Speech James Reilly, Minister for Health and Children at the 40th Psychiatric Nurses Association Conference
An awful lot of people are not that happy, when they’re faced with the big Four Oh. But this year’s conference marks a significant milestone in your association’s history, so it’s a pleasure to be here to congratulate you on reaching this milestone. As a representative body, you have many plans, needs and wants.
But as a professional group, I would hope that the next forty years re-position psychiatric nursing. For too long, it’s been the Cinderella among health services. That shouldn’t be the case.
You deal with people at the points of most pressure in their lives. When they have hit bottom. When they are forced to face aspects of themselves they’ve spent a long time trying to get away from. When they have lost hope.
You care for them, protect them and administer medication to them. But you do much more than that.
It’s unmeasurable, untrackable, unprovable. But we know that the intervention of one human being can make a world of difference to the health – and particularly the mental health – of those who are suffering.
In the current challenging times, your role is of even more important as our economic problems impact on mental health. I want to move psychiatric nursing away from being the Cinderella of the Health service. Mental Health must not be an afterthought. It must stand in its own right and have ring-fenced funding. Thirty five million Euro has been set aside by this Government. My colleague, Minister of State Kathleen Lynch will be driving this issue, and any of you who have met Minister Lynch knows that she’s a powerhouse of energy and commitment.
The two of us want to ensure mental health services receive the funding and attention they deserve, not the neglect they have traditionally suffered.
I served for 20 years as a visiting GP to a large mental health institution, St Ita’s in Portrane. Every time I drove into it, I was reminded that it was built at the edge of the Portrane peninsula. And that was almost central, compared to what had first been planned. The original plans were to build it on Lambay Island. Out of sight, out of mind. Not acceptable in a modern society.
We need to bring mental health issues central stage and mainstream. Hence our determination that each primary care centre will have mental health capability and that people will have choice. For too long, we’ve had a health service that was essentially an acute illness service. It was tilted towards hospitals. That’s going to change. Because it has to. We have to get to a situation where, first of all, every citizen is given the tools to safeguard and promote their own health. Including mental health. Then we have to ensure that illness, when it inevitably happens, is dealt with at the lowest level of complexity. That means the primary centre. The new primary care centre.
90% of mental health needs are dealt with at primary care level and for the other 10%, their first point of contact with the health services is their GP. This Government is committed to developing closer links between mental health services and primary care. The focal point of modern mental health services is the community and the development of community based facilities. Those facilities will house both primary care and mental health professionals. That will be a huge benefit for the service user and their families.
International research has shown that having those shared premises is a key enabler for successful team working. There is no doubt that having the Community Mental Health team in the same building as the Primary Care Team will help to build closer relationships. Professionals will talk to each other. Listen to each other. Share information. All of that will benefit everyone, service users and professionals alike.
It has also been shown that people with severe mental illness have poorer physical health than the general population. Having primary care services available alongside mental health services, ensures that the physical health needs of individuals with mental health problems can be dealt with effectively.
But there’s another factor we should never overlook. The plan to put St Ita’s on an island is the perfect example of the kind of prejudicial thinking that leads to stigma. And nobody’s in a better position to see stigma in action than psychiatric nurses. We’re all individuals. We like being individuals. We yearn to be treated as individuals. Not as cross-sections of the public. But sometimes, being different is not an advantage. Stigma happens when being different is labelled as being wrong. Or dangerous. Or dislikeable.
In Biblical times, people suffering from Hansen’s Disease – leprosy – were forced to carry bells to identify themselves as sufferers and warn others off. Centuries ago, in Puritan times, a big red letter was sewn onto the clothing of someone who stepped out of line – to publicly shame them, wherever they went. Stigma, in the twentieth century, is more subtle. But equally painful. The stigmatised person feels left out, excluded, shamed. We must challenge and change any physical factor that contributes to stigmatising mental health patients.
Having an effective, modern mental health service embedded in the primary care sector will help to reduce the possibility of such stigma. It will prevent isolation by treating mental health alongside other health needs. It will contribute to building a healthy and productive society.
The active involvement of service users is one of the most significant reforms that have taken place in our mental health services in recent years. Service users have a unique insight into the experience of mental illness and have a greater understanding of mental health needs and service needs.
The findings from the most recent survey of its members by the National Service Users Executive provide real evidence that our services are improving and importantly, that the recovery ethos underpins that service. It showed that satisfaction rates are extremely high for some local services. We must learn from those areas that are scoring well and disseminate best practice across all other areas.
We need to get the message across about the importance of changing attitudes to mental health, putting the service user at the centre, and embedding the recovery approach in the delivery of mental health services.
Our primary goal is to radically reform the health system so as to guarantee equal access to healthcare for all in our country. This can only be achieved through a single-tier system, where access is based on need. Not on ability to pay.
Hence, the core commitment on health within the Programme for Government is to introduce Universal Health Insurance for the whole population of Ireland. A truly, integrated and cost-effective healthcare system must involve moving away from the old hospital-centred model, where healthcare was episodic, reactive and fragmented, to focusing on delivering more care in the community. It will require reallocation of resources so that we deliver more services in the less costly primary and community care sector.
