Address by Mr. Tim O’Malley T.D., Minister of State at the Department of Health and Children at opening of the 19th European Health Psychology Conference at National University of Ireland in Galway on Wednesday, 31st August 2005.
I would like to thank you for inviting me to address you here this morning at your Conference, which focuses on “Enhancing Individual, Family & Community Health”. This is the nineteenth Annual Conference of the European Health Psychology Society organised by the Department of Psychology in NUI, Galway.
May I take this opportunity to welcome the speakers and delegates who have come from abroad to be with us here this evening. I understand that some of you come from as far a field as New Zealand, Australia, US and Europe. You are all very welcome to Galway.
A conference of this nature provides a forum where those interested in mental wellbeing can meet and exchange views. At the outset, I would like to emphasise the Irish Government’s commitment to supporting both the development of quality mental health services in Ireland and to learn from and contribute to the development of services in Europe. A conference of this nature provides us with an opportunity to consider the changes which have been taking place in the delivery of mental health services throughout Europe and to exchange views on the direction which our policies might take for the future.
We are all aware that good mental health is an integral component of general health and well-being, which allows a person to realise his or her abilities. With a balanced mental disposition, one is more effective in coping with the stresses of life, can work productively and fruitfully and is better able to make a positive contribution to his or her community. Thankfully, society now recognises more fully the burden that mental illness places on sufferers and their families.
As we know, people with a mental illness were excluded, for many years, from full participation in community life as a result of widespread stigmatisation of mental illness. Thankfully, there is now recognition of the right of each person to participate fully in the social, economic, political and cultural activities of their communities. Recognition of that right is vital if we are to build an inclusive society in which all of our citizens can contribute their experiences, talents and abilities. The core principle underlying this policy is that persons suffering from any form of ill health should be enabled to live as independently as possible.
Mental health promotion is a very broad concept as it emphasises the promotion of the psychological health and well being of individuals, families and communities. I see it as a key task of the health services not just to treat mental illness but more importantly, using the principles of health promotion, to try and improve the mental health of the population at large.
There is a growing awareness and concern throughout the country about mental health matters and the National Health Promotion Strategy, 2000-2005, in conjunction with the health strategy “Quality and Fairness”, sees mental health as being equally as important as physical health in the overall wellbeing of a person. Increasingly, mental health is being recognised as a major challenge facing health services in the twenty first century.
The promotion of positive mental health will contribute significantly to combating the ignorance and stigma, which often surrounds mental illness. Better understanding of mental illness encourages people to access professional help sooner rather than later and this facilitates early recovery.
I think you will all agree that substantial changes have been unfolding in the mental health services in Ireland in recent years. The perception of an institutional style mental health service, standing in isolation and closed from the rest of the community, is thankfully becoming a thing of the past.
Government policy in the area of mental health care is to provide care in the community by offering the right level of intervention and support to enable people with psychiatric and psychological difficulties to achieve the maximum independence and control over their lives. We are continuing to develop, a modern comprehensive community-based mental health service. This has resulted in a continuing decline in the number of in-patients with a corresponding increase in the provision of a range of care facilities based in the community to complement in-patient services.
Many of you here today will have experienced this change in the delivery of services, which has brought about many improvements in patient care.
Modern healthcare accepts that each person must play a central role in their own treatment of recovery. It recognizes that each individual plays a critical and essential role in the assessment of their own needs and that quality of care is inextricably linked to the involvement of the user in determining their health care.
There is a growing awareness among service providers that establishing a good quality of life for patients requires their involvement in the planning of the services that are important to them and which support their choices. The perspective of the patient and their families needs to be understood and appreciated.
The mental health services, both statutory and voluntary, have met the challenges of change in recent years with enthusiasm and vigor and I am confident that the further development of our services, in a spirit of partnership between statutory and voluntary bodies, will be approached in the same positive manner.
Development of Community Based Services
Since 1984, Irish Government policy in relation to the delivery of mental health services has followed the recommendations of the Report “Planning for the Future” which called for the establishment of a comprehensive, community oriented mental health service as an alternative to institutional care for persons with mental illness. The shift from a predominantly hospital based service to a service delivered to patients with the least disruption to their daily lives in the community, has taken place in Ireland in recent years with significant improvements in standard of patient care.
Recent years have seen dramatic changes in both the concept and practice of mental health care delivery. Enormous strides have been made and continue to be made in developing a comprehensive, community-based service which is integrated with other health services.
