Speech by Mr.Tim O Malley TD, Minister of State with special responsibility for Disability and Mental Health Services
Good morning ladies and gentlemen.
I am delighted to be here with you today. I would like to thank the Association of Community Mental Health Nurses for inviting me to address you at your AGM/Education Day. I see from today’s busy schedule that there are a number of speakers presenting different perspectives on developments in mental health services. This provides an excellent opportunity to discuss these issues and it enables me to acknowledge the importance and value of your work in the delivery of mental health services.
The effective use of your nursing skills in everyday practice is invaluable to patients and their families. As community mental heath nurses you are one of the most frequent channels of communication between those with a mental illness and service providers.
The World Health Organisation estimates that one in four people will be affected by a mental disorder at some stage of his or her life. This is why preventing mental disorders and promoting mental health is of immense interest. Mental disorders can cause enormous emotional suffering, diminished quality of life and also alienation and stigma.
The definition of health in the Health Strategy Quality and Fairness A Health System for You is adopted for the World Health Organisation. Health is seen as “a complete state of physical, mental and social well-being and not merely the absence of disease and infirmity”. It includes positive concepts reflecting that health is “a resource for everyday life … emphasising social and physical resources as well as physical and mental capacity.”
The Health Strategy is centred on a whole-system approach to health. The Strategy is a blueprint to guide policy makers and service providers in achieving better health for everyone. The four guiding principles are – Equity, People-Centredness, Quality and Accountability. It identifies overall national goals and the framework for change to guide activity and planning in the health system for the next seven to ten years.
It is now acknowledged that primary care should be the cornerstone of modern health services and the “gatekeeper” to specialist services. The inter-disciplinary model of primary care as set out in the strategy document Primary Care A New Direction is designed to broaden the focus and extend the availability of Primary Care Services. A strengthened Primary Care System will play a more central role as the first and ongoing point of contact for people with the health care system. This will be achieved through the development of integrated inter-disciplinary teams.
Development of Psychiatric Services
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.
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.
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.
Many of you here today have not only experienced but have contributed significantly to this shift in the delivery of services, which has brought about critical improvements in patient care.
The Government is fully committed to furthering this process and under the National Development Plan significant capital funding is being made available to the mental health services. A major part of this funding will go towards the development of acute psychiatric units linked to general hospitals as a replacement of services previously provided in psychiatric hospitals. In addition to the twenty-one acute units now in place, a number of units are currently at various stages of development. The plan will also provide for more community facilities such as mental health centres and community residences, which will accelerate the phasing out of the old psychiatric institutions.
Mental Health Act, 2001 – Mental Health Commission
In relation to the future direction of mental health services, as you are all aware, the Mental Health Act, 2001 was enacted in July 2001 and will significantly improve safeguards for mentally disordered persons who are involuntarily admitted for psychiatric care and treatment. The Act brings Irish law in this area into conformity with the European Convention for the Protection of Human Rights and Fundamental Freedoms. The main vehicle for the implementation of the Mental Health Act, 2001 is the Mental Health Commission which was established with effect from 5th April 2002.
The Commission is chaired by Dr. John Owens, Consultant Psychiatrist and former Clinical Director of the Cavan/Monaghan Mental Health Service. Other members of the Commission include representatives of the medical, nursing and paramedical professions, voluntary bodies and mental health service users.
Implementation of the Provisions of the Mental Health Act, 2001
The detailed work programme of the Commission is a matter for the Commission itself to determine, in accordance with its statutory functions under the Mental Health Act. However, the Commission has indicated that one of its priorities is to put in place the structures required for the operation of the Mental Health Tribunals.
The 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 Mental Health Commission has appointed Dr Teresa Carey to the position of Inspector of Mental Health Services which will replace the former office of the Inspector of Mental Hospitals. A number of assistant inspectors has also been appointed. The Inspectorate is required to visit and inspect all approved centres at least once a year. The Minister will be empowered to make regulations specifying the standards to be maintained in all approved centres and these will be enforced by the inspector. The Inspector’s annual report and review of the mental health services will be published along with the Commission’s annual report.
In relation to the Mental Health Act generally, it is important to realise that you, as community mental health nurses, are well placed to influence the future development of mental health services and to contribute to a more people-centred approach to service delivery. Your pivotal role between the patient and service providers gives you an opportunity to be a force for change in the way services are delivered. Your co-operation will be central to the successful implementation of the Mental Health Act, 2001.
An Expert Group on Mental Health Policy was established on 4th August 2003 to prepare a national policy framework for the further modernisation of the mental health services, updating the 1984 policy document, Planning for the Future. The Group consists of 18 widely experienced people who are serving in their personal capacities. The membership encompasses a wide range of knowledge and a balance of views on many issues affecting the performance and delivery of care in our mental health services. It is envisaged that the Expert Group will examine, inter alia, models of care, the respective roles of medication and complementary therapies, measures to reduce stigma and psychiatric services for specialised groups such as the homeless, prisoners and children/adolescents. The Group requested submissions from interested organisations, individuals and the general public in October 2003 and over 140 submissions were received. These submissions are now being considered by the members of the Group.
Developments in Nursing
The health service is going through a period of rapid growth, development and change. This is particularly the case in the area of nursing education where a major transformation has taken place since the Commission on Nursing reported in 1998. By far the most profound development has been the transfer of nursing education to the higher education sector, and the introduction of the new 4 year degree leading to registration in general, psychiatric and mental handicap nursing. I am pleased to say that an Expert Group has been established to develop a comprehensive strategy for the future of midwifery and paediatric nurse education. Nurse education must be constantly developed and redesigned to ensure the health system meets the demands of a modern society. As you know the Government has committed substantial funding and revenue to the existing nursing degree programme.
A new, purpose-built capital infrastructure is being put in place in the thirteen higher education institutes at a total cost in excess of €230m. The capital allocation includes the cost of building, fitting out and equipping the new schools of nursing, and the students will have state-of-the-art facilities when the programme is complete.
The Government’s commitment does not end there. By the time the programme has a full complement of students in the autumn of 2005, the annual non-capital cost of running the programme will be in excess of €90.0m per year. These are very substantial sums in anyone’s book, and reflect the Government’s commitment to the development of nursing and the wider health service.
The new nursing degree programme offers another vital step in the professional development of nursing. It is a further enhancement of the way in which nursing students are prepared for the profession. As such it is envisaged that it will shape a critical mass of excellent practitioners for the future, nurses with a greater level of theoretical underpinning, which will in turn allow them to develop their clinical skills to a more sophisticated extent, to work autonomously and to respond to future challenges in health care, for the benefit of patients and clients of the health service alike.
When I consider these recent developments within the mental health services, I feel confident that the future for people who suffer mental illness, and for those who work with and for such patients, will be a lot brighter.
I will now conclude by extending my appreciation for the kind invitation to address your conference. In your discussion today it is important to build on the work to date in partnership with other healthcare providers to promote the health and well-being of those with a mental illness.
I hope the rest of your day is a success and that you all enjoy this opportunity to debate issues of mutual interest with colleagues.