However, moving patients into the community, or keeping them in the community in the first place, demands an integrated joined-up approach. Patients must be able to access a comprehensive range of mental health services in the primary care setting. Starting with the first formal contact, which is with their GP.
A number of Primary Care teams – roughly six out of ten – providing mental health services through Clinical Psychologists, Community Mental Health Nurses, liaison Community Psychiatric Nurses and liaison Consultant Psychiatrists.
It’s very positive that Community Mental Health Teams will be aligned to a Health and Social Care Network and will liaise with a number of Primary Care Teams. Shared community facilities have worked well in areas such as Ballymun, Virginia, Athy and Ballinasloe. In other areas, where services are not co-located, there is a nominated Mental Health Nurse aligned to the Primary Care Team providing services for the area such as Teams in Galway, Mayo and Kilkenny.
The development of child and adolescent services is a priority too. 55 multidisciplinary Child and Adolescent Mental Health teams now operate nationally and further 5 teams will be developed in 2011.
Bed capacity for children and adolescents has increased from 12 beds in 2007 to 52 at present.
Work is due to commence this year on the second phase of the child and adolescent unit at St. Vincent’s Hospital, Fairview which will increase capacity from 6 to 12 beds, providing 58 beds nationally by 2012.
Work has commenced on the Linn Dara Child and Adolescent Mental Health Day Facility in Cherry Orchard, Dublin and is expected to be completed by September 2011.
The numbers of psychiatric nurses employed has gone down since the moratorium was introduced. That’s a fact. The moratorium presents challenges to service delivery. That’s a fact, too. I wish I could waft both of those facts away, but to restore the public finances, we have to restructure and reorganise the public service and reduce public service numbers over the coming years. The moratorium on recruitment and promotion in the health service is part of that.
The 2011-2014 Employment Control Framework for the Health sector is designed to reduce numbers of management and administrative staff and non-frontline staff employed in the sector and redeploy staff within the employment ceiling to the Primary and Community settings. A key objective of that is to facilitate the development of integrated health care.
The framework allows for the target growth of certain exempted grades (including medical consultants, certain therapists, clinical psychologists, counsellors and social workers.). The framework also provides that 100 psychiatric nurse vacancies can be filled, by psychiatric nurses or otherwise, where they’re required to support the implementation of A Vision for Change.
The framework also allows for the filling of non-exempted posts on exceptional grounds. The filling of such posts on exceptional grounds may be made at the discretion of the HSE’s National Director of HR to maintain essential services and meet priority service change/reconfiguration requirements.
Nevertheless, the overall target reduction in numbers must be met.
More positive changes currently being examined include a nurse led Admission Therapy Unit (Mental Health). Studies show that this approach, with its focuson psycho education, illness management and promotion of health, can deliver improved clinical outcomes and increased client satisfaction.
Another example of role expansion in this document is Mental Health Home Care Services where the mental health nurse is a key worker, managing the clients care in their own home.
This starts with conducting a comprehensive initial assessment of the clients needs, followed by delivering interventions aimed at enabling the clients to participate in their recovery and optimise integration within their community. This approach, too, has delivered increased patient satisfaction and reduced waiting times for medication, especially at weekends as nurses on home care teams provide a seven day service.
Many thanks to those who made presentations and submitted case studies to support the development of this policy. Aisling Culhane, Research and Development Advisor with the Psychiatric Nurses Association,a member of the Steering Group in this project, made significant contribution to our new thinking in this regard.
Moving from an individual to the organisation as a whole, I am particularly pleased that the PNA, having considered the matter carefully, voted in favour of the Public Service Agreement. Not a decision taken lightly. But undoubtedly the right decision. We need a common understanding of our goals and how they can be achieved in difficult circumstances. The Action Plan for the Health Sector submitted to the Implementation Body by my Department identifies a broad range of areas where you as members of a progressive and caring profession can contribute significantly.
What is perhaps most striking about the Health Sector’s Implementation Plan is how it demonstrates continuation and progress. Modernisation of the health services and the system of service delivery isn’t going to stop, simply because of an economic turndown. Psychiatric nurses have made substantial contributions to the improvements in mental health services in recent years. Those improvements are significant.
For example the number of patients resident in Irish psychiatric facilities reduced by 33.5% over the last ten years.
Shorter episodes of in-patient care have been achieved and in 2009, 49% of all discharges occurred within two weeks of admission. The number of admissions to psychiatric facilities went down by 19% during the 10 year period 1999 to 2009.
Involuntary admissions went down even more.
The number of patients readmitted to hospital has shown a year on year reduction since 2001. This reduction in readmission levels points to an improvement in community based services.
We’ve made progress. We’re going to make more progress.
And – before I conclude – let me touch on a crucial area for future progress. Psychiatric nursing is a profession and a vocation. It must also be a worthwhile career. It’s a career which inevitably brings daily challenges. We must plan so that it also brings daily achievement, satisfaction and pride. Because you are more than health professionals. You are catalysts, helping to empower patients to live full, healthy and hopefully happy lives.
The role you fulfill must be rewarding and must be appreciated by the society you serve. More appreciated than it has been in the first four decades.
Here’s to the next forty years!