Address by Mr. Tim O´Malley T.D., Minister of State at the Department of Health and Children at the University College Cork (UCC) Mental Health Awareness Meeting
I am pleased to be with you this evening and I would like to thank UCC Student´s Union, who organised this event for inviting me here to address you. It is an excellent opportunity to discuss the future direction of the mental health services.
Development of Psychiatric Services
The fact that an event such as this is taking place is a reflection of the great changes that 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.
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 service, which is comprehensive, community-based and integrated with other health services.
The shift in the delivery of services from predominantly hospital-based care has been extremely successful and undoubtedly the quality of care for persons with a mental illness has been enhanced by this development. Some of you here today will have experienced this change in the delivery of services, which has brought about many improvements in patient care.
Mental Health Policy
The National Health Strategy, “Quality and Fairness – A Health System for You”, published in 2002, includes a commitment to prepare a national policy framework for the further modernisation of the mental health services, updating the 1984 policy document, Planning for the Future. It is the intention to begin this process in the next few months. “The Psychiatric Services – Planning for the Future” published in 1984 recognised that old institutional hospitals are unsuitable for the delivery of a modern mental health service and developed the concept of a comprehensive community orientated psychiatric service.
Mental Health Act, 2001
Alongside these important developments the enactment of the Mental Health Act, 2001 in July 2001 was a very significant achievement. The primary objective of this Act is to address the civil and human rights of the mentally ill. I would like to take this opportunity to touch on a few important aspects of the Act.
The Mental Health Commission, established in April 2002, will be the main vehicle for the implementation of the provisions of the new Mental Health Act. It is an independent statutory body whose primary functions are to promote, foster and encourage the establishment and maintenance of high standards and good practices in the delivery of mental health services and to protect the interests of people who are detained for psychiatric care and treatment. The Commission’s independent status will be crucial, in my view, in driving the agenda for change and modernisation in the mental health services in the coming years.
The Commission will arrange for an independent review, by a Mental Health Tribunal, of all decisions to detain a patient on an involuntary basis and each decision to extend the duration of such detentions. Ireland has a significantly higher rate of involuntary admission than other European countries. The report entitled Activities of Irish Psychiatric Services, 2000, published by the Health Research Board, indicated that 11% of all admissions to psychiatric hospitals and units in 2000 were involuntary admissions. This represented a rate for involuntary admissions in Ireland of 75.3 per 100,000 of total population, compared with a rate of 49 per 100,000 in England and Wales and 26 per 100,000 in Italy. It is to be hoped that the implementation of the new mental health legislation, with its more stringent procedures for involuntary detention, will significantly reduce the number of involuntary admissions, bringing practice in this country more into line with the rest of Europe.
The Commission will also be recruiting an Inspector of Mental Health Services, as provided by the Act, and assisting him/her in putting a system of annual inspections and reports in place.
I believe that both the Mental Health Commission and the new Inspector of Mental Health Services have the potential to play a pivotal role in the further modernisation of mental health services.
Dr. John Owens, who is with us here this evening, was appointed to be chair of the Mental Health Commission. Dr. Owens, a consultant psychiatrist and former Clinical Director of the Cavan/Monaghan mental health service, has been to the forefront of innovation in the Irish mental health service. The Cavan/Monaghan services, under his leadership, have developed the concept of home-based treatment, which has resulted in a dramatic decrease in the numbers of acute admissions and involuntary detentions in the local psychiatric hospitals.
The Commission recently appointed a CEO who has now taken-up her post.
Mental Health Promotion
At national level, priority is being given to education awareness and to promoting a better understanding among the public towards mental health thereby facilitating a greater and more positive acceptance of the transfer of mental health services from institutional to community based settings.
There is a growing awareness and concern among the community about mental health matters and the National Health Promotion Strategy, 2000-2005 in conjunction with the new health strategy “Quality and Fairness” see 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 and my department recognises the need for positive mental health promotion. For that reason I would like to congratulate all those involved in organising this event for recognising the need for positive mental health promotion in the college setting.