Under our National Development Plan, significant capital funding has been made available to the mental health services. A major part of this funding has gone towards the development of acute psychiatric units linked to general hospitals as a replacement of services previously provided in psychiatric hospitals. There are now 23 such units in place and other units are at varying stages of development.
The plan also provides for more community facilities. Services have been geared towards creating a modern comprehensive community-based mental health service. This has resulted in a continuing decline in the number of in-patients with a corresponding increase in the provision of a range of care facilities based in the community to complement in-patient services. There are approximately 418 community psychiatric residences in the country providing over 3,210 places. These developments have resulted in a continuing decline in the number of in-patients. In December 1984 there were 12,484 patients in psychiatric hospitals and units, compared to 3,701 at 31st December 2003.
Development of Services
The annual revenue expenditure on our mental health services has now reached €766m (2005 estimate). An additional €15m is being made available this year for further improvements in the mental health services. Additional funding in recent years has allowed for the development and enhancement of multi-disciplinary teams in the areas of child and adolescent psychiatry, psychiatry of later life, liaison psychiatry, rehabilitation psychiatry and suicide prevention programmes and support for the voluntary sector. The Mental Health Services will also benefit from the multi annual funding package for the disability services announced by the Government late last year.
Mental Health Act, 2001
The enactment of the Mental Health Act, 2001 in July 2001 was a significant milestone in the modernization of mental health care in Ireland. The Act provides for the establishment of an independent agency known as the Mental Health Commission, which is the main vehicle for the implementation of the provisions of the Mental Health Act. The Mental Health Commission was established in April 2002. Its primary functions are to provide a modern framework within which people who are mentally disordered and who need treatment or protection, either in their own interest or in the interest of others, can be cared for and treated. The Commission is also charged with putting in place mechanisms by which the standards of care and treatment in our mental health services can be monitored, inspected and regulated.
One of the principal responsibilities of the Mental Health Commission under the provisions of the Mental Health Act, 2001 is the operation of review tribunals. Mental Health Tribunals, operating under the aegis of the Mental Health Commission, will conduct a review of each decision by a consultant psychiatrist to detain a patient on an involuntary basis or to extend the duration of such detention. The review will be independent, automatic and must be completed within 21 days of the detention/extension order being signed. As part of the review process the Mental Health Tribunal will arrange, on behalf of the detained person, for an independent assessment by a consultant psychiatrist. The Commission will also operate a scheme to provide legal aid to patients whose detention is being reviewed by a tribunal. In meeting the requirement to provide free legal representation to patients, the State is in effect providing legal advocacy to people with a mental disorder. I understand that the commencement of the tribunals is a priority for the Commission, which is presently working with stakeholders to ensure that the tribunals are commenced as soon as possible.
The provisions of the Mental Health Act, 2001 bring our legislation in relation to the detention of mentally disordered patients into conformity with the European Convention on the Protection of Human Rights and Fundamental Freedoms.
Expert Group on Mental Health Policy.
In the light of the innovative developments in the care and treatment of mental illness and the legislative reforms contained in the Mental Health Act, 2001, I established an Expert Group on Mental Health Policy in 2003 to prepare a national policy framework for the further modernisation of mental health services, updating the 1984 policy document, Planning for the Future. The Expert Group has consulted widely in relation to its work. Submissions were requested from interested organisations, individuals and the general public in October 2003 and over 150 submissions were received. It is my understanding that the Expert Group will consider the role of psychological therapies within the Mental Health Services in the context of its overall review. The Group is due to report later this year.
The on-going development of community-based mental health services, the legislative reforms of the Mental Health Act, 2001 and the review of our current mental health policy confirm that the area of mental health is now receiving the attention it deserves. I am hopeful that these developments will facilitate further advancements and developments within our services and that the lives of those who suffer mental illness, and their families, will be improved by our efforts. During my term of office as Minister of State with special responsibility for mental health, I am endeavoring to continue to accelerate the growth in more appropriate care facilities for people with a mental illness through the further development of community-based facilities throughout the country.
In conclusion, I would like to compliment everyone involved in the organisation of this conference. It provides a valuable opportunity for European and International health service providers and policy makers to exchange views and share experiences.
I pay tribute to everybody involved in the work of the Society and I believe that the services provided by its members are of real practical value to the many people and their families. Thank you for your attention.