Address to Mental Health Nurse Managers Ireland Annual Conference by Minister of State at the Department of Health and Children, Mr Tim O´Malley TD

Ladies and gentlemen I am delighted to be here in Wexford and to have this opportunity to address your conference on the theme “Into Primary Care”.

Changing demographics, life styles, illness patterns and increasing public expectations are focusing public health services worldwide to examine, plan and deliver public health services differently. The Health Strategy Quality and Fairness has identified these factors and their impact on the health of the Irish population.

In a comprehensive and ambitious strategy document, Primary Care: A New Direction, the Government acknowledges the central role of primary care in the future development of our health services. Primary Care: A New Direction proposes developments;

  • to provide a strengthened primary care system which will play a more central role as the first and on-going point of contact for people with the health-care system
  • to provide an integrated, interdisciplinary, high-quality, team-based and user-friendly set of services for the public
  • and to enhance capacity for primary care in the areas of disease prevention, rehabilitation and personal social services to complement the existing diagnosis and treatment focus

This approach will enable Primary Care to develop the capacity to meet the challenges presented by; ageing of the population; earlier hospital discharge; provision of care in appropriate settings; and to deal with health problems at the lowest level of complexity. This means being available to all people regardless of who they are, where they live or what health and social problem they may have.

Since the go-ahead was given in 2002, the initial group of ten primary care teams have continued to develop and in several cases are now demonstrating, to service users and providers, the benefits of multi-disciplinary team working in primary care. Each team is building on the services and resources already in place, so as to develop a primary care team in line with the interdisciplinary model described in the Strategy.

I recognise that moving to the interdisciplinary model of service delivery can pose a range of challenges for both the health professionals involved, and for the health boards, who have the responsibility for leading the developments. I would therefore like to acknowledge the energy and commitment which all involved have brought to the process over the last year-and-a-half.

The benefits of this Primary Care model are becoming evident through improved access to therapy and nursing services, and their provision locally for the service user. Collaborative working amongst health professionals at local level supports a shared understanding and combined service response to a range of health care issues, while also providing continuity of care for patients and their carers. As this service model matures, it is anticipated that primary care teams will develop and enhance the range of clinical competencies required to meet the assessed health needs of the population.

Mental Health in Primary Care

The World Health Organisation estimates that one person in every four will be affected by a mental disorder at some stage of his or her life. Depression, self inflicted injuries and alcohol use disorders are among the top 20 leading causes for disease burden in the world. It is estimated that by the year 2020, depression will become the second leading cause for disease burden. Given this scenario it is not hard to understand why preventing mental disorders and promoting mental health is of great importance to policy-makers, researchers and service providers alike.

The provision of an effective primary care response to the mental health needs of the population and the establishment of linkages with specialist services in the community are among the key issues being considered by the developing teams. Most mental illness is diagnosed and treated in Primary Care, however it is recognised that there is a need to strengthen the capacity of primary to meet the needs of the mentally ill. The health strategy consultation process featured more submissions about mental health than any other condition. Central to most submissions is the need to adopt a holistic approach to mental health care. Many other specific concerns include:-

  • the failure to integrate mental health care into the primary care setting,
  • poor links between community and hospital care
  • poor recognition and detection of mental illness
  • and lack of treatment alternatives to pharmacology

A number of different approaches to the development of primary care teams are being taken, according to the local circumstances in each case. It must be recognised that the process of team development and consolidation will be ongoing for some time, and not all of the issues will be resolved from the outset. The experience of developing these first primary care teams will help to inform the wider reconfiguration of primary care services in the coming years.

The new structures being developed under the Reform Programme are intended to ensure that the system is organised and managed to support the implementation of the Health Strategy, including the Primary Care Strategy. The structures will be designed to achieve consistent and comprehensive implementation of national policy and, as regards primary care, to manage and drive the establishment of primary care teams and networks as the standard model of service delivery.


New Mental Health Policy

The health strategy recognised the need to update mental health policy to take account of the recent legislative reform, developments in the care and treatment of mental illness, and current best practice. The Strategy gave a commitment that a national policy framework for the further modernisation of the mental health services would be prepared, updating the present policy document “Planning for the Future” which was published in 1984.

As Minister of State in the Department of Health and Children with responsibility for mental health, I established an Expert Group to undertake the task of preparing a national policy framework for the development of mental health services. You will all be aware that the Group is chaired by Professor Joyce O´Connor, President of the National College of Ireland. Other members of the Expert Group include representatives of the medical, nursing and paramedical professions, voluntary bodies and mental health service users. The membership encompasses a wide range of knowledge and a balance of views on issues affecting the performance and delivery of care in our mental health services. I believe that this diversity of disciplines within the Group will greatly assist with its work.