The college setting represents a huge challenge for mental health promotion as the question of good mental health in young people becomes ever more important. However, given the nature of tonight´s event I feel that it is more appropriate to concentrate on the positive elements of mental health and on positive mental health promotion itself. 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 this stage I’d like to emphasise the importance of voluntary organisations in supporting and promoting positive mental health among the population. My department is fully committed to working together with voluntary groups to promote positive mental health among third level students. As close links between the Health Services and Voluntary Organisations are of the utmost importance every regional health board in the country has a development officer who liases between the statutory health services and the Local Mental Health Associations to provide an integrated and comprehensive service. Also, the Health Promotion Unit of my department funds and supports in a variety of different ways the efforts of mental health organisations like Mental Health Ireland, AWARE, Schizophrenia Ireland and GROW. We have also supported the production of “a resource manual for mental health promotion and suicide prevention in third level institutions” jointly produced by Trinity College Dublin and the Northern Area Health Board which will be available to all third level institutions in the country.
There are also numerous regional initiatives that are currently being run by the health boards in conjunction with non-statutory organisations, which focus on mental health issues like stress management, depression, stigma reduction and suicide-related matters. These are issues, of paramount importance in the colleges setting, and to which more attention needs to be given if we are to ensure that positive mental health and well being of young people is promoted in third level institutions.
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. Eventually, with time and education, hopefully the stigma will fade further away, and when that day comes it will mean that at long last, society will have accepted all people with disabilities, in every form, and they will be treated with human kindness and given the rights they deserve.
Suicide and Suicide Prevention
As we are all aware, suicide has become a serious social problem that is not confined to Ireland but is a growing global problem. Suicide is now the most common cause of death among 15 to 24 year olds in Ireland exceeding deaths due to cancer and road traffic accidents. Apart from the increase in the overall rate of suicide, a disturbing feature is the significant rise in the male suicide rate.
The most recently published figure from the Central Statistics Office indicates that there were 448 deaths from suicide in 2001. These figures are disappointing in that they indicate an increase of 35 on the 2000 figure of 413. The figures highlight the need to intensify our efforts and to put extra resources in place for suicide research and suicide prevention programmes.
The Department of Health and Children has, over the past few years, given special attention to the resourcing of suicide prevention initiatives and the level of funding being provided by the Department of Health and Children for suicide prevention is now more than 20 times what it was in 1999.
The National Task Force on Suicide
As the suicide figures increased in the early 1990´s, my Department became aware of the need for reliable and concrete information on which to build a national strategy to address the growing problem of suicide in Ireland. The National Task Force on Suicide was therefore established in 1995 to address the growing prevalence of suicide in Irish society.
In September 1996, the Task Force published its Interim Report. It contained a detailed analysis of statistics relating to suicide and attempted suicide in Ireland and a preliminary analysis into the factors that could be associated with suicidal behaviour.
The Final Report was published in January, 1998 and marked the completion of detailed examination of the incidence of suicide and attempted suicide and outlined a comprehensive strategy to reduce the incidence of suicide and attempted suicide in Ireland. It identified the various authorities with jurisdiction in suicide prevention strategies and their respective responsibilities. Relevant Government Departments have been contacted with a view to implementing the Task Force recommendations insofar as they are concerned. All other statutory agencies identified in the report with jurisdiction in suicide prevention strategies have also been contacted requesting that the necessary measures be put in place to ensure the implementation of the recommendations, which relate to their respective areas.
The Task Force also recommended that steps be taken to make the mental health services more accessible to the public, particularly to young people. Concern was also expressed at the risk of suicide in older people. Additional funding has been made available to further develop consultant led child and adolescent psychiatry and old age psychiatry services to assist in the early identification of suicidal behaviour and provide the necessary support and treatment to individuals at risk. Many of the Task Force’s recommendations require continuous development, particularly in the area of training and in the development of services relating to suicide and suicide prevention.
Additional revenue funding of €7.6m has been provided in 2003 for improvements in mental health services. This will further enhance the significant improvements which have been made in recent years. In the report of the Inspector of Mental Hospitals for 2001, published in September 2002, the Inspector noted that steady progress was being made in implementing the national policy of replacing 19th century mental hospital accommodation with acute assessment and treatment units in general hospitals and, for less acute illness, appropriate community residential premises. There are now 18 Acute Psychiatric Units operating in General Hospitals. A further 3 units will become available to their respective mental health services in the near future, 2 units are under construction and several others are at various stages of planning. In relation to community residences, there are approximately 400 community psychiatric residences in the country, providing over 3,000 places.
The Health Strategy recognises that there is now a need to update mental health policy to take account of recent legislative reform, developments in the care and treatment of mental illness and current best practice. The Strategy gives a commitment that a national policy framework for the further modernisation of the mental health services, updating the “Planning for the Future” policy document published in 1984, will be prepared. The methodology to be employed in this process is now being examined by the Department and decisions in this regard will be taken shortly.