inlong-termpalliativecareandthedevelopmentofage-friendlyservicesandsettingsincommunityandprimarycaresettings.
It is important to acknowledge that throughout the lifecycle,anindividual’smentalhealthcanalsobeinfluencedbyotherstressors,suchasdisability.Peoplewithdisabilities,likeeveryoneelse,canexperiencementalhealthdifficulties,andtherecanbean increased prevalence among people with certain conditions.Itisimportanttoincludepeoplewithdisabilitiesinmainstreampublicservicesandprovidesupportstomaintainpositivementalhealththataredisability-competentandaccessible.
Intermsofhealthcarethatshouldbeavailableforthewholepopulation,Sláintecare is the ten-year programme that seeks to transform our health and socialcareservices.Itistheroadmapforbuildinga world-class health and social care service for the Irish people. The Sláintecare vision is to achieve a universalsingle-tierhealthandsocialcaresystemwhereeveryonehasequalaccesstoservicesbasedonneed,andnotabilitytopay.Itishopedthatovertime,everyonewillbeentitledtoacomprehensiverangeof primary, acute and social care services. This policy supportsthemaingoalsandobjectivesofSláintecare andseekstocreateeasieraccesstomulti-disciplinary,service user-centred supports at primary care level thatwillresultinbetteroutcomes.TheSláintecare ImplementationStrategywaspublishedinJuly2018andimplementationwillactasanenablertosupportactionscontainedinthispolicy.
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Sharing the Vision | A Mental Health Policy for Everyone
Mental health, priority groups and stigma Thepopulationhealthapproachthatthispolicyadvocatescontainsuniversalrecommendationsthatbenefiteveryoneinsociety,butalsoacknowledgesthatadditionalworkisrequiredtopromotepositivementalhealthandbuildresilienceamongspecificprioritygroupsdeemedtobe‘atrisk’.Theidentificationofprioritygroupsdisplayingevidenceofvulnerabilitytoandincreasedriskofsuicidalbehaviourin Connecting for Life (2015–2020) is a useful reference point.PrioritygroupsincludemembersoftheLGBTQ+community;membersoftheTravellercommunity;peoplewhoarehomeless;drugusers;peoplewhocomeincontactwiththecriminaljusticesystem;peoplewhohaveexperienceddomestic,clerical,institutional,sexualorphysicalabuse;asylumseekers;refugees;migrantsandsexworkers.Thisisnotanexhaustivelistandadditionalgroupssuchaschildrenincare,careleavers,peoplewithdisabilities,peoplewho have severe-to-profound deafness and people withsubstance(drugandalcohol)misuseproblemsshouldalsobereviewed.Tailoredinterventionstofulfilunmetneedsandtobuildstrengthsamongthesegroups,includingtargetedcampaignsandpreventiveoutreachwork,shouldbedoneinpartnershipwithorganisationsworkingwiththeprioritygroupstoachieveincreasedeffectivenessandimpact.
Arecurringthemearisingoutoftheconsultationprocesswasthatmentalhealthstigma,self-stigmatisation,prejudiceanddiscriminationaresome of the main reasons why people experiencing mentalhealthdifficultiesdonotseekhelp.Reducingthestigmaanddiscriminationassociatedwithmentalhealthdifficultiesiscentraltoimprovedwellbeingatasocietallevel.TheNationalStigma-ReductionProgramme(NSRP)willexpandtopromoteawarenessofthenatureandextentofprejudiceanddiscriminationinrespectofallmentalhealthconditionsandfocusonstigma-reductioninitiativesforthegeneralpopulation,workplaces,healthandsocialcaresettings,andothergroups.TheNSRProgrammeisthereforenotasingleintervention,butaportfolioofcoherentandparallelstigma-reductioninitiativesdevelopedcollaborativelyandwithsharedresponsibilityacrossgovernmentandhealthservices.
Inaddition,theConnecting for Life strategy (2015–2020),whichaimstoreducethelossoflifebysuicide and limit cases of self-harm, also maintains a healthpromotionagenda.Thisinvolvespreventiveandawareness-raisingworkthroughouttheentirepopulation,supportiveworkwithlocalcommunitiesand targeted approaches to priority groups. Local actionplansplayanimportantroleinenhancingcommunity capacity to reduce suicide and more widelyinbuildingthecapacityofcommunitiestosupportwellbeingandmentalhealth.Aninterimreview of Connecting for LifeconductedinFebruary2019requestedthatthelifetimeofthestrategybeextendedto2024.Thisongoingfocuswillaugmenttheprominenceofnationalmentalhealthpromotionmessagesaboutstigmaandsuicideprevention.
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Chapter 2 | Promotion, Prevention and Early Intervention Domain
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Additional health promotion supports Health Promotion Programmes Historically,theparticipationofpeoplewithmentalhealthdifficultiesinhealthpromotionprogrammeshasbeenlowerthanthatofthegeneralpopulation.Allhealthpromotionprogrammesmustbeexpandedtotargetpeoplewithexistingmentalhealthdifficultiesandpromotetheirwellbeingandrecovery.Staffinmentalhealthandotherserviceshaveacriticalroletoplayinmentalhealthpromotion.TherearenowanumberofnationalhealthpromotionandimprovementofficersoperatingacrossHSEareasandtheHSEmustensureaconsistentfocusonmentalhealthpromotionaswellasphysicalhealthpromotionbytheseofficerstoachieveparityofeffortinthepromotionofmentaland physical health.
Voluntary and Community Sector The Voluntary and Community Sector (VCS) engages inmentalhealthpromotionworkandcanplayanimportant role in providing mental health support servicesforthecommunitieswithwhichitworksby
tailoringnationalmentalhealthpromotionprogrammesto the needs, preferences and circumstances of those communities.Itisthereforeimportantthatlocalcommunityprojectsconnectwithanationalmentalhealthpromotionagendatoensurethattheirjointeffortsareeffectiveandappropriatelyresourced.
Digital Mental Health Engagement with digital mental health technology is increasing in popularity and although it is acknowledgedthatthisisalargelyunregulatedfield,well-designedproductscanhavebeneficialimpacts.Thegrowthine-healthinitiativessuggeststhatopportunitiesformentalhealthpromotion,preventionandearlyinterventionusingdigitalchannelsandsocialmedianeedtobeconsideredandresearched.It is proposed that digital developments will form partoftheNationalMentalHealthPromotionPlanunderpinnedbyevaluationandqualityassuranceinrelationtocontentanddesign.
Sharing the Vision | A Mental Health Policy for Everyone
Domain: Education, prevention, early intervention recommendations
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1
Healthy Irelandalreadyhasaremitforimprovedmentalhealthandwellbeing.Tofurtherstrengthenthis,adedicatedNationalMentalHealthPromotionPlanshouldbedevelopedandoverseenwithinHealthy Irelandimplementationframeworks,withappropriateresourcing.TheplanshouldbebasedontheprinciplesandscopedescribedinChapter2ofSharing the Vision.
2 Evidence-baseddigitalandsocialmediachannelsshouldbeusedtothemaximumtopromotementalhealthandtoprovideappropriatesignpostingtoservicesandsupports.
3
TheDepartmentofHealthWomen’sHealthTaskforceandtheNationalImplementationMonitoringCommitteewillundertakeajointprojectwithin12monthstooutlineaneffectiveapproachtothementalhealthofwomenandgirls.Theprojectshouldensurethatmentalhealthprioritiesandservicesaregender-sensitiveandthatwomen’smentalhealthisspecificallyandsufficientlyaddressedintheimplementationofpolicy.
4 Theworkprogrammeforhealthpromotionandimprovementofficersshouldbereviewedtoensureparityofeffortandemphasisonmentalhealthpromotionandphysicalhealthpromotion.
5Newandexistingcommunitydevelopmentprogrammeswhichpromotesocialinclusion,engagementandcommunityconnectednessshouldbeappropriatelyresourcedanddevelopedinlinewiththeproposedNationalMentalHealthPromotionPlan.
6TheproposedNationalMentalHealthPromotionPlanandtheexistingworkofConnecting for Life shouldincorporatetargetedmentalhealthpromotionandpreventionactionsthatrecognisethe distinctneedsofprioritygroups.
7
ANationalStigma-ReductionProgrammeshouldbeimplementedtobuilda‘wholecommunity’approachtoreducingstigmaanddiscriminationforthosewithmentalhealthdifficulties.Thisshouldbuildonworktodateanddetermineaclearstrategicplan,withassociatedoutcomesandtargetsacrossrelated strands of work.
8
Learningfrominnovationsinimprovingoutcomesforchildrenandyoungpeopleshouldbeidentifiedandshouldinformrelevantmainstreamserviceprovision.ThisincludeslearningfrompreventionandearlyinterventionprogrammessuchasTusla’sAreaBasedChildhood(ABC)andPrevention,PartnershipandFamilySupport(PPFS)Programmesaswellascross-borderprogrammesaddressingtheimpactofAdverse Childhood Experiences (ACEs).
9
AllschoolsandcentresforeducationwillhaveinitiatedadynamicWellbeingPromotionProcessby2023,encompassingawhole-school/centreapproach.SchoolsandcentresforeducationwillbesupportedinthisprocessthroughtheuseoftheWellbeingFrameworkforpracticeandWellbeingResourceswhichhavebeendevelopedbytheDepartmentofEducationandSkills.
10
AprotocolshouldbedevelopedbetweentheDepartmentofEducationandSkillsandtheHSEontheliaisonprocessthatshouldbeinplacebetweenprimary/post-primaryschools,mentalhealthservicesand supports such as NEPS, GPs, primary care services and specialist mental health services. This is neededtofacilitatereferralpathwaystolocalservicesandsignpostingtosuchservices,asnecessary.
11
TheNationalMentalHealthPromotionPlanintegratedwiththeHealthyWorkplaceFrameworkshouldincorporateactionstoenhancethementalhealthoutcomesoftheworking-agepopulationthroughinterventionsaimedatmentalhealthpromotionintheworkplace.Thisshouldconsiderenvironmentalaspectsoftheworkingenvironmentconducivetosupportingpositivementalhealthandwellbeing.
12ArangeofactionsdesignedtoachievethegoalsoftheNationalPositiveAgeingStrategyforthementalhealthofolderpeopleshouldbedevelopedandimplemented,supportedbytheinclusionofmentalhealthindicatorsintheHealthyandPositiveAgeingInitiative’sresearchprogramme.
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Chapter 3
Service Access, Coordination and Continuity of
Care Domain
Sharing the Vision | A Mental Health Policy for Everyone
Chapter 3 | Service Access, Coordination and Continuity of Care Domain
3434
Figure 3.1: Outcomes: service access, coordination and continuity of care
All service users haveaccesstotimely,
evidence informedinterventions
Health outcomes for people with dualdiagnosisareimprovedby ensuringgreatercollaboration betweenmentalhealthand
other relevant services
Service delivery is organised toenableincreasednumbers
of people to achieve personal recovery
Services are coordinated through a’steppedcare’approachto
providecontinuityofcarethatwilldeliverthebestpossibleoutcomes
for each service user
Outcome 2(a) Outcome 2(b)
Outcome 2(d) Outcome 2(c)
Introduction
Theoverridingintentioninthisdomainistoensurethatserviceusersandtheirfamilies,carersandsupporters(FCS)havetimelyaccesstoevidence-informedsupports,asaresultofanoutcomes-basedfocusthatputspeoplebeforeprocesses.Inlinewiththecorevaluesandprinciplesofthispolicy,mentalhealthserviceswillbeevidence-informedandrecovery-oriented and will adopt trauma-informed approaches to care, basedonlivedexperienceandindividualneed.Mentalhealthserviceswillbeclinicallyeffective,deliveredinadherencetostatutoryrequirementsandbasedonanintegratedmulti-disciplinaryapproach.ThiseffectivepartnershipandinterworkingbetweendifferentservicesandprofessionalsalongthecarepathwaywillequipserviceusersandtheirFCStobebetterinformedabouttherangeofresourcesavailable,andremovebarriers,inorder to assist people to achieve personal recovery. The renewed focus on partnership in care will strive to ensure service users and FCS are central in the design, development and delivery of services and take a lead role in recoveryplanning.Figure3.1summarisesthefourhigh-leveloutcomesforDomain2.TheoutcomessuggestwhataserviceuserorFCSmightexpectfromthementalhealthservicesinthefuture.Therecommendationssetoutforthisdomainaredesignedtocontributetotheachievementofoneor more of these outcomes.
You said...
Servicesneedtobeservice user oriented and recovery plans must include service users,familymembers,carersandsignificantothers.
We listened.
Sharing the Vision | A Mental Health Policy for Everyone
3535
Figure 3.2: Stepped care approach
Thisdomainsetsoutproposalsforthecontinuousrange of integrated service elements needed in a modern recovery-oriented mental health system. All serviceswillbecoordinatedthrougha‘steppedcare’
approachtoprovidecontinuityofcare(seeFigure3.2)inordertodeliverthebestpossibleoutcomesforeachservice user.
Tier 2
GP, Primary care team, community pharmacies, CIPC, social prescribing, etc.
Primary Care
Tier 1
Social support, peer support, support from families, friends and carer (FCSs), support for FCSs, support from Community and
Voluntary groups, housing support, employment.
Interventions where focus is not specialist mental health care
Tier 3
Full range of Community Mental Health Teams
Specialist Mental Health Services
Tier 4
Specialist Inpatient or Residential Unit
Specialist inpatient or Residential services
Chapter 3 | Service Access, Coordination and Continuity of Care Domain
Pathways to support This policy recognises that no single service can cater for the diverse needs of a person with mentalhealthdifficulties.Toimproveapopulation’shealthand social care outcomes, a multi-sectoral,multi-stakeholderapproachisrequired.The‘steppedcareapproach’enablesan individual to avail of a range of supports and services as closetohomeaspossibleatthe level of complexity that correspondsbesttotheirneeds and circumstances. This approach focuses on working toshapeacontinuumofmentalhealth services in which local VCS groups have a recognised role, where primary care supports are closely linked to specialist mental health services and where mental health services across the lifespan are integrated and coordinated. Figure3.3setsoutthisenvisagedcontinuumofmentalhealth services and pathways.
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Figure 3.3: Envisaged continuum of mental health services and pathways
Access to a range of Talking Therapies in
Primary Care Settings
Social Prescribing
Digital-HealthInterventions
Community-basedSupports provided
by CMHT
Access to Talking Therapies and related
supports in the Voluntary or Community Sector
Peer Networks and
Recovery Education
One-to-One Sessional
Other state agencies
as required
One-to-One Sessional
Community-basedSupports providedby CMHT
Digital-HealthInterventions
Access to Talking Therapies andrelated supports in the Voluntary or Community Sector
Access to a range of Talking Therapies in Primary Care Settings
Peer Networks andRecovery Education
In-patient supports
Day Hospitals
Home-Based Supports
Specialised Rehabilitation
Units
GP PrimaryCare Team
Community Rehabilitation
Units
Acute Units
Planned Short-BreakCare Facility
Crisis House
Crisis Resolution
Assertive OutreachTeams
High IntensityMedium IntensityLow Intensity
ACCESS ACCESS
Self-referral Community MentalHealth Teams
Out-of-hours crisis cafes
Emergency department
GPs / Primary Care Centres
Combined VCS, Primary Care and Specialist Mental Health Services
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Access to a range of Talking Therapies in
Primary Care Settings
Social Prescribing
Digital-HealthInterventions
Community-basedSupports provided
by CMHT
Access to Talking Therapies and related
supports in the Voluntary or Community Sector
Peer Networks and
Recovery Education
One-to-One Sessional
Other state agencies
as required
One-to-One Sessional
Community-basedSupports providedby CMHT
Digital-HealthInterventions
Access to Talking Therapies andrelated supports in the Voluntary or Community Sector
Access to a range of Talking Therapies in Primary Care Settings
Peer Networks andRecovery Education
In-patient supports
Day Hospitals
Home-Based Supports
Specialised Rehabilitation
Units
GP PrimaryCare Team
Community Rehabilitation
Units
Acute Units
Planned Short-BreakCare Facility
Crisis House
Crisis Resolution
Assertive OutreachTeams
High IntensityMedium IntensityLow Intensity
ACCESS ACCESS
Self-referral Community MentalHealth Teams
Out-of-hours crisis cafes
Emergency department
GPs / Primary Care Centres
Combined VCS, Primary Care and Specialist Mental Health Services
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Thecontinuumbuildsontheprogress with service reform in recent years. The service elements will integrate with one anotherandwiththedifferentcontexts in which a service user may live to ensure that needs are met in keeping with their stage of recovery and individual wishes and preferences. In interpretingthecontinuumofcare, it is important to recognise that an individual may need services and supports from one or more of the service elementsatthesametime,depending on their prevailing needs and preferences. The continuumaimstoreducetheconfusionbetweenprimarycareandcommunity-basedcarebyprovidingclarityintermsoflocation,settingsandlevelsofspecialism.
Inordertodescribethedifferentserviceelementsinsome detail and to propose recommendations,thecontinuumwillbeseparatedinto supports accessed through primary care, VCS and self-referral, as shown in Figure 3.4,andreferralpathwaysandspecialist mental health services, asshowninFigure3.5.
Talking therapies are psychological treatments. They involve talking to a trained therapist to support peopletodealwithnegativethoughts and feelings. They helptomakepositivechangesinanindividual’slife.Talkingtherapies can take place in: groups, one-to-one, using a computer or over the phone.
Peer-support A system of giving and receiving help founded on key principles of respect, sharedresponsibilityandmutualagreement of what is helpful. Peer-supportisnotbasedonpsychiatricmodelsanddiagnosticcriteria.Itisaboutunderstandinganother’ssituationempathicallythrough the shared experience of emotionalandpsychologicalpain.
Other state agencies as required
Social-prescribing
One-to-One Sessional
Community-basedsupports providedby CMHT
Digital-HealthInterventions
Access to Talking Therapies andrelated supports in the Voluntary or Community Sector
Access to a range of Talking Therapies in Primary Care Settings
Peer Networks andRecovery Education
One-to-One Sessional
Community-basedSupports providedby CMHT
Digital-HealthInterventions
Access to Talking Therapies andrelated supports in the Voluntary or Community Sector
Access to a range of Talking Therapies in Primary Care Settings
Peer Networks andRecovery Education
Medium IntensityLow Intensity
ACCESS ACCESSGPs Primary Care Teams
Self-Referral
Figure 3.4: Supports accessed through primary care, the voluntary and community sector or self-referral
Supports accessed through Primary Care, Voluntary & Community Sector or Self-Referral
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Some digital health programmes focus onpromotinghealthandwellbeingandpreventingillhealth,whileothersmaydeliverearlyinterventionandmentalhealth treatment. There are numerous digitalhealthprogramsavailable,coveringa range of mental and physical health concerns, and thus increasing individual healthcare management choices.
Social-prescribing,orcommunityreferral,enablesGPs,nurses and other primary care professionals to refer people toarangeoflocal,non-clinicalservices.Anindividual’shealthisdeterminedprimarilybyarangeofsocial,economicandenvironmentalfactors,andsocial-prescribingaimstosupportpeopletotakegreatercontroloftheirownhealth.Referralscanbemadetoavarietyofactivitieswhicharetypicallyprovidedbyvoluntaryandcommunitysectororganisationssuchasartsactivities,grouplearning,gardening,befriending,cookery,healthyeatingadviceandarangeofsports.
Other state agencies as required
Social-prescribing
One-to-One Sessional
Community-basedsupports providedby CMHT
Digital-HealthInterventions
Access to Talking Therapies andrelated supports in the Voluntary or Community Sector
Access to a range of Talking Therapies in Primary Care Settings
Peer Networks andRecovery Education
One-to-One Sessional
Community-basedSupports providedby CMHT
Digital-HealthInterventions
Access to Talking Therapies andrelated supports in the Voluntary or Community Sector
Access to a range of Talking Therapies in Primary Care Settings
Peer Networks andRecovery Education
Medium IntensityLow Intensity
ACCESS ACCESSGPs Primary Care Teams
Self-Referral
Supports accessed through Primary Care, Voluntary & Community Sector or Self-Referral
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Primary Care
You said...
There is a real need for additionalsupportsinprimary care that are accessibletopeoplewhen and where they need help.
We listened.
Generalpractitionersplayapivotalroleasthefirstandcontinuingpointofcontacttopatientsbutitisacknowledgedthatthereisarequirementtoscaleup access to supports for common mental health difficultiesinprimarycaresettings.Over90%ofmentalhealthneedscanbesuccessfullytreatedinaprimarycaresetting,whiletheremaining10%referredto secondary care services are greater and more clinically complex.9 In line with Sláintecare, this policy envisages an increasing role for the primary care sector which, if appropriately resourced and with appropriate governance, can provide a comprehensive range of interventions.
AVFC recommended increased access to primary care supports for people with mental health needs who do notrequirespecialistmentalhealthservices.WhileinitiativessuchasCounsellinginPrimaryCare(CIPC)havebeenintroduced,thereisstillinsufficientaccessto these types of supports in primary care. This, in turn,hascontributedtoanover-relianceonspecialistsecondarycaresystems,resultinginwaitinglistsforsuch care in various mental health services.
Consequently,thispolicycontainsseveralrecommendationsadvocatingadditionaluniversalsupportsdeliveredbyappropriatelyqualifiedtherapiststo provide care to individuals with mental health needs,includingthosepresentingwithco-existinghealthrequirementssuchasaddiction.Thescalingup of access to supports in primary care should help to reduce the over-reliance on specialist mental healthcare. For example, developing further capacity forAttentionDeficitHyperactivityDisorder(ADHD)andautism-specificserviceswillplayaroleinreducingthenumberofreferralsintoChildandAdolescentMental Health Services (CAMHS). Furthermore, the recommendationsalsoconsiderhowbesttoutilisedigitalhealthinterventionstofacilitateincreasedavailabilityandspreadofsupports.
Morebroadly,therevisedpolicyseekstoimprovecollaborationbetweenprimarycare,secondarymentalhealth services and specialised services to facilitate integrationofcareforserviceusers–akeythemein the original AVFC.Theco-locationofCMHTsandprimarycareteamsinsomeareas,withthecreationof a Team Coordinator role in some CMHTs, has contributedtoreducingreferralsofmildermentalhealthdifficultiestosecondaryservices.Thisliaisonmodelremainsrelevantandwillbesupportedbyadditionalrecommendationsrelatingtoa‘sharedcare’approach to mental health in primary care.
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Integrated services
You said...
People using specialist mental health services should have access to all primary care services.
We listened.
As set out in AVFC, it should remain the case that all users of specialist mental health services, including thoseinlong-stayfacilities,mustberegisteredwiththeirGP.However,registrationinitselfisinsufficientand the physical healthcare of people with a mental healthdifficultyshouldbeledbytheirGP.Thisisconsistent with the priority in the Sláintecare report attributedto‘creatinganintegratedsystemofcare,withhealthcareprofessionalsworkingcloselytogether’,bringingtogetherphysicalandmentalhealthservicesto improve the physical health of people with mental healthdifficultiesandviceversasimultaneously.
VCSorganisationsshouldbekeypartnersinthedesignanddevelopmentoftheHSE’smentalhealthservicesatnationalandlocallevel,aswellasreferralpartnersfor primary mental healthcare. Their services extend to therapeuticandotherrecoverysupportsforindividualsand FCS and can, therefore, help to reduce the use of inappropriate referrals to specialist mental health services.Inaddition,recognisingthatpeople’shealthisdeterminedprimarilybyarangeofsocial,economicandenvironmentalfactors,theVCScanbeanactivepartnerinthedevelopmentofsocialprescribing–
sometimescalledcommunityreferral–whichisawayfor GPs, nurses and other primary care professionals to refer people to a range of local, non-clinical services. Sociallyprescribedactivitiescanincludevolunteering,engaging in the arts, group learning, gardening, befriending,cookery,healthyeatingadviceandarangeof sports.
ManyofthesupportsprovidedbytheVCSsectorarefundedand/orprovidedthroughaserviceagreementwiththepublicmentalhealthsystem.Togetthebestvalue from the VCS sector and to draw upon the sector’sstrongpositionwithincommunities,itisvitalthatpublicprimarycareandmentalhealthserviceswork in partnership with VCS groups, involving them in the design and delivery of integrated area support services. This partnership approach will allow those working in primary care and CMHTs to connect serviceuserswithVCSorganisationsandfacilitate theintegrationofpatientsintotheirlocalcommunity.
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ACCESS ACCESSOut-of-hours crisis cafes
Emergency department
GPs / Primary Care Centres
High IntensityMedium IntensityLow Intensity
Peer Networks and
Recovery Colleges
Home-Based Supports
Access to a range of Talking Therapies in
Community/Voluntary Sectors
Inpatient Supports
Community-basedsupports provided
by CMHTDay Hospitals
Community Mental Health
Teams
Specialised Rehabilitation
Units
Community Rehabilitation
Units
Acute Units
Planned Short-BreakCare Facility
Crisis House
Crisis Resolution
Assertive OutreachTeams
Digital-HealthInterventions
One-to-One Sessional
Figure 3.5: Secondary care and specialist mental health services
Recovery Collegesoftenfocusonequippingstudentswithnew skills that can foster their recovery, as well as enhancing theiroverallcapacitiesandcapabilities.Commonofferingsinclude classes focused on self-care, life-skills, physical health, employmentandinformationtechnology.
Crisis Resolution (CR)offersafterhoursandurgentpsychiatricassistance.CRis an integral part of each Community Mental Health Teamproviding24houradviceand assessment for people presentingincrisiswhichis associated with a known or suspected mental health problem.
Assertive outreach teams provide intensive support for people with complex needs. The team aim to support individuals to get help from other services. This support can help people manage their conditionbetterandreduce thechancesofgoingback to hospital.
Talking therapy is a general termtodescribeanypsychological therapy that involves talking. You may also hear the terms counselling or psychotherapy.
Referral Pathways and Specialist Mental Health Services
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ACCESS ACCESSOut-of-hours crisis cafes
Emergency department
GPs / Primary Care Centres
High IntensityMedium IntensityLow Intensity
Peer Networks and
Recovery Colleges
Home-Based Supports
Access to a range of Talking Therapies in
Community/Voluntary Sectors
Inpatient Supports
Community-basedsupports provided
by CMHTDay Hospitals
Community Mental Health
Teams
Specialised Rehabilitation
Units
Community Rehabilitation
Units
Acute Units
Planned Short-BreakCare Facility
Crisis House
Crisis Resolution
Assertive OutreachTeams
Digital-HealthInterventions
One-to-One Sessional
Referral Pathways and Specialist Mental Health Services
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Community Mental Health Teams
You said...
Service users need to access coordinated care, maintain a person-centred care plan and have access to a keyworker who understands the system and assists individuals, family and carers to avail of all supportsoffered.
We listened.
The cornerstone of service delivery in secondary care willcontinuetobethemulti-disciplinaryCommunityMentalHealthTeams(CMHTs).Themulti-disciplinarynatureoftheCMHTsenablesavarietyofprofessionalperspectivestobecombinedincaseformulation,careplanningandservicedelivery.Multi-disciplinaryteamwork provides integrated care to service users, withtheemphasisonsupportingindividualstorecoverin their own community.
