FUTURE MENTAL HEALTH SERVICE DEVELOPMENTS IN IRELAND

1
FUTURE MENTAL HEALTH SERVICE DEVELOPMENTS IN
IRELAND

• IMHCN
• MONAGHAN OCTOBER 14 2005

2
PLANNING IN IRISH MENTAL HEALTH SERVICES

• COMMISSION OF INQUIRY INTO MENTAL HANDICAP 1965
• COMMISSION OF INQUIRY INTO MENTAL ILLNESS 1966
• PLANNING FOR THE FUTURE 1984
• EXPERT BODY FORMULATING NEW MENTAL HEALTH POLICY
  2005

3
RECOMMENDATIONS OF PLANNING FOR THE FUTURE 1984
(1)

• SERVICES TO BE BASED ON GEOGRAPHICAL CATCHMENTS
  (100,000) AND SECTORS (25,000)
• SERVICES TO BE COMMUNITY-BASED, INTEGRATED AND
  COMPREHENSIVE, WITH CONTINUITY OF CARE
• SERVICES TO BE DELIVERED BY COMMUNITY-BASED
  MULTIDISCIPLINARY MENTAL HEALTH TEAMS

4
RECOMMENDATIONS OF PLANNING FOR THE FUTURE 1984
(2)

• PROGRAMME OF DEINSTITUTIONALISATION
• SUPPORTED RESIDENCES
• DAY HOSPITALS
• DAY CENTRES
• MENTAL HOSPITALS TO BE CLOSED
• ACUTE UNITS TO BE ESTABLISHED IN GENERAL
  HOSPITALS
• CLOSE WORKING RELATIONSHIPS
• WITH PRIMARY CARE

5
MENTAL HEALTH LEGISLATION IN IRELAND

• MENTAL TREATMENT ACT 1945
• AMENDMENTS 1961
• MENTAL HEALTH ACT 2001
• STILL NOT FULLY COMMENCED

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MENTAL HEALTH SERVICE REGULATION AND INSPECTION

• MENTAL HEALTH COMMISSION 2002
• TO PROMOTE ENCOURAGE AND FOSTER THE ESTABLISHMENT
  AND MAINTENANCE OF HIGH STANDARDS AND GOOD
  PRACTICE IN THE DELIVERY OF MENTAL HEALTH CARE
• TO PROTECT THE RIGHTS OF DETAINED PATIENTS
• INSPECTORATE OF MENTAL HEALTH SERVICES

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CHARACTERISTICS OF A MODERN, HIGH QUALITY MENTAL
HEALTH SERVICE (1)

• PATIENT CENTRED
• RESPECT FOR PATIENTS RIGHTS, ENTITLEMENTS AND
  DIGNITY
• COMMUNITY-BASED
• ALTERNATIVES TO INPATIENT AND RESIDENTIAL CARE
• HIGH QUALITY COMMUNITY FACILITIES
• DELIVERED BY MULTIDISCIPLINARY TEAMS
• RANGE OF NECESSARY THERAPISTS
• WELL-FUNCTIONING TEAMS
• NECESSARY RANGE OF SPECIALITY
• SERVICES

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CHARACTERISTICS OF A MODERN, HIGH QUALITY MENTAL
HEALTH SERVICE (2)

• EFFECTIVE MANAGEMENT SYSTEMS
• PLANNING
• IMPLEMENTING
• MONITORING
• EFFECTIVE INFORMATION SYSTEMS TO SUPPORT
• SERVICE PLANNING
• SERVICE MONITORING
• EFFECTIVE CLINICAL GOVERNANCE SYSTEMS
• TO SUPPORT THE DELIVERY OF
• SAFE AND EFFECTIVE CARE

9
COMMUNITY MENTAL HEALTH TEAMS THE REALITY

• FEW WELL-FUNCTIONING TEAMS NATIONALLY
• LACK OF NECESSARY STAFF
• LACK OF TEAM SYSTEMS

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COMMUNITY MENTAL HEALTH TEAM STAFFING N (1)

• 5,000 PSYCHIATRIC NURSES
• MAJORITY STILL TIED TO INPATIENT AND RESIDENTIAL
  FACILITIES
• SERIOUS SHORTAGE OF
• PSYCHOLOGISTS, SOCIAL WORKERS, OCCUPATIONAL
  THERAPISTS AND OTHER THERAPIST
• 276 APPROVED CONSULTANT PSYCHIATRIST POSTS
• SHORTAGES PRIMARILY WITHIN
• SPECIALTY SERVICES OF REHABILITATION,
• INTELLECTUAL DISABILITY, FORENSIC SERVICES

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COMMUNITY MENTAL HEALTH TEAM STAFFING (2)

