Mental health services need long-overdue cultural and structural revamp

Opinion: Progress in implementing 2006 reform plan has been painfully slow


When a government policy is approaching its sell-by date and has not yet been fully implemented, there can be a temptation to consign it to a dusty shelf and think of it as yesterday’s news.

The government’s mental health policy, A Vision for Change , published in 2006, was to be implemented by 2016. Mental Health Reform has been calling for the full implementation of the policy since 2006, which would see a departure from overly medicalised hospital-based services to modern, multidisciplinary, recovery-focused and community-based mental health services.

Now, seven years into the policy, A Vision for Change remains an unfulfilled promise of a radical transformation. The slow progress is mainly due to structural and cultural barriers. Structurally, clear authority and accountability within the Health Service Executive to deliver a national plan have been lacking. Culturally, immense change in attitudes, behaviour and power structures by professionals and people using services is required.

Timely review
A review of the Mental Health Act is under way and a review of A Vision for Change is expected this year. This should lead to an updated and extended policy beyond 2016.

This year is also the year when mental health services will have, for the first time, a national director for mental health. The elevation of mental health to a distinct programme within the HSE marks a defining change. However, it is imperative the national director have the authority, accountability and budgetary control to deliver on the modernisation of Ireland’s mental health services.

The majority of the old psychiatric institutions have been closed; innovative services have been nurtured; the value of recovery has been promoted. However, without power to direct plans nationally, there remain significant inequities across the State.

The key message Mental Health Reform hears is that people want to be listened to, to have a consistent relationship with a professional and to have an offer of treatment that is more than just medication.

The challenge for the director for mental health will be to keep reform moving on the twin tracks of structural and cultural change and, in the immediate future, to protect the budget for mental health. While the programme for government made a commitment to invest €35 million annually in community mental health services, the bulk of this money was not spent last year and there has been an unacceptable delay in appointing staff.

In 2013, mental health services are still staffed at 24 per cent below the level recommended in A Vision for Change . Mental Health Reform has high expectations of what can be achieved through the role of director.

‘Population health
A Vision for Change
articulated a policy for the mental health of the nation – a “population health” approach that recognised the roles of primary care, mental health promotion and suicide prevention.

However, these sections are some of the least implemented by the HSE.

For Mental Health Reform, the policy review needs to reaffirm this “population health” approach to mental wellbeing, with a choice of services based on listening, respectful relationships and therapeutic supports that are “more than medication”.

In other words, a recovery approach helping the achievement of Mental Health Reform’s goal “for an Ireland where people with mental health difficulties can recover their good health and live a full life in their community”.

Orla Barry is director of Mental Health Reform, the national coalition of organisations to promote improved mental health services in Ireland (

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