TheprescribedcompositionofCMHTsintheoriginalAVFC may have restricted the development of appropriate responses in some teams and for some patientgroups.TheCMHTshouldcontinuetoinclude,butnotnecessarilybelimitedto,thecoreskillsofpsychiatry, nursing, social work, clinical psychology andoccupationaltherapy.Givendevelopmentsover the last decade and the emphasis on achieving recovery-orientedoutcomes,thereshouldbe
additionalcompetenciesinteamssuchasdieticians,peersupportworkers,outreachworkers,jobcoachesandothers.Ratherthanspecifyabsolutenumbersofspecificprofessionalsthatshouldbeonthedifferentteams, the approach in this policy is to emphasise the importanceofdeterminingthespecificskillsthatarerequiredbyateam.Thus,thecompositionandskillmixofeachCMHTshouldtakeintoconsiderationthe needs and social circumstances of its sector population,withflexibilityastohowtheseneedsaretobemet.Aswellasthecoreskillsthiscouldinclude,forexample,bringinginsessionalworkerswithspecifictherapeuticskillsandotherprofessionalsasrequired.The proposed model of mental health supports re-conceptualisestheroleoftheoutpatientclinictoabroaderconceptofcommunity-basedsessionalsupportprovidedbymentalhealthprofessionalsand peer workers. The physical environment where theseservicesaredeliveredandthelocationsoftheCMHTsshouldbeaccessible,modern,fitforpurposeand conducive to recovery. Such centres should also facilitate VCS provision to integrate CMHT and VCS supports,whereappropriate.ThelocationofCMHTsin physical environments of this kind will reinforce the access that individuals have to short-term assistance in their own community, drawing on a wide range of therapies and supports in the wider mental health systemincludingaccesstoe-healthalternatives.Allfuturenewprimarycarebuildingplanningdevelopments should therefore include appropriate settingsfordeliveryofamentalhealthservice.
CMHTswilllinkinwithlocalVCSsupportstobuildasustaining network around the service user and their FCS. Together, CMHTs and the VCS should work toprioritisecareplanningwithserviceusersaskeydecision-makers in their own care or recovery plan. Suchplansareimportantbecausetheyreflecttheserviceuser’sparticularneeds,preferences,goalsandpotential,includingcommunityfactorsthatmayimpede or support recovery. In many cases there may bemorethanoneteammemberinvolvedinthecareofanindividual;therefore,thispolicyre-emphasisestheneedforakeyworker,thatis,amemberoftheexistingteamthroughwhomservicescouldbepersonalisedandcoordinated.Teammembersmustbetrainedadequatelyinactivelisteningandbesupportedbytheirmanagerstotalktopatientsabouttheirrecovery.
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Clinical leadership The engagement for this policy indicates that models ofleadershipfortheCMHTsshouldbereviewedinlinewithinternationalpractice.Clinicalleadership,asdescribedinAVFC2006–16,wasvestedintheconsultant psychiatrist role, in keeping with the requirementsoflegislation.Considerationshouldbegiventoamendinglegislationtofacilitatethedeliveryof a shared governance model.
Inthemeantime,asdescribedinAVFC, Team CoordinatorsshouldbeinplaceinallCMHTstofacilitate enhanced intra-team management of referrals and clinical inputs as well as to create appropriate coordinated linkages into the community. Such a shared governance model necessitates a focus on teameffectiveness,requiringeachteammembertoworktothemaximumoftheirscopeofpractice,aswell as to develop shared team competencies. In this way,eachmemberoftheteamtakesresponsibilityfortheeffectivenessoftheteamsothatthereisappropriate service delivery and the outcomes set out in this policy are achieved.
TherangeofsupportsavailablethroughCommunityMentalHealthTeamsaresetoutinFigure3.4.Access to CMHTs is generally through GP referral or itcanoccurfollowingattendanceatanemergencydepartment (ED). Investment in acute medical emergencyservicesundertheHSE’sAcuteMedicineClinicalProgrammeneedstobeprioritisedtoincludethe streamlining of the triage process so that access to thecorrectmentalhealthassessmentcanbeprovidedasearlyaspossible.
Alternative Access Routes to Emergency Care
You said...
EDsarenotsuitableenvironments for children to wait for assessment and alternativesshouldbeexplored.
We listened.
Quiteoften,peopleinneedofsupportorurgentcareattendemergencydepartments(EDs)toaccessmentalhealth treatment. While individuals are in many cases appropriatelyseeninanED,itcanbeachallengingenvironment for some people with mental health difficulties.Specifically,thestakeholderconsultationsforthisreportprioritisedtheavailabilityofnon-ED-basedout-of-hoursalternativesofferingreferraltomental health services.
Out-of-hours crisis cafés are proposed as a new referraloption,tosupportindividualstodealwithan immediate crisis and to plan safely, drawing on their strengths, resilience and coping mechanisms to managetheirmentalhealthandwellbeing.Attendeeswouldbeabletoaccesstalktherapies,copingstrategiesandone-to-onepeersupport,providedbypaidcorestaffassistedbyateamofappropriatelytrainedvolunteers,workingonarotabasis.ThecafésmayreducedemandsonEDsbyprovidingan environment more suited to the needs of some individuals who present. Moreover, appropriately and safelystaffedcrisiscaféscanalsobeanalternativeaccesspointforchildrenandadolescents.Inaddition,
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tele-psychiatrymodelscouldbeawaytoprovide24-hourpsychiatryconsultationstoserviceusersofall ages, who can access supports from a variety of locationssuchasprimarycarecentres,GPpracticesand VCS services.
InproposingthecontinuumofservicessetoutatFigure3.3asthevisionforamodernrecovery-oriented mental health system, it is recognised that thebalanceofemphasisacrosseachserviceelementmay vary in HSE areas across the country, in line with prevailing needs and geographies. Every service elementmustbepresentineachRegionalIntegratedCareOrganisation(RICO)areabuteachareawouldneedtoconsiderthebestbalanceandmodelsofdelivery and service elements to meet their area needs,takingintoaccounttheirstaffinglevels.Theseproposals include the proviso that all service elements inFigure3.3shouldincludeaccesstotalktherapiesasafirst-linetreatmentoptionformostpeoplewhoexperiencementalhealthdifficulties.
Specialist mental health services across the lifecycle Thissectiondetailsthementalhealthservicesthatshouldbeavailableforindividualsaccessingspecialistservicesatdifferentstagesofthelifecycle.
Child and adolescent mental health services Child and adolescent mental health services CMHTs arethefirstlineofspecialistmentalhealthservicesforchildren and young people who are directly referred totheCAMHSteamfromanumberofsources.The CAMHS teams accept referrals for moderate-to-severementalhealthdifficultiesofchildrenandadolescentswhichcannotbemanagedwithinprimarycare.ReferralstoCAMHSalsosupportchildrenandadolescents with a mental illness and intellectual disabilities.Wherethechildoradolescentpresentswithamoderate-to-severementaldisorderandautism,CAMHSteamsprovideappropriatemulti-disciplinarymental health assessment and treatment for the mental disorder in partnership with other agencies includingHSEPrimaryCare,Children’sDisabilityNetworkTeams,andotheragenciessupportingchildren and adolescents.
The 0–25 cohort The Youth Mental Health Task Force Report recommends thattheagerangeforeligibilityforCAMHSbeincreasedto25inordertoimprovecontinuityofcareandleadtobetteroutcomesforserviceusers,asthetransitionfromCAMHStoadultservicesiscomplex.Atpresent,youngpeoplemakethetransitiontoadultservicesattheageof18.Thiscanbeanageinlifewhenchange,uncertaintyandvulnerabilitiesprevail.Failuretosecureasafetransitioncanleadtodisengagementandultimatelytopoorerhealthoutcomes.Thereareconsiderableimplicationsinthisreconfigurationofservices.Apilotreconfigurationofservicesthatcouldascertainthespecificmentalhealthneedsofthe0–25cohortshouldbeestablishedtoinformthestaffingrequirementsofCAMHSandGeneral Adult Mental Health Service (GAMHS) teams.
Itisrecognisedthatitwilltakeanumberofyearstoprovide the necessary training for a new cohort of mentalhealthprofessionalstofacilitatesuchashiftand therefore the current relevant professionals are requiredtobeflexibleandopentonewapproaches.Inthemediumterm,itshouldbepossibletoprovidea seamless, age-appropriate specialist mental health serviceforthoseagedupto25years.Intheinterim,an immediate priority is to ensure that short-term additionalsupportsareavailableforindividualswhoaremakingthetransitionfromCAMHStoGAMHSatage18,giventheissuesandvulnerabilitiesthatcanprevail.
AlthoughtherehasbeenanincreaseinthenumberofCAMHSinpatientbedssincetheoriginalAVFC policywaspublished,itisacknowledgedthattherehavebeensomechallengesinaccessingsufficientage-appropriateinpatientbeds,exacerbatedbystaffavailabilityissuesandcomplexityofcases.Adultinpatientunitsare,generallyspeaking,notappropriateenvironments for children and adolescents. However, intheeventthatthereisnoCAMHSinpatientbedavailableandshort-termadmissiontoanadultunitistheonlyoption,thenarangeofactionsarenecessary.TheseactionsneedtobeconsistentwiththeCAMHSinpatientstandardoperatingguidelinestoprovideappropriate,effectiveandsafecare.
One of the main challenges regarding access to inpatientorresidentialcareconcernsthesmallnumberofchildrenandadolescentswhohavemultipleneeds,
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includingintellectualdisability,autismorboth,andwhorequirehigh-intensitysupport.Aspecialistunitforsuch children and adolescents would not necessarily addresstheuniqueneedsofeachandwouldbegeographicallyinaccessibleformany.Apreferredapproachistodevelopabespokesetofsupportsthataddress the needs of each individual case in the most appropriatesetting.
General adult mental health services (GAMHS) Majorlifeeventsoccurmoreoftenduringadulthood.Significantadditionalpressuressuchasunemployment,bereavementorlackofaccommodationcancontributetopoormentalhealth.Asaresult,themajorityofservices provided are designed to support the general adultpopulation.
Thereare114GeneralAdultCMHTsoperatingacrossthecountrywithastaffin2017of1,522clinicalwhole-time-equivalents(WTEs)–about76%ofthatenvisaged in AVFC2006–2016.Itisworthnotingthattheadultpopulationaged18to65yearshasbeengrowingonlymodestlyinrecenttimes,averaging0.8%eachyearbetweenthe2011andthe2016censuses.AserviceimprovementprojectintheHSEhasbeenexaminingtheserviceuser’sjourneythroughGeneral Adult CMHTs to ensure consistency in user experiencesandserviceofferingsacrossthecountry.KeythemesandpriorityareashavebeenidentifiedwhichagreewithmanyoftherecommendationsalreadymadeinDomain2andapplytoandbeyondGeneral Adult CMHTs. These themes include information,educationandsignpostingforpatients;realmulti-disciplinaryworking;greaterlinkswithexternalcommunityservices;FCSinvolvementandsupport;amongmanyothers.Animplementationplanwillbedevelopedtothisend.
InlinewiththelegalobligationsundertheDisabilityAct2005,generaladultmentalhealthserviceswillbeaccessibletopeoplewithdisabilitieswhodonotrequireamorespecialistservice.
You said...
Thereshouldbesupported respite facilitiesasanalternativetoinpatientacute care to meet the needs of the service user. The provision of day services or home outreachshouldbeconsidered.
We listened.
Adult inpatient capacity and alternatives to inpatient admissionFollowingstakeholderengagementandnotingtherecommendationscontainedwithintheJointOireachtasCommitteeontheFutureofMentalHealthcare report, the Oversight Group report highlightedtheneedtoconsidertheadequacyofacuteinpatientbedsprovidedforthegeneraladultandolderadultpopulation.Whiletherearecurrentlymoreacuteadultinpatientbedsper100,000thantherecommendednumbersuggestedintheoriginalAVFC,occupancylevelsinacutebedsindicatethattheacuteinpatientsystemisunderconsiderablestress.Considerationofcapacityneedstotakeintoaccounttheavailabilityorlackofotherbeds,suchasthoseinforensic,mentalhealthandintellectualdisability,child and mental health services and other specialist provisionwhereadditionalcapacityisplanned.Capacitymustalsolookatthealternativestoacuteinpatientcare,suchashomecareteams,assertiveoutreachteamsanddayhospitals,asdescribedbelow.Theambitiousfocusofthispolicyistoprioritiseand
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develop a full suite of services to operate alongside appropriateandeffectiveacuteinpatientcareandthentoconsidertheneedforfurtheracuteinpatientbeds.Inthisway,anyneedforadditionalinpatientbedswillbeconsideredagainstavailablelocalservices.Addedtothisthereisaresponsibilityforproviderstoexaminetheuseofbedsandensurethatacutebedsare used as intended and that delayed discharges are reviewed.Systematicanalysisofcapacityrequirementsshouldbeanormalcomponentofourmentalhealthcaresystem’splanningcycleandtakeintoaccountinternationalevidencetoassistplanningandprovision.Itisproposedinthispolicythatacommitteebeestablishedintheshorttermtoreviewacuteinpatientcapacityandpatientflow.Recommendationsfromthisgroupwillfeedintotheimplementationmonitoringcommitteeforconsideration.
Inaddition,thecontinuumprovidesforadditionalday hospitals and home-based care teams to provide continuousintegratedcareinpartnershipwithassertiveoutreachteamsandcrisis resolution teams. These services will operate according to agreed standardoperatingproceduresthatprovideforarangeofalternativestoinpatientcare.Theseserviceswillofferadditionaloptionstoacuteinpatientcareandassistwithpatientflowfromhospitalwardstoalternativesuitablesettings.Recoverycollegeswillaugmentbothservicesbyofferingserviceusersanopportunitytocreateeducationcoursesinpartnershipwith mental health professionals with a focus on equippingserviceusersandtheirfamilies,carersand supporters with new skills that foster recovery, promote self-care and enhance resilience. Together, theseserviceswillprovidevaluableappropriatealternativestotheacutehospitalsetting.
AVFC recognised the role of day hospitals as an alternativetoinpatientadmissionforsomeserviceusers,therebydivertingadmissionstoacuteunits.Thefunctionofadayhospitalistoprovideintensivetreatmentequivalenttothatavailableinahospitalinpatientsettingforacutelyillindividuals,wheretheytypicallyattendfromtheirhomeorcaresettingfor assessment, care and support. In day hospitals, multi-disciplinaryteamsprovidearangeoftherapeuticservicesincludingoccupational,psychologicalandsocial therapy programmes. Service users have integrated recovery care plans and can access
individual or group support programmes. Day hospitals willrequirecorestaffinadditiontoCMHTs,andinordertomeetvariedgeographicneeds,flexibilityofinfrastructureshouldbeconsidered,withdayhospitalsoperatingasafixedfacilitywithmobilestaff,ormobilestaffprovidingdayhospitalcareinanumberoffacilities.
Inadditiontodayhospitals,home-based crisis resolution teams provide intensive support to individualswithseverementalhealthdifficultiesorthosewithfirstincidencepresentationwhoareincrisis.Crisisresolutionteamsalsoprovideanalternativetoinpatienttreatment.Supportfromtheseteamsistime-limited,providingintensiveinterventionandsupportwithsufficientflexibilitytorespondtodifferentserviceuserorcarerneeds.Typically,thisentailsarangeoftherapeuticapproaches,includingmedicationmanagement,cognitiveandbehaviouralinterventionsandevidence-informedfamilyinterventions.Theteamsprovidearapidresponseand24-hourservice,withsupportprovidedintheserviceuser’sownenvironmentandwiththeactiveinvolvement of service users and their family, carers andsupporters,andliaisonwithlocalpartners– GPandVCSservices.Home-basedcrisisresolutionteamscouldalsoplayaroleinsupportingout-of-hourscrisis cafés. The Recovery College is another service element whichhasbeendevelopedmorerecently.ThegoalofaRecoveryCollegeistocreateacultureofrecovery,andtoempowerpeoplewithmentalhealthproblems,theirfamiliesandfriendsandthebroadercommunitytoimprovequalityoflifeandtopromotecommunityinvolvement through the provision of co-produced and co-facilitatedlearningandconversation.
Individualswhohavemultifacetedneedsrequirehigh-intensitysupport–beyondthosediscussedinthissection–andspecialistunitswillnotnecessarilyaddresstheiruniqueneeds.Inaddition,someunitsaregeographicallyinaccessibleformany.Theperson-centred approach of this policy suggests that it might bemoreappropriatetodesignaspecialsetofsupportsthataddresstheneedsoftheindividualinasuitablesetting.Tothisend,AVFCsoughttheestablishmentofanumberof intensive care rehabilitation units (ICRUs) forasmallnumberofpeoplewithdifficult-to-manage
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behaviour.ICRUsareunitswhichprovidesecurecareforasmallnumberofpeopleonalonger-termbasis.
Inaddition,thereisalsoacontinuedneedforshort-term psychiatric intensive care units (PICUs) for a smallnumberofpeoplewhocannotbeaccommodatedinacuteunitsduetothenatureoftheirbehaviour.Two psychiatric intensive care units to meet this need havealreadybeendevelopedinresponsetoAVFC anditisproposedthattwomoreunitsbedevelopedand future capacity considered as part of the acute inpatientgroup.Thesewillbediscussedinfurtherdetailintheforensicmentalhealthservicessectionlater in this chapter.
AnalternativeformofcaretoICRUsandPICUsisthe development of individualised packages of care forpeoplewhosebehaviourandcomplexityofneedrequiresahighlevelofcare.Individualsmayhaveotherdiagnosesaswellasmentalhealthdifficulties.Apreferred approach is to have a special set of supports thataddresstheneedsofeachcaseinthebestsetting.Thisshouldalsofacilitatecareformanywhoare currently on placements outside their area.
Mental health services for older people AsinotherEuropeancountries,thepopulationover65yearsisrisinginIreland.Mentalhealthdifficultiesinlaterlifearebothcommonandtreatablebutwhenunrecognisedand/oruntreatedareassociatedwithincreasedmorbidityandmortality.Dementiaforexample,affects5%ofpeopleover65increasingto20%ofthoseover80years.Peoplewithdementiaare typically referred to mental health services for older people teams when their diagnosis is associated withsignificantbehaviouraland/orpsychologicalsymptoms. Access to services for people with early onsetdementiaisinconsistentacrossthecountry.Inaddition,commonandpredictablelifeeventssuchasbereavementshouldbeprovidedforthroughidentificationofneedandserviceaccessbutalsothroughstrengthened,enhancedcommunities.
Theexpertisefortheassessmentandtreatmentofmentalhealthdifficultiesinolderpeopleisfoundinmental health services for older people (MHSOP) teams.Accesstotheseteamscanbedifficult.Olderpeoplewhohavementalhealthdifficultiesshouldhaveaccesstospecialistexpertiseandjointcare
arrangementsshouldbeputinplacewhereexpertisetomeetthe‘whole’needsofanindividualislocatedinboththegeneraladultteamsandthementalservicesfor older people teams. The age range for mental health services and general adult health teams needs tobereviewedtoreflectthehigherlifeexpectancyandchangingexpectationsofageinginIreland.
Home-basedassessmentandsupportsareparticularlyimportant for older people. Voluntary community sector(VCS)organisationscanworkwithMHSOPteamsandplayanimportantroleinconnectingolderpeopletoactivitiesintheirlocalcommunity.Giventhatoneinthreepeopleover65regularlytakesfiveormoremedications,acombinedfocusonimprovingaccess to talk therapies for older people and on more effectivemedicationmanagementisapriority.
Tailored interventions Forensic mental health services The forensic mental health services (FMHS) are concerned with the treatment of people with mental healthdifficultieswhohavecomeincontactwithlawenforcement agencies, that is, An Garda Síochána, the courts and the Prison Service. The FMHS also provideexpertisetootherspecialistmentalhealthservices on the assessment and management of peoplewithmentalhealthdifficultieswhohaveapropensityforviolenceandchallengingbehaviour.Inthis refresh it is important to repeat the commitment made in AVFCthatservicestothisgroupshouldbebasedonthesamevaluesandprinciplesappliedthroughout the policy. Thus this policy reinforces the needforeverypersonwithmentalhealthdifficultiescoming into contact with the forensic system to have accesstoacomprehensivestepped(ortiered)mentalhealthservicethatisrecovery-orientedandbasedonintegrated co-produced recovery care plans supported byadvocacyservicesasrequired.
Aswithallothermentalhealthservicesdescribedinthis domain, the stepped care approach applies to those in need of forensic mental health support and services.Accesstopreventionservices,primarycarementalhealthservices,earlyinterventionandspecialistmentalhealthservicesasdescribedinearliersectionsshouldbeopentothisgroupastoanyother.
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Thereareanumberofforensicmentalhealthinitiativesthatwillworktogethertoenhancementalhealthservicesoverthelifetimeofthisrevisedpolicy:
• The development of a new state-of-the-art facilityinPortrane,NorthCountyDublinin2020willprovidecareforupto170individualsandwillcontinuetoprovideservicesbothinthecommunity and in prisons. The facility will also have a forensic child and adolescent mental health service (FCAMHS) unit and an intensive carerehabilitationunit(ICRU).
• The2015New Connections report set out a series ofrecommendationsforadequatelymeetingthepsychologicalneedsoftheprisonerpopulation.These include access to a range of talking therapies and the development of mental health peersupportsinprisons.Therecommendationsof the New Connections report are promoted and endorsed in this policy.
• Court diversion schemes seek to ensure that offenderswithamentalhealthdifficultydonotgetinvolvedneedlesslyinthecriminaljusticesystem.Whenoffendingbehaviourisclearlyrelatedtoamentalhealthdifficulty,adiversionschemecanallowoffenderstobedivertedtothe care of the mental health services. In those circumstances,offendersdonotgointothePrisonService,wheretheremaybeadelayinidentifyingand responding to their mental health needs.
• Thenationalforensicmentalhealthservice(NFMHS)beganitsprisonin-reachandcourtliaisonservice(PICLS)in2007.Theserviceaimstoidentifyprisonerswithamentalhealthdifficultyasrapidlyaspossibleandputinplacepracticalsolutionsforappropriatementalhealthcare.
Whilemanycountrieshaveintroducedspecificand comprehensive mental health policy changes to provide for court diversion, Ireland does not yet haveaspecificpolicytoprovideforcourtdiversiontocommunitysettingsorcommunitytreatment.Theeffectivenessoftheservicedependsonongoingresourcingandaccesstofacilitiesandservicesinthecommunitytowhichindividualscanbediverted.
A small group of individuals each year who are found notguiltybyreasonofinsanity(NGBRI)mustbedetained under the Criminal Law Insanity Act in a designated centre under the Act. An intensive care
rehabilitationunit(ICRU)willbebuiltasanadjuncttothe new forensic facility on the Portrane campus. This unitwillhavedualregistrationasanapprovedcentreunder the Mental Health Act and a designated centre under the Criminal Law Insanity Act. It will therefore beavailabletoacceptthosewhohaveNGBRIstatusbutwhodonotrequirethelevelofcareprovidedintheCentralMentalHospital(CMH).TheoperationofthenewICRUcentrewillbereviewedtodeterminetheneedforandeffectivenessofthismodelofcareandthepossiblelocationoffurtherICRUs.
Furthermore,theprofileofthementalhealthneedsoftheprisonpopulationneedstobeexploredtogatherdataontheprevalenceofautism,intellectualdisabilityandneedsrelatingtoaddictionanddualdiagnosis,oftennotspecificallycateredforbyanassociatedmodel of care (MOC) in prisons. Such data will allow foramorejoined-upapproachbyallprofessionalsdeliveringcareinaprisonsetting.Inanefforttosupportthisjointapproach,mentalhealthadvocacygroupscouldbeencouragedandsupportedtoconnectintoprisonsettingstoensurethatindividualsare aware of and can access the services they need to support them in their recovery.
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Dual diagnosis
You said...
Peoplewithaddictionsshouldnotbeexcludedfrom accessing mental health services. People with a dual diagnosis needtobeabletogetthebestcareavailableto assist their recovery.
We listened.
(a)Oneformofdualdiagnosisisdefinedastheco-existenceofmentalhealthproblemsandsignificantsubstance–drugandalcohol–misuseproblemsinanindividual.Drugandalcoholmisusefrequentlyco-existwithmentalhealthdifficulties.Oncementalhealthanddrugandalcoholproblemsbecomeestablished,theycannegativelyimpacteachother.
Accesstoprimarycareaddictionservicesandexistingmentalhealthsupportswhenthereisaco-existingmentalhealth/addictionproblemremainscomplicated.Itisrecognisedthatthereissignificantoverlapbetweentheseconditionsandthatanindividualwithanaddictionhasarighttoaccessrelevantmentalhealthsupportswithinprimarycare.Thenationalpolicyonsubstancemisuse,Reducing Harm/Supporting Recovery,describeshowtieredlevelsofalcoholaddictionsupportsareneededinordertodevelopeffectivementalhealthservicesforpeoplewithco-existingmentalhealthdifficultiesandaddictionordualdiagnosis.Thistieredapproachshouldextendto mental health supports within primary care. The HSE Dual Diagnosis Improvement Programme also emphasises the need for integrated services across
primary care and specialist mental health services. There is a need to further develop universal access to primarycareaddictionservicesthatincludeassociatedmodels of leadership and governance.
AVFC recommended that general CMHTs include counsellorsskilledinworkingwithaddictionissues,and further develop specialist adult and adolescent dual diagnosis mental health teams to manage complex,severesubstanceabuseandmentalhealthdifficulties.Thesespecialistteamswouldoperatethrough clear linkages to CMHTs and would clarify pathways in and out of their service. AVFC further recommended that the dual diagnosis mental health teamsbemulti-disciplinary,similartoothermentalhealth services, and that those working with such teamsshouldhaveaspecialinterestandexpertiseinsupportingpeoplewithadualdiagnosisinvolvingmoderate-to-severementalhealthdifficulties.Theserecommendationsremaininplace.
AVFC recommended that specialist mental health services should support only individuals ‘whoseprimarydifficultyismentalhealth’.Thisrecommendationisnowreversed.Individualswithco-existingmentalhealthdifficultiesandaddictiontoeitheralcoholordrugsshouldnotbepreventedfromaccessingmentalhealthservices.Consequently,itwillnotbenecessarytoestablishwhetheramentalhealthdifficultyis‘primary’foranindividualtoaccessthe support of a mental health team. A shared case managementapproachmayberequiredforparticularlycomplexpatients.
Collaborativeworkingbetweenmentalhealthservicesandsocialinclusionaddictionserviceshascommencedwith the development of shared areas such as alcohol liaison posts with acute hospitals and an emerging model of tele-psychiatry support for adolescents with bothmorbidmentalhealthandaddictionproblems.Thisapproachagreeswiththerecommendationsofthenationalpolicyonsubstancemisuse,Reducing Harm/Supporting Recovery, which are consistent with theaspirationsofthismentalhealthpolicy.Inorderto provide care with clear pathways, a model of care describingthetieredlevelsofsupportneedstobedevelopedand,infact,workiscontinuingintheHSEto prepare such a model. The model should provide forpsychiatrysupportatprimarycarelevel,ifrequired,
Chapter 3 | Service Access, Coordination and Continuity of Care Domain
butdevelopedasan‘outreach’serviceprovidedbydual diagnosis specialist mental health teams.
(b) Another form of dual diagnosis is where someone hasanintellectualdisabilityorautismandaconcurrentmentalhealthcondition.Itisacceptedthatmentalhealthproblemscanbemorecommonforpeoplewithautismspectrumdisorder(ASD)thaninthegeneralpopulation.Inlinewiththesteppedcareapproachandthecontinuumofcare,primarycareandCommunityMental Health Teams need to have the training and skillsrequiredtosupportpeoplewithsuchdualdiagnoseswherethatistheappropriatetierofcare.
Mental health services for homeless people Regardingotherpeoplewhoneedmentalhealthsupport, a stepped approach to providing mental healthcare and access to specialist mental health servicesforpeoplewhoarehomelessshouldbeconsidered.Wherepossible,individualsshould receive support at the primary care level through aGPandifnecessarybereferredtotherelevantCMHT in their area.
When those living in long-term emergency accommodationcannotgainaccesstothementalhealthservicestheyrequire,homelessservicesshouldprovide for their mental health needs. This would includelow-levelinterventionsandappropriatereferralstospecialistservices.Duplicationofservicesshouldbeavoidedand,wherepossible,homelesspeople should access their local community mental healthteam.Homelessnessshouldnotcreateabarrierto accessing mental health services. For the rough-sleepingpopulation,adedicatedmentalhealthserviceoperatingonanoutreachmodelisrequiredinlargeurbanareas.