• COMMUNITY MENTAL HEALTH TEAM CORE STAFF
• MEDICAL
• NURSING
• PSYCHOLOGY
• SOCIAL WORK
• OCCUPATIONAL THERAPY
• SECRETARIAL SUPPORT
• ADDITIONAL STAFF
• COGNITIVE / BEHAVIOURAL THERAPISTS
• FAMILY THERAPISTS
• SPEECH AND LANGUAGE THERAPISTS
• BEREAVEMENT COUNSELORS
• CARE WORKERS
• FAMILY SUPPORT WORKERS
• AVERAGE TEAM SIZE 15-20 MEMBERS

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CMHT FUNCTIONING

• TEAM MANAGEMENT
• TEAM COORDINATOR
• TEAM CLINICAL LEADER
• TEAM PRACTICE MANAGER
• SINGLE POINT OF ACCESS
• FACILITATES ACCESS
• ALLOWS TELEPHONE CONSULTATIONS
• ALLOWS TRIAGING WITH REFERRAL AGENCIES
• TEAM DISCUSSION AND ALLOCATION OF REFERRALS
• TEAM DISCUSSION OF ASSESSMENTS AND CARE PLANS
• KEY THERAPIST/ KEY CONTACT
• FROM THE MOST APPROPRIATE PROFESSIONAL
  DISCIPLINE
• POINT OF CONTACT BETWEEN PATIENT / CARERS AND
  TEAM
• COORDINATES CARE PROGRAMME

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CHALLENGES OF TEAM WORKING

• FEW DISCIPLINES FAMILIAR WITH REAL TEAM
  FUNCTIONING
• MEDICAL
• INDIVIDUAL THERAPISTS
• TRADITIONAL MEDICAL ROLE
• NURSING STAFF
• SHIFT FROM INSTITUTIONS TO COMMUNITY
• PROFESSIONAL DEVELOPMENT CRITICAL
• ALLIED HEALTH PROFESSIONALS
• LITTLE OPPORTUNITY TO WORK IN A MDT SETTING

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ISSUES FOR THE FUTURE

• MANPOWER PLANNING
• TRAINING FOR ALL DISCIPLINES IN MDT SETTING
• PROBLEM OF CHANGING CURRENT
• STAFF MIX
• BAN ON PUBLIC SERVICE RECRUITMENT

15
COMMUNITY BASED SERVICES THE REALITY (1)

• CURRENT BED PROVISION
• 3,556 TOTAL DESIGNATED BEDS IN 2004 117/100,000
  OVER 16
• 1,338 DESIGNATED ADMISSION BEDS 44.1/100,000
  OVER 16
• 24-HOUR NURSE-STAFFED RESIDENTIAL UNITS
• 1727 57/100,000 OVER 16
• CURRENT ADMISSION RATE
• NATIONAL AVERAGE 760 / 100,000 OVER 16
• SPREAD FROM 292 TO 1200 / 100,000 OVER 16
• CURRENT INVOLUNTARY DETENTION RATE
• NATIONAL AVERAGE 80.4 / 100,000 OVER 16
• SPREAD FROM 30 TO 160 / 100,000 OVER 16

16
COMMUNITY BASED SERVICES THE REALITY (2)

• SERVICES STILL PREDOMINANTLY BED-BASED
• COMMUNITY DEVELOPMENTS MAINLY RESTRICTED TO
  DISCHARGE OF LONG STAY PATIENTS
• 175 NEW LONG STAY PATIENTS CREATED IN 2003
• SOME SERVICES CONTINUE TO ADMIT AND TRANSFER TO
  LONG STAY MENTAL HOSPITAL WARDS
• ONLY 5 SPECIALIST REHABILITATION SERVICES
  NATIONALLY
• FEW EXAMPLES OF ALTERNATIVES TO INPATIENT CARE
• HOME-BASED TREATMENT OF ACUTE ILLNESS
• ASSERTIVE OUTREACH TREATMENT

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COMMUNITY-BASED SERVICESTHE CHALLENGE

• A NEW MIND-SET FOR ALL STAFF
• DEVELOPMENT OF COMMUNITY MENTAL HEALTH TEAMS
• PARTICULAR CHALLENGES FOR
• NURSING STAFF
• MEDICAL STAFF

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CORE SPECIALTY SERVICES

• GENERAL ADULT MENTAL HEALTH SERVICES (50,000)
• REHABILITATION MENTAL HEALTH SERVICES (100,000)
• CHILD AND ADOLESCENT MENTAL HEALTH SERVICES
  (100,000)
• MENTAL HEALTH SERVICES FOR THE ELDERLY (100,000)
• MENTAL HEALTH SERVICES FOR INTELLECTUAL
• DISABILITY (150,000)
• FORENSIC MENTAL HEALTH SERVICES
• (350,000 )

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ADDITIONAL SPECIALTY SERVICES FOR PARTICULAR
PATIENT GROUPS

• EATING DISORDERS
• ADDICTION SERVICES
• LIAISON SERVICES
• MENTAL HEALTH SERVICES FOR THE HOMELESS
• AUTISTIC SPECTRUM DISORDERS
• PSYCHOSEXUAL DISORDERS
• ACQUIRED BRAIN INJURY
• MENTAL HEALTH SERVICES FOR HEARING IMPAIRED
• SERVICES FOR REFUGEES