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 the community. Thankfully, society now recognises more fully the burden that mental illness place on sufferers and their families.

“Planning for the Future” in 1984 recognised that old institutional mental hospitals were unsuitable for the delivery of a modern mental health service, and developed the concept of a comprehensive community-orientated psychiatric service. On foot of the recommendations of that landmark report, we have seen dramatic changes in both the concept and practice of mental health care delivery in Ireland. Enormous advances have been made and continue to be made in developing a service which is comprehensive, community-based and integrated with other health services.

Undoubtedly the quality of care for many people with a mental illness has been enhanced by these developments. The contribution of psychiatric nurses in this development process and in the provision of community services as alternatives to hospitalisation, is widely acknowledged. As Directors of Nursing in the Mental Health Services, You have contributed significantly to this change in the delivery of services, which has brought about many improvements in patient care.


The issue of funding is never far from the minds of managers. In recent years, there has been a significant increase in funding for mental health services. Since 1997 additional revenue funding of more than €90m has been provided for on-going developments in mental health services, to develop and expand community mental health services, to increase child and adolescent services, to expand the old age psychiatry services, to provide liaison psychiatry services in general hospitals and to enhance the support provided to voluntary agencies.

I do accept however, that much still remains to be done. The Government is committed to the provision of quality care in the area of mental health, to upholding the civil and human rights of those who suffer from mental illness, and to encouraging measures aimed at combating the stigma that is often associated with such illness. During my term of office as Minister of State with special responsibility for mental health, I am endeavouring to continue to accelerate the growth of more appropriate care facilities for people with a mental illness, through the further development of community-based facilities.

Since coming to office, I have taken the opportunity of visiting a number of psychiatric hospitals and have seen at first hand the commitment of staff to the provision of a high quality service. From the outset, I accepted that further investment was required to upgrade or replace some of the physical facilities, and that greater capital investment was required to provide a community-based infrastructure.

That said, some of the most notable developments in quality patient-centred mental health services have been achieve through more effective utilisation of existing resources, particularly that of nursing skills. The Hanly Report recognises that nurses, midwives and other healthcare professionals have a vital role to play, and I quote:-

“The Task Force believes that all health care professionals should focus on the tasks which are appropriate to them, rather than on those which they have ´always´ or ´traditionally´ done. This applies to nursing and midwifery as much as to other professions. Dealing with roles and scope of practice with this consideration in mind helps to identify how the role of nurses and midwives can be enhanced, how some interventions currently performed by others could be done as effectively by nurses and midwives, and how certain tasks currently carried out by nurses and midwives could safely and more efficiently be undertaken by others.”

There is a keen appreciation among all of us as to the potential for further enhancing the contribution of nurses and midwives to the delivery of healthcare. This potential is underpinned by the transfer of pre-registration nurse education to the third level sector, the development of Clinical Nurse Specialist and Advanced Nurse Practitioner roles, and the continuing focus on scope of practice development on the part of An Bord Altranais and the National Council.

Mental Health Legislation

The enactment of the Irish Mental Health Act, 2001 was a very significant achievement, and it brings Irish 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. The Mental Health Commission, established in April 2002, will be the main vehicle for the implementation of the provisions of the Mental Health Act.

The Commission has indicated that one of its priorities will be to put in place the structures required for the operation of the Mental Health Tribunals. A new Inspector of Mental Health Services, Dr. Teresa Carey was recently appointed by the Mental Health Commission. The office of Inspector of Mental Health Services replaces that of the Inspector of Mental Hospitals.

Unfortunately people’s experiences with mental healthcare services vary from exceptional standards of care and treatment, to poor and less than satisfactory. As a consequence these imbalances contribute to and sustain an uneven spread of strengths and deficiencies in service delivery. We must all aim to make delivery of mental healthcare more equitable and effective countrywide, and recognise that a collaborative approach represents the best way forward for both the service user and the service provider. As Directors of Nursing, You are uniquely placed to influence the future development of our mental health services, and to contribute to a more people-centered approach to service delivery.

In conclusion, I would again like to stress the Government´s commitment to the development of services for those suffering from mental illness. I am determined to build on the substantial progress to date, so that we can all work together to bring about a mental health service worthy of the 21st century.

Thank you