Liaison mental health services Liaison mental health services (LMHS) provide a criticalspecialistmentalhealthserviceforeverybody,youngandold,attendingemergencydepartments,aswellaspatientswithbothphysicalandmentalhealthsupportneedswhoareinpatientsinacutehospitals. Liaison mental health deals with the area
where physical and mental health meet and ensures that individuals in acute hospitals can access mental health services. AVFC recommended an increase from 9LMHSteamsto13;however,servicepressuresin acute hospitals regarding the provision of liaison mentalhealthservicesareemerging,specificallyinthe areas of psycho-oncology, perinatal mental health andthementalhealthofolderpeople–notleastinthecontextoftheageingpopulation.Investmentinthe expansion of LMHS services is needed to address emerging liaison demands while responding to newer LMHS service developments.
Specialist needs-based services Intensive recovery support services (for individuals with complex mental health difficulties) Toreflecttherecoveryethosandthenatureoftheworkinrehabilitationteams,itisproposedthatrehabilitationandrecoveryservicesforpeoplewithcomplexmentalhealthdifficultiesbere-named‘intensiverecoverysupportservices’(IRSS).Theseteamscanbeaccessedbypeoplewhohavecomplexandmultipleneedsandwhorequireintensivesupport,often,butnotalways,onalong-termbasis.
Emerging models of care recommend a range of alternativecarestructuresandassociatedintensiverecovery support services for service users across all Community Health Networks.10 These include specialisedrehabilitationunits(SRUs)providinganintensiveinpatientrehabilitationprogrammeforserviceuserswiththegreatestneed,andactivemedium-termrecoverysupportsbasedonanintegratedrecoverycareplan.Specialisedrehabilitationunitsareincludedintheproposed‘continuumofcare’,togetherwithcommunityrehabilitationresidences(CRRs).Unitsdependonamulti-disciplinaryteamtosupportandenablethepersonconcernedtomove towards independent community living accommodation.ThefullrangeofsupportsandservicesdescribedinFigure3.4shouldbeavailabletothisgroupandincludeadditionalsupportfromassertiveoutreachteams.
10HSE.ModelofCareforPeoplewithSevereandEnduringMentalIllnessandComplexNeeds(2019).Availableat:https://www.hse.ie/eng/services/list/4/mental-health-services/rehabilitation-recovery-mental-health-services/model-of-care-for-people-with-severe-and-enduring-mental-illness-and-complex-needs.pdf
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Assertive Outreach Teams
You said...
We need more outreach teams to meet people where theyare;meetingpeople in their homes, nursing homes, asylum centres or homeless services shouldbeavailableand should provide earlyintervention/preventionandsupport.
We listened.
Assertiveoutreachteamshaveaspecificfocusonrehabilitationandrecoveryandoperatespecialisedmobiletreatment.Theyworktoreducehospitaladmissions and readmissions, prevent relapse, andimproveaperson’schancesofreturningtoemployment,educationortraining,and,moregenerally,toenhancetheirqualityoflife.Suchinterventioninvolvesamulti-disciplinaryteamthatcould include a range of professionals including clinical psychologists,nurses,occupationaltherapists,peerand mental health or social care support workers, psychiatrists and social workers. The emphasis must beonanassertiveapproachtomaintainingcontactwith service users and on encouraging them to return tonormalvocationalandotherlifepursuits.Theworkoftheassertiveoutreachteamsandtheintensiverecovery support services will provide linkages
betweenpatientsandappropriatesupportssuchashousing,employmentandeducation.Thispolicyadvocatesthatassertiveoutreachteamsbeexpandedsothatspecialistmentalhealthcareisaccessible tothosewhomightotherwisefacedifficultiesaccessing it.
Mental health services for early intervention in psychosis The HSE National Clinical Programme for Early Intervention in Psychosishasthepotentialtotransformthelivesofpeoplewithemergingorfirst-episodepsychosis. Where access to a specialist integrated serviceisnotavailable,theriskandexperienceoflong-termdisabilityinthispopulationiswellknown.Theclinicalprogrammepublishedamodelofcareforearlyinterventioninpsychosis(MOCEIP)inJune2019.Followingthismodeltherehasbeenextensivetrainingofcliniciansinbehaviouralfamilytherapy(BFT) as well as ongoing work to provide specialist cognitivebehaviouraltherapy(CBT)forpatientswithpsychosis.Thisisenhancedbythedevelopmentofan individual placement and support (IPS) service tofacilitateprogressionorreturntocompetitiveemployment.Threedemonstrationpilotsiteshavebeenactivatedandifpositivelyevaluated,additionalsiteswillbenefitserviceusersinotherregions.TheSocialReformFundcoordinatesasimilarIPSprogramme that works with Community Mental HealthTeams;thisisdescribedingreaterdetailinChapter4,SocialInclusion,undertheheading‘Employmentsupports’.
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People with an intellectual disability
You said...
There are many groups in Ireland who have specificneeds.Mentalhealth services should beequippedandtrained to deal with themultifacetedneedsof these individuals.
We listened.
AsdescribedinAVFC, mental health and intellectual disability(MHID)teamsshouldbedevelopedtoprovidepopulation-widecoverageandensurefairandequalaccesstomentalhealthcareforpeopleofallageswithanintellectualdisability(ID).Thetieredapproachtopatientcareadvocatedinthispolicywillsupportpeoplewithintellectualdisabilityinaccessingmainstream services especially where the MHID model of care is not yet in place.
Significantmentalhealthandintellectualdisabilityservice gaps remain across the country and a key objectiveoughttofocusonfurtherdeliveryofanationalnetworkofMHIDteams–foradultsandchildren–withclearcatchmentareasdefined.Aperson-centredMHIDteammodelofcareisbeingformalised to ensure consistent service delivery. This modelshouldbeadoptedandreplicatednationally.Aphasedresourceplanisinplacetodevelop‘baselineteams’involvingaconsultantpsychiatrist,aclinicalnursespecialist,apsychologistandadministrativesupportinareaswherethereisnoexistingteamandtoaugmenttheexistingteamsasneeded.Giventhecommunicationchallengesthatcanexistforthesepatients,itisalsoimportanttoincludespeechand
languagetherapists(SLT)ascoremembersoftheAdult-ID and CAMHS-ID teams.
AVFCrecommendedthedevelopmentofacutebedsand day hospital services for mental health and intellectualdisabilitytreatment.InvestmentinacuteMHIDservicesneedstobeprioritised,asenvisagedinAVFC, and developed as part of the HSE MHID service improvementprogrammeandinconjunctionwithHSEsocialcareandSection38/39socialcarevoluntaryagencies.Innovativeacutetreatmentservicesneedtobeexplored,whichmightincludetherapeuticrespiteforchildrenwithintellectualdisabilitiesandsignificantmentalhealthandbehaviouralsupportneeds.
ADHDWhileattentiondeficithyperactivitydisorder(ADHD)inchildrenisaclearlyrecognisedconditionrequiringa stepped care approach, as is evident in a growing bodyofclinicalresearch,ADHDinadultsisanimpairinglifelongcondition.Itisaconditionwhichisunder-recognised and under-diagnosed, and one that leadstoimpairedqualityoflife,resultsinongoingdistress,andisoftenassociatedwithinappropriatetreatmentinterventions.Oncediagnosed,adultswithADHDcanbenefitfrommentalhealthtreatment,includingpsychosocialinterventions.Sharing the Vision supportsimplementationoftheHSEnationalclinicalprogramme for adults with ADHD. This programme emphasises the need for appropriate specialist assessmentandpsychosocialinterventionstosupportaffectedpeopleastheymovefromchildren’sintoadultmental health services.
Suicide preventionConnecting for Life(CFL)(2015–2020)isawhole-of-societystrategytocoordinateandfocusnationaleffortsinIrelandtoreducethelossoflifebysuicideand to reduce cases of self-harm. The strategy applies tothewholepopulationandtospecifiedprioritygroups.Itinvolvespreventiveandawareness-raisingworkwiththepopulationasawhole,supportworkwithlocalcommunitiesandtargetedapproachestopriority groups. The strategy notes that in high-income countries,mentalhealthdifficultiesarepresentforupto90%ofpeoplewhodiebysuicide.Itrecognisesthatlinking with AVFC is central to the success of the work outlined in Connecting for Life. This policy supports continuedimplementationoftheConnecting for Life recommendations.
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Eating disordersEatingdisordersareassociatedwithhighmortalityandmorbidity.TheHSENational Clinical Programme for Eating Disorders(NCP-ED)isacollaborativeinitiativebetweentheHSE,theCollegeofPsychiatristsofIrelandandBodywhys–thenationalsupportgroupforpeoplewitheatingdisorders.Thisprogrammeappliesacross the age range, that is, child and adult, and has developed a model of care to introduce new services andtoimproveexistingservicesforpeoplewitheatingdisorders.Theeightrecommendationsoneatingdisorders made in AVFCarecoveredintheactionsinthe model and are endorsed in this policy.
Specialist perinatal supportsTheperinatalperiodbringsrisksofmentalhealthdifficultiesforsomewomen.Perinatalmentalhealthdisordersincludebothnewonsetandarelapseorrecurrenceofpre-existingdisorders.11 Mental healthdifficultiesatthissensitivetimemayaffecttherelationshipbetweenmother,childandfamilyunit. This carries the risk of the later development of significantemotionalandbehaviouraldifficultiesinthechild.Inits2016ServicePlan,theHSEMentalHealthDivision,inrecognitionoftheimportanceofperinatal mental health, included the development of a Model of Care for Specialist Perinatal Mental Health servicesthatfocusonthemother,thebabyandtheirrelationshipinthecontextofthefamily.TheModelof Care for Specialist Perinatal Mental Health should continuetoberesourcedandrolledoutnationally.
Neuro-rehabilitation (including acquired brain injury)Neuro-rehabilitationistheprocessofsupportingindividualswithbrainorspinalinjuries,whooftenexperiencesignificantmentalhealthdifficultiesrequiringspecialistcare.Peoplewiththesetypesofinjuriesoftenexperiencesignificantdifficultiesinaccessingappropriateservicesthatrequireanintegrated response from the health service. In 2019theHSEpublishedtheNational Strategy and Policy for the Provision of Neuro-rehabilitation Service in Ireland – Implementation Framework (2019–2021), whichprovidesforspecificspecialistmentalhealth
servicesincludingneuro-psychiatry,anessentialpartofaneffectiveneuro-rehabilitationservice.12 These mentalhealthsupportscouldbeprovidedaspartofthe development of liaison mental health services and in the context of the proposed integrated Liaison MentalHealthModelofCare.Implementationofthe National Strategy and Policy for the Provision of Neuro-rehabilitation Service in Ireland –ImplementationFramework should remain a priority and should include theessentialmentalhealthsupportcomponentsof this service development, in the context of the proposed Liaison Mental Health Model of Care.
Providing mental health services that recognise and respond to diversityThe AVFC policy recognised that there are groups ofpeopleinthepopulationwhohaveadditionalneedswhentheydevelopamentalhealthdifficulty.Specifically,itrecognisedthatserviceusersfromother countries and cultures, Travellers and the LGBTQ+communitymayhavespecificvulnerabilitiesordifficultiesthatshouldbeconsideredinthewaymental health services are delivered. Sharing the Vision proposes that a more developed framework for theimplementationofcultural,diversityandgendercompetencyisrequiredtorespondtotheneedsofthesegroupsaspertheDCYALGBT+ National Youth Strategy,2018–2020.
Aroundsevenper10,000peopleinthegeneralpopulationhavesevere-to-profounddeafnessatanyonetimeandtheprevalenceofmentalhealthdifficultiesamongthisgroupismuchhigherthaninthegeneralpopulation.Mentalhealthservicesmustbeculturallyappropriateandaccessibletomembersofthe deaf community through the provision of training, supervisionandsupportforstaff.Alliedtothisthereis a need to ensure that interpreters are appropriately qualifiedtoworkinamentalhealthservicecontext.Outreachinitiativesfrommentalhealthservicestopeople who are deaf, live in the community and are at risk, or who are already living with a mental health difficulty,shouldalsobeavailable.
11Theperinatalperiodcommencesat22completedweeks(154days)ofgestationandendssevencompleteddaysafterbirth:WorldHealthOrganization.‘Maternal,new-born,childandadolescenthealth:Maternalandperinatalhealth’.Accessed17February2020.Availableat:https://www.who.int/maternal_child_adolescent/topics/maternal/maternal_perinatal/en/
12HSE.NationalStrategy&PolicyfortheProvisionofNeuro-RehabilitationServicesinIreland:ImplementationFramework2019–2020(2019).Availableat:https://www.hse.ie/eng/services/list/4/disability/neurorehabilitation/national-strategy-policy-for-the-provision-of-neuro-rehabilitation-services-in-ireland.pdf
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People living in Direct Provision can have a higher prevalenceofmentalhealthdifficultiesthanthegeneralpopulation.Thisgroupshouldhaveaccesstomentalhealthservicesandsupports,asdescribedinthesteppedcareapproach,onthesamebasisastherestofthepopulation.Provisionofspecialist,in-reachmentalhealthservicesshouldbeconsidered,whenappropriate. The mental health needs of this group shouldbetakenintoaccountwhenDirectProvisionservicesarebeingplanned.
Access to advocacyAdvocacyisabouthavingsomeoneavailabletohelpapersonmakedecisionsabouthealthcareorotherservices such as access to social welfare, housing or othersocialentitlementsorservices.Advocatescanalso help an individual to make a complaint or seek redress,therebyholdingpublicservicestoaccount.Advocates are people whose primary role is to support an individual around decision-making or having their voice heard. For a variety of reasons, people may notbeabletoadvocateforthemselves.Peoplemayneedtoadvocateforthemselves(‘self-advocacy’),needsupportfromapeer(‘peeradvocacy’)orneedsomeonetospeakontheirbehalf(‘representativeadvocacy’).
AVFC,inRecommendation3.2,recommendedthat‘advocacyshouldbeavailableasarighttoallpatientsinallmentalhealthservicesinallpartsofthecountry’.However, the research and engagement for Sharing the Vision showed that there are gaps in access to advocacy supports and that some needs are unmet. Challengesincludealackofawarenessofexistingadvocacysupports.Thisisparticularlyrelevantforpeoplewithmentalhealthdifficultieslivinginthecommunity,relativetothosebeingsupportedinacuteunitsandlonger-stayfacilities.
Therighttoadvocacyneedstobere-emphasisedandthedevelopmentofadditionaladvocacyservicespursued. There is also a need for research to determine the advocacy needs of people with a mental healthdifficultylivinginthecommunity,asknowledgeof the scale and nature of need in this area is limited.When the Assisted Decision-Making (Capacity) Act is commenced,adultswithamentalhealthconditionwillhavetheoptiontoappointanassistanttohelptheminmakingdecisionsinrelationtotheirmentalhealthtreatmentandinmakingAdvanceCareDirectivesinrelationtoanticipatedfuturetreatment.
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13 DirectoriesofinformationonVCSsupportsshouldbeprovidedtostaffworkinginprimarycareandCMHTstoensuretheyareawareofandinformserviceusersandFCSaboutallsupportsavailableincludingthosefromVoluntaryandCommunitySectororganisationsinthelocalarea.
14 WhereVoluntaryandCommunitySectororganisationsareprovidingservicesalignedtotheoutcomesinthispolicy,operationalgovernanceandfundingmodelsshouldbesecureandsustainable.
15Socialprescribingshouldbepromotednationallyasaneffectivemeansoflinkingthosewithmentalhealthdifficultiestocommunity-basedsupportsandinterventions,includingthoseavailablethroughlocal Voluntary and Community Sector supports and services.
16
Accesstoarangeofcounsellingsupportsandtalktherapiesinthecommunity/primarycareshouldbeavailableonthebasisofidentifiedneedsothatallindividuals,acrossthelifespan,withamild-to-moderatementalhealthdifficultycanreceivepromptaccesstoaccessiblecarethroughtheirGP/PrimaryCareCentre.Counsellingsupportsandtalktherapiesmustbedeliveredbyappropriatelyqualifiedandaccreditedprofessionals.
17 Thementalhealthconsultation/liaisonmodelshouldcontinuetobeadoptedtoensureformallinksbetweenCMHTsandprimarycarewiththepresenceof,orin-reachby,amentalhealthprofessionalaspart of the primary care team or network.
18
AnimplementationplanshouldbedevelopedfortheremainingrelevantrecommendationsinAdvancing the Shared Care Approach between Primary Care & Specialist Mental Health Services(2012)inordertoimproveintegrationofcareforindividualsbetweenprimarycareandmentalhealthservicesinlinewithemerging models and plans for Community Health Networks and Teams.
19 ThephysicalhealthneedsofallusersofspecialistmentalhealthservicesshouldbegivenparticularattentionbytheirGP.Asharedcareapproachisessentialtoachievethebestoutcomes.
20ThereshouldbefurtherdevelopmentofearlyinterventionandassessmentservicesintheprimarycaresectorforchildrenwithADHDand/orautismtoincludecomprehensivemulti-disciplinaryandpaediatricassessmentandmentalhealthconsultationwiththerelevantCMHT,wherenecessary.
21Dedicatedcommunity-basedAddictionServiceTeamsshouldbedeveloped/enhancedwithpsychiatryinput,asrequired,andimprovedaccesstomentalhealthsupportsinthecommunityshouldbeprovidedtoindividualswithco-existinglow-levelmentalhealthandaddictionproblems.
22 Theprovisionofappropriateenvironmentsforthosepresentingatemergencydepartmentswhoadditionallyrequireanemergencymentalhealthassessmentshouldbeprioritised.
23Thereshouldbecontinuedinvestmentin,andimplementationof,theNationalClinicalCareProgrammefortheAssessmentandManagementofPatientsPresentingtoemergencydepartmentsfollowingself-harm.
24 Out-of-hourscrisiscafésshouldbepilotedandoperatedbasedonidentifiedgoodpractice.SuchcafésshouldfunctionasapartnershipbetweentheHSEandotherproviders/organisations.
25 Themulti-disciplinaryCMHTasthecornerstoneofservicedeliveryinsecondarycareshouldbestrengthenedthroughthedevelopmentandagreedimplementationofasharedgovernancemodel.
26CMHTs’outreachandliaisonactivitieswithVoluntaryandCommunitySectorpartnersinthelocalcommunityshouldbeenhancedtohelpcreateaconnectednetworkofappropriatesupportsforeachservice user and their FCS.
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27 Anindividualisedrecoverycareplan,co-producedwithserviceusersand/orFCS,whereappropriate,shouldbeinplacefor,andaccessibleto,allusersofspecialistmentalhealthservices.
28 AllserviceusersshouldhaveamutuallyagreedkeyworkerfromtheCMHTtofacilitatecoordinationandpersonalisationofservicesinlinewiththeirco-producedrecoverycareplan.
29 FurthertrainingandsupportshouldbeputinplacetoembedarecoveryethosamongmentalhealthprofessionalsworkingintheCMHTaswellasthosedeliveringserviceselsewhereinthecontinuumofservices.
30 CMHTsandsessionalcontactsshouldbelocated,wherepossibleandappropriate,inavarietyofsuitablesettingsinthecommunity,includingnon-healthsettings.
31 Thepotentialfordigitalhealthsolutionstoenhanceservicedeliveryandempowerserviceusersshouldbedeveloped.
32
ThecompositionandskillmixofeachCMHT,alongwithclinicalandoperationalprotocols,shouldtakeintoconsiderationtheneedsandsocialcircumstancesofitssectorpopulationandtheavailabilityofstaffwithrelevantskills.AslongasthecoreskillsofCMHTsaremet,thereshouldbeflexibilityinhowtheteamsareresourcedtomeetthefullrangeofneedswherethereisstrongpopulation-basedneedsassessment data.
33 The shared governance arrangements for CMHTs as outlined in AVFC2006–16shouldbeprogressed,including further rollout of Team Coordinators.
34 ReferralpathwaystoallCMHTsshouldbereviewedandextendedbyenablingreferralsfromarangeofotherservices,(asappropriate)includingSeniorPrimaryCareProfessionalsincollaborationwithGPs.
35 Acomprehensivespecialistmentalhealthout-of-hoursresponseshouldbeprovidedforchildrenandadolescentsinallgeographicalareas.ThisshouldbedevelopedinadditiontocurrentEDservices.
36AppropriatesupportsshouldbeprovidedforonaninterimbasistoserviceuserstransitioningfromCAMHStoGAMHS.Theageoftransitionshouldbemovedfrom18to25,andfuturesupportsshouldreflectthis.
37 Nationallyagreedcriteriashouldbedevelopedtogovernandresourceindividualisedsupportpackagesforthespecificneedsofasmallcohortofchildrenandyoungpeoplewhohavecomplexneeds.
38 Inexceptionalcaseswherechildandadolescentinpatientbedsarenotavailable,adultunitsprovidingcaretochildrenandadolescentsshouldadheretotheCAMHSinpatientCodeofGovernance.
39TheHSEshouldconsultwithserviceusers,FCS,staff,andthosesupportingprioritygroupstodevelopastandardisedaccesspathwaytotimelymentalhealthandrelatedcareinlinewiththeindividual’sneeds and preferences.
40 Sufficientresourcingofhome-basedcrisisresolutionteamsshouldbeprovidedtoofferanalternativeresponsetoinpatientadmission,whenappropriate.
41AStandardOperatingGuidelineshouldbedevelopedtoensurethatsufficientlystaffeddayhospitalsoperateaseffectivelyaspossibleasanelementofthecontinuumofcareandanalternativetoinpatientadmission.
42IndividualswhorequirespecialistMentalHealthServicesforOlderPeople(MHSOP)shouldreceivethatserviceregardlessoftheirpastorcurrentmentalhealthhistory.Peoplewithearlyonsetdementiashould also have access to MHSOP.
43 TheagelimitforMHSOPshouldbeincreasedfrom65yearsto70yearssupportedbyjointcarearrangementsbetweenGAMHSandMHSOPteamsforindividualswhorequiretheexpertiseofboth.
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44 GPs,mentalhealthserviceprescribersandrelevantstakeholdersshouldcollaboratetoactivelymanagepolypharmacy.
45 TheHSEshouldcollatedataonthenumberandprofileofdelayeddischargesinacutementalhealthinpatientunitsanddevelopappropriatelyfundedresponses.
46
AnExpertGroupshouldbesetuptoexamineAcuteInpatient(ApprovedCentre)bedprovision(includingPICUs)andtomakerecommendationsoncapacityreflectiveofemergingmodelsofcare,existingbedresources,andfuturedemographicchanges,withsuchrecommendationsbeingalignedwith Sláintecare.
47 SufficientPsychiatricIntensiveCareUnits(PICUs)shouldbedevelopedwithappropriatereferralanddischarge protocols to serve the regions of the country with limited access to this type of service.
48
Across-disabilityandmentalhealthgroupshouldbeconvenedtodevelopnationalcompetenceinthe commissioning, design and provision of intensive supports for people with complex mental health difficultiesandintellectualdisabilitiesandtodevelopasetofcriteriatogoverntheprovisionofthisservice.
49IntensiveRecoverySupport(IRS)teamsshouldbeprovidedonanationalbasistosupportpeople withcomplexmentalhealthneedsinordertoavoidinappropriate,restrictiveandnon-recovery-orientedsettings.
50 ThedevelopmentofanationalnetworkofMHIDteamsandacutetreatmentbedsforpeopleofallageswithanintellectualdisabilityshouldbeprioritised.
51 SpeechandLanguageTherapists(SLT)shouldbecoremembersoftheAdult-IDandCAMHS-IDteams.
52 InvestmentintheimplementationoftheModelofCareforEarlyInterventionPsychosis(EIP),informedbyanevaluationoftheEIPdemonstrationsites,shouldbecontinued.
53TheNationalMentalHealthClinicalProgrammesforEatingDisorders,AdultswithADHDandthe Model of Care for Specialist Perinatal Mental Health Services should continue to have phased implementationandevaluation.
54Everypersonwithmentalhealthdifficultiescomingintocontactwiththeforensicsystemshouldhaveaccesstocomprehensivestepped(ortiered)mentalhealthsupportthatisrecovery-orientedandbasedonintegratedco-producedrecoverycareplanssupportedbyadvocacyservicesasrequired.
55Thereshouldbeongoingresourcingofandsupportfordiversionschemeswhereindividualswithmentalhealthdifficultiesaredivertedfromthecriminaljusticesystemattheearliestpossiblestageandhavetheirneedsmetwithincommunityand/ornon-forensicmentalhealthsettings.
56 ThedevelopmentoffurtherIntensiveCareRehabilitationUnits(ICRUs)shouldbeprioritisedfollowingsuccessfulevaluationofoperationofthenewICRUonthePortraneCampus.
57
Atieredmodelofintegratedserviceprovisionforindividualswithadualdiagnosis(e.g.substancemisusewithmentalillness)shouldbedevelopedtoensurethatpathwaystocareareclear.Similarly,tieredmodelsofsupportshouldbeavailabletopeoplewithadualdiagnosisofintellectualdisabilityand/orautismandamentalhealthdifficulty.
58In order to address service gaps and access issues, a stepped model of integrated support that provides mentalhealthpromotion,preventionandprimaryinterventionsupportsshouldbeavailableforpeopleexperiencing homelessness.
59 Assertiveoutreachteamsshouldbeexpandedsothatspecialistmentalhealthcareisaccessibletopeople experiencing homelessness.
Chapter 3 | Service Access, Coordination and Continuity of Care Domain
Sharing the Vision | A Mental Health Policy for Everyone
63
60 ContinuedexpansionofLiaisonMentalHealthServicesforallagegroupsshouldtakeplaceinthecontext of an integrated Liaison Mental Health Model of Care.
61 The HSE should maximise the delivery of diverse and culturally competent mental health supports throughout all services.
62 Building on service improvements already in place, individuals who are deaf should have access to the fullsuiteofmentalhealthservicesavailabletothewiderpopulation.
63PersonsinDirectProvisionservicesandrefugeesarrivingundertheIrishrefugeeprotectionprogrammeshouldhaveaccesstoappropriatetieredmentalhealthservicesthroughprimarycareandspecialistmental health services.
64 Appropriatelyqualifiedinterpretersshouldbemadeavailablewithinthementalhealthserviceandoperate at no cost to the service user.
65 The HSE should ensure access to appropriate advocacy supports in all mental health services.
65
Chapter 4
Social Inclusion Domain
Sharing the Vision | A Mental Health Policy for Everyone
Chapter 4 | Social Inclusion Domain
66
Figure 4.1: Outcomes: social inclusion
Service users are respected, connected and valued in
their community
Improvedoutcomesinrelationtoeducation,housing,employment
and income for service users relativetothepopulationasawhole (i.e. reduced disparity).
Increasedabilityofservice users to manage their own lives [self-determination]viastronger
socialrelationshipsand sense of purpose
Outcome 3(a)
Outcome 3(c) Outcome 3(b)
Introduction
This domain focuses mainly on people living with complexmentalhealthdifficultieswhoaremostvulnerabletosocialexclusionarisingfromstigmaanddiscrimination,inadequateaccommodationoftheirneedsinworkplaces,andinsufficientaccesstoincome,housing,employmentandtrainingoreducation.Theepisodicnatureofthesementalhealthproblemscanleadtoemploymentdifficultiesandchallengesavailingof social support systems.
Peoplewithdisabilities,includingmentalhealthdifficulties,oftenexperiencenumerousbarrierstoemploymentandhousing.Theremayalsobebarrierstomoregeneralsocialinclusionofpeoplewithmentalhealthdifficulties.Tacklingstigmaanddiscrimination,asoutlinedinDomain1(promotion,preventionandearlyintervention),canhelptobuildsocialinclusion.Beingempoweredtoliveinone’sownhomeandcommunity,withadditionalsupportswhere
appropriate,isakeyfactorinfacilitatingandsustaining recovery.
