Speech to Dail Eireann on Severe and Enduring Mental Illness

^^ Mental Health Services Provision ^^

 Dan Neville speaking in Dail Eireann on Topical Issues, Thursday 19th December 2013

 Deputy Dan Neville: I thank the Ceann Comhairle for allowing me raise this issue and I thank Minister of State for coming to the House to respond.  People with severe and enduring mental illness can experience a range of problems which results in their lives becoming restricted and impoverished.  Difficulties arise as a direct result of the disorder, and persistent symptoms can cause distress for the individual and for those around them.  Medication can have disabling side effects, while non-compliance can lead to disengagement from prescribed treatment, causing likely collapse.  This leads to a loss of self-confidence and sense of purpose in life, institutionalisation, social isolation and housing difficulties.  This group of service users is perhaps the most vulnerable in the mental health services, and ultimately the quality of the service overall can be measured by the quality of care provided to this group.  In the past this group reflected limitations in professional appreciation of their emotional and practical needs and limited appreciation of their potential to grow and develop as individuals through and beyond the experience of severe mental illness.

A Vision for Change, the report of the expert group on mental health policy, states that rehabilitation and recovery mental health teams should provide a specialised service for people disadvantaged by a range of problems which can develop with severe mental illness and which cannot be adequately dealt with by the general adult community mental health teams.  It is important that a process is introduced which enables disadvantaged individuals to access as independent a life as possible in social, cultural and economic terms.  A strong commitment to the principle of recovery should underpin the work of the rehabilitation team.  This reflects the belief that it is possible for all service users to achieve control over their lives, recover their self-esteem and move towards building a future life where they experience a sense of belonging and participation.  Many of this group experienced substantial distress resulting from persistent symptoms, institutionalisation and loss of selfhood, and require individualised specialised interventions with appropriate recovery-oriented programmes.  Many could reach a level of functioning sufficient to live and enjoy a more independent life in the community.

The needs of service users with enduring mental illness for social as well as clinical recovery is not addressed by the service provision.  Many of the vocational and training programmes which are a key component of rehabilitation and recovery do not meet the needs of service users for moving into mainstream employment.  There is a lack of adequate housing and accommodation options to enable service users move through the difficult stages of recovery and progress towards the goal of independent community-based living.  A Vision for Change recommended assigning a rehabilitation and recovery community mental health team to population groups of 100,000.  Assertive outreach teams providing community-based interventions should be the principal modality through which these teams work.

  Deputy Alex White: I thank the Deputy for raising this issue.  Positive mental health is an essential component of the Government’s strategy to enhance the overall health and well-being of our population.  While mental health problems are, unfortunately, increasing throughout society, emerging awareness and associated debate surrounding these issues can only be welcomed.  A corresponding development of policies and ensuring timely and accessible services for those with serious mental illness has therefore never been more important.  In this context, the Government remains firmly committed to implementing A Vision for Change so that we have, in reality, a comprehensive, integrated, and evidence-based system of mental health services.  While this approach includes, for example, obvious areas such as promotion, prevention, and a variety of treatment services, the specific area of recovery and associated rehabilitative supports is also being progressed.

An improved understanding of mental illness means that most people who use mental health services will recover to enjoy a good quality of life.  The inclusion in A Vision for Change of rehabilitation and recovery community mental health teams endorses the concept of rehabilitation within an overall, effective service.  Rehabilitation and recovery span virtually all aspects of mental health services, extending from continuing care to community residences, day centres and individual family supports.  More than 2,800 people with a history of mental health illness live in community residences receiving either high, medium or low-level support, depending on assessed needs.  Additional services are provided via social housing, day centre or social support networks within local communities.

The HSE service plan for 2013 specifically identified the need to embed and develop the ethos of recovery in the mental health care programme.  The HSE will continue to strengthen this and all relevant aspects of its multidisciplinary model of care over 2014.  There are 13 consultant-led rehabilitation and recovery teams.  The national mental health division in the HSE is conducting a comprehensive review of its resources to maximise potential and address any gaps in specialist rehabilitation and recovery services.  Where specialist rehabilitation and recovery teams have yet to be provided, these services can alternatively be delivered by general adult mental health teams.

A major direction undertaken by our mental health services since the publication of A Vision for Change is to provide services in community settings and improve access for individuals.  In this regard, a significant portion of the €90 million provided since 2012 for new service developments has been directed to strengthening community mental health teams, including rehabilitation supports for adults and children.

Recruitment of the posts approved for 2012 and 2013 is continuing.  As of the end of November, the recruitment process is complete or in the final stages for 395, or 95%, of the 414 posts approved in 2012.  Of the posts approved in 2013, the recruitment process is complete for 134, or 28%, with 278, or 58%, at various stages of recruitment.  The posts related to the €35 million allocated in 2013 will continue to come on stream and are targeted to be completed in quarter 2 of 2014.

As I have indicated, addressing the historic deficiencies of our mental health services remains a priority for Government.  The Deputy and the House can remain assured that we are firmly committed to delivering A Vision for Change, including its important aspects relating to rehabilitation services.

 Deputy Dan Neville: I welcome the response of the Minister of State.  I am aware of the development of community-based mental health services.  What I am referring to is the specialised services required for those who have enduring and persistent mental illness.  A Vision for Change contains a specific recommendation on this, including an outline of the provisions required, which I do not have time to put on the record.  It is interesting that it recommends having between ten and 15 psychiatric nurses in each assertive outreach team, with a maximum caseload of 12 service users to one nurse.  This is how difficult it is to ensure rehabilitation.  It will require all staff in the mental health system who are appointed to rehabilitation and recovery services to receive training in recovery-oriented competencies and principles.

Evaluation of the service provided to the severe and enduring group of service users should incorporate quality of life measures and assess the benefit and value of those services directly to the service users and their families.  The Minister of State referred to the appointment of posts and the allocation of €490 million over the past two years, and I accept that this is the case.  I am very disappointed with the slow rate of recruitment to these teams but I understand the difficulties that have been experienced.  The planning stage by the HSE each year has been very slow.

n the first year, recruitment did not commence until October.

I would like again to voice my disappointment that the €35 million promised for this year’s budget did not materialise.  I welcome the allocation of €25 million but the expectation was that €35 million would be allocated.

Deputy Alex White: As the Deputy correctly said, chapter 12 of A Vision for Change addresses the issue he raised, which is the needs of people with severe and enduring mental illness in the context of rehabilitation and recovery, and the document envisaged a consultant-led team per 100,000 of population.  He listed the professionals who would be associated with the team and the work that would be required of them.  Ultimately, one team per 100,000 of population would require 45 teams nationally.  I note the Deputy’s comments regarding the ongoing recruitment process.  My ministerial colleague, Deputy Kathleen Lynch, has worked tirelessly to ensure resources are provided and deployed to make sure these posts are filled and progress has been made in that regard.

The ring-fenced moneys in 2014 will enable the HSE to continue to develop and modernise our mental heath services in line with the recommendations of A Vision for Change and will allow for the recruitment of between 250 and 280 additional staff to enhance further our adult community mental health teams, child and adolescent mental health teams and specialist mental health teams, which will go a long way to redressing the historic and legacy issues in mental health service provision.  A significant amount has been achieved by the Government and, in particular by Deputy Kathleen Lynch, in that regard.  I thank the Deputy for raising the issue, as he has done on many occasions previously.  I welcome his support and his constant pressure on this issue.