Speech by Minister O’Malley at the National Federation of Voluntary Bodies’ symposium ‘Meeting the Challenge of Building a Person Centred Mental Health Service for People with Intellectual Disabilities’
I would like to thank the National Federation of Voluntary Bodies for inviting me to address you today. I welcome the opportunity to open this national symposium, entitled ‘Meeting the Challenge of Building a Person Centred Mental Health Service for People with Intellectual Disability’. The occasion presents me with an opportunity to reflect on recent developments within services for people with disabilities and in particular the mental health services. It also allows me to acknowledge the importance of the work of the Federation of Voluntary Bodies in responding to the needs of people with intellectual disability.
Mental Health & Intellectual Disability
It is only in relatively recent times that there has been widespread acceptance of the fact that people with intellectual disability can also have a mental health problem. Individuals with an intellectual disability are more vulnerable to environmental factors that influence mental health. They are less able to adapt and respond to features of their environment and to changes in it. I believe that services need to be sensitive to this vulnerability. For example, a recent review of research studies estimated that 50% of people with severe and profound intellectual disabilities will have a mental health problem at some point in their lives, as will 20-25% of those with mild and moderate intellectual disabilities.
Mental Health Act, 2001
There is no doubt that we face challenges, but I am pleased with the progress we have made over the last number of years. We are about to commence all remaining provisions of the Mental Health Act. We have begun to implement A Vision for Change, and we have published the six Sectoral Plans on Disability, all of which are designed to meet the needs of people with a disability in line with the concept of main-streaming. I will comment on each of these areas in turn. A significant development within the area of mental health provision is the commencement next week of all remaining provisions of the Mental Health Act 2001. This Act provides a modern framework for treating and caring for people who have a mental disorder. It puts in place mechanisms by which the standards, care and treatment in mental health services can be monitored, inspected and regulated.
The sections relating to the Mental Health Commission were commenced in 2002. The Commission’s role is to promote, encourage and foster the establishment and maintenance of high standards and good practice in the delivery of mental health services and to protect the interests of people detained under the 2001 Act. We also established the Office of the Inspector of Mental Health Services which replaced the previous functions of the Inspector of Mental Hospitals.
I welcome the fact that we can now commence the remaining provisions of the Mental Health Act, 2001. Their commencement on 1 November represents a major landmark in the modernisation of mental health services. The new provisions include the establishment of Mental Health Tribunals which 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. I know that the HSE, the Mental Health Commission and my Department have been working closely to ensure that we are ready to commence the rest of the Act next Wednesday. I will leave further discussion of the Act, to Ms Patricia Gilheaney of the Mental Health Commission who will be speaking later this afternoon.
A Vision for Change
Another major development was the launch of “A Vision for Change” – Report of the Expert Group on Mental Health Policy in January this year. This is the first comprehensive review of mental health policy since Planning for the Future was published in 1984 and has been accepted by Government as the basis for the future development of mental health policy.
The report outlines a vision for mental health services and sets out a framework for action to achieve it over the next 7-10 years. It makes recommendations on how our mental health services should be managed and organised in the future.
The report reflects a person-centred treatment approach based on an integrated care plan, reflecting best practice, which most importantly has evolved in consultation with service users and their carers.
I am committed to implementing “A Vision for Change”. The Government provided an additional €25 million to start the process this year, and it will continue to be a key priority in the coming years. I appointed an independent monitoring group, in March this year to monitor progress in the implementation of the report. In addition, the Health Service Executive recently established an implementation group to ensure that mental health services develop in a synchronised and consistent manner across the country and to guide and resource service managers and clinicians in making the recommendations in “A Vision for Change” a reality. Both of these groups will play an important role in ensuring that the recommendations of “A Vision for Change” are implemented in a co-ordinated and timely manner.
Disability Services There is a growing recognition by society of the right of people with disabilities to participate in and contribute to the social and economic life. This has underpinned much of what has happened in recent years. Some of the significant milestones have included:
- Recognition of the need to develop a more person centred approach in providing support services,
- The move from institutional settings to community based services,
- The very significant investment by the Government in health and personal social and other services for people with disabilities, and
- The various legislative and policy measures, taken by the Government in the areas of equality, education and access to facilities, services and information.
Person Centred Services
One of the principles included in the Health Strategy is to ensure that health services are people-centred. It is also the approach which is increasingly being taken by service providers. It is reflected in recent legislation, more notably the Disability Act 2005 and Education for Persons with Special Educational Needs Act 2004.
If we are to pay more than lip service to the principle of “person centred services”, we need to look very hard at the way in which we plan and deliver services. It is no longer acceptable that individuals are expected to fit into the “system”. The “system” must change if it is to truly respond and meet the needs of those who require its support.
National Disability Strategy
The Government has a clear and effective strategy in relation to the planning and delivery of services to people with disabilities, including those with mental illness. The provision of services to meet the identified needs of people with disabilities is a key element of the National Disability Strategy. One of the most important parts of the overall Strategy was the Health Sectoral Plan on Disability published alongside the five other Sectoral Plans in July. The plan details the right of persons with a disability to an assessment of need, and to a formal service statement which details the services to be provided. There is also a right of appeal.
These important provisions will be implemented for the under-5 age group from 1 June 2007, with a phased implementation for all others over the four years that follow. I believe that this is a substantial step in our efforts to meet the assessed needs of people with a disability. The new system means that we must work hard to tailor individual services to individual people in a manner not generally achieved up to now. Implementing the Disability Act will bring great challenges, but I am convinced that successful implementation will bring a far more person-centred service to all.
Achieving the improvements I have outlined will require resources, as well as the commitment of all involved in planning and delivering services.
A multi-annual investment programme with a total value close to €900m has been put in place by the Government for the period 2006 to 2009. I am proud of this investment, and believe that, properly allocated, it will bring substantial improvements to services.
We are currently making decisions which will guide the way services support people with disabilities over the coming years. The outcome of many of those decisions will also influence the perception of other sectors of society concerning the abilities of people with disabilities and the role which they can and do have within our communities.
I would like to stress the Government’s commitment to the development of services for people with disabilities, including those who also suffer from mental illness. It is now the responsibility of all of us to build on the substantial progress to date so that we can all work together to bring about services worthy of the Ireland of the 21st century.