Thevariousrecommendationsandinterventionsproposedinthisdomainareallaimedatenablingservice users living with complex mental health difficultiesandtheirfamily,carersandsupporterstofeel connected and valued in their community. This domain will facilitate improved outcomes for people withmentalhealthdifficultiesinhousing,employment,incomeandtrainingoreducation.Betteroutcomes,broughtaboutbybuildingstrongersocialrelationshipsand through developing and enhancing access to housing,employment,incomeandeducationortraining, will nurture social inclusion and respect for diversity.Theserecommendationsaimtoempowerserviceusersbysupportingthemtoachievefullandeffectiveparticipationinsociety.Figure4.1showstheoutcomes for the domain social inclusion.
Sharing the Vision | A Mental Health Policy for Everyone
Equality of accessAVFC recognised that individuals with mental health difficultiesshouldhaveaccesstohousing,employmentandeducationortrainingonthesamebasisaseveryothercitizen.TheUnitedNationsUniversalDeclarationofHumanRightsrecognisesthatpeoplewithdisabilitiesshouldhaveequalrightstoliveina community and that measures to facilitate their fullinclusionandparticipationshouldbeprioritisedincludingaccesstoeducation,health,employmentandsocialprotection.Thispolicyincorporatesthesamefundamentalprincipleofequalityofaccesstohousing,employmentandtrainingoreducationforpeoplelivingwithamentalhealthdifficulty.
Housing supports Peoplewithpoormentalhealthrequireaccesstogood-quality,secureandappropriatehousingtofacilitateandsustaintheirrecovery.Alackofsuitablehousingasanalternativetoinstitutionalcarecanleadtoaninefficientandexpensivementalhealthsystem,withserviceusersreceivingunsuitablecare.Housingsupportsforthesepeoplerequireeffectivecollaborationbetweengovernmentdepartments,localauthoritiesandsocialhousingorganisations.Apartfrom housing, there is also a need to ensure that thosewithcomplexmentalhealthdifficultiesreceivemulti-disciplinarysupportsfromhealthprofessionalsandVCSorganisationstoimprovetheirqualityoflife.Serviceusersalsorequireassistancetosustaintenancies and live independently. As a result, there mustbeeffectiveliaisonbetweenmentalhealthservicesandlocalauthoritiesintheprovisionofsocialhousingforpatientswhorequireit.Centraltothisis ensuring that people with complex mental health difficultieshaveequalaccesstohousingallocationsandthatparticularneedsconcerningtheirlivingenvironment are properly addressed.
AVFC highlighted that many people in HSE hostel accommodationwouldbebetterofflivingmoreindependently in the community. It recommended that the housing and mental health sectors work togethertoachievethisandclarifiedtherolesofthe
twosectors.Importantprogresshasbeenmadeandgoodpracticedevelopedthroughrecentpilotprojectsthat provide access to appropriate housing, as well as practicalsupportstosustainindependentliving,alongwithmentalhealthrehabilitationsupports.13AjointprotocolagreedbytheDoHandtheDepartmentofHousing, Planning and Local Government (DHPLG) in consultationwithkeystakeholdersisrequiredtoassistpeople living in HSE mental health service congregated settingstomovetomainstreamcommunity-basedliving.14
Sustainableresourcingbasedonidentifiedneedfortenancy-related/independentlivingsupportsforpatientswithcomplexmentalhealthdifficultiesmustbeconsideredforserviceusersmovingfromHSE-supportedaccommodationtoindependentlivingand for individuals in hospital or homeless services identifiedashavingahousingneed.
Rebuilding Ireland – the Action Plan for Housing and Homelessness commits to delivering supports to homelesspeoplewithmentalhealthandaddictionissues. The plan recognises that homelessness is a complex phenomenon. It is usually the result of anumberofinterrelatedissues,whichcanincludementalhealthissues,addictions,relationshipbreakdown,familyissues,domesticviolence,financialloss, economic insecurity, rent arrears, tenancy issues, anti-socialbehaviour,crime,prisonerreleaseandthevulnerabilityofmigrants,amongotherfactors.Theplan therefore recognises that a successful ‘whole-of-government’responseisneededtosuchissuesifthecurrenthomelessnesscrisisistobetackledeffectively.Assuch,recommendationsinthispolicyneedtobeimplementedtogetherwithvariousrecommendationscoveredinchapter3,includingaccesstoprimarycareservices;supportsforindividualswithadualdiagnosis;and access to outreach mental health services for homelesspeopleinemergencyaccommodation.
In2016newhousingdesignguidelineswerelaunchedbytheHSEandtheHousingAgencytopromoteindependent living and recovery for people living withmentalhealthdifficulties.15Theguidelinesoffer
13ExamplesofcollaborativepilotprojectsaretheDorasandSlánAbhaileprojectsinNorthDublinfundedbytheGenioProgrammebetween2012and2016.
14Acongregatedsettingisaplacewheretenormorepeoplewithadisabilitylivetogetherinasinglelivingunit.15ÁineO’Reilly,EmerWhelan,andIsoildeDillon.DesignforMentalHealth–HousingDesignGuidelines(Dublin:HousingAgencyandHSE,2016).Availableat:http://www.housingagency.ie/sites/default/files/publications/36.%20Design%20for%20Mental%20Health%20Housing-Design-Guidance-MAY-2017.pdf
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Chapter 4 | Social Inclusion Domain
aperspectiveonhousingtypeanddesignforpeopleconsideringalternativestocongregatedsettingsandshouldbeafactorforallofthehousing-relatedrecommendationsinthispolicy.
Employment supports Forindividualswithenduringmentalhealthdifficulties,orthoserecoveringfromaonce-offbutsignificantmentalhealthdifficulty,thepossibilityofsecuringemploymentorreturningtoworkcanbeakeyfactor in recovery. Employment is important to social statusandidentityasitprovidessocialconnectionand promotes self-esteem, self-worth, increased confidence,responsibilityandindependence.Meaningfulemploymentfostershope,participationandasenseofabetterandbrighterfuture.Inaddition,employmentcanreduceand/orstabilisesymptoms,increaseself-worthandprovidegreaterdisposableincome.
Thereareanumberofemploymentandtraininginitiativesthatareimportantintermsofkeepingpeopleconnectedwithotherindividualsandofferingpracticalsupportsforgainingfutureemployment.Theindividual placement and support (IPS) employment model helps people with a complex mental health conditiontoremaininorhaveaccesstoworkinmainstreamsettingswhilealsosupportingemployerstoaddressrelatedrecruitmentandretentionissues.Assuch,itdiffersfromothervocationalrehabilitationapproaches that employ people in sheltered workshopsandothernon-mainstreamjobs.TheIPSmodelisinternationallyrecognisedasacost-effectivemethodofsupportingpeoplewithseverementalhealthdifficultiestoachievesustainable,competitiveemployment.TheoperationoftheSocialReformFundhas provided an opportunity to roll out and implement the IPS model in all nine Community Healthcare Organisations(CHOs)andinthenationalforensicmentalhealthservice.IPScouldbescaledupifthatprovesappropriateafterafullpositiveevaluationhasbeencompleted.
Training and vocational education supports TheHSE’sNew Directions – Personal Support Services for Adults with Disabilities Report(2012)included
peoplewithmentalhealthdifficulties,andtheprinciplesandmodelsdescribedinitarehighlyrelevantforpeoplewiththesedifficulties.16 It commits to developing services that are person-centred andsupportingthesocialinclusionofindividualsintheircommunitybybuildingpersonalcapacityandcompetencies. Where desired, services can provide bridgingprogrammestovocationaltrainingandotherformaleducationandlearningopportunities.ExistingresourcesshouldbeusedbytheHSEtoreconfigureexistingadultdaysupportsforpeoplewithcomplexmentalhealthdifficulties,inlinewiththeNew Directions policy. Peer-provided and peer-led supports could have an important role to play in the range of servicesoffered.
Income protection and social welfare In AVFC, measures were put forward to protect the incomeofindividualswithmentalhealthdifficultiesthatcentredoninformingthemaboutthebenefitstowhichtheyareentitled.AVFC also recognised that help and advice are needed to ensure such individuals aresupportedbythesocialwelfaresystem,includingtheflexibleprovisionofsocialwelfarepayments.Theseissuesarestillprevalent,andacrucialrequirementisthatincomesupportsbeflexibletoallowpeopleenterorleavetheworkforceintimesofillnesswithconfidenceandsecurity.
Peer-led, peer-run and community development projects Peer-ledandpeer-runprojectsinthecommunityareimportant ways to promote the social inclusion of peoplewithamentalhealthdifficulty.Specifically,therearekeysocialandcommunityactivitiesthatcanenhancepositivementalhealthbygeneratingsocialcapitalandpromotinganindividual’ssocialinclusionand mental health recovery. Such networks are a bufferagainststress,whilecreatingopportunitiesfor meaningful social engagement and personal development.Severalpeer-ledprojectsexistbutaremainlyvolunteer-ledinitiativesthatdonothaveaccesstoreliablefundingstreams.Itisimportanttofundpeer-ledprojects,butfundingmustbeinformedbyprojectevaluationandhavestandardoperatingguidance (SOG) in place.
16NationalWorkingGroupNewDirections.New Directions–ReviewofHSEDayServicesandImplementationPlan2012–2016–WorkingGroupReportFebruary2012(2012).Availableat:http://www.inclusionireland.ie/sites/default/files/documents/Reports/new_directions.pdf
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Sharing the Vision | A Mental Health Policy for Everyone
69
66Tailoredmeasuresshouldbeinplaceinrelevantgovernmentdepartmentstoensurethatindividualswithmentalhealthdifficultiescanavail,withoutdiscrimination,ofemployment,housingandeducationopportunitiesandhaveanadequateincome.
67 Localauthoritiesshouldliaisewithstatutorymentalhealthservicestoincludethehousingneedsofpeoplewithcomplexmentalhealthdifficultiesaspartoftheirlocalhousingplans.
68The Department of Health and the Department of Housing, Planning and Local Government, in consultationwithrelevantstakeholders,shoulddevelopajointprotocoltoguidetheeffectivetransitionofindividualsfromHSE-supportedaccommodationtocommunityliving.
69InconjunctionwithsupportsprovidedbytheHSEincludingIntensiveRecoverySupportteams,sustainableresourcingshouldbeinplacefortenancy-related/independentlivingsupportsforserviceuserswithcomplexmentalhealthdifficulties.
70ThehousingdesignguidelinespublishedbytheHSEandtheHousingAgencyin2016topromoteindependentlivingandmentalhealthrecoveryshouldbeareferencepointforallhousing-relatedactionsinSharing the Vision.
71
AsustainablefundingstreamshouldbedevelopedtoensureagenciescanworkeffectivelytogethertogetthebestoutcomesfortheindividualusingtheIndividualisedPlacementSupportmodel,whichisanevidence-based,effectivemethodofsupportingpeoplewithcomplexmentalhealthdifficultiestoachievesustainable,competitiveemploymentwheretheychoosetodoso.
72 ThecurrentHSEfundingprovidedfordaycentresshouldbereconfiguredtoprovideindividualisedsupportsforpeoplewithmentalhealthdifficultiesandbeconsistentwiththeNew Directions policy.
73
InlinewiththestrategicprioritiesoftheComprehensiveEmploymentStrategyforPeoplewithDisabilities,thewaypeoplecomeon/offincomesupportsshouldbestreamlinedtomaximiseentryorre-entrytotheworkforcewithconfidenceandsecurity.Thisshouldhappenwithoutthreatoflossofbenefitandwithimmediaterestorationofbenefitswheretheyhaveanepisodicconditionormustleaveajobbecauseoftheirmentalhealthdifficulty.
74 TheHSEshouldcontinuetodevelop,fundandperiodicallyevaluateexistingandnewpeer-led/peer-runservicesprovidedtopeoplewithmentalhealthdifficultiesacrossthecountry.
Domain: Social inclusion recommendations
71
Chapter 5
Accountability and Continuous Improvement Domain
Sharing the Vision | A Mental Health Policy for Everyone
Chapter 5 | Accountability and Continuous Improvement Domain
72
Figure 5.1: Outcomes accountability and continuous improvements
Continuousimprovementis futurefocussedanddrivenbyadequatelyresourcedinnovationacross the mental health system
and related sectors
Services that deliver consistently highqualitypersoncentred
supports that meet the needs and havetheconfidenceofservice
users and FCSs
Mentalhealthisembedded asanationalcrosscuttingprioritythatiseffectivelyintegrated
into the key policies and settingsinsociety
Outcome 4(a)
Dynamic performance reportingprovidesvisibility
of the performance and impact of Sharing the Vision
Outcome 4(b)
Outcome 4(d) Outcome 4(c)
Introduction
Positivementalhealthisnotamatterforthehealthsectoralonebutsitsinamuchbroadercontextofdecisionsmadeacrosstherelevantpublicservices.Thesecanimpactpositivelyornegativelyonthewellbeingofthepopulationgenerally,aswellasonthe mental health of individuals living with a mental healthdifficulty.Mentalhealthpolicymustthereforebeanintegralnationalcross-cuttingpriority.Assuchitneedstobeintegratedintoallkeyandrelevantpoliciesandsettingsinsociety.Thisdomainfocusesontheorganisationalprocessesneededtoimplementand track delivery of the reforms proposed with an emphasisoninnovationandcontinuousimprovement.
Aspartoftheimplementationplanning,allrecommendationsandassociatedactionshaveassignedleadresponsibilitiesacrossrelevantgovernment departments and agencies, as set out intheImplementationRoadmap(AppendixIII).SuchgovernancewillbereinforcedbythesettingupoftheNationalImplementationManagementCommittee,representativeofcross-sectoralinterestsaswellaspatients,FCSandpeerorganisations.Figure5.1showstheoutcomesforthedomainaccountabilityandcontinuousimprovements.
Sharing the Vision | A Mental Health Policy for Everyone
Accountability and continuous improvement Theneedtobuildamoreaccountableandtransparenthealth service is a focus of Sláintecare and is also a keyobjectiveforSharing the Vision.Patients,FCSandthewiderpublicneedtohaveconfidenceintheinformationavailablesothattheycanjudgethepaceandimpactofthisrefreshedpolicyandthedifferenceitmakestothehealthandwellbeingofpatients.Policyimplementationandreforminthefuturemustmaintaintheeffortandbuildontheevidenceof‘whatworks’inthepresent.Continuousimprovementandthe capacity to address new challenges depend on innovationandnewwaysofworkingacrosssystemsand sectors.
Thereareanumberofestablishednationalinitiativestosupportinnovationinreplicating‘whatworks’.Theemphasisnowmustbeonfuture-focused,continuousimprovementdrivenbyadequatelyresourcedinnovationwhileactivatingtheprocessesandskillstosupportchange.Thefocusoncontinuousimprovement must extend to other sectors contributingtothewellbeingofthepopulation,supportingpeoplelivingwithamentalhealthdifficultywhile they recover.
Governance leadership and organisation AVFCrecommendedthataNationalMentalHealthDirectoratebeestablishedundertheleadershipofanationaldirectortoprioritisethementalhealthagenda and to drive it centrally within the HSE. ThiswasachievedwiththeappointmentofthefirstHSEnationaldirectorin2013.Aspartofstructuralchangesannouncedin2016,anewnationaldirectorofcommunityhealthserviceoperationssubsumedtheoperationalrolesoftheexistingnationaldirectorsforprimarycare,socialcare,healthandwellbeing,andmentalhealth.Thesechangesenabledtheexistingnationaldirectorstoworkcloselywiththechiefstrategyandplanningofficertoplantheintegrationof acute care, primary care, social care, mental health andhealthandwellbeing.Thechangesintroducedbythe HSE were designed to enhance performance and management across the health service and to integrate HSEservicestodeliverthehealthprioritiesoutlinedinthe Programme for Government.
There is an ongoing need for a dedicated focus on
mentalhealthstrategy,withnational-levelleadership,togivetherequiredattentiontooperationalissuesandtomaximiseintegrationacrosscaregroups.HealthAreaswilloperateonanintegratedbasisdeliveringservicesbaseduponpopulationneeds.Mentalhealthserviceswillnolongerbeseenasaseparateservicewithinalargerstructurewhereintegrationandcohesionareaspiredtobutnotalwaysdelivered. The model for delivery of care proposed suggests that mentalhealthservicesshouldaligntoexistingandemerginghealthstructurestoenabletheprovisionof community health and social care services across primary care, social care, mental health, and health andwellbeinginamorecoordinatedandintegratedway.Consequently,MentalHealthServiceswillfullyparticipateintheSláintecare programme reforms and beatthecentreofthenewstructuresofhealthcaredelivery.Themovetocollaborativeandcross-boundaryworkinginCommunityHealthNetworks(CHN),operatingatlowerpopulationlevelswithinRegionalHealthAreas,willencourageprimaryandsecondarycaretobealignedanddeliveredclosertothe community.
AVFCstipulatedthatforgeneraladultmentalhealthservicesthereshouldbeonecommunitymentalhealthteam(CMHT)forsectorpopulationsofapproximately50,000.ThisremainsvalidandprovidesagoodbasisforsynergywiththeCHNmodel,whichalsooperatestoacatchmentpopulationof50,000,therebyprovidingscopefor‘co-terminosity’ofservicedelivery.Effectiveorganisationalstructuresareessentialtodeliverintegratedmentalhealthservicesandtobringaboutthereformandimplementationoftheassociatedrecommendationsproposedinthisrevisedpolicy.Butthereisaneedtoprioritisetheimplementationofrecommendationsandactionsthatwill directly impact on the lives of people with mental healthdifficultiesassoonaspossibleandnottowaituntilallstructuralchangesarefinalised.
Inordertoreconcilefullintegrationofmentalhealthservices within the Sláintecare reforms with the need forgovernanceandanevidence-basedapproach,theimplementationofSharing the VisionwillbeoverseenbytheNationalImplementationandMonitoringcommittee.AstheSláintecare programme evolves, it willbetheworkoftheNationalImplementationandMonitoringCommitteetoreconsiderandre-evaluatehow to ensure governance for mental health services within the programme.
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Chapter 5 | Accountability and Continuous Improvement Domain
Patient Safety InNovember2015,theGovernmentapprovedamajorprogrammeofpatientsafetyreformswhichincludedtheestablishmentofaNationalPatientSafetyOffice(NPSO) in the Department of Health. The NPSO wasestablishedinDecember2016tooverseeaprogrammeofpatientsafetymeasures. Ensuringthedeliveryofhighqualityandsafehealthand social care is a top priority of the Department andtheNPSO.ThepatientisatthecoreofpolicydecisionsandtheDepartmentiscommittedtoworking with the HSE and other key stakeholders in drivingthedeliveryofamajorprogrammeofpatientsafetyreforms.Theseareenabledbydevelopingandintroducingeffectivepatientsafetypoliciesandlegislationthat–
• are founded upon improving understanding of safetybydrawingintelligencefrommultiplesourcesofpatientsafetyinformation,
• promote engagement and involvement of service usersandproviderstoimprovepatientsafetythroughout the whole system,
• ensuresprovidersdelivereffectiveandsustainablechange in the most important areas,
• promotescollaborationtoachievehealthprioritiesandcontributetowidersocialandeconomicgoals,sothatpolicyalignswithnationalinitiativessuch as Sláintecare
• promotesapositivecultureofpatientsafetywherethereisgoodteamwork,openness,patient-centred approaches and support for learning.
The work of the NPSO includes progressing aprogrammeofpatientsafetylegislation,theestablishmentofanationalPatientSafetyAdvocacyService,settingupanIndependentPatientSafetyCouncil,extendingtheclinicaleffectivenessagenda,themeasurementofpatientexperience,andtheintroductionofpatientsafetysurveillance. HSE’s Patient Safety Strategy The HSE Patient Safety Strategy 2019-2024, launched bytheHSEBoardinDecember2019,setsoutstrategycommitmentsandactionstoimprovethesafetyofallpatientsbyidentifyingandreducingpreventableharmwithinthehealthandsocialcaresysteminIreland.Itrecognisesthatkeytopatientsafety and person-centred care is a culture where patients,carers,families,advocatesandhealthcare
professionals work together in partnership to ensure positivepatientexperiences,maximisepositivehealthoutcomes and minimise the risk of error and harm. The goalistoachieveaculturethatwelcomesauthenticpatient-partnershipintheircareandintheprocessofco-producing, delivering and improving care. Leadership in Safe, High Quality Mental Health Care Leadership, governance, clinical commitment and clinicaleffectivenessapproachesarerequiredtodeliversafe,highqualitymentalhealthcareatnational,regional and local level. There is a need for investment incapacitydevelopmentforqualityandpatientsafetyin our mental health services. Thisrequiresthateachservicehasadedicatedpatientsafetyandqualityleadershipandoversightfunction,whichencompassesbothpatientsafetyelements(e.g.complaints procedures, advocacy, and management of riskandadverseevents)andqualityelementssuchasstandards,clinicaleffectivenessguidelines,auditandkey performance indicators.
Disadvantage and service planning AVFC highlighted the need to take account of local deprivationpatternsinplanninganddeliveringmentalhealthservices.Thereisaneedforacontinuedemphasisonthisnotjusttopromotegreateraccountabilityandtransparencyinresourceallocation,butalsotosupporttheachievementofsomeoftheoutcomes regarding access to services and social
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Sharing the Vision | A Mental Health Policy for Everyone
inclusion.Takingdeprivationfiguresintoaccount,areasthathavepoorlevelsofprovisionforspecificservicesrelativetootherareaswillbeprioritised.Thismeansthatwhennewresourcesbecomeavailable,theywillbeallocatedbasedonneed.Thisallocationmodelshouldinclude the skill mix in mental health human resources. Skillmixanalysisshouldbecarriedouttodeterminetheoptimumnumberandtypeofhealthandsocialcareprofessionals in any given service. The emphasis will beonmeetingtheneedsofpatientsratherthanfillingquotasforanysingleprofessionalgroup.
Physical infrastructure for mental health services AsnotedinDomain2,Sharing the Vision envisages greater use of appropriate mainstream premises, such as family resource centres, schools and community centres in the delivery of a more individualised and recovery-oriented mental health service. Modern primarycarecentresandothernew-buildfacilitiesshouldbeusedwherepossibletoprovideagood-qualitybuiltenvironmentforpeopleaccessingandstaffworkinginmentalhealthservices.Approvedcentresoracuteunitsareaparticularpartofthementalhealthinfrastructureneedingspecialattention.Many psychiatric units in acute hospitals were not purpose-builtandweredesignedasstandardhospitalwards and simply designated as psychiatric units. This environment did not take into account the needs of peoplewithmentalhealthdifficulties,particularlyfor access to outside space, and, indeed, more space generally.
Akeyelementofcontinuousimprovementisthereforethe provision of physical environments which are conducive to recovery and which create a good working environment for professionals delivering services.Asageneralprinciple,multi-stakeholderservicedesignmethodologiesshouldbeemployedwhenmentalhealthpremisesandinpatientunitsarebeingdesignedorrefurbished.17
Measuring performance Toestablishtargets,allocateresourcesandsetmentalhealthpriorities,standardisedperformanceindicators (PIs) and targeted service outcome data arerequired.Thesemustbesetatnationallevel,led
andcoordinatedbytheDepartmentofHealth.TheformatofprogressreportingshouldalsofacilitatethecaptureofuniqueissuesinRICOareas.Animportantcomponent of measuring and monitoring performance isregulartrackingoftheviewsofserviceusersabouttheir experiences with the mental health system and the impact of these experiences on their health and wellbeingoutcomes.Itisalsoimportanttocapturetheexperiences of FCS to ensure that they understand the supportbeingaccessedbytheirrelativeorfriendandthe expected outcomes.
Complaintsrepresentavaluablesourceofinformationontheperformanceofasystemandcanofferuseful guidance for service improvement. Dealing effectivelywithcomplaintscanbeapowerfulwaytoprovideavisibleresponseinrelationtocontinuousimprovement.Duringtheconsultationprocess,acommonthemethatemergedsuggestedthatattimespeoplewithmentalhealthdifficultiesmayfinditdifficulttomakeacomplaint.Modelsforcomplaintshandlingthatincludebetterqualityinformationandtraining in making complaints do exist. Each HSE regionhasanindependentcomplaintssystembutthereneedstobeawarenessofthe‘yourserviceyoursay’complaintsprocess,andthisprocessmustbeclearabouthowtomakeacomplaintandmustsupportindividuals who do not know how to make a complaint.
Capturing and embedding innovation ThementalhealthdivisionoftheHSEhasbeenworkinginpartnershipwiththeCentreforEffectiveServices(CES)since2015toimplementchangeandwider reform in line with AVFC. This partnership has resultedintheco-establishmentofaStrategicPortfolioandProgrammeManagementOffice(SPPMO).18 A core functionofthispartnershipisfosteringinnovationandtheapplicationandadaptationofevidence-informedmethodstosecuresustainableimplementationandimprovement in delivering mental health services. PatientandFCSengagementisintegraltoallserviceimprovementprojects,withaconsistentfocusonthedevelopment of recovery-focused services through co-production.
Afurtherinitiativetofosterinnovationandcontinuousimprovementisthesocialreformfund(SRF).Thiswas
75
17PublicServiceDesign.Availableat:https://www.socent.ie/wp-content/uploads/2015/10/PSD_manual_UK_LR.pdf.(Accessed14February2020).18MHDSPPMOBackground:MentalHealthDivisionStrategicPortfolioandProgrammeManagementOffice”.HSE.Accessed14February2020.Availableat:https://www.hse.ie/eng/staff/resources/mentalhealthdivisionsppmo/
Chapter 5 | Accountability and Continuous Improvement Domain
intendedtosupportthereconfigurationofservicestowards more person-centred supports which are alsotransparent,accountableandcost-effective.ThementalhealthcomponentoftheSRFhasfocusedonthreeareas:advancingandembeddingrecoverypractices,implementingemploymentsupportsforpeoplelivingwithamentalhealthdifficultythroughdeliveryoftheIPSmodeloutlinedinDomain3(socialinclusion),andcommunity-basedliving,whichsupportspeoplewithmentalhealthdifficultiestoidentifyandaddresstheirhousingneedsandtomakethebestoftheiropportunitiestoliveindependentlyinthecommunity.
Thereareotherareasofinnovationinthementalhealth services and the wider mental health system. Itisimportantthatinformationisgatheredonallinnovationssothatlearningcanbesharedandreplicated,andduplicationavoided.AllinnovationinmentalhealthservicesshouldbedrivenbytheStrategicPortfolioandProgrammeManagementOffice,sothatproveninnovationscanbeintroducedmorewidelyandthepracticesorserviceswhichtheysupersedecanbeceasedormodifiedappropriately.
Meeting standards in quality frameworks and best practice guidelines In2008theDepartmentofHealthandtheHSEcommittedtothedevelopmentofahealthservicecharter.TheNationalHealthcareCharter,You and Your Health Service,wasdevelopedbypatientadvocacygroupsandotherinterestgroupstodescribewhatpatientscanexpectwhenusinghealthservicesinIreland. The charter focuses on eight principles that underpinhigh-quality,people-centredcaretoinformandempowerindividuals,familiesandcommunitiestolookaftertheirownhealthandinfluencequalityhealthcareinIreland.Mentalhealthprinciplesmustbepart of the charter so that people using mental health services know what to expect from those services. Theseprinciplescanbeincludedinstaffcontractsandininductiontoencouragequalityinmentalhealthservice delivery.