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SPECIALTY SERVICE DEVELOPMENTTHE REALITY

• SERIOUS UNDERDEVELOPMENT OF
• REHABILITATION MENTAL HEALTH SERVICES
• MENTAL HEALTH SERVICES FOR INTELLECTUAL
  DISABILITY
• FORENSIC MENTAL HEALTH SERVICES
• LITTLE DEVELOPMENT OF SERVICES FOR SPECIAL
  PATIENT GROUPS

21
SPECIALTY SERVICE DEVELOPMENTWHAT NEEDS TO CHANGE

• CURRENTLY 30 MENTAL HEALTH CATCHMENTS
  INDEPENDENT REPUBLICS
• PRIOR TO HEALTH SERVICE REFORMS MANAGEMENT FROM
  3-4 SEPARATE PROGRAMMES
• NO NATIONAL PLANNING AND
• MONITORING BODY

22
RE-ORGANISATION OF MENTAL HEALTH SERVICES

• NEW CATCHMENTS OF 350,000
• 13 NATIONALLY v 30 CURRENTLY
• APPROXIMATELY 20 COMMUNITY MENTAL HEALTH TEAMS
  PER CATCHMENT
• COMMUNITY MENTAL HEALTH TEAMS TO SELF-MANAGE

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NEW MANAGEMENT SYSTEMS FOR MENTAL HEALTH SERVICES

• CATCHMENT MANAGEMENT TEAMS
• PROFESSIONAL MANAGERS
• MEDICAL DIRECTOR
• NURSING DIRECTOR
• DIRECTOR OF MENTAL HEALTH PSYCHOLOGY
• DIRECTOR OF MENTAL HEALTH SOCIAL WORK
• DIRECTOR OF MENTAL HEALTH OCCUPATIONAL THERAPY
• USER
• CONCEPT OF SHARING OF
• MANAGEMENT BETWEEN CLINICIANS
• AND MANAGERS

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NATIONAL MANAGEMENT OF MENTAL HEALTH SERVICES

• NATIONAL MENTAL HEALTH SERVICE DIRECTORATE
• PROFESSIONAL MANAGERS AND SENIOR CLINICIANS
• SET SERVICE DEVELOPMENT PRIORITIES NATIONALLY
• MONITOR SERVICE DEVELOPMENTS
• AND SERVICE DELIVERY NATIONALLY

25
FINANCING THE MENTAL HEALTH SERVICES

• CURRENT FUNDING OF 6.8 OF NATIONAL HEALTH BUDGET
• AVERAGE 149 PER CAPITA
• MAJOR REGIONAL VARIATIONS
• FACTOR OF 8
• NO SYSTEMS TO ENSURE
• COST-EFFECTIVE SERVICE
• DELIVERY

26
CAPITAL FUNDING WITHIN THE MENTAL HEALTH SERVICE

• SIGNIFICANT UNDER-INVESTMENT IN COMMUNITY
  INFRASTRUCTURE
• MUCH OF CURRENT INFRASTRUCTURE
• IS SUBSTANDARD AND NOT PURPOSE-BUILT
• CAPITAL EXPENDITURE IN THE LAST 10 YEARS VARIED
  BETWEEN 2 AND 5.7 OF TOTAL HEALTH CAPITAL
  EXPENDITURE

27
REVENUE FUNDING

• 734 MILLION REVENUE BUDGET 2004
• NEED RATIONALISATION OF EXISTING PROFESSIONAL
  RESOURCE
• NEED SUBSTANTIAL
• INCREASE IN REVENUE
• FUNDING

28
INFORMATION SYSTEMS FOR AUDIT AND GOVERNANCE

• ADMISSION RATES 4 FOLD VARIATION
• CERTIFICATION RATES 4 FOLD VARIATION
• ECT PRESCRIPTION 4 FOLD VARIATION
• NEW LONG STAY GENERATION 5 FOLD VARIATION

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PATIENT CENTRED SERVICE

• SERVICES BUILT AROUND PATIENTS, NOT PROGRAMMES OR
  FACILITIES
• A SERVICE THAT RESPECTS AND PROTECTS CIVIL RIGHTS

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FROM HERE TO THERE

• A NEW NATIONAL POLICY
• A NEW MIND-SET AMONG MENTAL HEALTH PROFESSIONALS
• A REAL POLITICAL COMMITMENT TO GIVE PRIORITY TO
  THE NEEDS
• OF PEOPLE WITH MENTAL
• ILLNESS

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FUTURE MENTAL HEALTH SERVICE DEVELOPMENTS IN
IRELAND

• IMHCN
• MONAGHAN OCTOBER 14 2005