There is disappointment in the mental health services over its painfully slow reform. Sylvia Thompsonreports.
It is almost one year since the major report on mental health, A Vision for Change, was published to widespread praise and acclaim. But the mood among health professionals and users of mental health services has changed to one of widespread disappointment.
The report, compiled by an expert group, promised to radically transform mental health services, but the pace of progress has been painfully slow, according to health professionals.
John Owens, chairman of the Mental Health Commission, says: "The report was accepted and funded as Government policy.
"It was accepted by the Health Service Executive. It was accepted by the Royal College of Psychiatrists, the Psychiatric Nurses Association and the Mental Health Commission. It's intolerable that nothing of substance has happened," he says.
"The last mental health document, Planning for the Future (1994), took a long time to be implemented," says Owens.
"That [ report] was mainly about the closing down of psychiatric hospitals. This report - which is principally about establishing community mental health teams throughout the country - needs fast implementation. The treatment of patients' illnesses depends on it."
John Saunders, director of Schizophrenia Ireland and a member of the implementation group for A Vision for Change, says: "There isn't a clear plan of action as to how to implement the policy document.
"The National Service User Executive, an organisation driven by the HSE and voluntary mental health organisations, is close to being formed but, apart from that, little has happened."
Saunders says his biggest concern is that there is no sign of the organisational and management structures necessary for the new catchment-area management teams and multidisciplinary community mental health teams.
The report recommends that the country be divided into population areas of up to 400,000 people each with a catchment-area management team and about 23 multidisciplinary community mental health teams with up to 14 staff members, taken from psychology, social work, occupational therapy, mental health nursing and psychiatry.
"Currently, there is an exercise in head counting to see what members are absent from different teams but everyone knows that already," says Saunders.
"What will be more difficult will be to get professionals from different disciplines to work together and share management responsibilities."
He also believes the HSE should make public what it is doing.
"One of the secrets of the success of A Vision for Change will be the attitudinal and behavioural change it will bring," says Saunders.
"We already know that viewing the patient as a partner encourages recovery. But we still have professionals who view themselves as the expert and authority on mental illness.
"It will take years for the patient to be an equal partner, but if multidisciplinary teams with their full staff in place were a reality, this would speed up that process. So far, it's a slow and tedious process."
Dr Siobhan Barry, psychiatrist and clinical director of Cluain Mhuire family centre in Blackrock, Co Dublin, is so dissatisfied with progress on implementing A Vision for Change that she will publish a paper one year later on January 24th, 2007, entitled A Vision in Hindsight.
Barry says: "This year has been dominated by the roll-out of the 2001 Mental Health Act. That's not part of A Vision for Change. From the point of view of health professionals on the ground, little or nothing has been achieved 11 months later.
"I am concerned that the money won't stretch to establish full multidisciplinary teams.
"Nobody has yet acquired a team as set out in the Vision for Change document. I also fear that money required for A Vision for Change is being skimmed off into other areas," she says.
Speaking specifically about her own service, Barry says it took six months to have a new member of the team validated. "This doesn't give one huge confidence," she adds.
Martin Rogan, assistant national director with responsibility for mental health in the HSE, says plans are moving forward to close all 15 remaining psychiatric hospitals and move patients into the community with various levels of support according to need.
He cites St Loman's Hospital in Palmerstown, Dublin as the hospital at the most advanced stage so far.
"In 2005, we sold 22 acres of the hospital land for €31 million and that money has been re-invested in the building of a community mental health centre/day hospital and apartments for those with long-term needs. We are also rebuilding the day hospital in Ballyfermot and building new residential units in Crumlin."
Rogan says it is highly significant that funds raised from selling former psychiatric hospitals will be ring-fenced for use within the mental health services for the first time ever.
He also says the Government has continued to support the funding requirements set out in the report in this year's Budget with an allocation of €25 million.
In terms of service development since the policy document was published, he says: "We have made plans for 18 new multidisciplinary community mental health teams and, at the moment, we are looking at what team members are currently on multidisciplinary teams around the country and what population bases they serve."
Rogan believes most staff in the mental health services are keen to work with the recovery model, outlined in a Vision for Change.Essentially, this model offers support to people with mental health problems in practical areas of their lives such as finding accommodation and suitable employment alongside more specific healthcare services.
He says: "There is an 80 per cent unemployment rate among those people with severe and enduring mental illness. We need to offer a service that allows them to reach their highest potential functioning in their lives."
Rogan says the HSE is working out 10 themes "to drive forward" the policy objectives of the report. These themes are expected to be decided on in January.
Many people - both those using mental health services and those working within it - are already concerned that this is yet another bureaucratic exercise that is preventing true implementation of A Vision for Change.