The Quality Framework for Mental Health Services in Ireland(MentalHealthCommission,2007),theJudgement Support Framework (Mental Health Commission,2015),andtheBest Practice Guidance
for Mental Health Services(HSE,2017)allplayanimportantroleincontinuousimprovementandmeasurement/monitoringofdesiredstandardsandpracticesinmentalhealthcareinIreland.ThesereportswillaugmenttheworkoftheNationalImplementationandMonitoringCommitteeandconsiderationoftheirrecommendationswillaidthedevelopmentofstandardised improvement systems that are aligned to the outcomes focus in this policy.
Enablers Newpolicyrecommendationsareimplementableandachievablewhenthereareoverarching‘enablers’tosupportandencouragechange.Thefollowingenablerswillbeimportantleversforimplementation:
(1) Resource allocation Recenthealthsystemthinkinghasemphasisedtheneedtomoveawayfromtraditionalincrementalbudgetingarrangements,ofteninblocksums,andtowardsamorestrategicapproachtoinvestinginhealthpromotion,earlypreventionandcareservices. Sláintecare sets out a very extensive agenda of strategic planning and commissioning reform to supportthegoalofasingle-tierintegrateduniversalhealthcare system. Sláintecare seeks to: • develop a way to determine resources and
integratedservicesonaregionalbasis• developanintegratedregionalresourceallocation
formula • designproposalsformulti-annualbudgeting• designasystemofpopulation-basedfunding• benchmarkquantumofhealthandsocialcare
budgetinacomparativeinternationalcontext• advancecommunity-basedcostingandworkwith
key health stakeholders and academic researchers todevelopanactivityandcostdatabaseforhealth and social care in Ireland
For many sectors of the health and social care system theseapproacheswillmarkasignificantdeparturefromthetraditionalresourceallocationmethodologiesatnational,regionalandservice-providerlevel.Building on the original AVFCrecommendations,anationalmentalhealthresourceallocationsystemisnowinplacewhichinformsdecisionsontheprioritisedallocationofavailableresources.Itrepresentsavaluableplatformonwhichtobuildthecomparativecasesfortheinvestmentrequiredintheserviceand,ultimately,todemonstratetheoutcomesachieved.
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Sharing the Vision | A Mental Health Policy for Everyone
(2) Mental health information systems Domain2emphasisestheimportanceofinformation-sharing,fromtheinitialpointofaccessrightthroughtoaftercarearrangementsandtheprocessofdischarge(asappropriate).Effectiveinformation-sharingwillavoidthefrustrationofpatientsoftenhavingtorepeatthedetailsoftheircircumstances‘fromscratch’witheach professional encountered. It will also facilitate partnershipandinterworkingbetweendifferentservicesandprofessionals–contributingtobetterorganisationofthementalhealth‘system’thatmayhelpincreasednumbersofpeopletoachieverecovery.
NationalmentalhealthserviceswithintheHSEhavelongrecognisedtheneedforasinglenationalinformationsystemforalloftheabove.Considerableworkhasbeenundertakenwithinmentalhealthservices to develop and deliver on the vision for a mentalhealthelectronichealthrecord(MHEHR).InseekingtodeveloptheMHEHR,HSEnationalmentalhealthserviceseffortswereandcontinuetobeinformedbyboththeeHealth Strategy for Ireland (2013)andtheHSE’sKnowledge and Information Strategy(2015). (3) ICT enabled health systems TheestablishmentoftheMentalHealthDivisionin2013ledtotheinclusioninthe2014ServicePlanofaninterimData-GatheringSolutionProjectwiththeaimofsupportingtheCMHTstomanagetheperformanceinformationrequiredofthemforreportingontheServicePlan.AspartoftheInterimData-GatheringSolutionProject,aproofofconceptinitiativewasconductedwiththreeCommunityMentalHealth Teams across CAMHS, General Adult, and PsychiatryofLaterLife(PoLL)services.ThisinitiativeledtoanagreementwiththeOfficeoftheChiefInformationOfficerforaframeworkforICT-enabledsupports for the mental health services which included threeprojects:• NationalMentalHealthICTInfrastructure
ImprovementProject• NationalMentalHealthe-RosteringProject• NationalElectronicMentalHealthRecordProject.Progressinalloftheseareasmustbeprioritisedtocontributestronglytotheambitionoutlinedwithinthispolicyforongoingreformandcontinuousimprovement.
(4) Digital technologies Throughout Sharing the Vision, thepotentialforapplicationofdigitaltechnologieshasbeenrecognised as an aid to core service delivery. The use of digital technologies can support individualised care, provide online professional development and enhanceonlinetherapeuticsupportinterventions.Digitalinteractionscaninvolvedirectinteractionbetweenahealthprofessionalandthepatient.It also encompasses mental health professionals supportingprimarycareproviderswithexpertisewithvariousconsultations.Mentalhealthcarecanbedeliveredinalive,interactivecommunication.Itcanalsoinvolverecordingmedicalinformation(images,videos, etc.) and sending this to a distant site for later review.Digitalhealthhelpsmeetpatients’needsforconvenient,affordableandreadily-accessiblementalhealthservices.Itcanbenefitpatientsinanumberofways, such as: • Improve access to mental health specialty care • Helpintegratebehaviouralhealthcareand
primarycare,leadingtobetteroutcomes• Reducetheneedfortripstohospitals• Reducedelaysinaccessingcare• Improvecontinuityofcareandfollow-upHowever,whenpromotingthepotentialofutilisingdigitalhealthinterventions,itisacknowledgedthatsafetyandriskissuesneedtobeconsidered.
(5) Mental health research Mentalhealthresearchispotentiallyaverybigfield,rangingfromresearchongeneticsandpharmacological treatments to the outcomes produced bymentalhealthservices.AVFCprioritisedtwoareasof mental health research in Ireland that needed furtherinvestment.Thesearepopulationhealth(PH)researchandhealthservices(HS)research.Thefirstisafieldwhichanalyseshealthoutcomesandpatternsofhealthdeterminantsaswellasthepolicyinterventionslinking them. The second examines how people get access to healthcare, how much that care costs and what happens as a result of the care. These two areasofresearcharereferredtocollectivelyas PH&HSresearch.
As part of the process of developing a strategy, researchprioritiesformentalhealthPH&HSresearchshouldbeidentified.AllthoseworkinginthementalhealthservicesshouldbeencouragedtogetinvolvedinmentalhealthPH&HSresearchandthereshouldbe
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Chapter 5 | Accountability and Continuous Improvement Domain
acontinuingfocusonensuringthatpeoplewithlivedexperienceofmentalhealthdifficultiesareinvolvedateverystageoftheresearchprocess.Theallocationofresearchfundinginthisareashouldreflectparityof esteem for mental health compared to other health conditions.
(6) Legislative reform The fundamental aim of mental health services is to protect, promote and improve the lives and mental wellbeingofallpatients.Peoplewithcomplexmentalhealthneedsare,orcanbe,particularlyvulnerabletoabuseandviolationoftheirrights.Whilelegislationiscreatedtoprotectthemostvulnerableinsociety,itisacknowledgedthatfurtherworkisrequiredtoensurethat all individuals accessing services, voluntarily or involuntarily,areguaranteedrespectandprotectionoftheir human rights.
Aprogrammeofcontinuouslegislativereformunderpins the modern mental health system articulatedwithinthispolicy.Legislationinvariousareasisbeingupdatedatpresent.TheMentalHealthAct2001iscurrentlysubjecttoreview;theAssistedDecision-Making(Capacity)Act2015isbeingupdated;andanewdecisionsupportserviceisbeingestablished.
Self-determinationisavitalpartofsuccessfultreatment and recovery. The Assisted Decision-Making (ADM) Capacity Act creates the right for a person whosecapacitymaybeinquestiontobesupportedtomaketheirowndecisions,andthereisanobligationonservicestofulfilthisright.TheguidingprinciplesoftheADMCapacityActincludethepresumptionofcapacityandtherequirementthatapersonshouldbegivenallpossiblesupporttomaketheirown decision. The Act provides for two categories of assistance to people with capacity issues to make theirowndecisions–adecision-makingassistant,andaco-decision-maker,whowouldbeasubstitutedecision-maker.Forchildren,managingpositiverisk-takingrequiresacollaborativeapproachwherethefamily, the child and mental health professionals work outapositiverisk-takingstrategyaspartofthecareplanning process.
Safeguarding vulnerable people Thenationalsafeguardingpolicy,Safeguarding Vulnerable Persons at Risk of Abuse – National Policy and Procedures(2014),appliestoallHSEandHSE-fundedservices.19Itrecognisesthatallvulnerablepeoplehavearighttobeprotectedagainstabuseandtohaveconcernsaboutabusiveexperiencesaddressed.Ithighlightsthatitistheresponsibilityofallserviceproviders, statutory and non-statutory, to ensure thatpatientsaretreatedwithrespectanddignity,and that they receive support in an environment in whicheveryeffortismadetopromotetheirwelfareandtopreventabuse.TheimplementationofthepolicyisunderpinnedbytheworkoftheHSENationalSafeguardingOffice.AnadultsafeguardinghealthsectorpolicyisbeingdevelopedbytheDepartmentof Health. This policy will cover all health services and it should inform the delivery of care in mental health services when it is complete.
Service users, self-harm and suicide Forhealthandsupportservicestoeffectivelyrespondto suicide and self-harm in the community, there mustbeaccesstotimelyandhigh-qualitydataonsuicideandself-harm.Thecollectionandreportingofincidentsofsuicideshouldbereviewedandrevised,toprovidetimelydataforenhancedandfocusedsuicidepreventionactionsinthecommunity.Thisisconsistentwith the Connecting for Life strategy.
Othercountrieshaverecognisedthepotentialofstrategicallyfocusingonlevelsandpatternsofself-harmandsuicidalityamongpeopleattendingmentalhealthservicesasaneffectivemeansofpotentiallyreducinglevelsofmorbidityandmortalitythroughstrategicserviceenhancementsandresponsesbasedontheavailabilityofgooddata.
Involuntary detention Most admissions to approved centres occur on a voluntarybasis,butsituationsstillarisewhereapersoncanbeadmittedtoanapprovedcentreinvoluntarily.
People with a diagnosis of mental illness have the same human rights as everyone else, including a civilrighttolibertyandautonomy.AccordingtotheNationalDisabilityAuthority,thepurposeofthe
19SafeguardingVulnerablePersonsatRiskofAbuse–NationalPolicyandProcedures:incorporatingservicesforelderabuseforpersonswithadisability.SocialCareDivision,HSE.(2014)
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Sharing the Vision | A Mental Health Policy for Everyone
ConventionontheRightsofPersonswithDisabilitiesistopromote,protectandensurethefullandequalenjoymentofallhumanrightsandfundamentalfreedomsbyallpersonswithdisabilities,andtopromote respect for their inherent dignity. It applies establishedhumanrightsprinciplesfromtheUNDeclarationofHumanRightstothesituationofpeoplewithdisabilities.Itcoverscivilandpoliticalrightstoequaltreatmentandfreedomfromdiscrimination,andsocialandeconomicrightsinareaslikeeducation,healthcare, employment and transport. These rights continuetoapplyforpeoplewhoaredetainedonaninvoluntarybasis.
RestrictiveinterventionsarestillinuseinIrelandinvariousapprovedcentresregulatedbytheMentalHealth Commission (MHC). The MHC recognises that anyinterventionemployedthatmaycompromiseaperson’slibertyshouldinallinstancesbethesafestandleastrestrictiveoptionoflastresortnecessarytomanagetheimmediatesituation.20Suchinterventionoughttobeproportionatetotheassessedriskandemployedfortheshortestpossibleduration.Fourmainareas of seclusion and restraint are currently in use in approved centres:
Seclusion
When a person is left alone in a room at any time where the exit door is locked, preventing person from leaving.
Physical restraint
When a person is prevented from free movement due to physical force applied by one or more persons.
Involuntary medication
When a person receives intramuscular or intravenous medication against their will.
Mechanical restraint 21
When a bodily restraint involving a device or special clothing is used to limit an individual’s free movement.*
While a zero restraint and seclusion service may not alwaysbeachievableduetosafetyrequirementsofserviceusersandstaff,thereareexampleswheremajorreductionsintheuseofrestraintareworkingeffectively.Therefore,ahigh-levelaimofthispolicy is to reduce the use of restraint and seclusion.
20CodeofPracticeontheUseofPhysicalRestraintinApprovedCentresIssuedPursuanttoSection33(3)(e)oftheMentalHealthAct2001.CodeofPracticeMentalHealthCommission(2009).
21MentalHealthCommission.SeclusionandRestraintReductionStrategy.Dublin,2014.Availableat:https://www.mhcirl.ie/File/Seclusion-and-Restraint-Reduction-Strategy.pdf
* MechanicalRestraintuseIrelandisactivelybeingphasedoutandisusedonlyinveryrarecircumstances.
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Domain: Accountability and continuous improvement recommendations
75Theorganisationofmentalhealthservicesshouldbealignedwithemergingintegratedcarestructuresunder SláintecarereformsincludingtheproposedsixRegionalHealthAreasandwithinthesetheCommunityHealthNetworkscorrespondingtopopulationsofabout50,000.
76Implementationofthispolicyoverthenexttenyearsshouldachieveare-balancingofresourcesandtakeaccountofpopulationdeprivationpatternsinplanning,resourcinganddeliveringmentalhealthservices.
77
A standardised set of performance indicators (PIs) directly aligned with the desired outcomes in Sharing the VisionandagreedstandardsofcareandqualityframeworksshouldbedevelopedbytheDepartmentofHealthandtheNationalImplementationMonitoringCommitteeaccountingforquantitativeandqualitativedeliveryofintendedoutcomes.
78 RegularsurveysofserviceusersandFCSshouldbeindependentlyconductedtoinformassessments of performance against PIs and target outcomes in this Sharing the Vision.
79Informationontheprocessofmakingacomplaint,includingnecessarycontactdetails,shouldbevisible,accessibleandwidelyavailableinavarietyofmedia,languagesandformatsformaximumaccessibilityinallmentalhealthservicesettingsandinotherfora.
80 Acultureofopendisclosuretosupportpatientsafetyisembeddedinmentalhealthservices.
81 Trainingshouldbeprovidedforservicesusersandstaffonmakinganddealingwithcomplaints.
82 MentalhealthservicesshouldensurethattheprinciplessetoutintheNationalHealthcareCharter, You and Your Health Service,areembeddedinallservicedelivery.
83FutureupdatesoftheQualityFramework,theJudgementSupportFrameworkandtheBestPracticeGuidanceshouldbeconsistentwiththeambitionandthespecificoutcomesforthementalhealthsystem set out in this policy.
84
TherelevantbodiesshouldcometogethertoensurethatthemeasuresfortheQualityFramework,theJudgementSupportFramework,theBestPracticeGuidance,Sharing the Vision PIs and performance system,andanyfuturemeasurementsystemsarealignedandthattherequireddataisderived,wherepossible,fromasinglecommondataset.
85TheworkunderwayatnationalleveltodevelopacostandactivitydatabaseforhealthandsocialcareinIrelandshouldprioritisementalhealthservicestoleveragedevelopmentalworkalreadyunderwayandsupporttheevolutionofoutcome-basedresourceallocation.
86 ANationalMentalHealthInformationSystemshouldbeimplementedwithinthreeyearstoreportonthe performance of health and social care services in line with this policy.
87TheDepartmentofJusticeandtheImplementationandMonitoringCommittee,inconsultationwithstakeholders,shoulddeterminewhetherlegislationneedstobeamendedtoallowforgreaterdiversionofpeoplewithmentalhealthdifficultiesfromthecriminaljusticesystem.
88Trainingandguidanceshouldbeprovidedtostaffonthepracticeofpositiverisk-taking,basedontheprinciplesoftheAssistedDecision-Making(Capacity)Act2015,wherethevalueofpromotingpositiverisk-takingisrecognisedbytheMentalHealthCommissionregulator.
Sharing the Vision | A Mental Health Policy for Everyone
81
89 Accesstosafeguardingteamsandtrainingshouldbeprovidedforstaffworkinginstatutoryandnon-statutorymentalhealthservicesinordertoapplythenationalsafeguardingpolicy.
90TheJusticeandHealthsectorsshouldengagewiththecoroners,theGardaSíochána,theNationalOfficeforSuicidePrevention,theCSOandresearchbodiesinrelationtodeathsincustody,recordingdeathsbysuicideandopenverdicts,tofurtherrefinethebasisofsuicidestatistics.
91Significantimprovementsshouldbemadeinthemonitoringandreportingoflevelsandpatternsofself-harmandsuicidalityamongpeopleattendingmentalhealthservices,toinformacomprehensiveandtimelyserviceresponsetoeffectivelyreducelevelsofharmanddeath.
92 Inkeepingwiththeevolvingunderstandingofhumanrightstoempowerpeopleandimprovequalityofcareinmentalhealthcarefacilities,legislationmustbeupdatedandadditionalsupportsputinplace.
93ANationalPopulationMentalHealthServicesResearchandEvaluationStrategyshouldbedevelopedandresourcedtosupportaportfolioofresearchandevaluationactivityinaccordancewithprioritiesidentifiedintheresearchstrategy.
94
Inordertobringaboutchange,astrategicapproachisrequiredinvolvingthenecessaryskillsinchangemanagement.ThisapproachhasbeendevelopedintheformerHSEMentalHealthDivisionStrategicPortfolioandProgrammeManagementOfficeandshouldbemainstreamedandembeddedinthewiderHSE.
95
TheinitiativesundertheformerMentalHealthDivisionStrategicPortfolioandProgrammeManagementOffice(SPPMO)andtheongoingSocialReformFund(SRF)shouldbegatheredtogetherandmadeavailablebothtoencouragefurtherinnovationandtoavoidduplicationinthepublicserviceand NGO sectors.
96Innovationswhichhavegoodevidenceforclinicaland/orsocialandcosteffectivenessshouldberolledoutnationally.Thiswillrequirethechangingofpracticesandmodificationorcessationofserviceswhicharesupersededbythenewformofdelivery.
97Mentalhealthservicesshouldmakeuseofothernon-mentalhealthcommunity-basedphysicalfacilities,whicharefitforpurpose,tofacilitatecommunityinvolvementandsupporttheimplementationoftheoutcomes in this policy.
98Capitalinvestmentshouldbemadeavailabletoredesignorbuildpsychiatricunitsinacutehospitalswhichcreateatherapeuticandrecoverysupportiveenvironment.Itisessentialthatallstakeholdersareinvolvedinastructuredservicedesignprocessforallredesignsornewbuilds.
99Anational‘whole-of-government’ImplementationCommitteeshouldbeestablishedwithstrongserviceuserandVCSrepresentationtooverseetheimplementationoftherecommendationsinthispolicyandto monitor progress.
100AjointreviewofthetwospecialisttrainingprogrammesbytheIrishCollegeofPsychiatristsofIrelandandtheIrishCollegeofGeneralPractitionersshouldbeundertakentodevelopanexemplarmodelofmental health medical training and integrated care.
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Implementation
Sharing the Vision | A Mental Health Policy for Everyone
Chapter 6 | Accountability and Continuous Improvement Domain
22NorthernIrelandAuditOffice.PerformanceManagementforOutcomes:AGoodPracticeGuideforPublicBodies(2018).Availableat: https://www.niauditoffice.gov.uk/sites/niao/files/media-files/NIAO_performance%20management%20for%20outcomes.pdf
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Figure 6.1: Good practice guide – key areas for performance management
Introduction
AVisionforChange(2006)containednoimplementationplanandthisresultedinpoormeasurementofoutcomes.Theextensiveprocessofconsultation,reviewandvalidationundertakenbytheOversightGroupunderlinedtheneedtoensureeffectiveimplementationoftherevisedpolicy.Therefore,underpinningthedeliveryofthekeyoutcomesenvisagedbySharing the Vision is performance management. The NorthernIrelandAuditOfficepublishedagoodpracticeguideandstatesthatperformancemanagementoccurswithinsixkeyareas(Figure6.1).22Thispolicyrecognisestheneedforcontinuingmonitoringandperformance management.
Understanding the environment
Establishpriorities,withserviceuserinput,thatarerelevanttotheoutcome-focusedrecommendationscontainedinthispolicy.
Setting priorities Implementrecommendationsthatmattertotheserviceusernottheorganisation(outcomesasopposedtooutputs).
Allocating resources and understanding
levers for action
Moveawayfromhigh-leveldecisionsaboutfundingandtowardsafocusontheoutcomesbeingachieved.Alignspendingwithdeliveryplansbuiltuponinter-agencyconsultation.
Performance managing projects
Work with key partners to share the vision with all service providers, encouragingacultureofreportingbothpositiveperformanceandpoorperformance.
Monitoring of progress
Effectiveperformancethatismonitoredregularlyandreviewedagainstcriteriathatmeasuresimplementation.
Making improvements
Put mechanisms to evaluate good performance or under-performance in place.Implementfluidresourceallocationandmovetosupportservicesthatperformwell.Capturepoorperformancetrendstodeterminerequiredcorrectiveactions.
Making improvements
Put mechanisms to evaluate good performance or under-performance in place.Implementfluidresourceallocationandmovetosupportservicesthatperformwell.Capturepoorperformancetrendstodeterminerequiredcorrectiveactions.
Sharing the Vision | A Mental Health Policy for Everyone
National Implementation and Monitoring Committee AssetoutintheIntroductiontothisdocument,aNationalImplementationandMonitoringCommittee(NIMC)istobeestablishedtooverseeimplementationofthepolicyandmonitorprogressatnationallevelandstrategicallyacrosstheHSE.TheCommitteewillbemandatedtodrivereconfiguration,monitorprogressagainst outcomes and deliver on the commitments madeinthispolicy.ItisexpectedthattheCommitteewill work with partners to evaluate performance against the key performance indicators, check overall progressguidedbyresearchandlearningfrombestpractice,andgatherinformationonexamplesofbothgoodandbadpractice.Itisonlywhenthesemechanismsareinplacethatthesystemwillbeinapositiontorespondeffectivelytosupportthementalhealthneedsofthewholepopulation.
ItisenvisagedthattheNIMCwillbefullyrepresentativeofthosestakeholdersprincipallyinvolvedinensuringeffectivedeliveryofthepolicyrecommendations,includingstrongserviceuserandVCSrepresentation.WeoutlinebelowtheindicativecompositionoftheNIMCmembership:
• Serviceusers/advocacyorganisations• HSE • DepartmentofHealth/Sláintecare • DepartmentofJusticeandEquality• DepartmentofEducationandScience• Department of Housing, Planning and Local
Government • DepartmentofEmploymentandSocialProtection• Housing Agency • ReceptionandIntegrationAgency• HealthResearchBoard• College of Psychiatrists of Ireland • IrishCollegeofGeneralPractitioners• NationalOfficeofSuicidePrevention. TheNIMCwillmeetregularlyandpublishaprogressreportontheimplementationstatusofSharing the Vision.
HSE Sharing the Vision structure ToensureongoingoperationalimplementationofrecommendationscontainedinSharing the Vision onaday-to-daybasis,itisproposedthattheHSEestablishastructuretoassisttheNIMCindrivingimplementationoverthetermofthepolicy.TheHSEstructurewillreportto,andparticipatein,theNIMC and will ensure that the policy programmes are deliveredinlinewiththeimplementationplanagreedwith the NIMC to include key performance indicators andregularprogressreportsasrequired.
Implementation roadmap Sharing the VisionincludesanImplementationRoadmapwith outcome indicators that will encourage alignment betweendifferentservices.Theroadmapallocatesownershipofrecommendationstoleadagenciesandsetstime-boundimplementationtargetsagainsteachrecommendation.
Focusingonearlyinitiationandcompletiontargets, theroadmapisbasedonananalysisofeachofthe100recommendationsinthepolicy.It:• indicateswhererecommendationsarealready
complete • assignsaproposedcompletiontimeframeto
everyrecommendation/associatedactionthat is either •short(18months)•medium(36months)or•long(36months–10years).
Someofthe99recommendationsarefarreachingandsosmalleractionsareassignedtoenableimplementation.Thisworkhasalsoprovidedthebasisforacostanalysisandbudgetingexercise,focusingontherecommendationstargetedforcompletionoverthenext18months.ThefulllistofrecommendationsandtheirassociatedimplementationandcompletiontimeframesisincludedatAppendixIIIofthisdocument.
The HSE Sharing the VisionstructureandtheNationalImplementationandMonitoringCommitteewill:
• Developadetailedimplementationplantoensurethatthedeliveryofallrecommendationsisplannedandmanagedeffectivelywithappropriate•leadresponsibilityallocation
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Chapter 6 | Accountability and Continuous Improvement Domain
•actions• outputs • outcomes •prioritisation•timelines• key performance indicators.
• Ensurethatimplementationactionsarekeptunder review for ongoing appropriateness.
• Develop an Outcomes Framework to allow for ongoingevaluationoftheimpactof Sharing the Vision.
• AssessonacontinualbasistheexistingcapacityandrangeofservicesavailabletodeliverontheobjectivesofSharing the Vision.
• Developariskregisterandmitigationplan.• Identifyandfosterthedisseminationofinnovative
high-qualitymentalhealthpracticeinIreland.• Researchinternationalbestpracticemodelsto
serveasbenchmarksofmentalhealthservicesinIreland.
• BeaccountabletogovernmentforoveralldeliveryoftherecommendationsofSharing the Vision.
The HSE Sharing the Vision Structure will providecostingsforallmedium-andlong-term
recommendations;thesewillbeincorporatedintotheImplementationPlanatanearlystagetoensurethatthedeliveryofthepolicyisfullycosted.Additionally,itshouldbenotedthattheimplementationofthepolicyoverthemedium-andlong-termwillbesubjecttosecuringresourcesintheannualestimates.
Recognisingtheoutcomesfocuswhichwasattheheart of Sharing the Vision, it is considered that the development of the Outcomes Framework is an essentialcomponentintheimplementationandevaluationoftherevisedpolicy.Thefourdomainschosenandthe15domain-basedhigh-leveloutcomesidentifiedinearliersectionsofthispolicyformaveryusefulbasisforthedevelopmentofafully-fledgedOutcomes Framework. Work on this framework, whichwillbeapriorityfortheSharing the Vision implementationstructure,willlooktoidentifyinparticularsetsoftangibleindicatorswhichcanbeusednotjustbymanagersandpolicymakersbutalsobythewiderpublictoassesstheongoingimpactofSharing the Vision.Figure6.2isaschematicversionofhowtheOutcomes Framework aligns with the overall policy.
86
Figure 6.2: Sharing the Vision Outcomes Framework
Promotion, prevention and early intervention domain
SocialInclusion
Service access, co-ordination and continuity of care
Accountability and continuous improvement
IndicatorSet
IndicatorSet
IndicatorSet
IndicatorSet
Sharing the Vision Outcomes
Outcomes
1a
1c
1b
1d
Outcomes
2a
2c
2b
2d
Outcomes
3a
3c
3b
Outcomes
4a
4c
4b
4d
Sharing the Vision | A Mental Health Policy for Everyone
WhileitwillbetheresponsibilityoftheNIMCtobringstrategicinsight,externalrigourandamultilateralperspectivetooversightofthedeliveryoftheactionsarisingoutoftherecommendations,thehealthsystem itself will need to recognise the importance of collaborativeworkingtomeettheneedsofitsspecificdefinedpopulation.Understandingthementalhealthneedsofthepopulationbeingserved,defininglocal
andregionalprioritiesandmakingdecisionsaboutresourceallocationwillbeacatalystfortargetedmental health service delivery.
