THERE IS a grim familiarity in the latest findings of the Inspectorate for Mental Health Services on the standards of psychiatric care. They show that too many residents continue to be housed in antiquated Victorian institutions. In addition, community mental health services have not developed as envisaged in government policy and there is still no sense that a coherent vision and philosophy drives the delivery of services.
The findings are familiar because so little has changed over the years. Mental health services have always suffered from neglect and stigma, but the government insisted this era was drawing to a close when it published its plan to modernise the sector four years ago. A Vision for Changewas adopted as government policy at the beginning of 2006. It had widespread support from all sectors and was accompanied by solemn pledges that resources and political will would be available to ensure the mistakes of the past were not repeated. Old psychiatric hospitals would be closed down and replaced with community-based centres. The concept of a national network of comprehensive, community-based, multi-disciplinary mental health teams would be realised. The voice of service users would no longer be ignored.
Yet, four years on we are still waiting for meaningful signs of progress. In three successive reports, an independent monitoring group – established to assess progress on the implementation of A Vision for Change– has expressed serious concern at slow progress. The more time passes without convincing evidence of its implementation, the more disillusioned and disenchanted the plan's champions become.
This amounts to a grievous violation of the dignity and human rights of our most vulnerable citizens. Some of the reasons for the lack of progress are clear. The failure to establish a separate mental health directorate in the Health Service Executive – a key recommendation in the plan – is one. Resources too have been an issue with significant funds due for investment in mental health diverted into other parts of the wider health budget.
What is needed is simple: the philosophy at the heart of Government policy must give rise to meaningful action with real targets, timelines, resources and assigned responsibility. It is not too late to salvage the hope and expectation that surrounded the launch of the blueprint for change. Political leadership and a willingness to make progress is vital. People with mental health problems have waited too long for a service which respects their dignity and rights.