87
89
AppendicesAppendix I: TermsofReferencefortheOversightGroup90
Appendix II: MembershipoftheOversightGroup91
Appendix III: ImplementationRoadmap94
References112
Bibliography114
Sharing the Vision | A Mental Health Policy for Everyone
Appendix
Appendix I:Terms of Reference for the Oversight Group
A Vision for Change – Part II 1. Reviewandupdatetheexistingmentalhealth
policy A Vision for Change(2006)havingregardtotheExpertEvidenceReviewofinternationalbestpractice,progressoncurrentservicedevelopmentsinIrelandandtherequirementofthePublicSpending Code23,withaparticularfocuson:(a) primaryprevention,earlyinterventionandpositivementalhealth,includinghavingregardtotheworkunderwaywiththePathfinderProjectandtheYouthMentalHealthTaskforce;
(b) integrationofcareanddeliverysystemsbetweenprimaryandsecondaryservicestakingaccountofthemovetoappropriate24/7servicesupports;
(c) developmentofe-mentalhealthresponses;(d) workforceplanning,forecastingandskillmixincludingmechanismstoattractandretainstaffwithinexistingnationalHRpolicy;
(e) emergingneedsofvulnerablegroups,peoplewithco-morbiditiesandspecialistneedsinformedbytherelevantclinicalprogrammes;and
(f) developmentofresearch,dataandevaluationcapabilitytoensureachievementofbestmentalhealthoutcomescanbedemonstratedwiththeresourcesavailable.
(g) proposingpolicychangesthatwillbenefitallthose engaging with mental health services. Aparticularemphasisonsocialinclusionandtheneedsofvulnerablegroupsshouldbeincorporatedwithafocusonreducingstigmaanddiscrimination.
2. Identifyandconsultoncross-sectoralandcross-societalresponsibilitiesinthecontextof(1)above.
3. AlignasfaraspossibletherefreshedpolicywithexistingnationalpoliciesandimplementationarrangementsthathavebeendevelopedsincethepublicationofA Vision for Change(2006).
4. Conductaconsultativeprocesswithkeystakeholders to inform proposals.
5. Produce,forsubmissiontotheDepartmentofHealth,anupdateddraftpolicyframeworkwhichsetsoutcurrentandfutureserviceprioritieswithinatime-boundimplementationplan,forconsiderationbygovernmentasasuccessorpolicyto A Vision for Change(2006).
23InaccordancewiththePublicSpendingCode,allIrishpublicbodiesareobligedtotreatpublicfundswithcare,andtoensurethatthebestpossiblevalueformoneyisobtainedwheneverpublicmoneyisbeingspentorinvested.ThePublicSpendingCodeimposesobligationsat allstagesoftheproject/programmelifecycle,withthestagesoftheprojectdefinedasfollows:•Appraisal:assessingthecaseforapolicyintervention•Planning/Design:apositiveappraisalshouldleadontoaconsideredapproachtodesigninghowtheproject/programmewillbeimplemented•Implementation:carefulmanagementandoversightisrequiredforbothcapitalandcurrentexpenditure.Ongoingevaluationshouldalsobe
a feature of current programmes•Post-ProjectorPost-ImplementationReview:checkingfordeliveryofprojectobjectives,andgainingexperienceforfutureprojects.
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Sharing the Vision | A Mental Health Policy for Everyone
Appendix II:Membership of the Oversight Group
91
Mr Stephen Brophy DoH(November2018–March2019)
Dr Amanda Burke Consultant Psychiatrist
Mr Greg Canning DoH(January2018–October2018)
Mr Colm Desmond DoH(October2017–December2017)
Dr Philip Dodd NationalClinicalLead
Ms Martha Griffin ExpertbyExperienceLecturerDCU
Mr Liam Hennessy Head of Mental Health Engagement
Mr Hugh Kane Chairperson
Dr Fiona Keogh NUIGalway
Mr Leo Kinsella HSE Mental Health Lead
Mr Dave Maguire DoH(March2019–June2019)
Dr Shari McDaid MentalHealthReform
Mr John Meehan HSEMentalHealth/NOSP
Ms Stephanie Morrow Research
Mr Tom O’Brien DoH
Ms Yvonne O’Neill HSE Mental Health Division
Dr Brian Osborne GeneralPractitioner
Secretariat
Mr Martin O’Dwyer DoH
Ms Emily Flaherty DoH
Ms Anna Wallace DoH
Appendix
92
The Department of Health acknowledges the additionalsupportprovidedbytheWorkResearchCentre, MorrowGilchrist and Prospectus, who assisted the Department to gather research, interpret data andsupportthedraftingoftheImplementationRoadmap.TheDepartmentalsoacknowledgesthemanystakeholderswhocontributedtotheprocessandthoseindividualswhomadetimetoattendadvisory
groupsessions.Thoseinvitedtoattendtheadvisorysessionsaredetailedbelow.Itisveryimportantthatthe Department thank the many service users and family carers who engaged with us and shared their experiencessohonestlytoensurethispolicybeginspositivechangeforhowmentalhealthservicesaredelivered in Ireland.
Alzheimer Society of Ireland
Association of Occupational Therapists
Association of Professional Counsellors & Psychotherapists (APCP)
Association for Psychoanalysis and Psychotherapy (APPI)
Barnardo’s
BeLonG To
Bodywhys – the Eating Disorders Association of Ireland
CAIRDE
DCYA
DEASP
DES
DHPLG
DoH units (Healthy Ireland/Primary care, etc.)
DoJE
Family Carers
Gateway
Housing Association for Integrated Living
HSE
HSE Mental Health Heads of Service
Institute of Guidance Counsellors
Irish Advocacy Network
Irish Association for Counselling and Psychotherapy
Irish Association of Speech and Language Therapists
Irish Council for Psychotherapy
Sharing the Vision | A Mental Health Policy for Everyone
93
Irish Forum of Psychoanalytic Psychotherapy (IFPP)
Irish Institute of Mental Health Nursing
Irish Nutrition and Dietetics Institute
Irish Society of Chartered Physiotherapists
Jigsaw
Mental Health Engagement Leads
Mental Health Nurse Managers Ireland
National Advocacy Service for People with Disabilities
National Association for Pastoral Counselling and Psychotherapy
National Family Support Network
National Social Work Organisation of Ireland
NEPS
PCHEI
Peer Support Workers
Psychological Counsellors in Higher Education Institutes
Recovery College Coordinators
Rehab
Samaritans
Simon Communities of Ireland
Soar Foundation
Social Care Ireland
SpunOut.ie
Threshold Training Network
Appendix
94
Appendix III:Implementation Roadmap
TheImplementationRoadmapbelowprovidesadditionalactionsandoutcomeindicatorsforeachrecommendationtosupporttheNationalImplementationandMonitoringCommitteewithitswork.Notallpartnersaredefinedandonly‘leadagencies’arelisted.However,acohesivepartnershipapproachisessentialandwillbethefocusofthe
NIMCduringtheimplementationphase.Inaddition,thetimeframesbelowpertaintoactions–notrecommendations.
• Short = 0–18 months • Medium = 18–36 months • Long = 36 months–10 years
Sharing the Vision | A Mental Health Policy for Everyone
95
Dom
ain
1 |
Pro
moti
on, P
reve
ntion
and
Ear
ly In
terv
entio
n
Out
com
e 1aPositivementalhealth,resilienceandpsychologicalwellbeingamongthepopulationasawhole
Out
com
e 1bPositivementalhealth,resilienceandpsychologicalwellbeingamongprioritygroups…throughtargetedpromotionandpreventivemechanisms
Out
com
e 1cReducedstigmaanddiscriminationarisingthroughimprovedcommunity-wideunderstandingofmentalhealthdifficulties
Out
com
e 1dReducedprevalenceofmentalhealthdifficultiesand/orreducedseverityofimpact(s)throughearlyinterventionandpreventionwork
Reco
mm
enda
tion
Actio
ns/T
asks
Lead
Out
com
e In
dica
tors
Targ
et
Tim
efra
me
Out
com
e
1H
ealth
y Ire
land
alre
ady
has
a re
mit
for i
mpr
oved
mentalhealthandwellbeing.Tofurtherstrengthen
this,adedicatedNationalMentalHealthPromotion
Planshouldbedevelopedandoverseenwithin
Hea
lthy
Irela
ndimplementationframeworks,with
appropriateresourcing.Theplanshouldbebasedon
theprinciplesandscopedescribedinChapter2of
Shar
ing
the
Visio
n.
DevelopaNationalMentalHealthPromotionPlan.
Establishamentalhealthpromotionpolicypriority
prog
ram
me
in H
SE in
line
with
Hea
lthy
Irela
nd
implementation.
DoH/H
ealth
y Ire
land
Fully
com
plet
ed p
lan
in p
lace
with
ap
prop
riate
reso
urce
s.Sh
ort
Med
ium
1a
2Evidence-baseddigitalandsocialmediachannels
shouldbeusedtothemaximumtopromotemental
healthandtoprovideappropriatesignpostingto
serv
ices
and
sup
port
s.
Utilisedigitalandsocialmediatopromotemental
heal
th a
war
enes
s
Appl
y re
sour
ces
to fu
rthe
r dev
elop
evi
denc
e on
the
extentofthepositivementalhealth,resilienceand
psychologicalwellbeingofthepopulationincluding
the
rele
vant
impa
ct o
f soc
ial m
edia
. C
o-pr
oduc
e ev
iden
ce o
n im
prov
emen
ts in
the
mentalhealthofthepopulationincludingthose
accr
uing
thro
ugh
the
use
of s
ocia
l med
ia.
Build
on
evid
ence
em
ergi
ng fr
om T
he Ir
ish
Long
itudi
nal S
tudy
on
Agei
ng (T
ILD
A) a
nd th
e H
ealth
y Ire
land
Sur
vey.
HSE
Dig
ital a
nd s
ocia
l med
ia u
sed
topositivelyinfluenceMH
promotion.
Increasedpublicengagementin
onlinementalhealthinitiatives.
Reportableevidenceofthe
positivementalhealthofthe
population.
Evid
ence
on
impa
ct o
f soc
ial m
edia
on
men
tal h
ealth
. TI
LDA
indi
cato
rs fo
r Old
er P
erso
ns
andtheirMHwellbeingembedded
in c
ross
gov
t fra
mew
orks
and
st
rate
gies
, HI–OutcomesFramework,
DC
YA O
utco
mes
Fra
mew
ork.
Med
ium
1a
3TheDepartmentofHealthWomen’sHealth
TaskforceandtheNationalImplementation
MonitoringCommitteewillundertakeajoint
projectwithin12monthstooutlineaneffective
appr
oach
to th
e m
enta
l hea
lth o
f wom
en a
nd
girls.Theprojectshouldensurethatmentalhealth
prioritiesandservicesaregender-sensitiveandthat
women’smentalhealthisspecificallyandsufficiently
addressedintheimplementationofpolicy.
EnsurethatWomen’sHealthTaskForceand
NationalImplementationMonitoringCommittee
developaprojecttofocuson:
mentalhealthprioritiesandservicesthatare
gender-sensitive;
worktoensurewomen’smentalhealthis
specificallyandsufficientlyaddressedinthe
implementationofpolicy;and
wor
k to
em
pow
er a
ll m
enta
l hea
lth s
ervi
ce u
sers
andtheirfamiliesequitably.
Women’sHealthTask
Forc
eFu
lly c
ompl
eted
pla
n in
pla
ce w
ith
appr
opria
te re
sour
ces.
Shor
t1b
Appendix
96
4Theworkprogrammeforhealthpromotionand
improvementofficersshouldbereviewedtoensure
parityofeffortandemphasisonmentalhealth
promotionandphysicalhealthpromotion.
Reviewandamendexistingjobspecification.
HSE/H
ealth
y Ire
land
MentalHealthPromotionPlans
incorporatethedistinctneedsof
prio
rity
grou
ps.
Shor
t1a,1b
5Newandexistingcommunitydevelopment
prog
ram
mes
whi
ch p
rom
ote
soci
al in
clus
ion,
en
gage
men
t and
com
mun
ity c
onne
cted
ness
shouldbeappropriatelyresourcedanddeveloped
inlinewiththeproposedNationalMentalHealth
PromotionPlan.
Ensurethefundingfornewandexistingcommunity
deve
lopm
ent p
rogr
amm
es e
nhan
ces
com
mun
ity
connectednessandmentalhealthpromotion.
Designanddeliverhealthpromotioninitiatives
sotheyincludeandareaccessibletopeoplewith
disabilities
HSE/H
ealth
y Ire
land
Appr
opria
tely
fund
ed c
omm
unity
de
velo
pmen
t pro
gram
mes
demonstratingenhanced
com
mun
ity c
onne
cted
ness
and
mentalhealthpromotion.
Med
ium
1a
6TheproposedNationalMentalHealthPromotion
PlanandtheexistingworkofC
onne
cting
for
Life
sho
uld
inco
rpor
ate
targ
eted
men
tal h
ealth
promotionandpreventionactionsthatrecognise
thedistinctneedsofprioritygroups.
EnsuretheNationalMentalHealthPromotionPlan
incorporatesthedistinctneedsofprioritygroups.
Supp
ort C
onne
cting
for L
ife to
del
iver
targ
eted
mentalhealthpromotionandpreventionactions
thatrecognisethedistinctneedsofprioritygroups.
Hea
lthy
Irela
nd/DoH/NOSP
MentalHealthPromotionPlansincorporatethe
distinctneedsofprioritygroups.
Hea
lthy
Irela
nd/DoH/
NO
SPMentalHealthPromotionPlans
incorporatethedistinctneedsof
prio
rity
grou
ps.
Conn
ectin
g fo
r Life
del
iver
s m
enta
l healthpromotionactionsthat
incorporatethedistinctneedsof
prio
rity
grou
ps.
Shor
t
Shor
t
Shor
t
1b,1d
7ANationalStigma-ReductionProgramme
(NSRP)shouldbeimplementedtobuilda‘whole
community’approachtoreducingstigmaand
discriminationforthosewithmentalhealth
difficulties.Thisshouldbuildonworktodateand
dete
rmin
e a
clea
r str
ateg
ic p
lan,
with
ass
ocia
ted
outc
omes
and
targ
ets
acro
ss re
late
d st
rand
s of
w
ork.
DevelopastrategicwholecommunityNSRPplan
forpublicationandannualreviewwithspecific
outc
omes
and
targ
ets.
Dep
artm
ent o
f Hea
lth s
houl
d ex
tend
the
timeframeandfundingforthestrategyfor
Conn
ectin
g fo
r Life(CFL)to2024.
HSE/DoH
NSRPplanevaluatedtomeasure
itsbeneficialimpactacrossthe
population.
Extendedtimeframeand
asso
ciat
ed fu
ndin
g fo
r Con
necti
ng
for L
ifeuntil2024.
Med
ium
1a,1b,1c,
1d
8Learningfrominnovationsinimprovingoutcomes
forchildrenandyoungpeopleshouldbeidentified
and
shou
ld in
form
rele
vant
mai
nstr
eam
ser
vice
provision.Thisincludeslearningfromprevention
andearlyinterventionprogrammessuchasTusla’s
AreaBasedChildhood(ABC)andPrevention,
Part
ners
hip
and
Fam
ily S
uppo
rt (P
PFS)
Pro
gram
me
aswellascross-borderprogrammesaddressingthe
impa
ct o
f Adv
erse
Chi
ldho
od E
xper
ienc
es (A
CEs
).
EnsuretheWhatWorksinitiativedeliveredby
DC
YA s
eeks
to c
aptu
re a
nd d
issem
inat
e th
is learningtoinformeffectivepolicy,provisionand
practitionerresponsestotheneedsofchildrenand
youn
g pe
ople
.
HSE
Evid
ence
of i
nteg
rate
d re
spon
ses
tovulnerablefamiliesinformed
byACEandlearningfrompilot
prog
ram
mes
.
Med
ium
1d
9Allschoolsandcentresforeducationwillhave
initiatedadynamicWellbeingPromotionProcess
by2023,encompassingawhole-school/centre
approach.Schoolsandcentresforeducationwill
besupportedinthisprocessthroughtheuseofthe
WellbeingFrameworkforpracticeandWellbeing
Resourceswhichhavebeendevelopedbythe
DepartmentofEducationandSkills.
ImplementWellbeingPolicyStatementand
FrameworkforPracticeinallschoolsandcentres
foreducation,aswellasNEPS,withappropriate
reso
urci
ng.
DES
WellbeingPolicyStatement
andFrameworkforPractice
impl
emen
ted
in a
ll sc
hool
s an
d centresforeducationsupportedby
adequateresources.
Med
ium
1a,1d
Sharing the Vision | A Mental Health Policy for Everyone
97
10Aprotocolshouldbedevelopedbetweenthe
DepartmentofEducationandSkillsandtheHSEon
theliaisonprocessthatshouldbeinplacebetween
primary/post-primaryschools,mentalhealth
serv
ices
and
sup
port
s su
ch a
s N
EPS,
GPs
, prim
ary
care
ser
vice
s an
d sp
ecia
list m
enta
l hea
lth s
ervi
ces.
This
is ne
eded
to fa
cilit
ate
refe
rral
pat
hway
s to
loca
l servicesandsignpostingtosuchservices,
as n
eces
sary
.
Establishworkinggroupwithappropriate
representationtodevelopliaisonprotocolbetween
scho
ols
and
men
tal h
ealth
ser
vice
s an
d su
ppor
ts.
DoH
Prot
ocol
in p
lace
whi
ch fa
cilit
ates
re
ferr
al p
athw
ays
to lo
cal s
ervi
ces
andsignpostingtoNEPS,GPs,
prim
ary
care
ser
vice
s an
d sp
ecia
list
men
tal h
ealth
ser
vice
s.
Med
ium
1d
11TheNationalMentalHealthPromotionPlan
inte
grat
ed w
ith th
e H
ealth
y W
orkp
lace
Fra
mew
ork
shouldincorporateactionstoenhancethemental
healthoutcomesoftheworking-agepopulation
throughinterventionsaimedatmentalhealth
promotionintheworkplace.Thisshouldconsider
envi
ronm
enta
l asp
ects
of t
he w
orki
ng e
nviro
nmen
t conducivetosupportingpositivementalhealth
andwellbeing.
Developactionplantoenhancethementalhealth
outcomesoftheworking-agepopulation,with
prioritisationofthoseworkinginmentalhealth
servicesthroughcollaborationwithDoHH
ealth
y Ire
land
and
rele
vant
par
tner
s.
ToreinforcetheeffectivenessoftheDES
framework,aneffectivestructureforcross-sectoral
collaborationintheareaofwellbeingandmental
healthpromotionwillbeincorporatedintothe
NationalMentalHealthPromotionPlan.
HSE
Actionplaninplacesupporting
thepositivementalhealthand
wellbeingoftheworkforce.
Startingwiththementalhealth
wor
kfor
ce.
Developwellbeingandpromotion
withcrosssectoralcollaboration
andincorporateintonational
mentalHealthPromotionPlan.
Med
ium
1a,1d
12Arangeofactionsdesignedtoachievethegoalsof
theNationalPositiveAgeingStrategyforthemental
healthofolderpeopleshouldbedevelopedand
implemented,supportedbytheinclusionofmental
healthindicatorsintheHealthyandPositiveAgeing
Initiative’sresearchprogramme.
Developspecificmentalhealthactionstoachieve
thegoalsoftheNationalPositiveAgeingStrategy.
Identifymentalhealthindicatorstobeincludedin
theHealthyandPositiveAgeingInitiative’sresearch
prog
ram
me.
DoH
Actionsinplacetoachievethe
goalsoftheNationalPositive
Agei
ng S
trat
egy.
Mentalhealthidentifiersinplace
intheHealthyandPositiveAgeing
Initiative’sresearchprogramme.
Shor
t1d
Appendix
98
Dom
ain
2 |
Ser
vice
Acc
ess,
Coor
dina
tion
and
Conti
nuity
of C
are
Out
com
e 2aAllserviceusershaveaccesstotimely,evidence-informedinterventions
Out
com
e 2bServicedeliveryisorganisedtoenableincreasednumbersofpeopletoachievepersonalrecovery
Out
com
e 2cServicesarecoordinatedthrougha‘steppedcare’approachtoprovidecontinuityofcarethatwilldeliverthebestpossibleoutcomesforeachserviceuser
Out
com
e 2dHealthoutcomesforpeoplewithdualdiagnosisareimprovedbyensuringgreatercollaborationbetweenmentalhealthandotherrelevantservices
Reco
mm
enda
tion
Actio
ns/T
asks
Lead
Out
com
e In
dica
tors
Targ
et
Tim
efra
me
Out
com
e
13DirectoriesofinformationonVCSsupportsshould
beprovidedtostaffworkinginprimarycareand
CM
HTs
to e
nsur
e th
ey a
re a
war
e of
and
info
rm
serviceusersandFCSaboutallsupportsavailable
incl
udin
g th
ose
from
Vol
unta
ry a
nd C
omm
unity
Sectororganisationsinthelocalarea.
Mapavailablesupports.
ProvidestaffworkinginprimarycareandCMHTs
withinformationaboutavailablesupportssuchas
‘yourmentalhealth.ie’.
HSE
Com
mun
ity a
sset
map
in p
lace
. Al
l ser
vice
use
rs a
nd F
CS
are
mad
e aw
are
of s
uppo
rts
incl
udin
g th
ose
in th
e Vo
lunt
ary
and
Com
mun
ity
Sect
or.
Shor
t2a
14W
here
Vol
unta
ry a
nd C
omm
unity
Sec
tor
organisationsareprovidingservicesalignedtothe
outcomesinthispolicy,operationalgovernanceand
fundingmodelsshouldbesecureandsustainable.
Maximisetheuseofexistingandemerging
operationalgovernanceandfundingmodelsto
supportcollaborativealignmentwithrequired
outc
omes
.
HSE
Collaborativelyagreedoperational
gove
rnan
ce a
nd fu
ndin
g m
odel
s inplacewhichmaximisereliable,
secureandsustainablefunding
linke
d to
out
com
es.
Med
ium
2a,2b
15Socialprescribingshouldbepromotednationally
asaneffectivemeansoflinkingthosewithmental
healthdifficultiestocommunity-basedsupports
andinterventions,includingthoseavailablethrough
loca
l Vol
unta
ry a
nd C
omm
unity
Sec
tor s
uppo
rts
and
serv
ices
.
Enablethedevelopmentofserviceuser-ledand
responsivesocialprescribingthroughidentified
com
mun
ity li
nks
and
supp
orts
.
HSE
The
expa
nded
use
of s
ervi
ce
user
-led
and
resp
onsiv
e so
cial
prescribing.
Shor
t2a,2c
16Ac
cess
to a
rang
e of
cou
nsel
ling
supp
orts
and
talk
therapiesincommunity/primarycareshouldbe
availableonthebasisofidentifiedneedsothat
all i
ndiv
idua
ls, a
cros
s th
e lif
espa
n, w
ith a
mild
-to-moderatementalhealthdifficultycanreceive
promptaccesstoaccessiblecarethroughtheirGP/
Prim
ary
Car
e C
entr
e. C
ouns
ellin
g su
ppor
ts a
nd
talktherapiesmustbedeliveredbyappropriately
qualifiedandaccreditedprofessionals.
Incr
ease
rang
e an
d ea
se o
f acc
ess
to c
ouns
ellin
g su
ppor
ts a
nd ta
lk th
erap
ies
in th
e co
mm
unity
. As
sess
cur
rent
ser
vice
s an
d en
sure
futu
re
coun
selli
ng a
nd ta
lk th
erap
y se
rvic
es a
re p
rovi
ded
byappropriatelyqualifiedandaccredited
prof
essio
nals.
HSE
Acce
ss to
cou
nsel
ling
supp
orts
and
talktherapiesavailablebasedon
identifiedneed.
Com
plet
ed a
sses
smen
t of t
he le
vel
ofqualificationandaccreditation
of c
urre
nt p
rovi
ders
. C
ouns
ellin
g an
d ta
lk th
erap
ies
are
deliveredbyappropriatelyqualified
and
accr
edite
d pr
ofes
siona
ls.
Med
ium
2a,2c
17Thementalhealthconsultation/liaisonmodel
shouldcontinuetobeadoptedtoensureformal
linksbetweenCMHTsandprimarycarewith
thepresenceof,orin-reachby,amentalhealth
prof
essio
nal a
s pa
rt o
f the
prim
ary
care
team
or
netw
ork.
Ensu
re th
at th
e de
velo
pmen
t of t
he C
HN
and
PC
T operatingmodels
adoptthementalhealthconsultation/liaisonmodel.
HSE
CHNandPCTsutilisingmental
healthconsultation/liaisonmodel
with
CM
HTs
.
Shor
t2b,2c
Sharing the Vision | A Mental Health Policy for Everyone
99
18Animplementationplanshouldbedeveloped
fortheremainingrelevantrecommendationsin
Adva
ncin
g th
e Sh
ared
Car
e Ap
proa
ch b
etw
een
Prim
ary
Care
& S
peci
alist
Men
tal H
ealth
Ser
vice
s(2012)in
ordertoimproveintegrationofcareforindividuals
betweenprimarycareandmentalhealthservicesin
line
with
em
ergi
ng m
odel
s an
d pl
ans
for C
omm
unity
H
ealth
Net
wor
ks a
nd T
eam
s.
Developanimplementationplanwithupdated
recommendationsfromA
dvan
cing
the
Shar
ed C
are
Appr
oach
bet
wee
n Pr
imar
y Ca
re &
Spe
cial
ist M
enta
l H
ealth
Ser
vice
s(2012).
HSE
Appropriaterecommendations
from
Adv
anci
ng th
e Sh
ared
Car
e Ap
proa
ch b
etw
een
Prim
ary
Care
&
Spec
ialis
t Men
tal H
ealth
Ser
vice
s (2012)areimplemented.
Shor
t2b,2c
19Th
e ph
ysic
al h
ealth
nee
ds o
f all
user
s of
spe
cial
ist
mentalhealthservicesshouldbegivenparticular
attentionbytheirGP.Asharedcareapproachis
essentialtoachievethebestoutcomes.
Ensu
re a
ny p
erso
n us
ing
a sp
ecia
list m
enta
l hea
lth
serv
ice
has
acce
ss to
GP
and
prim
ary
care
ser
vice
s onthesamebasisasothercitizens.
Dev
elop
a s
hare
d ph
ysic
al h
ealth
pro
toco
l for
mentalhealthserviceuserspresentingtoGPs.
HSE
A sh
ared
phy
sical
hea
lthca
re
prot
ocol
for m
enta
l hea
lth s
ervi
ce
user
s in
pla
ce w
ith G
Ps.
Mentalhealthpatientsaccess
prim
ary
care
ser
vice
s w
ith s
uppo
rt
asrequired.
Shor
t2c
20Thereshouldbefurtherdevelopmentofearly
interventionandassessmentservicesinthe
prim
ary
care
sec
tor f
or c
hild
ren
with
AD
HD
and
autismtoincludecomprehensivemulti-disciplinary
and
paed
iatr
ic a
sses
smen
t and
men
tal h
ealth
consultationwiththerelevantCMHTwhere
nece
ssar
y.
Developagreedearlyinterventionandassessment
serv
ices
in p
rimar
y ca
re fo
r chi
ldre
n w
ith A
DH
D
andautismthroughcollaborationofPCandMH
serv
ices
.
HSE
ChildrenwithADHDandautism
rece
ivin
g ag
reed
mod
el o
f ear
ly
intervention/assessmentinprimary
care
.
Med
ium
2a
21Dedicatedcommunity-basedAddictionService
Teamsshouldbedeveloped/enhancedwith
psychiatryinput,asrequired,andimprovedaccess
to m
enta
l hea
lth s
uppo
rts
in th
e co
mm
unity
sho
uld
beprovidedtoindividualswithco-existinglow-level
mentalhealthandaddictionproblems.
Assesscurrentavailableresponsetowards
development/enhancementofintegrated
community-basedaddictionteamswithrequired
leve
l of m
enta
l hea
lth s
ervi
ce in
put.
Primarycare/HSE/
DoH
(loc
al d
rug
task
forc
es)
Integratedcommunity-based
addictionteamswithappropriate
men
tal h
ealth
ser
vice
inpu
t in
plac
e.
Med
ium
2a,2b
22Th
e pr
ovisi
on o
f app
ropr
iate
env
ironm
ents
for
thosepresentingatemergencydepartmentswho
additionallyrequireanemergencymentalhealth
assessmentshouldbeprioritised.
Assesscurrentavailableenvironmentanddevelop
improvementplansforprovisionofsuitable
emergencymentalhealthassessmentfacilities.
HSE
Appr
opria
te m
enta
l hea
lth
assessmentfacilitiesinemergency
depa
rtm
ents
are
pro
vide
d.
Shor
t2a,2b
23Thereshouldbecontinuedinvestmentin,and
implementationof,theNationalClinicalCare
Prog
ram
me
for t
he A
sses
smen
t and
Man
agem
ent
ofPatientsPresentingtoEmergencyDepartments
Follo
win
g Se
lf-H
arm
.
ImplementtheNationalClinicalCareProgramme
fortheAssessmentandManagementofPatients
PresentingtoEDsFollowingSelf-Harm.
HSE
Impl
emen
ted
fund
ed c
are
prog
ram
mes
. D
emon
stra
ted
impr
oved
out
com
es
forpatientsattendingEDs
follo
win
g se
lf-ha
rm.
Med
ium
24Out-of-hourscrisiscafésshouldbepilotedand
operatedbasedonidentifiedgoodpractice.Such
cafésshouldfunctionasapartnershipbetweenthe
HSEandotherproviders/organisations.
Developandpilotmodelinlinewithgoodpractice
for o
ut-o
f-ho
urs
crisi
s ca
fé.
HSE
Out
-of-
hour
s cr
isis
café
s pi
lote
d an
d ev
alua
ted.
Shor
t2a
25Themulti-disciplinaryCMHTasthecornerstone
ofservicedeliveryinsecondarycareshouldbe
stre
ngth
ened
thro
ugh
the
deve
lopm
ent a
nd a
gree
d implementationofasharedgovernancemodel.
Dev
elop
and
agr
ee a
sha
red
gove
rnan
ce m
odel
for
implementationbyallCMHTs.
HSE
OperationofCMHTsis
strengthenedbyuseofashared
gove
rnan
ce m
odel
.
Med
ium
2a,2b
Appendix
100
26CMHTs’outreachandliaisonactivitieswithVCS
partnersinthelocalcommunityshouldbeenhanced
to h
elp
crea
te a
con
nect
ed n
etw
ork
of a
ppro
pria
te
supp
orts
for e
ach
serv
ice
user
and
thei
r FC
S.
Co-designenhancedoutreachandliaisonactivities
to h
elp
crea
te a
con
nect
ed n
etw
ork
of a
ppro
pria
te
supp
orts
for e
ach
serv
ice
user
and
thei
r FC
S.
HSE
A co
-des
igne
d co
nnec
ted
netw
ork
of a
ppro
pria
te s
uppo
rts
for e
ach
serv
ice
user
and
thei
r FC
S is
in
plac
e th
roug
h C
MH
Ts.
Med
ium
2b
27An
indi
vidu
alise
d re
cove
ry c
are
plan
, co-
prod
uced
withserviceusersand/orFamilies,Carersand
Supporters,whereappropriate,shouldbeinplace
for,andaccessibleto,allusersofspecialistmental
heal
th s
ervi
ces.
Ensu
re c
onsis
tent
use
of c
o-pr
oduc
ed
indi
vidu
alise
d re
cove
ry c
are
plan
s fo
r all
user
s of
sp
ecia
list m
enta
l hea
lth s
ervi
ces.
HSE
Men
tal H
ealth
Con
siste
nt u
se o
f co-
prod
uced
in
divi
dual
ised
reco
very
car
e pl
ans
for a
ll us
ers
of s
peci
alist
men
tal
heal
th s
ervi
ces.
Med
ium
2b
28Al
l ser
vice
use
rs s
houl
d ha
ve a
mut
ually
agr
eed
key
workerfromtheCMHTtofacilitatecoordination
andpersonalisationofservicesinlinewiththeirco-
prod
uced
reco
very
car
e pl
an.
Ensu
re s
ervi
ce u
sers
are
sup
port
ed th
roug
h th
e pr
ovisi
on o
f a m
utua
lly a
gree
d ke
y w
orke
r.H
SE M
enta
l Hea
lthAl
l ser
vice
use
rs h
ave
a m
utua
lly
agre
ed k
ey w
orke
r.Sh
ort
2b
29Furthertrainingandsupportshouldbeputinplace
toembedarecoveryethosamongmentalhealth
prof
essio
nals
wor
king
in th
e C
MH
Ts a
s w
ell a
s th
ose
deliveringserviceselsewhereinthecontinuumof
serv
ices
.
Designtrainingandsupportprogrammetoembed
a re
cove
ry e
thos
in m
enta
l hea
lth p
rofe
ssio
nals.
Toensuredisabilitycompetence,ensurethat
appropriatetraininginaccommodatingand
supportingpeoplewithautismandwithother
formsofdisabilityisundertakenbyteammembers.
Strategy&Planning
HSE/S
láin
teca
re
part
ners
Trainingwillbedeliverednationally
and
incl
ude
reco
very
as
an in
tegr
al
com
pone
nt.
Trainingwillalsobedeliveredto
supportpeoplewithdisabilities.
Shor
t2b
30CMHTsandsessionalcontactsshouldbelocated,
wherepossibleandappropriate,inavarietyof
suitablesettingsinthecommunity,includingnon-
healthsettings.
ReviewlocationsofCMHTsandsessionalcontacts.
Strategy&Planning
HSE/S
láin
teca
re
part
ners
Completedreviewandoptimised
locations.
Med
ium
2a,2b
31Thepotentialfordigitalhealthsolutionstoenhance
serv
ice
deliv
ery
and
empo
wer
ser
vice
use
rs s
houl
d bedeveloped.
Identifyanddeveloppotentialdigitalsolutions.
Strategy&Planning
HSE/S
láin
teca
re
part
ners
Del
iver
and
dev
elop
dig
ital
interventionsnationallyand
evaluateefficacytomeasure
impa
ct.
Med
ium
2a
32ThecompositionandskillmixofeachCMHT,
alongwithclinicalandoperationalprotocols,
shouldtakeintoconsiderationtheneedsand
socialcircumstancesofitssectorpopulationand
theavailabilityofstaffwithrelevantskills.Aslong
as th
e co
re s
kills
of C
MH
Ts a
re m
et, t
here
sho
uld
beflexibilityinhowtheteamsareresourcedto
mee
t the
full
rang
e of
nee
ds, w
here
ther
e is
stro
ng
population-basedneedsassessmentdata.
Empowerlocalmanagerstoreviewcomposition
and
skill
mix
of C
MH
Ts a
ppro
pria
te to
the
loca
l needsofthepopulation.
Incl
ude
non-
men
tal h
ealth
pro
fess
iona
ls in
C
MH
Ts (e
.g. e
mpl
oym
ent s
peci
alist
s ca
n pr
omot
e em
ploy
men
t as
an a
spec
t of r
ecov
ery)
. Developflexibleclinicalandoperationalprotocols.
Strategy&Planning
HSE/S
láin
teca
re
part
ners
CMHTsaredeliveringtimely
interventionsdefinedbythe
specificneedsoftheirpopulation.
Med
ium
2a
33Th
e sh
ared
gov
erna
nce
arra
ngem
ents
for C
MH
Ts a
s ou
tline
d in
AVF
C2006–16shouldbeprogressed,
incl
udin
g fu
rthe
r rol
lout
of T
eam
Coo
rdin
ator
s.
Prog
ress
sha
red
gove
rnan
ce a
rran
gem
ents
.Strategy&Planning
HSE/S
láin
teca
re
part
ners
Shar
ed g
over
nanc
e ar
rang
emen
ts
implementednationally.
Team
Coo
rdin
ator
s in
pla
ce.
Med
ium
2a,2b
34ReferralpathwaystoallCMHTsshouldbereviewed
andextendedbyenablingreferralsfromarange
of o
ther
ser
vice
s (a
s ap
prop
riate
) inc
ludi
ng s
enio
r primarycareprofessionalsincollaborationwithGPs.
Reviewandextendreferralpathwaysto
inco
rpor
ate
a ra
nge
of o
ther
ser
vice
s.H
SE M
enta
l Hea
lth
Serv
ices
Evid
ence
of e
nhan
ced
refe
rral
pa
thw
ays.
Med
ium
2a
Sharing the Vision | A Mental Health Policy for Everyone
101
35A
com
preh
ensiv
e sp
ecia
list m
enta
l hea
lth o
ut-o
f-hoursresponseshouldbeprovidedforchildrenand
adolescentsinallgeographicalareas.Thisshouldbe
developedinadditiontocurrentEDservices.
Dev
elop
a c
ompr
ehen
sive
spec
ialis
t men
tal h
ealth
out-of-hoursmodelusingatieredapproach.
HSE
Men
tal H
ealth
Se
rvic
esIm
plem
ente
d co
mpr
ehen
sive
spec
ialis
t men
tal h
ealth
out
-of-
hour
s m
odel
with
evi
denc
e of
tieredapproachinallareas.
Shor
t2a
36Appropriatesupportsshouldbeprovidedforon
aninterimbasistoserviceuserstransitioningfrom
CAMHStoGAMHS.Theageoftransitionshouldbe
movedfrom18to25,andfuturesupportsshould
reflectthis.
Con
vene
an
Expe
rt G
roup
to:
Developareconfigurationplanwhichwillfacilitate
the
prov
ision
of a
ge-a
ppro
pria
te s
peci
alist
men
tal
healthservicesuptoage25.
Prov
ide
appr
opria
te s
uppo
rts
for i
ndiv
idua
ls transitioningfromCAMHStoGAMHSat18years.
Identifyrequiredadditionalsupportsforindividuals
transitioningfromCAMHStoGAMHSat18years.
ProducetransitionplaninlinewithCAMHSCOG.
Put i
n pl
ace
a no
min
ated
key
wor
ker t
o su
ppor
t the
transitionplan.
Additionaltrainingprovidedtoup-skillnominated
keyw
orke
rs.
DoH
Plan
in p
lace
whi
ch fa
cilit
ates
th
e pr
ovisi
on o
f age
-app
ropr
iate
sp
ecia
list m
enta
l hea
lth s
ervi
ces
up
toage25.
Supportsidentifiedandinplacefor
allindividualstransitioningfrom
CAM
HS
to G
AMH
S.
Shor
t2b
37Nationallyagreedcriteriashouldbedeveloped
to g
over
n an
d re
sour
ce in
divi
dual
ised
supp
ort
packagesforthespecificneedsofasmallcohort
of c
hild
ren
and
youn
g pe
ople
who
hav
e co
mpl
ex
need
s.
Developnationalcriteriaforindividualisedsupport
packagesforthespecificneedsofasmallcohort
of c
hild
ren
and
youn
g pe
ople
who
hav
e co
mpl
ex
need
s. Secureresourcingfortherequiredsupport
pack
ages
.
HSE
Chi
ldre
n an
d yo
ung
peop
le w
ho
have
com
plex
nee
ds in
rece
ipt o
f fu
lly re
sour
ced
supp
ort p
acka
ges
inlinewithnationalcriteria.
Shor
t2a
38Intheexceptionalcaseswherechildand
adolescentinpatientbedsarenotavailable,adult
units
pro
vidi
ng c
are
to c
hild
ren
and
adol
esce
nts
shouldadheretotheCAMHSinpatientCodeof
Gov
erna
nce.
EnsureadherencetotheCAMHSinpatientCodeof
Governancenationally.
HSE
Men
tal H
ealth
EvaluationtoensureCAMHS
inpatientcodeofGovernanceis
appliednationally.
Shor
t2a,2b
39Th
e H
SE s
houl
d co
nsul
t with
ser
vice
use
rs, F
CS,
staff,andthosesupportingprioritygroupsto
developastandardisedaccesspathwaytotimely
men
tal h
ealth
and
rela
ted
care
in li
ne w
ith th
e individuals’needsandpreferences.
Dev
elop
sta
ndar
dise
d ac
cess
pat
hway
to
timelymentalhealthandrelatedcarethrougha
comprehensiveconsultationprocess.
HSE
Stan
dard
ised
acce
ss p
athw
ay in
pl
ace.
Shor
t2a,2b
40Sufficientresourcingofhome-basedcrisisresolution
teamsshouldbeprovidedtoofferanalternative
responsetoinpatientadmission,whenappropriate.
Developandresourcehome-basedcrisisresolution
team
s.H
SE M
enta
l Hea
lth
Reducedlevelsofinpatient
admissionsduetoalternativecrisis
intervention.
Med
ium
2a,2b
41AStandardOperatingGuidelineshouldbe
developedtoensurethatsufficientlystaffedday
hospitalsoperateaseffectivelyaspossibleas
anelementofthecontinuumofcareandasan
alternativetoinpatientadmission.
DevelopandpublishStandardOperatingGuideline.
Provideadditionalstaffingindayhospitals.
HSE
Men
tal H
ealth
CirculatedStandardOperating
Gui
delin
e.
Adequatelystaffeddayhospitals.
Med
ium
2a,2b
42IndividualswhorequirespecialistMentalHealth
Serv
ices
for O
lder
Peo
ple
(MH
SOP)
sho
uld
rece
ive
that
ser
vice
rega
rdle
ss o
f the
ir pa
st o
r cur
rent
m
enta
l hea
lth h
istor
y. P
eopl
e w
ith e
arly
ons
et
dementiashouldalsohaveaccesstoMHSOP.
DevelopandpublishStandardOperatingGuideline
ensuringequalaccessforrelevantindividualsto
spec
ialis
t Men
tal H
ealth
Ser
vice
for O
lder
Peo
ple.
HSE
Men
tal H
ealth
Acce
ss to
spe
cial
ist M
enta
l H
ealth
Ser
vice
for O
lder
Peo
ple
is pr
ovid
ed re
gard
less
of m
enta
l he
alth
hist
ory.
Shor
t2a,2b
Appendix
102
43TheagelimitforMHSOPshouldbeincreased
from65yearsto70yearssupportedbyjointcare
arrangementsbetweenGAMHSandMHSOPteams
forindividualswhorequiretheexpertiseofboth.
Incl
ude
the
revi
sed
age
limit
in th
e ne
w S
tand
ard
OperatingGuidelineforMHSOP.
HSE
Agelimitincreasedto70years.
Shor
t2a,2b
44GPs,mentalhealthserviceprescribersandrelevant
stakeholdersshouldcollaboratetoactivelymanage
poly
phar
mac
y.
SupportcollaborationbetweenGPs,mentalhealth
serviceprescribersandrelevantstakeholdersbased
oninformedactionplanandtrainingprogramme.
HSE
Polypharmacyisactivelymanaged.
Shor
t2b
45HSEshouldcollatedataonthenumberandprofile
of d
elay
ed d
ischa
rges
in a
cute
men
tal h
ealth
inpatientunitsanddevelopappropriatelyfunded
resp
onse
s.
Collatedataonthenumberandprofileofdelayed
dischargesinacutementalhealthinpatientunits.
Dev
elop
app
ropr
iate
fund
ing
and
serv
ice
resp
onse
s to
min
imise
del
ayed
disc
harg
es.
HSE
Dataisavailableanddelayed
disc
harg
es a
re a
ppro
pria
tely
m
anag
ed.
Med
ium
2c
46AnExpertGroupshouldbesetuptoexamineAcute
Inpatient(ApprovedCentre)bedprovision(including
PICUs)andtomakerecommendationsoncapacity
reflectiveofemergingmodelsofcare,existing
bedresourcesandfuturedemographicchanges,
withsuchrecommendationsbeingalignedwith
Slái
ntec
are.
SetupanExpertGrouptoexamineAcuteInpatient
(ApprovedCentre)bedusageanddevelop
recommendations.
HSE
Men
tal H
ealth
Appr
opria
te le
vel a
nd u
sage
of
AcuteInpatient(ApprovedCentre)
beds.
Shor
t2c
47SufficientPsychiatricIntensiveCareUnits(PICUs)
shouldbedevelopedwithappropriatereferraland
disc
harg
e pr
otoc
ols
to s
erve
the
regi
ons
of th
e co
untr
y w
ith li
mite
d ac
cess
to th
is ty
pe o
f ser
vice
.
DevelopPsychiatricIntensiveCareUnits(PICUs)to
meetidentifiedneed.
Agre
e up
date
d re
ferr
al a
nd d
ischa
rge
prot
ocol
s.
HSE
SufficientPsychiatricIntensive
CareUnits(PICUs)inoperation.
Long
2a
48Across-disabilityandmentalhealthgroupshould
beconvenedtodevelopnationalcompetence
in th
e co
mm
issio
ning
, des
ign
and
prov
ision
of
inte
nsiv
e su
ppor
ts fo
r peo
ple
with
com
plex
men
tal
healthdifficultiesandintellectualdisabilitiesandto
deve
lop
a se
t of c
riter
ia to
gov
ern
the
prov
ision
of
this
serv
ice.
Convenecross-disabilityandmentalhealthgroup
todevelopnationalcompetenceandcriteriaforthe
prov
ision
of t
his
serv
ice.
HSE
Appr
opria
te s
ervi
ces
are
in p
lace
fo
r peo
ple
with
com
plex
men
tal
healthdifficultiesandintellectual
disabilities.
Shor
t2a,2b,2c,
2d
49IntensiveRecoverySupport(IRS)teamsshould
beprovidedonanationalbasistosupportpeople
with
com
plex
men
tal h
ealth
nee
ds in
ord
er to
avo
id
inappropriate,restrictiveandnon-recovery-oriented
settings.
DevelopIRSteamstoprovidetargetedsupportsto
indi
vidu
als
with
com
plex
men
tal h
ealth
nee
ds o
n a
nationalbasis.
HSE
Recovery-orientedcommunity-
basedsupportsinplacefor
indi
vidu
als
with
com
plex
men
tal
heal
th n
eeds
.
Long
2a,2b,2c
50ThedevelopmentofanationalnetworkofMHID
teamsandacutetreatmentbedsforpeopleof
allageswithanintellectualdisabilityshouldbe
prioritised.
DevelopnationalnetworkofMHIDteamsand
acutetreatmentbeds.
HSE
Equitableaccesstomentalhealth
serv
ices
for p
eopl
e of
all
ages
with
anintellectualdisability.
Med
ium
2a,2b
51SpeechandLanguageTherapists(SLT)shouldbe
coremembersoftheAdult-IDandCAMHS-ID
team
s.
Put i
n pl
ace
Spee
ch a
nd L
angu
age
Ther
apy
as a
co
re p
art o
f the
Adu
lt-ID
and
CAM
HS-
ID te
ams.
HSE
Spee
ch a
nd L
angu
age
Ther
apy
availabletoserviceuserswith
MH
ID s
uppo
rt n
eeds
.
Med
ium
2a,2b
52InvestmentintheimplementationoftheModelof
CareforEarlyInterventionPsychosis(EIP),informed
byanevaluationoftheEIPdemonstrationsites,
shouldbecontinued.
InvestintheimplementationofEIPservice
deliv
ery.
EvaluateEIPdemonstrationsites.
HSE
Men
tal H
ealth
EIPservicesavailableinlinewith
EIP
Mod
el o
f Car
e.Lo
ng2a,2b
Sharing the Vision | A Mental Health Policy for Everyone
103
53TheNationalMentalHealthClinicalProgrammes
forEatingDisorders,AdultswithADHDandthe
Mod
el o
f Car
e fo
r Spe
cial
ist P
erin
atal
Men
tal
HealthServicesshouldcontinuetohavephased
implementationandevaluation.
Develop/reviewtheImplementationPlansfor
theseClinicalProgrammes/ModelofCare.
Undertakephasedimplementationandresourcing
ofclinicalprogrammesforeatingdisorders,adults
with
AD
HD
and
spe
cial
ist p
erin
atal
men
tal h
ealth
se
rvic
es.
Undertakeevaluationstudiesofrelevant
demonstrationsites.
HSE
Prov
ision
of a
ppro
pria
te s
ervi
ces
forpeoplewitheatingdisorders
andadultswithADHD;
Appr
opria
te p
rovi
sion
of P
erin
atal
M
enta
l Hea
lth S
ervi
ces.
Med
ium
2a,2b
54Everypersonwithmentalhealthdifficultiescoming
into
con
tact
with
the
fore
nsic
sys
tem
sho
uld
have
accesstocomprehensivestepped(ortiered)mental
healthsupportthatisrecovery-orientedandbased
on in
tegr
ated
co-
prod
uced
reco
very
car
e pl
ans
supportedbyadvocacyservicesasrequired.
Com
plet
e m
enta
l hea
lth n
eeds
ana
lysis
of t
he
prisonpopulation.
Developacomprehensivetieredforensicmental
heal
th m
odel
of c
are.
Deliverphasedimplementationofthetiered
men
tal h
ealth
ser
vice
.
HSE/PrisonService
Acce
ss to
app
ropr
iate
men
tal
heal
thca
re fo
r ser
vice
use
rs w
ithin
theforensicservicenationally.
Med
ium
2a,2b
55Thereshouldbeongoingresourcingofandsupport
for d
iver
sion
sche
mes
whe
re in
divi
dual
s w
ith m
enta
l healthdifficultiesaredivertedfromthecriminal
justicesystemattheearliestpossiblestageand
havetheirneedsmetwithincommunityand/ornon-
forensicmentalhealthsettings.
Prov
ide
ongo
ing
reso
urci
ng a
nd s
uppo
rt fo
r di
vers
ion
sche
mes
.DoJE/HSE
Div
ersio
n sc
hem
es in
pla
ce a
nd
in u
se.
Med
ium
2b
56Th
e de
velo
pmen
t of f
urth
er In
tens
ive
Car
e RehabilitationUnits(ICRUs)shouldbeprioritised
followingsuccessfulevaluationofoperationofthe
newICRUonthePortraneCampus.
Carryoutacomprehensiveevaluationandreview
oftheICRUonthePortraneCampus.
Developanationalplanforthedevelopmentof
ICRUs.
Undertakephasedimplementationofthenational
ICRUdevelopmentplan.
HSE/PrisonService
AppropriateICRUprovisionforthe
relevantpopulation.
Med
ium
2b
57Atieredmodelofintegratedserviceprovisionfor
individualswithadualdiagnosis(e.g.substance
misusewithmentalillness)shouldbedevelopedto
ensu
re th
at p
athw
ays
to c
are
are
clea
r.
Similarly,tieredmodelsofsupportshouldbe
availabletopeoplewithadualdiagnosisof
intellectualdisabilityand/orautismandamental
healthdifficult.
Developaspecificserviceimprovementframework
acrossHSEPrimaryCare/MentalHealth/Acute
Hospitalstoadvancethisrecommendation.
Developatieredmodelofcare.
Developdemonstrationsitesofthetieredmodelof
care,withevaluation.
Developphasedimplementationofcomprehensive
serv
ice.
HSE
Tier
ed m
odel
of s
ervi
ce p
rovi
sion
developedandavailable.
Med
ium
2a,2d
58In
ord
er to
add
ress
ser
vice
gap
s an
d ac
cess
issu
es, a
st
eppe
d m
odel
of i
nteg
rate
d su
ppor
t tha
t pro
vide
s mentalhealthpromotion,preventionandprimary
interventionsupportsshouldbeavailableforpeople
expe
rienc
ing
hom
eles
snes
s.
Dev
elop
a s
tepp
ed a
nd in
tegr
ated
mod
el o
f su
ppor
t for
peo
ple
expe
rienc
ing
hom
eles
snes
s. Developanimplementationplanwhichincludes
evaluationofnewservicedevelopments.
HSE/HousingAgency
Step
ped
mod
el o
f sup
port
is
availablenationally.
Med
ium
2a
Appendix
104
59Assertiveoutreachteamsshouldbeexpandedso
thatspecialistmentalhealthcareisaccessibleto
peop
le e
xper
ienc
ing
hom
eles
snes
s.
Carryoutneedsanalysistodefineservicedeficit.
Developanimplementationplaninlinewiththe
step
ped
mod
el o
f men
tal h
ealth
sup
port
for t
he
homelesspopulation.
Advancethephasedexpansionoftheexisting
serv
ice.
HSE/HousingAgency
Out
reac
h te
ams
expa
nded
and
in
plac
e.M
ediu
m2a
60ContinuedexpansionofLiaisonMentalHealth
Serv
ices
for a
ll ag
e gr
oups
sho
uld
take
pla
ce in
the
cont
ext o
f an
inte
grat
ed L
iaiso
n M
enta
l Hea
lth
Mod
el o
f Car
e.
Dev
elop
an
inte
grat
ed L
iaiso
n M
enta
l Hea
lth
Mod
el o
f Car
e.
Developanimplementationplanwhichincludes
evaluationofservicedevelopments.
Supp
ort p
hase
d ex
pans
ion
of s
ervi
ces.
HSE
Com
preh
ensiv
e an
d in
tegr
ated
Li
aiso
n M
enta
l Hea
lth S
ervi
ces
areavailableinallrelevantacute
hosp
itals
Med
ium
2a,2b
61Th
e H
SE s
houl
d m
axim
ise th
e de
liver
y of
div
erse
an
d cu
ltura
lly c
ompe
tent
men
tal h
ealth
sup
port
s th
roug
hout
all
serv
ices
.
Gatherserviceuserandservicedeliveryfeedback
rega
rdin
g cu
ltura
lly a
ppro
pria
te s
ervi
ce p
rovi
sion.
Pr
ovid
e di
vers
e an
d cu
ltura
lly c
ompe
tent
sup
port
s ac
ross
all
serv
ices
.
HSE
Userfeedbackindicatesthat
serv
ices
are
del
iver
ed in
a d
iver
se
and
cultu
rally
com
pete
nt m
anne
r.
Med
ium
2a
62Bu
ildin
g on
ser
vice
impr
ovem
ents
alre
ady
in p
lace
, in
divi
dual
s w
ho a
re d
eaf s
houl
d ha
ve a
cces
s to
the
fullsuiteofmentalhealthservicesavailabletothe
widerpopulation.
ConductanevaluationoftheNationalSpecialist
Serv
ice
and
Mod
el o
f Car
e fo
r men
tal h
ealth
se
rvic
es fo
r the
dea
f com
mun
ity.
Basedonevaluationfindings,developagap
anal
ysis
and
serv
ice
impr
ovem
ent p
lan.
Su
ppor
t pha
sed
serv
ice
deve
lopm
ent a
nd
impr
ovem
ent.
Ensurethatstaffworkinginmentalhealthservices
have
the
appr
opria
te s
kills
and
kno
wle
dge
to w
ork
with
the
deaf
com
mun
ity.
Car
ry o
ut a
trai
ning
nee
ds a
naly
sis to
info
rm
thetrainingrequirementsofmentalhealthstaff
wor
king
with
the
deaf
com
mun
ity.
Dev
elop
and
impl
emen
t a tr
aini
ng, s
uppo
rt a
nd
supervisionplanformentalhealthstaffworking
with
the
deaf
com
mun
ity.
HSE
Dea
f com
mun
ity w
ith m
enta
l he
alth
sup
port
nee
ds c
an a
cces
s comprehensivetieredmental
heal
th s
ervi
ces.
Basedontargetedfeedbackfrom
deaf
men
tal h
ealth
ser
vice
use
rs,
mentalhealthstaffarecompetent
to s
uppo
rt th
e de
af c
omm
unity
attendingmentalhealthservices.
Shor
t2a,2b
Sharing the Vision | A Mental Health Policy for Everyone
105
63Pe
rson
s in
Dire
ct P
rovi
sion
and
refu
gees
arr
ivin
g undertheIrishrefugeeprotectionprogramme
shouldhaveaccesstoappropriatetieredmental
heal
th s
ervi
ces
thro
ugh
prim
ary
care
and
spe
cial
ist
men
tal h
ealth
ser
vice
s.
Con
vene
an
Expe
rt G
roup
(with
ser
vice
use
r co-production)toadviseonbestpracticefor
theadequateprovisionoftieredmentalhealth
supp
orts
to th
ose
in D
irect
Pro
visio
n an
d re
fuge
es
whohavesignificantissuesrelatingtotrauma.
DevelopanimplementationplanofDirect
Prov
ision
men
tal h
ealth
sup
port
acr
oss
HSE
Pr
imar
y C
are
and
Men
tal H
ealth
with
cle
ar
evaluationtargets.
Resourcephasedimplementation.
HSE/Reception&
IntegrationAgency
Pers
ons
in D
irect
Pro
visio
n ca
n ac
cess
the
sam
e su
ppor
ts a
s th
e widerpopulation.
Med
ium
2a
64Appropriatelyqualifiedinterpretersshouldbemade
availablewithinthementalhealthserviceand
oper
ate
at n
o co
st to
the
serv
ice
user
.
Dev
elop
gui
danc
e on
the
appr
opria
te te
nder
ing
andcommissioningofinterpretationservicesand
eval
uate
the
proc
ess
once
it is
in p
lace
. Resourcehigh-qualityinterpreterservicesfor
men
tal h
ealth
ser
vice
use
rs.
HSE
High-qualityinterpreterservices
areavailableatnocosttoservice
user
s.
Med
ium
2a
65Th
e H
SE s
houl
d en
sure
that
acc
ess
to a
ppro
pria
te
advocacysupportscanbeprovidedinallmental
heal
th s
ervi
ces.
Con
duct
a g
ap a
naly
sis o
f adv
ocac
y su
ppor
ts
need
s.
Developanimplementationplanforadvocacy
serv
ices
. Resourcephasedimplementationwithappropriate
evaluation.
HSE
Accessibleadvocacysupportsin
plac
e.M
ediu
m2a
Appendix
106
Dom
ain
3 |
Soc
ial I
nclu
sion
Out
com
e 3a
Ser
vice
use
rs a
re re
spec
ted,
con
nect
ed a
nd v
alue
d in
thei
r com
mun
ity
Out
com
e 3bIncreasedabilityofserviceuserstomanagetheirownlives[self-determination]viastrongersocialrelationshipsandsenseofpurpose
Out
com
e 3cImprovedoutcomesinrelationtoeducation,housing,employmentandincomeforserviceusersrelativetothepopulationasawhole(i.e.reduceddisparity)
Reco
mm
enda
tion
Actio
ns/T
asks
Lead
Out
com
e In
dica
tors
Targ
et
Tim
efra
me
Out
com
e
66Tailoredmeasuresshouldbeinplaceinrelevant
gove
rnm
ent d
epar
tmen
ts to
ens
ure
that
indi
vidu
als
withmentalhealthdifficultiescanavail,without
discrimination,ofemployment,housingand
educationopportunitiesandhaveanadequate
inco
me.
Developmulti-departmentalinitiativetoensure
mea
sure
s ar
e in
pla
ce fo
r ind
ivid
uals
with
men
tal
healthdifficultiestoavail,withoutdiscrimination,of
employment,housingandeducationopportunities
andhaveadequateincome.
DoH
Equalopportunitiesforindividuals
withmentalhealthdifficultiesto
avai
l of e
mpl
oym
ent,
hous
ing
and
educationopportunitiesandto
haveadequateincome.
Med
ium
3b,3c
67Localauthoritiesshouldliaisewithstatutorymental
heal
th s
ervi
ces
in o
rder
to in
clud
e th
e ho
usin
g ne
eds
of p
eopl
e w
ith c
ompl
ex m
enta
l hea
lth
difficultiesaspartoftheirlocalhousingplans.
Incl
ude
the
hous
ing
need
s of
peo
ple
with
com
plex
mentalhealthdifficultiesaspartoflocalhousing
plan
s, w
ith a
ssoc
iate
d re
sour
ces.
HousingAgency/local
authorities
Hou
sing
need
s of
peo
ple
with
complexmentalhealthdifficulties
are
met
.
Long
3c
68D
epar
tmen
t of H
ealth
and
Dep
artm
ent o
f Hou
sing,
PlanningandLocalGovernment,inconsultation
with
rele
vant
sta
keho
lder
s, sh
ould
dev
elop
a
jointprotocoltoguidetheeffectivetransitionof
individualsfromHSE-supportedaccommodationto
com
mun
ity li
ving
.
Developajointprotocoltoguidetheeffective
transitionofindividualsfromHSE-supported
accommodationtocommunityliving.
DoH/DHPLG
Implementationofagreedjoint
prot
ocol
. Sh
ort
3a,3b,3c
69InconjunctionwithsupportsprovidedbyHSE
includingIntensiveRecoverySupportteams,
sustainableresourcingshouldbeinplacefor
tenancy-related/independentlivingsupportsfor
serviceuserswithcomplexmentalhealthdifficulties.
Developsustainableresourcingsupportsfor
individualswithcomplexmentalhealthdifficulties.
HSE/HousingAgency/
localauthorities
Serv
ice
user
s w
ith c
ompl
ex
need
s pr
ovid
ed w
ith a
ppro
pria
te
tenancy/independentliving
supp
orts
.
Med
ium
3a,3b,3c
70Thehousingdesignguidelinespublishedbythe
HSEandtheHousingAgencyin2016topromote
inde
pend
ent l
ivin
g an
d m
enta
l hea
lth re
cove
ry
shouldbeareferencepointforallhousing-related
actionsinthispolicy.
Usehousingdesignguidelinesasbasisforall
housing-relatedactions.
HSE/HousingAgency/
localauthorities
Hou
sing
desig
n gu
idel
ines
are
incorporated,wherepossible,inall
housing-relatedrecommendations
cont
aine
d in
STV
.
Shor
t3a,3b,3c
71Asustainablefundingstreamshouldbedeveloped
toensureagenciescanworkeffectivelytogetherto
getthebestoutcomesfortheindividualusingthe
Indi
vidu
alise
d Pl
acem
ent S
uppo
rt m
odel
, whi
ch is
anevidence-based,effectivemethodofsupporting
peoplewithcomplexmentalhealthdifficultiesto
achievesustainable,competitiveemploymentwhere
they
cho
ose
to d
o so
.
Developasustainablefundingstreamtosupport
the
IPS
mod
el.
DoH/HSE
IPS
mod
el e
valu
ated
and
exp
ande
d supportedbyasustainablefunding
mod
el.
Med
ium
3a,3b,3c
72Th
e cu
rren
t HSE
fund
ing
prov
ided
for d
ay c
entr
es
shouldbereconfiguredtoprovideindividualised
supportsforpeoplewithmentalhealthdifficulties
andbeconsistentwiththe
New
Dire
ction
s po
licy.
HSEtoengageinevaluationofcurrentfunding
providedandreconfigureserviceswherenecessary.
HSE
Fundingreconfiguredtoeffectively
supp
ort i
ndiv
idua
lised
sup
port
in
line
with
New
Dire
ction
s po
licy.
Med
ium
3a,3b,3c
Sharing the Vision | A Mental Health Policy for Everyone
107
73Inlinewiththestrategicprioritiesofthe
Com
preh
ensiv
e Em
ploy
men
t Str
ateg
y fo
r Peo
ple
withDisabilitiesthewaypeoplecomeon/off
incomesupportsshouldbestreamlinedtomaximise
entryorre-entrytotheworkforcewithconfidence
and
secu
rity.
Thi
s sh
ould
hap
pen
with
out t
hrea
t oflossofbenefitandwithimmediaterestoration
ofbenefitswheretheyhaveanepisodiccondition
ormustleaveajobbecauseoftheirmentalhealth
difficulty.
Streamlinethewayindividualscomeon/offincome
supp
orts
to m
axim
ise e
ntry
or r
e-en
try
to th
e workforcewithconfidenceandsecurity.
DEA
SP
Proc
esse
s fo
r ind
ivid
uals
com
ing
on/offincomesupportsmaximise
the
entr
y or
re-e
ntry
to w
orkf
orce
.
Med
ium
3c
74TheHSEshouldcontinuetodevelop,fundand
periodicallyevaluateexistingandnewpeer-led/
peer
-run
ser
vice
s pr
ovid
ed to
peo
ple
with
men
tal
healthdifficultiesacrossthecountry.
Evaluatepeer-led/peer-runservicesforpeople
withmentalhealthdifficulties.
Developnewandsupportexistingevaluated
peer-led/runservicesforpeoplewithmentalhealth
difficulties.
HSE
Evaluatedpeer-led/peer-run
serv
ices
sup
port
ed a
nd e
xpan
ded.
Shor
t
Med
ium
3a,3b
Appendix
108
Dom
ain
4 |
Acc
ount
abili
ty a
nd C
ontin
uous
Impr
ovem
ent
Out
com
e 4aMentalhealthisembeddedasanationalcross-cuttingprioritythatiseffectivelyintegratedintothekeypoliciesandsettingsinsociety
Out
com
e 4b
DynamicperformancereportingprovidesvisibilityoftheperformanceandimpactofS
harin
g th
e Vi
sion
Out
com
e 4c
Servicesthatdeliverconsistentlyhigh-qualityperson-centredsupportsthatmeettheneedsandhavetheconfidenceofserviceusersandFCS
Out
com
e 4dContinuousimprovementisfuture-focusedanddrivenbyadequatelyresourcedinnovationacrossthementalhealthsystemandrelatedsectors
Reco
mm
enda
tion
Actio
ns/T
asks
Lead
Out
com
e In
dica
tors
Targ
et
Tim
efra
me
Out
com
e
75Theorganisationofmentalhealthservicesshould
bealignedwithemergingintegratedcarestructures
unde
r Slá
inte
care
refo
rms
incl
udin
g th
e pr
opos
ed
sixRegionalHealthAreasandwithinthesethe
Com
mun
ity H
ealth
Net
wor
ks c
orre
spon
ding
to
populationsofabout50,000.
Ensurethededicatedlineofauthorityisvisiblein
the
stru
ctur
es a
t reg
iona
l lev
el.
HSE
Visiblelineofauthorityfor
inte
grat
ed m
enta
l hea
lth s
ervi
ces.
Med
ium
4a,4c
76Implementationofthispolicyoverthenextten
yearsshouldachieveare-balancingofresources
andtakeaccountofpopulationdeprivationpatterns
in p
lann
ing,
reso
urci
ng a
nd d
eliv
erin
g m
enta
l hea
lth
serv
ices
.
Usepopulationdeprivationpatternsinplanning,
reso
urci
ng a
nd d
eliv
erin
g m
enta
l hea
lth s
ervi
ces.
Rebalanceresourcingofmentalhealthserviceson
thisbasis.
HSE
Men
tal h
ealth
ser
vice
reso
urci
ng
targetedtosupportthespecific
needsofthepopulation.
Med
ium
4a,4b,4c
77A
stan
dard
ised
set o
f per
form
ance
indi
cato
rs
(PIs)
dire
ctly
alig
ned
with
the
desir
ed o
utco
mes
in
STV
and
agr
eed
stan
dard
s of
car
e an
d qualityframeworksshouldbedevelopedby
theDepartmentofHealthandtheNational
ImplementationMonitoringCommitteeaccounting
forquantitativeandqualitativedeliveryofintended
outc
omes
.
Dev
elop
app
ropr
iate
per
form
ance
indi
cato
rs
alig
ned
to S
TV o
utco
mes
.D
oHPe
rfor
man
ce in
dica
tors
in p
lace
as
sess
ing
stan
dard
s of
car
e an
d qualityperagreedframeworks.
Med
ium
4b
78RegularsurveysofserviceusersandFCSshouldbe
inde
pend
ently
con
duct
ed to
info
rm a
sses
smen
ts
of p
erfo
rman
ce a
gain
st P
Is a
nd ta
rget
out
com
es in
ST
V.
Con
duct
and
repo
rt o
n re
gula
r sur
veys
with
ser
vice
us
ers
and
FCS.
Anationalmentalhealthserviceexperiencesurvey
proposalshouldbedevelopedtobeconsidered
forinclusionundertheNationalCareExperience
Prog
ram
me.
HSE
Serv
ices
pla
nned
and
dev
elop
ed in
linewithfindingofsurveys.
Med
ium
4b
79Informationontheprocessofmakingacomplaint,
includingnecessarycontactdetails,shouldbe
visible,accessibleandwidelyavailableinavariety
of m
edia
, lan
guag
es a
nd fo
rmat
s fo
r max
imum
accessibilityinallmentalhealthservicesettingsand
in o
ther
fora
.
Publishclearandaccessiblecomplaintsprocedure.
HSE
Clearandvisiblecomplaints
proc
edur
e.Sh
ort
4b
80Acultureofopendisclosuretosupportpatient
safetyisembeddedinmentalhealthservices.
Men
tal h
ealth
ser
vice
s al
ign
open
disc
losu
re to
serviceusersandFCSwithnationalpolicyand
legislation.
HSE
Ope
n di
sclo
sure
to s
ervi
ce u
sers
andFCSisalignedtonational
policyandlegislation.
Ong
oing
4c
Sharing the Vision | A Mental Health Policy for Everyone
109
81Trainingshouldbeprovidedforservicesusersand
staffonmakinganddealingwithcomplaints.
Prov
ide
com
plai
nts
trai
ning
for s
ervi
ce u
sers
and
staff.
HSE
Trai
ning
pro
vide
d on
impr
oved
use
an
d m
anag
emen
t of t
he c
ompl
aint
s pr
oces
s.
Shor
t4b
82M
enta
l hea
lth s
ervi
ces
shou
ld e
nsur
e th
at th
e principlessetoutintheNationalHealthcare
Cha
rter
, You
and
You
r Hea
lth S
ervi
ce,areembedded
in a
ll se
rvic
e de
liver
y.
EmbedtheprinciplessetoutintheNational
Hea
lthca
re C
hart
er.
HSE
Principlesembedded.
Shor
t4c
83Fu
ture
upd
ates
of t
he Q
ualit
y Fr
amew
ork,
the
JudgementSupportFrameworkandtheBest
PracticeGuidanceshouldbeconsistentwiththe
ambitionandthespecificoutcomesforthemental
heal
th s
yste
m s
et o
ut in
Sha
ring
the
Visio
n.
Ensu
re fu
ture
upd
ates
of t
he Q
ualit
y Fr
amew
ork,
theJudgementSupportFrameworkandtheBest
PracticeGuidanceareconsistentwithS
harin
g th
e Vi
sion.
DoH/HSE
Futu
re u
pdat
es o
f the
Qua
lity
Framework,theJudgement
Supp
ort F
ram
ewor
k an
d th
e Be
st
PracticeGuidancecompletedin
a m
anne
r con
siste
nt w
ith S
harin
g th
e Vi
sion.
Al
l fun
ded
cont
ract
s fo
r ser
vice
de
liver
y in
men
tal h
ealth
in
futureshouldembedthecore
prin
cipl
es a
nd g
uida
nce
from
thes
e fr
amew
orks
, as
stre
amlin
ed a
nd
rele
vant
.
Med
ium
4c
84Therelevantbodiesshouldcometogethertoensure
that
the
mea
sure
s fo
r the
Qua
lity
Fram
ewor
k, th
e JudgementSupportFramework,theBestPractice
Gui
danc
e, S
harin
g th
e Vi
sion
PIs
and
perf
orm
ance
sy
stem
and
any
futu
re m
easu
rem
ent s
yste
ms
are
alignedandthattherequireddataisderived,where
possible,fromasinglecommondataset.
Agre
e an
d al
ign
the
mea
sure
s an
d pe
rfor
man
ce
mea
sure
men
t inc
ludi
ng th
at o
f the
Qua
lity
Framework,theJudgementSupportFramework,
theBestPracticeGuidance.
DoH/HSE
Sing
le c
omm
on d
ata
set a
nd
mea
sure
men
t sys
tem
is in
pla
ce.
Med
ium
4c
85Theworkunderwayatnationalleveltodevelopa
costandactivitydatabaseforhealthandsocialcare
inIrelandshouldprioritisementalhealthservicesto
leve
rage
dev
elop
men
tal w
ork
alre
ady
unde
rway
and
supporttheevolutionofoutcome-basedresource
allocation.
Prioritisementalhealthservicesinthework
underwayatnationalleveltodevelopacostand
activitydatabaseforhealthandsocialcarein
Irela
nd.
HSE
Dev
elop
men
t of t
he m
enta
l hea
lth
servicecostandactivitydatabase
unde
rway
.
Shor
t4d
86Anationalmentalhealthinformationsystemshould
beimplementedwithinthreeyearstoreportonthe
perf
orm
ance
of h
ealth
and
soc
ial c
are
serv
ices
in
line
with
this
polic
y.
ImplementaNationalMentalHealthInformation
Syst
em.
HSE
NationalMentalHealth
InformationSystem
implementationinprogress.
Med
ium
4a,4d
87TheDepartmentofJusticeandtheImplementation
MonitoringCommittee,inconsultationwith
stakeholders,willdeterminewhetherlegislation
needstobeamendedtoallowforgreaterdiversion
ofpeoplewithmentalhealthdifficultiesfromthe
criminaljusticesystem.
Assesstheneedforamendedlegislationfor
diversionofpeoplewithmentalhealthdifficulties
fromthecriminaljusticesystemandamendif
nece
ssar
y.
DoJE
Appropriatelegislationisinplace
for d
iver
sion
of p
eopl
e w
ith m
enta
l healthdifficultiesfromthecriminal
justicesystem.
Med
ium
4a,4d
88Trainingandguidanceshouldbeprovidedtostaff
onthepracticeofpositiverisk-taking,basedon
the
prin
cipl
es o
f the
Ass
isted
Dec
ision
-Mak
ing
(Capacity)Act2015,wherethevalueofpromoting
positiverisk-takingisrecognisedbytheregulator.
Providetrainingandguidancetostaffonthe
practiceofpositiverisk-taking,basedonthe
prin
cipl
es o
f the
Ass
isted
Dec
ision
-Mak
ing
(Capacity)Act2015.
HSE
Trai
ning
and
gui
danc
e is
prov
ided
onthepracticeofpositiverisk-
taking,basedontheprinciples
of th
e As
siste
d D
ecisi
on-M
akin
g (Capacity)Actandapprovedbythe
regu
lato
r.
Shor
t4c
Appendix
110
89Ac
cess
to s
afeg
uard
ing
team
s an
d tr
aini
ng s
houl
d beprovidedforstaffworkinginstatutoryandnon-
stat
utor
y m
enta
l hea
lth s
ervi
ces
in o
rder
to a
pply
thenationalsafeguardingpolicy.
Prov
ide
acce
ss to
saf
egua
rdin
g te
ams
and
trai
ning
fo
r men
tal h
ealth
ser
vice
s.H
SEMentalhealthstaffarefullytrained
andsupportedinimplementingthe
nationalsafeguardingpolicy.
Shor
t4c
90TheJusticeandHealthsectorsshouldengagewith
the
Cor
oner
s, th
e G
arda
Sío
chán
a, N
OSP
, CSO
and
researchbodiesinrelationtodeathsincustody,
recordingofdeathsbysuicideandopenverdicts,to
furtherrefinethebasisofsuicidestatistics.
Refinesuicidestatisticsthroughengagementwith
coro
ners
, the
Gar
da S
íoch
ána,
NO
SP, C
SO a
nd
otherresearchbodies.
DoJE/DoH
Refinedsuicidestatisticsfordeaths
incustody,recordingofdeathsby
suic
ide
and
open
ver
dict
s.
Shor
t4c
91Significantimprovementsarerequiredinthe
monitoringandreportingoflevelsandpatternsof
self-harmandsuicidalityamongpeopleattending
men
tal h
ealth
ser
vice
s to
info
rm a
com
preh
ensiv
e andtimelyserviceresponsetoeffectivelyreduce
leve
ls of
har
m a
nd d
eath
.
Reviewcurrentreportingandmonitoringoflevels
andpatternsofself-harmandsuicidalityamong
peopleattendingmentalhealthservices.
HSE
Appr
opria
te m
onito
ring
and
reportingprocessesoflevels
andpatternsofself-harmand
suicidalityamongpeopleattending
men
tal h
ealth
ser
vice
s ar
e in
pla
ce.
Shor
t4c
92In
kee
ping
with
the
evol
ving
und
erst
andi
ng o
f hu
man
righ
ts to
em
pow
er p
eopl
e an
d im
prov
e qualityofcareinmentalhealthcarefacilities,
legislationmustbeupdatedandadditionalsupports
put i
n pl
ace.
Progressa‘zerorestraint,zeroseclusion’action
plan,whichshouldbedevelopedinpartnership
with
men
tal h
ealth
ser
vice
s.
Prioritisecomprehensivelegislationtoreformthe
Men
tal H
ealth
Act
in li
ne w
ith th
is po
licy
and
in li
ne
withinternationalhumanrightslaw.
In k
eepi
ng w
ith th
e ev
olvi
ng u
nder
stan
ding
of
humanrights,particularlytheUNConventionon
theRightsofPersonswithDisabilities,ensurethat
involuntarydetentionisnotusedexceptinalife-
savi
ng e
mer
genc
y.
Makeavailablearangeofadvocacysupports
includingbothpeerandrepresentativeadvocacyas
a rig
ht fo
r all
indi
vidu
als
invo
lved
with
the
men
tal
heal
th s
ervi
ces.
Arangeofadvocacysupportsincludingbothpeer
andrepresentativeadvocacyshouldbeavailableas
a rig
ht fo
r all
indi
vidu
als
invo
lved
with
the
men
tal
heal
th s
ervi
ces.
DoH/DoJE
Com
plet
ed re
view
of M
enta
l H
ealth
Act
. Representativeadvocacyavailable
to a
ll in
divi
dual
s. Developanactionplanfor‘zero
restraint,zeroseclusion’inmental
heal
th s
ervi
ces.
Shor
t4b,4c
93ANationalPopulationMentalHealthandMental
HealthServicesResearchandEvaluationStrategy
shouldbedevelopedandresourcedtosupport
aportfolioofresearchandevaluationactivityin
accordancewithprioritiesidentifiedintheresearch
stra
tegy
.
DevelopaNationalPopulationMentalHealthand
MentalHealthServicesResearchandEvaluation
Stra
tegy
.
HealthResearchBoard
PublishedandresourcedNational
PopulationMentalHealthand
MentalHealthServicesResearch
andEvaluationstrategy.
Shor
t4d
94Inordertobringaboutchange,astrategicapproach
isrequiredinvolvingthenecessaryskillsinchange
management.Thisapproachhasbeendeveloped
in th
e fo
rmer
HSE
Men
tal H
ealth
Div
ision
(MH
D)
StrategicPortfolioandProgrammeManagement
Officeandshouldbemainstreamedandembedded
in th
e w
ider
HSE
.
Embedthestrategicapproachtochange
managementutilisedintheformerMHDStrategic
PortfolioandProgrammeManagementOfficein
the
HSE
.
HSE
Visible,quantifiablechange
managementprojectsdeliveredin
men
tal h
ealth
ser
vice
s.
4d
Sharing the Vision | A Mental Health Policy for Everyone
111
95TheinitiativesundertheformerMentalHealth
DivisionStrategicPortfolioandProgramme
ManagementOffice(SPPMO)andtheongoing
SocialReformFund(SRF)shouldbegathered
togetherandmadeavailablebothtoencourage
furtherinnovationandtoavoidduplicationinthe
publicserviceandNGOsectors.
CollateandalignallinitiativesfromSPPMOand
SRFtosupportfurtherinnovation.
HSE
Innovationsupportedinmental
heal
th s
ervi
ces
acro
ss a
ll pr
ovid
ers.
Shor
t4d
96Innovationswhichhavegoodevidenceforclinical
and/orsocialandcosteffectivenessshouldberolled
outnationally.Thiswillrequirethechangingof
practicesandmodificationorcessationofservices
whicharesupersededbythenewformofdelivery.
Rolloutinnovationsthatdemonstrateclinicaland/
orsocialandcosteffectivenessincludingde-
commissioningofservicesnolongerfitforpurpose.
HSE
Neweffectiveinnovativeservices
arepromotedandexistingservices
withlimitedefficacyreplaced.
Med
ium
4d
97M
enta
l hea
lth s
ervi
ces
shou
ld m
ake
use
of o
ther
non-mentalhealthcommunity-basedphysical
facilities,whicharefitforpurpose,tofacilitate
com
mun
ity in
volv
emen
t and
sup
port
the
implementationoftheoutcomesinthispolicy.
Eval
uate
cur
rent
and
futu
re u
se o
f non
-men
tal
healthcommunity-basedfacilitiesandmake
recommendationsonhowtheycouldbebetter
used
to d
eliv
er m
enta
l hea
lth s
ervi
ces.
HSE
Widerangeoffacilitiesused
as a
ppro
pria
te to
sup
port
the
effectivedeliveryofmentalhealth
serv
ices
.
Med
ium
4c
98Capitalinvestmentshouldbemadeavailableto
redesignorbuildpsychiatricunitsinacutehospitals
whichcreateatherapeuticandrecoverysupportive
environment.Itisessentialthatallstakeholdersare
invo
lved
in a
str
uctu
red
serv
ice
desig
n pr
oces
s fo
r allredesignsornewbuilds.
Investinco-producedredesignand/orbuildingof
psyc
hiat
ric u
nits
in a
cute
hos
pita
ls.
Includeinallfutureprimarycarenewbuilding
developmentsappropriatesettingsfordeliveryofa
men
tal h
ealth
ser
vice
.
DoH/HSE
Refurbished/newco-designed
psyc
hiat
ric u
nits
in p
lace
for
patients.
Long
4c
99Anational‘whole-of-government’Implementation
Committeeshouldbeestablishedwithstrong
serviceuserandVCSrepresentationtooversee
theimplementationoftherecommendationsinthis
polic
y an
d to
mon
itor p
rogr
ess.
Establish‘whole-of-government’Implementation
CommitteewithserviceuserandVCS
representationtooverseetheimplementationof
therecommendationsinS
harin
g th
e Vi
sion.
Prioritisesustainable,continuousinvestmentand
financialresourcingoverthe10-yearlifeofthis
polic
y to
ens
ure
that
the
wid
er m
enta
l hea
lth
systemcandeliveroptimumoutcomesforpeople
withmentalhealthdifficulties.
Ensurethat,throughoutthelifetimeofthispolicy,
ongoingcommunicationandengagementtake
placetoensurethatimplementationplansare
consistentwiththeprioritiesidentifiedbymultiple
stak
ehol
ders
. Conductandpubliclyreportanindependentreview
oftheimplementationofS
harin
g th
e Vi
sion
ever
y threeyearsoverthelifetimeofthispolicy.
DoH
Whole-of-governmentNational
ImplementationandMonitoring
Committeeinplaceoverseeing
prog
ress
of S
harin
g th
e Vi
sion.
Shor
t4a,4b
100Ajointreviewofthetwospecialisttraining
programmesbytheCollegeofPsychiatristsof
Irela
nd a
nd th
e Iri
sh C
olle
ge o
f Gen
eral
Practitionersshouldbeundertakentodevelop
an e
xem
plar
mod
el o
f men
tal h
ealth
med
ical
tr
aini
ng a
nd in
tegr
ated
car
e.
Undertakeajointreviewofmentalhealthmedical
trai
ning
and
inte
grat
ed c
are
to e
nsur
e re
gist
ered
practitionerswhohaveattainedapprovedMental
HealthEducationareprovidedwithspecialist
psyc
hiat
ric tr
aini
ng to
incr
ease
cap
acity
.
ICGP/ICP
Spec
ialis
t men
tal h
ealth
med
ical
tr
aini
ng fo
r GPs
and
psy
chia
trist
s de
liver
ed.
Med
ium
4a,4d
Appendix
112
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